Dialectical Behavioural Therapy (DBT) Resource Bundle (386 pages)

Distress Tolerance workbook

D.B. T Dialectical behavioral therapy DEFINITION

DBT& MINDFULNESS Defined DBT& DISTRESS TOLERANCE Defined DBT skills are a set of cognitive-behavioral strategies aimed at helping individuals regulate and manage their emotions, thoughts, and behaviors. The four main skill areas include Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness. Mindfulness focuses on developing an awareness of the present moment and being able to calmly observe and accept one’s own experiences. Distress Tolerance involves learning how to tolerate difficult experiences and emotions without making the situation worse. Emotion Regulation focuses on developing strategies for managing difficult emotions, such as anger or sadness. Finally, Interpersonal Effectiveness involves developing strategies for communicating effectively in relationships and difficult conversations.

Distress tolerance is the ability to recognize and accept emotional distress without trying to make it go away or avoid emotions. It is a person's ability to manage an emotional incident without feeling overwhelmed It involves the understanding that sometimes emotional distress is inevitable and learning how to ride out difficult feelings without turning to unhealthy coping mechanisms. Some strategies for developing distress tolerance include mindfulness, self-soothing techniques, distraction techniques, improving communication skills, and learning to accept reality. It is important to remember that distress tolerance is a skill that can be learned, and it can help us manage difficult emotions healthily. Distress Tolerance EXPLAINED

Distress tolerance is the ability to recognize and accept emotional distress without trying to make it go away or avoid emotions. It is a persons aability to manage an emotional incident without feeling overwhelmed It involves the understanding that sometimes emotional distress is inevitable and learning how to ride out difficult feelings without turning to unhealthy coping mechanisms. Some strategies for developing distress tolerance include: mindfulness, self-soothing techniques, distraction techniques, improving communication skills, and learning to accept reality. It IS important to remember that distress tolerance is a skill that can be learned, and it can help us manage difficult emotions healthily. Distress Tolerance EXPLAINED DBT& MINDFULNESS Defined Distress tolerance skill with the A.C.C.E.P.T.S skill A set of skills for coping with overwhelming and uncomfortable emotions. ACCEPTS outlines strategies for distracting oneself from distressing emotions, giving them time to lessen in intensity, or fade away. MANAGING OVERWHELING & UNCOMFORTABLE EMOTIONS

istress tolerance is the ability to recognize nd accept emotional distress without trying to make it go away or avoid emotions. It is a rsons aability to manage an emotional incident without feeling overwhelmed It involves the understanding that sometimes emotional distress is inevitable and learning how to ride out difficult feelings without turning to unhealthy coping mechanisms. Some strategies for developing distress tolerance include: mindfulness, self-soothing techniques, distraction techniques, improving communication skills, and learning to accept reality. It IS important to remember that distress olerance is a skill that can be learned, and it n help us manage difficult emotions healthily. Distress Tolerance EXPLAINED DBT& MINDFULNESS Defined ACCEPTS SKILL A.C.C.E.P.T.S Distress tolerance skill Activities A. C. C. E. P. T. S. Contributions Comparisons Emotions Pushing Away Thoughts Sensations

Distress tolerance is the ability to recognize and accept emotional distress without trying to make it go away or avoid emotions. It is a persons aability to manage an emotional incident without feeling overwhelmed It involves the understanding that sometimes emotional distress is inevitable and learning how to ride out difficult feelings without turning to unhealthy coping mechanisms. Some strategies for developing distress tolerance include: mindfulness, self-soothing techniques, distraction techniques, improving communication skills, and learning to accept reality. It IS important to remember that distress tolerance is a skill that can be learned, and it can help us manage difficult emotions healthily. Distress Tolerance EXPLAINED DBT& MINDFULNESS Defined ACCEPTS SKILL A.C.C.E.P.T.S Distress tolerance skill A. C. C. E. P. T. S. Focus attention on a task you need to get done. Do something thoughtful. Compare how you are feeling now to a time when you felt different. Expose yourself to events, things, places that creates different emotions Leave the situation mentally. Build an imaginary wall between yourself and the situation. Block thoughts and images from your mind. Count to 10. Repeat words in your mind. Squeeze a rubber ball. Listen to very loud music. Hold ice in your hand or mouth. Put cold water on your face.

Distress Tolerance EXPLAINED DBT& MINDFULNESS Defined ACCEPTS SKILL write down hoW you can practice the ACCEPT skill in your own life WORKSHEETS

A. C. C. E. P. T. S.

ACCEPTS SKILL

What is a distressing emotion you would like to manage with ACCEPTS?

