Distress Tolerance Skills

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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.

GOALS

  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.

SKILLS

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

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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.

Good Wishes

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I just want to take the time and thank the people that follow and support this blog. I sincerely hope the entries help you.

I finally have internet again so now I will be able to post a lot more information. If you need information about something specific regarding mental health and addiction please let me know 🙂

Love you guys!
Shadow

Identify and Label Cognitive Distortions

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The following is out of a CBT (cognitive behavioral therapy) workbook.

Learning about your pattern of thinking can help you catch, modify, or change any distortions or negative thinking errors. Since our thoughts have a strong impact on our feelings and behaviors, there are positive benefits to correcting distorted thinking habits. Listed below are some common cognitive distortions. After reading each description, review your own thinking habits and then answer a simple yes or no if you have ever noticed yourself using the cognitive distortion. Remember, it’s not about good or bad or right or wrong it’s about becoming more mindful of your thinking patterns.

Cognitive Distortion:

Filtering: focusing only on the negative.

Polarized thinking; all or nothing thinking.

Overgeneralization: One negative event means everything is negative.

Mind-reading: Thinking others are thinking negative things about you.

Catastrophizing: Expecting disaster.

Magnifying: Magnifying the size of your problem.

Should statements: Feeling like you should or must do or not do something.

Blaming: Attributing blame to yourself.

Emotional reasoning: Feeling that something is true, therefore it must be true.

Personalization: Seeing yourself as the cause of a negative event.

Fortune telling: Making negative predictions.

Disqualifying the positive: Positive experiences are minimized.

Labeling: Putting negative labels on self or others.

 

From The Feeling Good Handbook by Dr. David Burns

Why boundaries?

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“If we don’t know what we feel, we can’t know who we are. If we don’t know who we are, we cannot tell someone else who we are. We will be false selves.”

Most of our problems in life have to do with relationships, and the source of these problems in relationships are most likely tied to boundary issues. We will continue to have problems in relationships if we do not establish healthy boundaries for ourselves. Learning about boundaries and learning how to practice healthy boundaries takes time. We will always have to pay attention to them in order to maintain them; otherwise, we may revert back into old boundary habits. They are not established automatically.

Boundaries tell us what is our business and what is not our business. It is our business what we think of ourselves and what we think of other people, but it is none of our business what others think of us (unless we have violated their boundaries and owe them amends). Many of us allow our lives to be manipulated by the fear of what others think of us.

This fear of what others think of us is an indication that we have created false selves. These false selves are the people we were led to believe others would accept and nurture. If anyone appears not to like us or accept us, we we feel threatened because we fear rejection. We fear rejection because we’ve been rejected. We were rejected and our feelings were shamed during our development years. We were shaped by those no-talk rules in our non-nurturing, dysfunctional family: “It’s not OK to say that.” Dad’s drunk and the child says, “Dad’s drunk!” “No, Dad’s not drunk, Dad’s sick.” “Well, he fell down and passed out on the bathroom floor!” “He likes to take a nap about this time of the evening, and that’s just the way it is. He’s not drunk and your father’s not an alcoholic.”

In other words, we didn’t see what we saw, we didn’t hear what we heard, and what we thought was going on, was not what was going on. Those are crazy-making messages for a child and contribute to the creation of a false self.

The child says, “I’m tired of Dad not being here because he works all the time. It makes me angry.” “Shame on your for feeling that.” “Well, OK, Mom, what feeling would you like me to have?” “You should feel grateful.” “Oh, OK, I’ll be grateful that Dad’s never here because he works all the time and drinks the rest of the time.”

The child is made to believe that Dad is working so much and working so hard because of the family’s needs-that’s what makes him drink too much. “OK, now I’m supposed to feel grateful that he works, and guilty because it makes him drink, and ashamed because I feel angry, and rejected because what I think is going on is not what’s really going on.”

The little four or five-year-old is learning how to create a false self. When he’s grown, his feel hit the floor every morning and it’s “HEYYYYY, Mister False Self is here. How are you?” “Just fine, no problems at all.” “How ’bout some feelings?” “No, thank you. All that stuff is too confusing for me.”

