Distress Tolerance Handout 1C


Improve the Moment


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 out of 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 a supreme being, greater wisdom, God, your own wise mind. Ask for strength to bare 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 expressions.

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. Do awareness exercises.

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 schlocky magazine or 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:

Cheer lead 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,” “Let go and let God,” “Be still and know I am God”.

Thinking about Pros and Cons

Make a list of the pros and cons of tolerating the distress. Make another list of the pros and cons of not tolerating the distress – that is, of coping by hurting yourself, abusing alcohol or drugs, or doing something else impulsive.

Focus on long term goals, the light at the end of the tunnel. Remember times when pain has ended.

Think of the positive consequences of tolerating the distress. Imagine in your mind how good you will feel if you achieve your goals, if you don’t act impulsively.

Think of all of the negative consequences of not tolerating your current distress. Remember what has happened in the past when you have acted impulsively to escape the moment.

Distress Tolerance Handout 1B


Crisis Survival Strategies


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 (or online). Go to a ballet or other dance performance, or watch one on TV. Be mindful of each sight that passes in front of you, not lingering on any (driving).

With Hearing:

Listen to beautiful or soothing music, or to invigorating or 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 800 or other information numbers 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 mindfully breathe in the fresh smells of nature.

With Taste:

Have a good meal; have a favorite soothing drink such as herbal tea or hot chocolate or coffee (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 scarf. 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.

Distress Tolerance Handout 1A


Crisis Survival Strategies


“Wise mind ACCEPTS

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 sufferings…(this creates a sense of gratitude; reminds me that things can always be worse and that I am not the only only one in a distressful situation; this takes the power out of the situation)

With opposite Emotions:

Read emotional books or stories (Bible Study); 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 ten; count in another language; count colors in a painting or tree, windows, anything; work on puzzles; watch TV; read… (Mantra: I’m okay and I am where I am supposed to be right now.)

With Intense other Sensations:

Hold ice in hand; squeeze a rubber ball very hard; kneed silly puddy in hand; stand under a very hard and hot shower; listen to very loud music; sex; put rubber band on wrist, pull out, and let go…

Learning That Feelings Are Normal


Learning that feelings are normal.

Growing up in dysfunctional families, transcenders usually learn that feeling are not only, not okay, they have seen feelings acted-out in horrible, crazy, terrifying ways which usually brought more trauma and pain. They fear that they are going to act like their parents if they feel their feelings.

In therapy, a major learning is that all feelings are normal, okay and important. The awareness and acceptance of the feelings are the most important elements in healing, growing, and getting to know their authentic self. Feelings can be fused together, that is, the feeling of anger may also have fused with it, jealousy, hurt, etc. These feelings must be identified and a more appropriate way created to express them.

Here is an example:

Tiffany: “In my family, anger and happiness were the only feelings allowed. So, every heavy feeling fused with anger, and the lighter ones were happiness. I worked really hard at separating my fused feelings to figure out what I was really feeling. I loved learning about me and whatever fears I felt. I quickly worked through, because I knew my feelings were the ‘me’ I had been looking for so many years.

“I still remember learning for the first time about feelings, that feelings are not good or bad but just are part of being human. We don’t have to judge them, make them wrong or try to do away with them. We do have to accept feelings and learn about ourselves from them. I further learned that no one can be responsible for anyone else’s feelings but that we were totally responsible for our own.

“I faced many fears about accepting my feelings, especially the ones that surprised me: ‘What would my parents thing?’ ‘How would people respond to having real feelings and having opinions that come from those feelings?’ ‘Would I still be loved if I didn’t care about others’ feelings?’ and the questions run on. What the feelings taught me was to treat myself and to work with myself gently and lovingly. The abuse had already been done.”


  • Feelings need to be felt so they are not acted out and decisions are not based on them. They need to be felt appropriately and have absolute priority in therapy because they are the road map to healing. The therapist/other must make feelings the priority in therapy. This helps and enables them to accept themselves and everything that was and it.
  • For transcenders, it is vital to learn that feelings are normal and how to express them appropriately. This is sometimes difficult since they have seen these feelings acted-out in such dysfunctional ways, especially anger.
  • It’s important to help the transcender overcome the fear of feeling their feelings and learn how to express them appropriately.
  • Teach clients they can trust themselves with their feelings.
  • It takes diligent detective work by the therapist and transcender to begin to separate and identify fused feelings.

Training Webinar



This is a link to resistance depression training. If you or a loved one are suffering from depression even after being treated, learn more here. It’s free, it’s an hour long and the registration form is quick and easy. Sign up online. At the end of the registration save the free fact sheet and share the link with others. 
-Much love and support,


Distress Tolerance Skills


Pain and distress are part of life. They can not be entirely avoided of removed. The inability to accept this fact leads to increased pain and suffering. Distress Tolerance, over the short run, is part and parcel of any attempt to change oneself. Impulsive actions, otherwise, will interfere with efforts to establish desired change. Distress tolerance skills constitute a natural progression from Mindfulness skills. They have to do with:

  1. ) The ability to accept, in a non-evaluative and nonjudgmental way, both oneself and the current situation
  2. ) The ability to perceive one’s environment without putting demands on it to be different.
  3. ) To experience your current emotional state without attempting to change it.
  4. ) To observe your own thought and action patterns without attempting to stop and control them.