List activities requiring concentration that would distract from your distressing emotion. Activities

Contributions List activities that allow you to focus on others, instead of your distressing emotion.

ACCEPTS SKILL

Comparisons Describe a time when you struggled with your distressing emotion, but showed resilience. Recall this experience when faced with the emotion again.

Emotions

How can you create a new emotion that competes with your distressing emotion?

ACCEPTS SKILL

Pushing Away What can you do to avoid thoughts and situations that create the distressing emotion?

Thoughts List mental strategies or activities that would distract you from your distressing emotion.

Sensations How can you create a safe physical sensation to distract from your distressing emotion?

ACCEPTS SKILL

T h l MANAGING DISTRESSING EMOTIONS e Fe eli ng s W he e

Insecure Anxious Fearless Confident Isolated Rejected A n g e r F e a r S t r o n g Nervous Skeptical Panic Overwhelmed Worry Tension Shock Paranoid Stress Rage

Ashamed Hopeless

Neglected Betrayed

Lonely Hopeless

Weak Unmotivated

Hurt Disappointe d Relief

Peaceful

Confused

Frustrated

Relaxed

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Mellow

Annoyed Aggrevated Bitter Disgust Hateful Aggressive Grumpy Hostile Jealous Irritated Proud

Sentimental

Trusting Focused Present

C a l m

Content

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Optimistic

Comfort

Important Powerful Determined Respected Empowered Valued Successful Worthy Intelligent

Jolly

Glee

Accepting

Bliss Enthusiasti c Joy Pleasure

Fun Excited

Satisfied

Cheerful Passion

Amused

ACCEPTS SKILL ACTIVITIES THINGS I DO TO PROCESS MY FEELINGS SELF REFLECTIONS

THINGS THAT KEEP ME BUSY

THINGS THAT MAKE ME FEEL CONFIDENT

ACCEPTS SKILL Self Assessment

How do I feel at this moment?

What am I putting off?

Overall Well-being

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I get enough sleep

I spend time to recharge

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I have a healthy eating habit

I keep my space clean

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I exercise my body regularly

I take care of my hygiene

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ACCEPTS SKILL

Select a. emotion from the emotions wheel.Use the following prompts to guide you in describing your emotions... Negative EMOTIONS Reflective Questions DESCRIBE YOUR EMOTIONS Activity .

Emotion:

The situation/experience when I felt this emotion

................................................. ................................................. .................................................

what thought is attached to the emotion

................................................. ................................................. ................................................. ................................................. ................................................. ................................................. What would the emotion physically look like? ................................................. ................................................. ................................................. What are the underlying/root emotions?

ACCEPTS SKILL EMOTIONS Reflective Questions

DESCRIBE YOUR EMOTIONS Activity

. Positive

Select a. emotion from the emotions wheel. Use the following prompts to guide you in describing your emotions...

Emotion:

The situation/experience when I felt this emotion

................................................. ................................................. .................................................

what thought is attached to the emotion

................................................. ................................................. ................................................. ................................................. ................................................. ................................................. What would the emotion physically look like? ................................................. ................................................. ................................................. What are the underlying/root emotions?

ACCEPTS SKILL Challenging negative THOUGHTS 1. Recognize. 2. Reframe. 3. Challange. Practice. 4. negative thinking patterns your negative thoughts your negative thoughts positive thinking professional help if needed 5. Seek.

ACCEPTS SKILL Challenging negative thoughts Depression, poor self-esteem, and anxiety are often the result of irrational negative thoughts. Someone who regularly receives positive feedback at work might feel that they are horrible at their job because of one criticism. Their irrational thought about job performance will dictate how they feel about themselves. Challenging irrational thoughts can help us change them. ................................................. ................................................. ................................................. ................................................. .... 2. Is there evidence contrary to my thought? ................................................. ................................................. ................................................. ................................................. .... 3. Am I attempting to interpret this situation without all the evidence? ................................................. ................................................. ................................................. ................................................. .... 1. Is there substantial evidence for my thought? Answer the following questions to assess your thoughts:

ACCEPTS SKILL Challenging negative thoughts Depression, poor self-esteem, and anxiety are often the result of irrational negative thoughts. Someone who regularly receives positive feedback at work might feel that they are horrible at their job because of one criticism. Their irrational thought about job performance will dictate how they feel about themselves. Challenging irrational thoughts can help us change them. .................................................. .................................................. .................................................. .................................................. 4. What would a friend think about this situation? 5. If I look at the situation positively, how is it different? .................................................. .................................................. .................................................. .................................................. .................................................. .................................................. .................................................. .................................................. .... 6. What will this matter a year from now? Five years from now? Answer the following questions to assess your thoughts:

ACCEPTS SKILL Challenging negative thoughts

g row t h m in GROWTH

d s et FIXED

If I try I will fail

I learn from my mistakes

This is too hard

I ALWAYS KEEP TRYING

CHALLANGES HELP ME GROW

I am not smart enough

I can try a different way

I don't know how to do it

Change your mind - change your life

ACCEPTS SKILL Challenging negative thoughts Write Down fixed mindsets that you want to change. write down how you can change your fixed mindset to a growth mindset FIXED GROWTH Action

ACCEPTS SKILL Wise mind distracts with ACCEPTS Rationl Wise Emotional Analytical Balanced Logical Mindful Factual Based on past events Impulsiv e Reactive Stress, anxiety & fear

Emotions are not important

Feelings controls a persons thoughts & behaviour. Acts impulsively with little regard for consequences.

Balance between the two haves. Able to recognise and respect their feelings and respond in a rational manner

Approaches the situation intellectually. Plans & makes decisions based on facts.

ACCEPTS SKILL Wise mind distracts with ACCEPTS Everyone possesses each of these states, but we gravitate toward a specific one most of the time. Three states of mind.

The reasonable mind

Approaches a situation intellectually. With a plan & make decisions based on facts.

The emotional mind

Used when feelings control a person’s thoughts and behavior. They might act impulsively with little regard for consequences.

The Wise mind

A balance between the reasonable and emotional halves. They are able to recognize and respect their feelings while responding to them in a rational manner.

ACCEPTS SKILL Wise mind distracts with ACCEPTS How you can practice the ACCEPT Skill to move to a WISE MIND ACCEPTS outlines strategies for distracting oneself from distressing emotions, giving them time to lessen in intensity, or fade away. Using ACCEPTS, clients will learn a variety of distraction techniques, including focusing on others, creating new competing emotions, and participating in distracting activities. Something thoughtful I can do ................................................ . ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. How I feel now vs. then ................................................ . ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. A task (s) that need to be done

ACCEPTS SKILL Radical Acceptance

Radical acceptance is the practice of accepting and allowing circumstances, events, and people in your life without judgment or resistance. The focus is to allow yourself to be with what is, rather than wishing things were different. This practice can be immensely helpful in managing difficult emotions, reducing stress, and cultivating a greater sense of peace and contentment. It can also help you develop healthier relationships with yourself and others by allowing you to observe and accept without needing to change things.

ACCEPTS SKILL Radical Acceptance

10. STEPS OF Radical Acceptance

Observe that you are fighting against reality. Remind yourself that the reality cannot be changed. Acknowledge something led to this moment. Practice acceptance with mindfulness. List what your behavior would look like if you accepted the facts.

to better understand the full impact of your choice. ahead- think about how you should appropriately act & cope. Mindful of physical sensations such as tension or stress. Embrace feelings such as disappointment, sadness, or grief. Accept that pain and discomfort are temporary. Choice ACCEPTS SKILL Radical Acceptance 10. STEPS OF Radical Acceptance Plan

something led to this moment.

ACCEPTS SKILL Radical Acceptance

Applying the steps in your life 10. STEPS OF Radical Acceptance

1.

List the facts of your reality

2.

List your emotions and feelings about the reality of your situation

something led to this moment.

ACCEPTS SKILL Radical Acceptance

Applying the steps in your life 10. STEPS OF Radical Acceptance

3.

List what brought you to this moment

4. List the pros and cons of the same behavioural choices

something led to this moment.

ACCEPTS SKILL Radical Acceptance

Applying the steps in your life 10. STEPS OF Radical Acceptance

5.

List the pros and cons of alternative behavioural choices

6.

what your behavior would look like if you accepted the facts.

something led to this moment.

ACCEPTS SKILL Radical Acceptance

Applying the steps in your life 10. STEPS OF Radical Acceptance

7.

create a plan of how you change your behaviour

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What is your plan to act & cope in the future

something led to this moment.

ACCEPTS SKILL Radical Acceptance

Applying the steps in your life List physical sensations in your body (tip: do a body scan) 10. STEPS OF Radical Acceptance

9.

10. LIST HOW YOU WILL PRACTICE MINDFULNESS

something led to this moment.

ACCEPTS SKILL Wise mind distracts withRadical Accpetance Activity We cannot control every problem we encounter, sometimes things are simply out of our control. Learning to accept the problems that are out of your control will lead to less anxiety, anger, and sadness when dealing with them.