We become who we think we are supposed to be and shame the person we really are. We live out our lives from behind those masks. Then, we go find another false self to have a relationship with. We are incapable of having an intimate relationship with another person who is real. We are threatened by the prospects of intimacy. Our relationship is like two pieces of a puzzle. We find a perfect fit and it feels close because we fit so well. We’re in LOVE. But there is no real intimacy. We’re really “in sick” or “in heat.” Together we seem to make one whole unit. But two half-people won’t make a full person. After a while the heat dies down between these two false selves, and she turns to him and says, “Well how do you feel?” And he says, “Well, I think…” “No, I didn’t ask what you thought, I asked how you felt.” “It doesn’t matter how I feel.” Well, I don’t think you love me.” “Of course I love you, I’m here, aren’t I? I haven’t left yet, have I?” Eventually this couple may end up in counseling on their way to the divorce court. The counselor may ask, “Tell me about yourself, Mr. Jones. Who are you?” “I work down at the mill over there, and I build these little widgets, and that’s what I’ve done for the last twenty years, and I’ll be retiring next year, and that’s what I do.” “No, no, Mr Jones. I asked who you are. You told me what you do.“”What do you mean, ‘who am I?'” “What do you like?” “What’s to like? You work, you pay bills, you sleep, you eat, you go back to work again.” “What do you do for fun?” “I’m fifty five years old. Fun is for kids. We don’t do fun.” “What was the last thing you and your wife did for fun?” “It was probably the year before we got married when we went to…”

Neither one of them can tell what they feel, think, want, or who they are. Their identities have been defined by this enmeshed, sick relationship they’ve been in for twenty years. All he knows is that he is sick and tired of her trying to fix him since the day they got married.

“I thought I was gonna, you know, get married and have a wife, and she’d have a husband. I didn’t know I was gonna be a project. And I can’t seem to get it right now matter what, so I don’t even try anymore.”

The more he retreats, the more frustrated she gets and that harder she tried to bring them closer by trying to be who and what he wants. Eventually, she gets so frustrated that she gives up and retreats also. Sometimes she’ll retreat to an affair, but eventually to a place of indifference toward him in order to avoid the pain associated with the relationship.

These situations involve boundaries. If we don’t know what we feel, we can’t know who we are. If we don’t know who we are, we cannot tell someone else who we are. We will be false selves.

Here, then, are some of the reasons we need healthy boundaries.

Healthy boundaries define who we are.

Healthy boundaries can help us to know who we are. They can help us to have a better sense of our separateness from others: where we end and others begin. Knowing who we are helps us to maintain a sense of reality. We will know who we are and are not, what we believe and don’t believe, what we think, feel, like and want.

Linda came in for counseling one day exasperated over her new-found revelation, “I just realized that I don’t know what I like to eat. I have been buying food and cooking all of these years out of habit, and I’ve suddenly realized I don’t even like the things I’ve been cooking and eating. I buy things in large volume just to save money, and I eat things I don’t like, thinking it is the frugal thing to do. I know I don’t like what Ive been eating, but I don’t know what I do like.”

Knowing who we are, what we believe, what we think, feel, like, and want means that people can no longer walk in and out of our lives at will-using and abusing us.

Complete the sentences below describing, as much as you can, some of the most basic things you know about yourself-thoughts, beliefs, opinions, likes, dislikes, wants, etc. Add to this list as you think of things in the future. Make up your own sentences.

I am a…(in relationship to others; for example, mother, father, brother, sister, etc.)

I am a…(things you do; for example, coach, painter, photographer, hunter, swimmer, teacher, student, writer, dreamer, etc.)

I am…(attributes and faults; for example, kind, helpful, selfish, stingy, pretty, ugly, stubborn, a push-over, etc.)

My best friend is…

The things I like are…

My favorite food is…

My favorite restaurant is…

My favorite color is…

My favorite clothes are…

My favorite TV choices are…

The things (or people) I hate are…

I believe God…

Healthy boundaries define who we are in relationship to others.

Healthy boundaries are intended to help us have good relationships. Some relationships are of our choosing and some are not. Often times we are stuck with relationships that are not of our choosing whether we like it or not. Some teenagers feel like they are stuck with their parents. You may be stuck with people you don’t like on the job, in the neighborhood, or in your religious group. Boundaries that define who we are help us to maintain our sanity in these unpleasant relationships. They help us to know what the extents and limits are with those with whom we are connected-how to let in what is good and keep out what is bad.

Coping with Anger

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Anger problems are common among people with dual disorders. Much friction can be caused in a relationship if you ignore your anger or act on it in ways that hurt others physically or emotionally. Anger problems can interfere with recovery if you don’t cope with these feelings in positive ways.

Anger can also empower you if dealt with in a positive way. It can motivate you to set or reach goals or work hard to accomplish things in your life.