Do not confuse nonjudgmental as approval.

Acceptance of reality is not equivalent to approval of reality.


  1. ) To temporarily stop you from thinking about your pain
  2. )To give you time to find an appropriate coping response
  3. To help let go of the pain by helping you think of something else
  4. To buy you time so that your emotions can settle down before you take action to deal with a distressing situation.

Do not confuse distraction with avoidance.

Avoiding a situation means that you choose not to deal with it.

Distracting yourself from a distressful situation means that you choose to deal with it in the future when your emotions have settled down to a tolerable level.


Distress tolerance skills are concerned with tolerating and surviving crises and with accepting life as it is in the present moment. People struggling with overwhelming emotions often deal with their pain in very unhealthy, very unsuccessful ways because they don’t know what else to do. When a person is in emotional pain, it’s hard to be rational and to think of a good solution. Many of the coping strategies used by people with overwhelming emotions only serve to make their problems worse and lead to even deeper emotional pain because they offer temporary relief that will cause more suffering in the future.

Four sets of crisis survival strategies are taught:

  1. Ways to distract yourself from the situations that are causing you emotional pain.
  2. Self Soothing. Skills to bring you some amount of peace and relief from your pain so that you can figure out what you’re going to do next. They help you learn to treat yourself compassionately, lovingly, and kindly. Many people with overwhelming emotions have been abused or neglected as children. As a result, they were taught more about how to hurt than to help themselves.
  3. Improving the moment and thinking of pros and cons.
  4. Radical acceptance to increase your ability to tolerate distress by learning to look at your life in a new way, changing your attitude, and acknowledging your present situation without judging the events or criticizing yourself. It means, seeing the situation as it really is. It means you stop trying to change what’s happened by getting angry and blaming the situation. It means refocusing your attention on what you can do now. This allows you to think more clearly and figure out a better way to cope with your suffering. Choosing to accept reality as it is.

20 Stress Management Tips


1. UNDERSTANDING. Examine the cause of your anxiety and stress. Understanding is the first step. Know and accept your limits.

2. LET IT GO. Concentrate on the things you can change. Let go of the things that are beyond your control.

3. LET IT OUT. Communication is ventilation. Don’t put off discussing problems. A good cry is okay and healthy.

4. GET ORGANIZED. Focus on the most important tasks first, not just the easiest. List your goals. Follow through.

5. SEEK HELP. It’s okay to ask. Needing help is not a sign of weakness. Learn to delegate. (personal note: we ALL need help. It’s when we try to handle everything on our own that things fall apart)

6. PLAN YOUR TIME. Set realistic goals. Allow enough time to complete tasks. Learn to say no when your schedule is full. Take time for yourself.

7. EXAMINE EACH SITUATION. Don’t automatically slip into old responses that are not effective for you.

8. CHANGE NEGATIVE BEHAVIOR. Approach tasks in a positive manner. Target situations and people that support positive behavior patterns.

9. BE PATIENT. Take a deep breath instead of losing control. Learn and practice relaxation techniques.

10. HAVE FUN. Laughter is the best medicine. Take the time to find humor in stress situations.

11. GET REST. Replenish your energy. Change your environment. Vacations are important for both body and mind. Don’t wait until you are “burned out” before scheduling a break. (personal note: WAY easier said than done for me)

12. EXERCISE REGULARLY. Let out that built-up stress. Improve your overall health while building your self-esteem and stamina.

13. AVOID NON-PRESCRIBED DRUGS AND ALCOHOL. These substances will decrease your capability to handle stress. Seek professional help if you or a family member has a problem. (take prescribed medication as written, don’t abuse it just because you get refills and have access)

14. EATING HABITS. Eat regular well-balanced meals. Keep healthy snacks available for those busy times. Reduce the caffeine and fat in your diet.

15. QUIET TIME. Spend a few moments everyday to dream, relax and create a peaceful environment.

16. CHECK YOUR BODY LANGUAGE. (not one normally thought about but this does play a big roll in mood) Smile, smile, smile. Relax your shoulders and neck. Stand tall. Take a moment to stretch and reach.

17. COMPLIMENT YOURSELF. Recognize it when you handle a difficult situation. Accept praise from others.

18. TREAT YOURSELF. Monitor your schedule and budget. Spend some of your time, money and energy on yourself.

19. REMEMBER THAT WE ARE NOT PERFECT. Mistakes are part of growth. They happen to all of us. Forgive yourself for your imperfections.

20. STILL NEED HELP? For additional information, ask your physician or contact Foundation’s Health Education Department at (916) 631-5249.