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THE PAST

HOW OTHERS REACT

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THE WEATHER

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MY ACTIONS

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My WORDS My DREAMS AND GOALS

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LIFE & DEATH

HOW I REACT TO THINGS HOW I TREAT PEOPLE ASKING FOR HELP MY CORE VALUES & BELIEFS

THE FUTURE

THE BELIEFS OF OTHERS

THE MISTAKES OF OTHERS

ACCEPTS SKILL Circle of control

Sometimes you will face a problem that is simply out of your control. In these situations, negative thoughts can takeover. Radical acceptance refers to a healthier way of thinking during these situations. Instead of focusing on how you would like something to be different, you will recognize and accept the problem or situation as it is. 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.

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ACCEPTS SKILL Radical Acceptance

Situation

You find out that you were not selected for a job where you felt that you were the best candidate.

Typical Thinking

Radical Acceptance

“This isn’t fair—I did everything right! I was the best one there. They can’t do this to me.”

“It’s frustrating that I didn’t get the job, but I accept that they felt someone else would be a better fit.”

Complete the table below based on your own experiences...

Situation

Typical Thinking

Radical Acceptance

Situation

Typical Thinking

Radical Acceptance

ACCEPTS SKILL Distracting activity ideas

Set boundaries, practice saying NO

Try a new food dish

Watch a good movie

Set goals for the next month

Breathing skills

Create a vision board

Start a new hobby

Take yourself on a solo date

Take a warm bath

Buy a book

Listen to a podcast

Take a walk outside

Do 30 minutes of yoga Buy yourself flowers/plant Go for a general health check up

Make a menu for the week

Do something for the first time List the things that you are grateful for

Get physical

Buy yourself something

Write out a bucket list

product Buy a self-care

Practice mindfulness

Start a journal

Do a creative project

Light some candles

Call a friend

De-clutter and organize your space

Drink a mindful cup of tea with a friend Have a cup of coffee

Engage with your 5 senses

Go sit in the sun

Go for a picnic

Finish some chores

Reflection cards

Take a nap

Go to the movies

Do a homeworkout

Put on clean beading

ACCEPTS SKILL Distracting activity ideas Write down 5 distracting skills you will practice when emotions become overwhelming 1. 2. 3. 4. 5.

ACCEPTS SKILL D IySoTuRr 5AsCe nTs e sw i t h THINGS YOU CAN SEE TOUCH HEAR SMELL TASTE TECHNIQUES THINGS YOU CAN 5 4 3 2 1 THINGS YOU CAN THINGS YOU CAN THINGS YOU CAN THING YOU CAN SEE TOUCH SMELL TASTE THINGS YOU CAN THINGS YOU CAN THINGS YOU CAN THING YOU CAN GROUNDING 5 4 3 2 1

ACCEPTS SKILL

5-4-3-2-1 SENSES D IySoTuRr 5AsCe nTs e sw i t h

Body Scan find a quiet space tune in to your body... to reconnect to your physical self. Note any sensations you're feeling without judgment.

5 things you can see around you

4 things you can touch around you

Note any areas of pain & tension.

3 things you can hear around you

2 things you can smell around you

1 thing you can taste

ACCEPTS SKILL Engaging with your 5 senses GO FOR A WALK OR SIT IN A PLACE YOU HAVE NEVER BEEN BEFORE FOR AT LAST 5 MINUTES AND TAKE NOTE OF ALL 5 OF YOUR SENSES LIST THE THINGS YOU CAN.... SEE

TOUCH

HEAR

SMELL

TASTE

ACCEPTS SKILL Mindfulness Techniques

PROGRESSIVE MUSCLE RELAXATION

Working through the body, tense one muscle group at a time. more relaxed and calm. The technique is simple: 1. 2. Then release the tension and notice the contrasting feeling of relaxation. Push the head back as far as it will go (against a chair) Feel the tension for 5 seconds. Bring the head down and press the chin down on to the chest for 5 seconds. Feel the tension for 5 seconds. Release , relax and feel relaxation for 10 seconds. JMR TECHNIQUE A relaxation technique that helps you release the tension you are holding in your body and feel

1. 2. 3. 4. 5.

ACCEPTS SKILL Mindfulness Techniques 7 STEP Body scan meditation Sit upright comfortably. Gently close your eyes. Breathe deeply. Slowly scan your body, and notice any sensations. Be aware of any thoughts you are having. 1. 2. 3. 4. 5.

6.

When your mind wanders, focus on your breath. Gently open your eyes when you are ready.

7.

