Distress Tolerance skills are a set of Dialectical Behavioral Therapy skills that are strategies to help you get though difficult feelings and situations, and tolerate (deal with, sit with, accept) the things that you can’t immediately change. Emotions can be extreme and lead to behaviors that are ineffective. You may not be able to change the stressful situation you’re in, but you can change the way you feel. Distress Tolerance skills are aimed to make your response to distress more effective.
IMPROVE the Moment is a core Distress Tolerance skill. Actually, it’s a whole set of skills, one for each letter of IMPROVE. Each one is a practice that can help you feel better. Using the IMPROVE skills will reduce your distress, and even if they work just for a moment, you can always repeat them. Even a moment of reduced distress is worth working for.
IMPROVE stands for:
- create Meaning
- One Thing in the Moment
Using imagery, you can create a situation or a scene that is different from the one that you are in now. In a way, you can leave the situation mentally even if you can’t physically. You can escape to a safe place or imagine the situation going the way you want it to.
To create your safe space, envision in your mind a place that you would like to be – a safe place, a relaxing place, a beautiful place. Focus on this place. Relax, and let yourself feel that you are in this place. It usually helps to notice details of the place that you imagine. See that safe place, maybe a room, that is fixed up just the way you want it. Maybe imagine a spot along the ocean, or being with a good, safe friend.
You might imagine floating down a river on your back, looking at the trees passing you by overhead. Or perhaps you’re in a field, watching the grass sway around you or the clouds above. Maybe you’re snuggled in your bed, wrapped in blankets with your dog at your feet.
When you’re in that space, let your hurtful feelings drain or wash out of you, relieving you and making you more comfortable. Breathe slowly and gently as you do this. Relaxing into your safe place will help you relax in reality too.
You can also imagine things going well for you. Imagine you know how to take care of the situation you are in. Envision the outcome you desire. If you practice doing this, you will find that it begins to work for you. Things do get better, and you can cope better. You can deal more effectively with the crises in your life if you practice feeling like you can take care of things.
Try practicing finding your safe place and imagining things going well when you’re not in crisis. This will make you better able to use the skill in a distressing moment.
Some of the techniques for Improving the Moment are cognitive techniques, that is, changing our feelings by changing how we think about ourselves and our situation. The way we think about our situation and ourselves in it has a lot to do with how we feel.
Doing this is not always easy, and may take some time and work, but it can be very helpful and comforting in a difficult situation.
Finding meaning is like making lemonade out of lemons. Making lemonade out of lemons involves taking some items that are not very tasty on their own and doing something (squeezing them and adding sugar and water to the juice) to get a result that is delicious. This concept can be hard to accept. But if you think about it, you can think of other situations where you “make lemonade out of lemons.” That is, where you make something good out of something not so good. We do this to make ourselves more comfortable, to turn a bad situation around.
Think about what you could do to turn these situations around:
- being snowbound
- being stuck in the mud in your friend’s driveway
- burning a batch of cookies
- losing the money for your Christmas gifts
You don’t have to believe that there is a purpose to your suffering. If you have religious or spiritual beliefs, you may feel this way. But if you don’t, you can still create meaning in other ways. There are other forms of spirituality. Some people find it in nature. You may be comforted, as I have been, by seeing that the natural world keeps right on going, no matter what happens. Creating Meaning can sometimes be the same as finding inspiration.
For example, are you seeing something more clearly? Are you learning something? Are you letting go of painful memories or feelings? Has this brought you closer to friends or family members? Are you preparing for a change in your life? Are you closer to nature? Have you discovered a book or a poem that helped you? Find something that you can change to something positive. Make lemonade out of lemons.
If you feel like yelling, try singing, loudly. Focus your angry energy into art (big splashes of paint on paper), on sculpture (pounding clay), photography (taking pictures of what makes you upset or what reminds you of it). Write about your sad or angry or painful thoughts. If you need company, cook dinner for a friend or go on a picnic. Come up with your own ways to make something positive of your distress or a little piece of it.
Remember that by trying to find positive things about our distress, we are not denying that things are bad, or trying to say that distressing things are not distressing. We are trying to IMPROVE the Moment, to find some things that help us feel better in the moment.
