Distress Tolerance Handout 1C

Standard

Improve the Moment

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 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.

Coping with Anger

Standard

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.

 

 

 

Grounding: A Coping Skill for Clients (people) With Emotional Pain

Standard

I received a handout titled Grounding: A Coping Skill for Clients With Emotional Pain in one of my classes. Instead of summarizing the worksheet I will transfer the worksheet onto this blog by hand. I think these skills are extremely helpful and I do some of them myself and they work wonderfully. I hope you can try some out too!

“Three major ways of grounding will be described-mental, physical, and soothing. “Mental” means focusing your mind; “Physical” means focusing on your senses (e.g., touch, hearing); and “soothing” means talking to yourself in a very kind way. You may find that one type works better for you, or all types may be helpful. Note that grounding is different from relaxation training or meditation. In grounding, it is essential to keep your eyes open the entire time and to keep talking out loud. These strategies keep you focused on the outside world.

Mental Grounding

  • Describe your environment in detail using all your senses. For example, “The walls are white, there are five pink chairs, there is a wooden bookshelf against the wall…” Describe objects, sounds, textures, colors, smells, shapes, numbers, and temperature. You can do this anywhere. For example, on the subways: “I’m on the subway. I’ll see the river soon. Those are windows. This is the bench. The metal bar is silver. The subway map has four colors…”
  • Play a “categories” game with yourself. Try to name “types of dogs,” “Jazz musicians,” “States that begin with “A”,” “cars,” “TV shows,” “writers,” “sports,” “songs,” or “cities.”
  • Do an age progression. If you have regressed (mentally) to a younger age (e.g, 8 years old), you can slowly work your way back up (e.g, “I’m now 9” “I’m now 10,” “I’m now 11″…) until you are back to your current age.
  • Describe an everyday activity in great detail. For example, describe a meal that you cook (e.g., “First I peel the potatoes and cut them into quarters, then I boil the water; I make an herb marinade of oregano, basil, garlic, and olive oil…”).
  • Imagine. Use an image: Glide along on skates away from your pain; change the TV channel to get a better show; think of a wall as a buffer between you and your pain.
  • Say a safety statement. “My name is ____; I am safe right now. I am in the present, not the past. I am located in _____; the date is _____.”
  • Read something saying each word to yourself. Or read each letter backwards so that you focus on the letters and not on the meaning of the words.
  • Use humor. Think of something funny to jolt yourself out of your mood.
  • Count to 10 or say the alphabet, very s..l..o..w..l..y.

Physical Grounding

  • Run cool or warm water over your hands.
  • Grab onto your chair as hard as your can.
  • Touch various objects around you: a pen, keys, your clothing, the table, the walls. Notice textures, colors, materials, weight, temperature. Compare objects you touch: Is one colder? Lighter?
  • Dig your heels into the floor-literally “grounding” them. Notice the tension centered in your heels as you do this. Remind yourself that you are connected to the ground.
  • Carry a grounding object in your pocket-a small object ( a small rock, clay or silly puddy, ring, piece of cloth or yarn, a stress ball) that you can touch whenever you feel triggered (anxious, panicky, etc.)
  • Jump up and down in a gentle way. Only coming off the ground a couple inches.
  • Use all five senses. For example: notice five things around you that are a certain color, notice four things you can physically touch, notice three things that you hear, notice two things that you can feel, notice one thing that you can smell. They don’t have to go in this order; you can mix them up.
  • Notice your body: The weight of your body in the chair; wiggling your toes in your socks; the feel of your back against the chair. You are connected to the world.
  • Stretch. Extend your fingers, arms, or legs as far as you can; roll your head around.
  • Clench and release your fists.
  • Walk slowly, noticing each footstep, saying “left” and then “right,” whit each step.
  • Eat something, describing the flavors in detail to yourself.
  • Focus on your breathing noticing each inhale and exhale. Repeat a pleasant word to yourself on each inhale (e.g., a favorite color or a soothing word such as “safe” or “easy”).

Soothing Grounding

  • Say kind statements as, as if you were talking to a small child. For example, “You are a good person going through a hard time. You’ll get through this.”
  • Think of favorites. Think of your favorite color, animal, season, food, time of day, or TV show.
  • Picture people you care about (e.g., your children), and look to photographs of them.
  • Remember the words to an inspiring song, quotation, or poem that makes you feel better, such as the Serenity Prayer.
  • Remember a safe place. Describe a place that you find very soothing (perhaps the beach or mountains, or a favorite room); focus on everything about that place-the sounds, colors, shapes, objects, and textures.
  • Say a coping statement. “I can handle this.” “This feeling will pass.”
  • Plan out a treat for yourself, such as a piece of candy, a nice dinner, or a warm bath.
  • Think of things you are looking forward to in the next week, perhaps time with a friend, going to a movie, or going on a hike.
  • Create a cassette tape of a grounding message that you can play when needed; consider asking your therapist or someone close to you to record it if you want to hear someone else’s voice.
  • Think about why grounding works. Why might it be that by focusing on the external world, you become more aware of an inner peacefulness? Notice the methods that work for you-why might those be more powerful for you than other methods?
  • Don’t give up.

Try to just pick 1 or 2 things from each category of grounding and see how they work for you. You could always refer pack to this post to try new ones. I have about 11 techniques that work for me; every one will use different techniques for different reasons.

Love,

Shadow.

God, grant me the Serenity to accept the things I can not change, the courage to change the things I can, and the wisdom to know the difference. Amen.

Image