ACCEPTS SKILL Mindfulness Techniques

Simple Body scan

Find a quiet space tune in to your body... to reconnect to your physical self. You can be anywhere, in any position Note any sensations you're feeling without judgment. Note any areas of pain & tension. Release the tension &let the feelings go without judgment

ACCEPTS SKILL Mindfulness Techniques

mindfulness eating

Consider the wider spectrum of the meal: where the food came from, how it was prepared, and who prepared it Notice internal and external cues that affect how much we eat Notices how the food looks, tastes, smells, and feels in our bodies as we eat Acknowledges how the body feels after eating the meal Expresses gratitude for the meal Use deep breathing or meditation before or after the meal Reflect on how our food choices affect our local and global environment

ACCEPTS SKILL Mindfulness Techniques Gratitude Jar

Write down all the

people places things

you are grateful for today..

ACCEPTS SKILL Mindfulness Techniques Cognitive defusion exercise leaves on a stream

During the leaves on a stream exercise, you will visualize yourself resting near a stream. Whenever thoughts enter your mind, you will imagine placing them atop a leaf, and watching as they float away. Instead of seeing the world from “inside” your thoughts, you will take a step back and view them from afar. By doing so, you will gain perspective on your thoughts and feelings, reducing their power. Find a quiet place, Sit or lie down in a Close your eyes or let Begin taking slow, free of distractions. comfortable position. your gaze soften. deep breaths. Imagine you are resting by the side of a stream. This scene can look however you like. Use all your senses to imagine what the stream and its surroundings look like, the sound of the water and other ambiance, the physical sensations, and anything else that comes to mind. Your objective during this exercise is simply to focus on the stream. When distractions enter your mind, such as thoughts or feelings, take a moment to notice them without judgment. For example, if you are distracted by other obligations, notice and acknowledge to yourself: “I am thinking about my to-do list.” Manage Your Thoughts -After taking a moment to observe a thought or feeling, return your attention to the stream. Place your thought upon a leaf. You might imagine writing the thought on the leaf or attaching it in some other way. Place the leaf in the water and watch it float down the stream until it disappears. Continue visualizing the stream, simply observing and releasing any thoughts that enter your mind. There is nothing else you need to do. You may set a timer for 10-15 minutes to know when practice concludes. feelings. This technique uses a concept called cognitive defusion, which works by creating distance from thoughts and feelings as a way to reduce the power they have over us. Leaves on a stream is a technique used in acceptance and commitment therapy (ACT) to cope with uncomfortable thoughts and

ACCEPTS SKILL Mindfulness Techniques TICK THE MINDFULNESS TECHNIQUES YOU ARE GOING TO USE TO DISTRACT FROM OVERWHELMING EMOTIONS

Breathing cards Grounding 5 senses

Journal prompts Body Scan Progressive muscle relaxation Mindfulness eating JMR technique Gratitude list

Distress tolerance is the ability to recognize and accept emotional distress without trying to make it go away or avoid emotions. It is a persons aability to manage an emotional incident without feeling overwhelmed It involves the understanding that sometimes emotional distress is inevitable and learning how to ride out difficult feelings without turning to unhealthy coping mechanisms. Some strategies for developing distress tolerance include: mindfulness, self-soothing techniques, distraction techniques, improving communication skills, and learning to accept reality. It IS important to remember that distress tolerance is a skill that can be learned, and it can help us manage difficult emotions healthily. Distress Tolerance EXPLAINED DBT& MINDFULNESS Defined TIPP SKLL D.B. T D Dialectical behavioral therapy DISTRESS TOLERANCE TECHNIQUES T . I .P.P T.I.P.P T. I. Paced breathing Temperature Intense Exercise Paired muscle relaxation skill to use in times of crisis or high emotional states like when you feel overwhelmed and your emotions are going to consume you. Distress tolerance skill P. P.

D.B. T skill to use in times of crisis or high emotional states like when you feel overwhelmed and your emotions are going to consume you. Distress tolerance skill T.I.P.P T. I. Distress tolerance skill Change the temperature This can be done many ways, such as splashing cold water on your face, filling a sink up with very cold water, or you could even use water from the fridge or add ice cubes to your tap water. Improves memory and brain function Aids in weight management and general health. Improve your quality of sleep. Reduce feelings of anxiety and depression. Intense exercise Exercise for at least 20-30 minutes a day. D Dialectical behavioral therapy T.I.P.P DISTRESS TOLERANCE TECHNIQUES T . I .P.P Temperature Intense Exercise

T. I. P. P.

Paced breathing Paced Breathing Breathe out slower and longer than when you breathe in. You can start with a 1-second difference and work your way up- breathing in for 4 seconds and out for 5 seconds.

Paired muscle relaxation Paired Muscle Relaxation Relaxing at night time or if you are feeling anxious. You can work from toe to head or head to toe or pick body parts that work for you. Notice the tension in your muscle, then tense that muscle as hard as you can while you breathe in, as you breathe out say the word ‘relax’ in your mind and release the tension.

