Adapted from Skills Training Manual for Treating Borderline Personality Disorder by Marsha Linehan. 1993 The Guilford Press. .
DISTRESS TOLERANCE
Crisis Survival Strategies
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DISTRACT WITH “ACCEPTS” Activities Contributing Comparisons Emotions Pushing away Thoughts Sensations
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SELF-SOOTHE the FIVE SENSES |
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Vision Hearing Smell Taste Touch |
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IMPROVE THE MOMENT Imagery Meaning Prayer Relaxation One thing at a time Vacation Encouragement |
DISTRACTING
A useful way to remember these skills is the phrase
"ACCEPTS" with Wisdom
With Activities:
Engage in exercise or hobbies; do cleaning; go to events; call or visit a friend; play computer games; go walking; work; play sports; go out to a meal, have decaf coffee or tea; go fishing; chop wood, do gardening; play pinball.
With Contributing:
Contribute to someone; do volunteer work; give something to someone else; make something nice for someone else; do a surprising, thoughtful thing.
With Comparisons:
Compare yourself to people coping the same as you or less well than you. Compare yourself to those less fortunate than you. Watch soap operas; read about disasters, others' suffering.
With opposite Emotions:
Read emotional books or stories, old letters; go to emotional movies; listen to emotional music. Be sure the event creates different emotions. Ideas: scary movies, joke books, comedies, funny records, religious music, marching songs, "I Am Woman" (Helen Reddy); going to a store and reading funny greeting cards.
With Pushing away:
Push the situation away by leaving it for a while. Leave the situation mentally. Build an imaginary wall between yourself and the situation. Or push the situation away by blocking it in your mind. Censor ruminating. Refuse to think about the painful aspects of the situation. Put the pain on a shelf. Box it up and put it away for a while.
With other Thoughts:
Count to 10; count colors in a painting or tree, windows, anything; work puzzles; watch TV; read.
With intense other Sensations:
Hold ice in hand; squeeze a rubber bail very hard; stand under cold shower; listen to very loud music.
SELF-SOOTHE
A way to remember these skills is to think of soothing each of your
FIVE SENSES:
With Vision:
Buy one beautiful flower; make one space in a room pretty; light a candle and watch the flame. Set a pretty place at the table, using your best things, for a meal. Go to a museum with beautiful art. Go sit in the lobby of a beautiful old hotel. Look at nature around you. Go out in the middle of the night and watch the stars. Walk in a pretty part of town. Fix your nails so they look pretty. Look at beautiful pictures in a book. Go to a ballet or other dance performance, or watch TV. Be mindful of each sight that passes in front of you, not lingering on any.
With Hearing:
Listen to beautiful or soothing music, or to invigorating and exciting music. Pay attention to sounds of nature (waves, birds, rainfall, leaves rustling). Sing to your favorite songs. Hum a soothing tune. Learn to play an instrument. Call a friend to hear a human voice. Be mindful of any sounds that come your way, letting them go in one ear and out the other
With Smell:
Use your favorite perfume or lotions, or try them on in the store; spray fragrance in the air; light a scented candle. Put lemon oil on your furniture. Put potpourri in a bowl in your room. Boil cinnamon; bake cookies, cake, or bread. Smell the roses. Walk in a wooded area and be aware of breathing in the fresh smells of nature.
With Taste:
Have a good meal; have a favorite soothing drink such as herbal tea or hot chocolate (no alcohol); treat yourself to a dessert. Put whipped cream on your coffee. Sample flavors in an ice cream store. Suck on a piece of peppermint candy. Chew your favorite gum. Get a little bit of a special food you don't usually spend the money on, such as fresh-squeezed orange juice. Really taste the food you eat; eat one thing mindfully,
With Touch:
Take a bubble bath; put clean sheets on the bed. Pet your dog or cat. Have a massage; soak your feet. Put creamy lotion on your whole body. Put a cold compress on your forehead. Sink into a really comfortable chair in your home, or find one in a luxurious hotel lobby. Put on a silky blouse, dress, or scar;. Try on fur-lined gloves or fur coats in a department store. Brush your hair for a long time. Hug someone. Experience whatever you are touching; notice touch that is soothing.
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IMPROVE THE MOMENT A way to remember these skills is the word IMPROVE With Imagery: Imagine very relaxing scenes. Imagine a secret room within yourself, seeing how it is decorated. Go into the room whenever you feel very threatened. Close the door on anything that can hurt you. Imagine everything going well. imagine coping well. Make up a fantasy world that is calming and beautiful and let your mind go with it. Imagine hurtful emotions draining you like water out of a pipe. With Meaning: Find or create some purpose, meaning, or value in the pain. Remember, listen to, or read about spiritual values. Focus on whatever positive aspects of a painful situation you can find. Repeat them over and over in your mind. Make lemonade out of lemons. With Prayer: Open your heart to supreme being, greater wisdom, God, your own wise mind.. Ask for strength to bear the pain in this moment. Turn things over to God or a higher being With Relaxation: Try muscle relaxing by tensing and relaxing each large muscle group, starting with your hands and arms, going to the top of your head, and then working down; listen to a relaxation tape; exercise hard; take a hot bath or sit in a hot tub; drink hot milk; massage your neck and scalp, your calves and feet. Get in a tub filled with very cold or hot water and stay in it until the water is tepid. Breathe deeply; half-smile; change facial expression. With One thing in the moment:
Focus your entire attention on just what you are doing right now. Keep yourself in the very moment you are in; put your mind in the present. Focus your entire attention on physical sensations that accompany non-mental tasks (e.g. walking, washing, doing dishes, cleaning, fixing). Be aware of how your body moves during each task. With a brief Vacation: Give yourself a brief vacation. Get in bed and pull the covers up over your head for 20 minutes. Rent a motel room at the beach or in the woods for a day or two; drop your towels on the floor after you use them. Ask your roommate to bring you coffee in bed or make you dinner (offer to reciprocate). Get a newspaper at the grocery store, get in bed with chocolates, and read it. Make yourself milk toast, bundle up in a chair, and eat it slowly. Take a blanket to the park and sit on it for a whole afternoon. Unplug your phone for a day, or let your answering machine screen your calls. Take a 1-hour breather from hard work that must be done. With Encouragement: Cheerlead yourself. Repeat over and over: "I can stand it," "It won't last forever," "I will make it out of this," "I'm doing the best I can do." Philippians 4:13
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