The P in IMPROVE stands for Prayer. This can be prayer to a supreme being, God, a higher power, or to your own Wise Mind. In moments of great distress prayer can relieve distress or help you tolerate it better.
Marsha Linehan talks about several kinds of prayer. She talks about the “Why me?” prayer and the “distress” prayer, in both of which you are asking for something, perhaps rather desperately. Maybe you are asking to be relieved from your distress or asking for something particular to happen or simply asking whomever you are praying to to have pity on you.
There is another way of using prayer that she calls Acceptance Prayer. This is a lot like radical acceptance. You open yourself to what is, whether you are praying to a God or higher power or to your own wise mind. It is a way of being present with your distress, of not fighting it, while at the same time not saying it is okay.
If you don’t pray to a higher power or God, try praying to or opening yourself to your own Wise Mind, that centered part of yourself, the part with a felt sense of what’s right.
Use of relaxation and stress reduction exercises is an excellent way to help ourselves feel better in the moment. Many of us are tense, and become more tense when we are in distress. Relaxing changes that response. The goal is to accept reality with the body, not to fight against it or try to push it away. The body and the mind are closely linked. Relaxing the body also relaxes the mind.
Some of the relaxation techniques that you might try are listening to a relaxation tape, exercising hard (think of how relaxed you feel after a good run or swim or a long walk), taking a hot bath, massaging your neck and scalp, legs and feet, breathing deeply, drinking some hot milk, cocoa or herbal tea, sitting in a hot or cold tub until the water becomes tepid, or listening to music.
Can you think of some other relaxing things? Each of you probably has some special thing that helps you relax. You can also try some body-focused Mindfulness exercises to guide you.
One Thing in the Moment
One Thing in the Moment is the same thing as One-mindfully, or Mindfulness. It means focusing on the one thing that you are doing right now, in the present moment. This can be very helpful if you are in a distressing situation or a crisis. It can give you some time to settle down and calm down.
Often our suffering is made more intense by remembering past suffering and worrying about future suffering. If we can stay in the moment and focus on what is happening in the here and now, our suffering will be greatly reduced. Mindfulness exercises can help you attend to the moment. Be sure to practice them often so you can use the in distress.
The idea behind Vacation is that a brief break from your situation can alleviate your distress. It doesn’t have to be a literal vacation- you don’t have to book a flight and a hotel and pack your bags. If you can do that, go for it. But there are ways of practicing Vacation that are far more accessible.
Try taking a mini-vacation. Shut your office door to get a moment to yourself. Lie on the couch with a pillow or a mask over your eyes. If you can, change your environment. Take your lunch to the park. Take a walk around the block. Make some space between you and your situation.
There are two rules for Vacation to abide by. The first is don’t take a vacation that will harm you. If you’re down to the wire on a deadline, taking a vacation might not be the best idea. If you take a mental health day when you’re expected at a crucial event, you’ll just be adding another future crisis to your plate.
Secondly, don’t let your Vacation get too long. If you take a break from studying, set a timer to remind yourself to return. It might be tempting to add a second Vacation onto your first, and then a third just like you’d hit ‘next episode’ on Netflix. The point of Vacation and of most DBT skills is to increase your Effectiveness in the moment or long term. A brief Vacation distances yourself from your suffering just long enough to alleviate it so you can move on and do what you need to do. It can be easy, but don’t let it turn into avoidance.
E stands for Encouragement. This skill is about talking to yourself in an encouraging way. Our moods are deeply affected by the way we talk to ourselves. We easily slip into negative self-talk when feeling distressed. It’s important to have some encouraging statements prepared to combat those negative thoughts.
What would you say to a friend in distress? Maybe “This will pass. You can get through it.” Or “You are strong enough to survive this.” Make sure not to fall into halfway statements. No “I guess I’m kind of strong” or “Maybe I’ll get through this.” Stick to truthful, sure statements.
Write your encouraging statements down to help yourself remember them. Refer to your list in times of distress until you memorize the statements and they become second nature. Practice makes perfect so don’t skimp on the positive self-talk.
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