TIPP SKILL EXERCISE

T.

Temperature Change the temperature This can be done many ways, such as splashing cold water on your face, filling a sink up with very cold water, or you could even use water from the fridge or add ice cubes to your tap water.

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. This causes the “dive response” to occur. (It may take 15–30 seconds to start.) Your heart slows down, blood flow to nonessential organs is reduced, and blood flow is redirected to the brain and heart. (This strategy works best when you are sitting quietly—activity and distraction may make it less effective ) COLD WATER & MENTAL HEALTH COLD WATER giveS you a natural high and has been shown to improve symptoms of depression & ANXIETY. This response can actually help regulate your emotions. This will be useful as a distress tolerance strategy when you are having a very strong, distressing emotion, or when you are having very strong urges to engage in dangerous behaviors. zip block ice bag dive response activity

TIPP SKILL

write down hoW you can practice EACH TIPP skill in your own life WORKSHEET INCORPORATE MINDFULNESS TECHNIQUES INTO YOUR SKILLS PRACTICE PLAN

I. T.

P. P.

TIPP SKILL WORKSHEET REFLECTIVE QUESTIONS

Which TIPP SKILL WILL YOU USE MOST & WHY?

WHAT ARE YOUR FEELINGS BEFORE AND AFTER YOU USE THE SKILL?

D.B. T I.M.P.R.O.V.E Distress tolerance skill I. M. P. R. O. V. E. Imagery Meaning PRAYER RELAXATION ONE VACATION ENCOURAGEMENT D Dialectical behavioral therapy DISTRESS TOLERANCE TECHNIQUES I.M.P.R.O.V. E

I.M.P.R.O.V.E Distress tolerance skill I. Improve the moment with Imagery. Imagine a beautiful scene or a safe space.

M. P. R. O. V. E.

Improve the moment with Meaning. Find purpose or meaning in your daily activities.

Improve the moment with Prayer. Ask for strength.

Improve the moment with Relaxation. Breathe deeply, take a hot bath, massage your neck.

Improve the moment with one thing in the moment. Focus your attention on this moment.

Improve the moment with Vacation from adulthood. Go to the beach or the woods for a walk.

Improve the moment with Encouragement from self. Say positive affirmations aloud to yourself.

IMPROVE SKILL

write down hoW you can practice EACH IMPROVE skill in your own life WORKSHEET

I. M. P. R. O. V. E.

IMPROVE SKILL WORKSHEET REFLECTIVE QUESTIONS

Which IMPROVE SKILL WILL YOU USE MOST & WHY?

WHAT ARE YOUR FEELINGS BEFORE AND AFTER YOU USE THE SKILL?

Distress tolerance is the ability to recognize and accept emotional distress without trying to make it go away or avoid emotions. It is a persons aability to manage an emotional incident without feeling overwhelmed It involves the understanding that sometimes emotional distress is inevitable and learning how to ride out difficult feelings without turning to unhealthy coping mechanisms. Some strategies for developing distress tolerance include: mindfulness, self-soothing techniques, distraction techniques, improving communication skills, and learning to accept reality. It IS important to remember that distress tolerance is a skill that can be learned, and it can help us manage difficult emotions healthily. Distress Tolerance EXPLAINED DBT& MINDFULNESS Defined TIPP SKLL D.B. T D Dialectical behavioral therapy DISTRESS TOLERANCE TECHNIQUES T . I .P.P H.A.L.T H LONELY HUNGRY ANGRY TIRED acronym reminds us to take a moment (HALT) and ask ourselves if we are feeling Hungry, Angry, Lonely, or Tired -these ARE basic needs TO BE MET. Distress tolerance skill

A L T

Distress tolerance is the ability to recognize and accept emotional distress without trying to make it go away or avoid emotions. It is a persons aability to manage an emotional incident without feeling overwhelmed It involves the understanding that sometimes emotional distress is inevitable and learning how to ride out difficult feelings without turning to unhealthy coping mechanisms. Some strategies for developing distress tolerance include: mindfulness, self-soothing techniques, distraction techniques, improving communication skills, and learning to accept reality. It IS important to remember that distress tolerance is a skill that can be learned, and it can help us manage difficult emotions healthily. Distress Tolerance EXPLAINED DBT& MINDFULNESS Defined TIPP SKLL D.B. T D Dialectical behavioral therapy DISTRESS TOLERANCE TECHNIQUES T . I .P.P H.A.L.T H Loneliness can occur by ourselves or when surrounded by many people. We isolate ourselves - withdrawing into ourselves out of fear or doubt. Ask yourself if you have reached out to anyone lately. Your support system is there for you when you feel depressed, overwhelmed, or anxious or if you need to talk to someone. Eating a good breakfast is important for beating hunger during the rest of the day. Take time to understand what causes your anger, and to work out how to express it in a way that won't damage you or others. Keep a record of the things or people that trigger your anger. Running on low energy compromises our ability to think and our capacity to cope. Taking the time to sleep, rest, and rejuvenate is critical to keeping healthy physically, emotionally, and spiritually. acronym reminds us to take a moment (HALT) and ask ourselves if we are feeling Hungry, Angry, Lonely, or Tired -these ARE basic needs TO BE MET. Distress tolerance skill Eat something healthy every three or four hours after that. This can help to prevent changes in mood, including outbursts of anger, by keeping your blood sugar level stable. A L T

