“I’m stressed!!! Help!!”

We’ve all been there. Bills, appointments, school, kids, work, health issues, deadlines….the list goes on. It can be extremely difficult to juggle all that life throws at us but it’s important for both our physical and mental health to cope effectively. So, how do we do it? How do we get through all of this?

Distress tolerance skills. In short, these are several skills that you can learn and implement to help yourself manage and cope with everyday stressors and the really big stuff like a divorce, death of a loved one or maybe even the unexpected loss of a job. Distress tolerance skills are part of Dialectal Behavioral Therapy or DBT. Below are the distress tolerance skills that the BWG IOP facilitators teach their group participants. Let’s take a look!

The STOP skill

• S – Stop! Don’t react to whatever you may be facing, whether internal or external. Stay in control of both your emotions and your physical body. Remain still. Do not move a muscle.
• T – Take a step back! If you can, remove yourself from the situation you are being faced with. Take a break and a deep breath, or several deep breaths. Don’t act impulsively based on your feelings.
• O – Observe! Take a moment to notice your surroundings and environment—both inside and out. What emotion am I experiencing right now? What are others doing, saying or how are they reacting?
• P – Proceed mindfully! Think about your goals in the situation. What do you want to happen in this moment? What can you do to make the situation better? What action would make it worse? Is my desired action going to be worth it in 5 min, 5 hours, 5 days, 5 weeks, 5 years?

The ACCEPTS skill

This is a great skill for distracting yourself. When you cannot change the situation at hand, distract with ACCEPTS.

• A – Activities: Watch an episode of your favorite show, go for a walk or exercise, play video games, clean up/organize a room or area in your home, hang out with a friend or your family or complete a puzzle.
• C – Contributing: Do some volunteer work. Help a friend or family member with a task or project. Or do something nice for someone else such as providing words of encouragement or giving someone a hug.
• C – Comparisons: Think about how you feel now as compared to a different time. Remember how fortunate you may be and think of the different people in the world who may be dealing with your same issue. This is not to invalidate how you feel but to help put things into perspective.
• E – Emotions: Tap into your emotions! Read an emotional book or movie. Listen to a song or album that speaks to you. It can be all types of emotions. Watch a scary movie or a comedy or listen to relaxing music.
• P – Pushing away: Whatever the situation is, simply push it to the side for a while. Deny the problem for a moment but only for a short time. Block out painful thoughts or images from your mind and refuse to think about it. Pack up those thoughts, put them in a box and leave it on a shelf. Either figuratively or literally.
• T – Thoughts: Count something. The number of red items you can see, the number of presents you can name, or count back from 100 by 7’s. Repeat words of your favorite song or watch or read something thought-provoking. Journal your thoughts.
• S – Sensations: Squeeze a stress ball, play-doh, use a fidget spinner, etc. Take a hot or cold shower. Listen to some loud music (be mindful of not damaging hearing). Cuddle up with some fuzzy socks and a soft blanket. Pet your furry companions!

Consider the Pros and Cons

What are the pros and cons of acting on your thoughts/urges? Will this help or hurt you or possibly others in your life? Make a separate list of pros and cons for what could happen if you resisted those urges. Consider what has happened in the past when you acted on crisis urges. Use your pros and cons list to help you choose a different course of action this time.

Self-Soothing skill

Tap into the 5 senses! Sight, taste, touch, smell, and hearing. What are 5 things I can see, 4 things I can touch, 3 things I can hear, 2 things I can smell and 1 thing I can taste? Go for a mindfulness walk and listen to all the sounds, soak in all the things you see and hear, what can I smell in this moment? Can I taste anything?

TIPP skill

• T – Tip the Temperature: Holding your breath, put your face in a bowl/sink of cold water, or hold a cold pack (or zip-lock bag of cold water) on your eyes and cheeks. Hold for 30 seconds and repeat as needed. When you put your full face into cold water or you put a zip-lock bag with cold water on your eyes and upper cheeks, and hold your breath, it tells your brain you are diving underwater.
• I – Intense Exercise: Engage in intense exercise even if only for a few minutes. Expend your body’s stored up physical energy by running, walking fast, jumping, playing basketball, lifting weights, etc. Use all of that stored up physical energy that your emotions are creating and channel it into something other than panic.
• P – Paced Breathing: Breathe deeply into your belly. Slow your pace of inhaling and exhaling way down (on average, five to six breaths per minute). Breathe out more slowly than you breathe in (for example, 5 seconds in and 7 seconds out).
• P – Paired Muscle Relaxation: While breathing into your belly deeply tense your body muscles (not so much as to cause a cramp). Notice the tension in your body. While breathing out, say the word “Relax” in your mind. Let go of the tension. Notice the difference in your body.

IMPROVE skill

• I – Imagery: Use your imagination to create a calming and relaxing setting where you feel safe and where nothing can hurt you. What can you feel, hear, smell, touch and taste?
• M – Meaning: Search for the purpose in a painful moment. Focus on this and remind yourself of the positive aspects in your mind.
• P – Prayer: Open your heart to a supreme being, God, or to whatever you believe in. Ask for strength and put your faith in a higher being.
• R – Relaxing actions: Do a calming activity. A hot bath, a long shower. Do some yoga or meditation. Focus on your breathing. Notice where you’re tense and relax your muscles, your jaw and shoulders.
• O – One thing in the moment: Focus on the here and now. Keep yourself in the moment by focusing all of your attention on what you’re currently doing. Specifically not focusing on the future or past, just the current moment.
• V – Vacation: Give yourself a short mind vacation. Turn off your phone for an hour. Disconnect with electronics. Read a book or imagine a nice place to go in your mind.
• E – Encouragement: Be your own cheerleader. Be kind to yourself or at the very least, be neutral to yourself. Say or think of phrases like, “You got this,” “I will be OK,” “I can get through this.”

Radical Acceptance skill

There are times that you’ll run into a problem that’s simply out of your control. It can be easy to think “This isn’t fair” or “I shouldn’t have this problem”, but it’s important to realize these comments only add to the pain and suffering you are already going through.

Radical acceptance refers to a healthier way of thinking during these situations. Instead of focusing on how you would like something to be different or trying to change it, try to recognize and accept the problem or situation as it is. Not trying to change it.

Remember, accepting is not the same as liking or condoning something. Learning to accept the problems that are out of your control will lead to less anxiety, anger, and sadness when dealing with them.

During distressing situations that you can or cannot problem-solve, try some of the above techniques. They will be sure to help you. If you are still struggling, consider reaching out for individual therapy or for an Intensive Outpatient Program where these and more are taught to help you improve the quality of your life.

Erin Pawlak, MS, LPCC-S
Therapist and Adolescent IOP Director