It is not your feelings of anger that causes problems but how you think about and express it that determines how anger affects your life. Some people try to ignore their anger and let it build up. They stew on the inside and become upset or depressed. They express anger indirectly by dragging their feet, forgetting important dates of people they feel anger toward, criticizing others behind their backs, or avoiding people they are mad at.

Other people let their anger out much too quickly and impulsively. They lash out at others and yell, cuss, scream, or act in other hostile ways. Some become violent, get into fights, or destroy objects or property. Violence is a significant problem for people with a substance abuse or psychiatric disorder.

The questions that follow will help assess your anger and how you express it.

  1. On a scale of 1 to 10, how much of a problem is your anger or how you cope with it or express it. 1-Somewhat of a problem  3-Moderate Problem  5-Serious Problem  7-Very serious  10-severe/life threatening.
  2. My anger usually shows in the following ways (i.e., I get sad, frustrated, pace, and feel nervous, etc.),
  3. I usually deal with anger by (i.e., holding it inside, letting it out immediately, talking it out, lashing out at others, fighting, etc.).
  4. I learned the following from my parents about anger or how to express it:
  5. My anger affects my physical or mental health in the following ways:
  6. My anger affects my relationships in the following ways:
  7. My anger affects my use of alcohol or other drugs by:
  8. I am still very angry at the following people:
  9. I can use my anger in a positive way by:

Setting a Goal

My goal in relation to how I cope with my anger is:

Steps I will take to reach this goal are:

Potential benefits of reaching my goal are:

Strategies for Managing Your Anger

  •  Recognize your angry feelings.

Pay attention to body cues, thoughts, and behaviors that tell you that you are angry. Use your anger cues to admit you are angry. Don’t deny, hide, minimize, or ignore your anger.

  • Figure out why you are angry.

When you feel angry figure out where it is coming from. Does it relate to something another person did or said to you? Does it relate to an event, experience, or situation? Or, is your anger caused by the way you think about things?

  • Decide if you really should feel angry.

Are you an angry person who seems to get mad too often or for no good reason? When angry, ask yourself if the facts of the situation warrant an angry reaction on your part. Or, ask yourself if your anger is the result of a character defect (i.e., you get mad frequently for little things).

  • Identify the effects of your anger and your methods of coping with anger.

How does your anger and your methods of coping with it affect your physical, mental, or spiritual health? How are your relationships with family members, friends, or others affected?

  • Use different strategies to deal with anger

These include cognitive (your beliefs about anger and the internal messages you give yourself), behavioral (how you act), and verbal (what you say to other people) strategies. Having a variety of strategies puts you in a good position to cope with anger in a wide range of situations.

  • Cognitive strategies for anger management include:
  • Evaluating your beliefs about anger and changing those beliefs that cause you problems. For example, if you believe you should “let it out” every time you get angry, you may find this isn’t always the best policy and that this belief should be modified. Or, if you believe you should never get mad, you might have to change this belief and give yourself permission to feel anger.
  • Catching yourself when you are angry and changing your angry thoughts.
  • Determining if your anger is really justified given the situation. This requires not jumping to conclusions and getting all of the facts of the situation first.
  • Using positive self-talk or slogans (for example, “this too shall pass,” “keep your cool and stay in control,” etc.)
  • Using fantasy. Imagine yourself coping in a positive way.
  • Evaluating the risks and benefits of expressing your anger or holding it inside.
  • Reminding yourself of negative effects of ignoring anger and holding it inside.
  • Reminding yourself of negative effects of expressing anger toward others in hurtful ways.
  • Identifying the benefits of handling anger in a positive way.
  • Taking a few minutes at the end of the day to see if you are harboring any anger from the events of the day.
  • Verbal strategies for anger include:
  • Sharing your feelings with whom you are angry.
  • Discussing the situation or problem that contributed to your anger directly with whom you are angry.
  • Sharing your angry feeling with a friend, family member, therapist, AA, NA, or CA sponsor. Many find it helpful to discuss anger at support group meetings.
  • Discussing the situation or problem that contributed to your anger with a neutral person to get their opinion on the situation.
  • Apologizing or making amends to others who were hurt as a result of how you expressed your anger.
  • Behavior strategies for anger management include:
  • Directing angry energy toward physical activity such as walking, exercising, or sports.
  • Directing feelings of anger toward some type of work.
  • Expressing your anger with creative media such as painting, drawing, and other forms of arts and crafts.
  • Writing about your feelings in a journal or anger log.