HALT SKILL WORKSHEET Write down some go-to nourishing meals you can easily make/ buy

I HAVE COMPLETED THE TIGGER PLAN ACTIVITY

WHEN I AM LONELY THESE ARE THE PEOPLE I CAN CONNECT WITH & ACTIVITIES WE ENJOY TOGETHER

HALT SKILL WORKSHEET SLEEP HYGIENE PLANNER

No caffeine or nicotine near bedtime Going to bed in calm, relaxed state Get enough sunlight during the day

Cool, dark and comfy bedroom

Add white noise to your bedroom

HALT SKILL WORKSHEET SLEEP HYGIENE PLANNER Year:

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Sleep Hours Wake Up Mood

Notes:

S.T.O.P Distress tolerance skill

S T. O. P.

STOP

TAKE A STEP BACK THINK

OBSERVE

PROCEED MINDFULLY

S.T.O.P Distress tolerance skill

S T. O. P.

When you feel that your emotions seem to be in control, stop! Do not react. Freezing for a moment helps prevent you from doing what your emotions want you to do (which is to act without thinking). Stay in control. Give yourself some time to calm down and think. Take a step back from the situation.Take a deep breath and continue breathing deeply as long as you need and until you are in control. Observe what is happening around you and within you, who is involved, and what are other people doing or saying. Listen to the Automatic Negative Thoughts that occur. Remember those are based on an outdated Belief System. Ask yourself, “What do I want from this situation?” or “What are my goals?” Stay calm, stay in control, and when you have some information and how that may impact your goals, you will be better prepared to deal with the situation effectively.

STOP SKILL WORKSHEET

WHAT IS the Prompting event for my distress (who, what, when, where):

Describe A crisis situations that happened to you. Then describe your use of the STOP skill.

I still couldn’t stand the situation, even for one more minute.

Rate level of distress (0 – 100) Before:

I was able to cope somewhat, at least for a little while.

It helped somewhat.

After USING STOP SKILL:

I could use skills, tolerated distress, and resisted problem urge

WORKSHEET triggers

What triggered the state of crisis?

Describe the problem your triggers are contributing to. What’s the worst-case scenario, if you are exposed to your triggers?

WORKSHEET triggers

think about each of the categories listed below. Is there a specific emotion that acts as a trigger for you? How about a person or place? List your responses in the provided spaces.

Emotional State

people

places

things

thoughts

MY TRIGGER PLAN WORKSHEET triggers

USE ANY OF THE SKILLS & TECHNIQUES YOU HAVE LEARNT FOR DISTRESS TOLERANCE

Describe your biggest trigger in detail

DESCRIBE your strategy for avoiding or reducing exposure to each trigger.

DESCRIBE YOUR strategy for dealing with each trigger head on, when they canno be avoided.

When you feel overwhelmed R.A.I.N technique ACCEPTS SKILL R.A.I.N Technique

RECOGNIZE ACCEPT INVESTIGATE WHAT IS GOING ON THE EXPERIENCE AS IT IS THE THOUGHT OR EMOTION NURTURE PRACTICE SELF-CARE

A. R. I. N.

R.A.I.N technique ACCEPTS SKILL R.A.I.N Guide

Sit or lie down in a comfortable position. Close your eyes.Take three deep but slow breathes. Let these steps guide you in this technique for when you are feeling overwhelmed and need to de-stress. Open your eyes, take in your surroundings for a few moments. Breathe and close your eyes. RECOGNISE your thoughts, feelings, physical sensations in your body. Name your feelings out loud or silently to yourself. Let go of any judgement. Say to yourself, out load or silently, it's okay to feel this way, my feelings are valid", this is how it is right now". Reflect deep within yourself Ask yourself, "where are these feelings and thoughts arising from? Where are these thoughts and feelings rooting in the sensations of your physical body? What do you actually need? (acceptance, forgiveness, belonging...) Open your palms to the ceiling Allow healing compasSion into your life Think of a person, place or thing that allows love to flow to you Write a list of how you will nurture yourself today (self-care practices)

ACCEPTS SKILL

RECOGNIZE

Use this space to note any feelings thoughts or physical emotions that arose during the exercise. Remember, you are writing from a point of non-judgement The thoughts, feelings & physical sensations I recognised... ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. Thoughts Feelings ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. Physical sensations

ACCEPTS SKILL

What affirmations can i say out loud or quietly to yourself... ACCEPT Let go of any judgement. Say to yourself, out load or silently, " it's okay to feel this way, my feelings are valid", this is how it is right now". ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. Thoughts Feelings ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. Physical sensations

ACCEPTS SKILL

Reflect deep within yourself. Where are these feelings coming from, where are they being held in your body. What is the root of my thoughts, feelings and body sensations.. INVESTIGATE ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. Thoughts Feelings ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. Physical sensations

ACCEPTS SKILL

NURTURE

How will you nurture your body, how will you practice self love and care.

My current self-care practices ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. My self-care goals ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. .................................................

ACCEPTS SKILL

NURTURE

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Spiritual

Emotional

Physical

Occupational

Intellectual

Social

Environmental

Financial

TO NURTURE YOURSELF AND YOUR GROWTH... MAKE A LIST OF SELF CARE PRACTICES YOU CAN IMPLEMENT IN ALL AREAS OF YOUR LIFE.

ACCEPTS SKILL

NURTURE

Financial ......................................................... ......................................................... ........................................................ ......................................................... ......................................................... ........................................................ ......................................................... ......................................................... ........................................................ ......................................................... ......................................................... ........................................................ ......................................................... ......................................................... ........................................................ ......................................................... ......................................................... ........................................................ ......................................................... ......................................................... ........................................................ Environmental intellectual ......................................................... ......................................................... ........................................................ Spiritual Physical Social OCCUPATIONAL EMOTIONAL

Distress tolerance is the ability to recognize and accept emotional distress without trying to make it go away or avoid emotions. It is a persons aability to manage an emotional incident without feeling overwhelmed It involves the understanding that sometimes emotional distress is inevitable and learning how to ride out difficult feelings without turning to unhealthy coping mechanisms. Some strategies for developing distress tolerance include: mindfulness, self-soothing techniques, distraction techniques, improving communication skills, and learning to accept reality. It IS important to remember that distress tolerance is a skill that can be learned, and it can help us manage difficult emotions healthily. Distress Tolerance EXPLAINED DBT& MINDFULNESS Defined Distress tolerance skill act skill MANAGING OVERWHELING & UNCOMFORTABLE EMOTIONS PILLARS OF ACCEPTANCE & COMMITMENT THERAPY acceptance cognitive defusion self as context

valuing

COMMITTED ACTION

ACCEPTS SKILL ACT

ACT is a type of mindfulness-based therapy that encourages people to embrace their thoughts and feelings rather than pushing them away, running from them, or feeling guilty about them. Hence, Acceptance and Commitment Therapy techniques emphasize acceptance rather than avoidance. The purpose of ACT is to help you develop psychological skills to deal more effectively with difficult thoughts and feelings, to reduce their impact and influence over you. As such, it aims to clarify your values (your heart’s desires) and focus your attention on what is important and engage fully in whatever you are doing. Acceptance and commitment therapy C T A Accept your reactions and be present Choose a valued direction take action

ACCEPTS SKILL ACT PERSONAL Values

Values are the things you cherish most in life. They play a role in shaping your goals, priorities, and identity. Values are influenced by your own beliefs, as well as by your family, friends, and society. Staying true to your values can help you express your most authentic self. circles of influence Instructions: List the top 5 values held by each group or person below.

Society

Friends

Family

Myself

ACCEPTS SKILL ACT Values EXPLORATION

Name a person (real or fictional) you respect or admire. What traits of theirs do you appreciate? What do you think this person values?

Describe what you would do on an ideal day. How does this compare with a typical day? Which typical daily activities reflect your values? Which do not?

Describe one of your close friends. What makes you close? What values do you share with your friend?

What is your dream job, and why? What does this say about your values?

ACCEPTS SKILL ACT Values EXPLORATION

If your friends and family give speeches about your life. What do you think they say? Which of your values are recognized in their speeches?

What are your three most prized possessions? Why do you value these items?

Imagine you come into a large fortune that allows you to never work again, and buy anything you want. What would you do? What do your actions say about your values?

When you were younger, what were your wishes for the future? How have your values changed as you’ve gotten older?