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.

Creating Meaning: Trauma and Substance Abuse



This lecture is a list of meanings that are typical of people with trauma and substance abuse. The structure of this lecture will be as follows: I will give Meanings That Harm with their definitions and examples, as well as Meanings That Heal to counteract the Meanings that Harm. While reading through these, maybe try to get in touch with yourself and listen to what hits home for you-what hurts for you- and then look at the suggestion to heal. There may be some peace here for you. There is for me.

Deprivation Reasoning: Definition: Because you have suffered a lot, you need substances (or other self-destructive behavior). Examples: “I’ve had a hard time, so I’m entitled to get high.” “If you went through what I did, you’d hurt yourself too.” Meanings that Heal: Live Well. A happy, functional life will make up for your suffering far more than will hurting yourself. Focus on positive steps to make your life better.

I’m Crazy: Definition: You believe that you shouldn’t feel the way you do. Examples: “I must be crazy to feel this upset.” “I shouldn’t be having this craving.” Meanings that Heal: Honor your feelings. You are not crazy.Your feelings make sense in light of what you have been through. You can get over them by talking about them and learning to cope with them.

Time Warp: Your sense of time is distorted; you believe that a negative feeling will go on forever. Example: “This craving won’t stop.” “If I were to cry, I would never stop.” Meanings that heal: Observe Real Time. Take a clock and time how long it really lasts. Negative feeling will usually subside after a while; often they will go away sooner if you distract with activities. (Don’t ruminate!)

Beating Yourself Up: Definition: In your mind, you yell at yourself and put yourself down. Examples: “I’m a bad person.” “My family was right; I’m worthless.” Meanings that Heal: Love-Not Hate-Creates Change. Beating yourself up may echo what people in the past have said to you. But yelling at yourself does not change your behavior; in face, it makes you less likely to change. Care and understanding promote real change.

The Past Is The Present: Definition: Because you were a victim in the past, you are a victim in the present. Examples: “I can’t trust anyone.” “I’m trapped.” Meanings that heal: Notice Your Power. Stay in the present: “I am an adult (not a child); I have choices (I am not trapped); I am getting help (I am not alone).”

The Escape: Definition: An escape is necessary (e.g, food, substances, gambling) because feelings are just too painful. Examples: “I’m upset; I have to binge on food.” “I can’t stand cravings: I have to smoke a joint.” Meanings that Heal: Keep Growing. Emotional growth and learning are the only real escape from pain. You can learn to tolerate feelings and solve problems.

The Good Old Days: Definition: You remember the wonderful highs from something (a drug, an abusive relationship), but ignore the tragedy of it. Examples: “Cocaine made me feel happy.” “I still love my partner, even though he abused me”. Meanings that Heal: See Both Sides. The drug may have felt good but the cost was losing your job; the relationship may have had some positives, but it had some serious negatives too.

Feelings Are Reality: Definition: Because something feels true, you believe it must be a fact. Examples: “I feel like I’ll never recover, so I might as well drink” “I feel depressed, so I might as well kill myself.” Meanings that Heal: Listen To What You Know. Use your mind rather than your feelings as a guide. What do you know to be the best for you? Feelings are valid, but they are not reality.

Ignore Cues: Definition: If you don’t notice a problem, it will go away. Examples: “If I ignore this toothache it will go away.” “I don’t have a problem with substances.” Meanings that Heal: Attend to You Needs. Listen to what you’re hearing; notice what your seeing; believe your gut feeling.

Dangerous Permission: Definition: You give yourself permission for self-destructive behavior. Examples: “Just one won’t hurt” “I’ll buy a bottle of wine for the recipe I want to try.” Meanings that Heal: Seek Safety. Acknowledge your urges and feelings, and then find a safe way to cope with them.

The Squeaky Wheel Gets The Grease: Definition: If you get better you will not get as much attention from people. Examples: “If I do well, my Therapist will focus on sicker patients.” “No one will listen to me unless I am in distress.” Meanings that Heal: Get Attention From Success. People love to pay attention to success. If you don’t believe this, try doing better and notice how people respond to you.

Mind Reading: Definition: You believe you can tell what other people are thinking without having to ask. Examples: “I know he didn’t say hello because he hates me.” “My sponsor would feel burdened if I called her late at night.” Meanings that Heal: Check It Out. Ask the person! You may be amazed by what you find out.

It’s All My Fault: Definition: Everything that goes wrong is due to you. Examples: “The trauma was my fault.” “If I have a disagreement with someone, it means I’m doing something wrong.” Meanings that Heal: Give Yourself a Break. You do not have to carry the world on your shoulders. When you have conflicts with others, try taking a 50-50 approach (50% is their responsibility, 50% is yours).

If This…Then That: Definition: You put off something important while waiting for something else. Examples: “If I get a job, then I’ll stop smoking pot.” “If I lose weight, then I’ll go to AA.” Meanings that Heal: Stay in the Present. Whatever you need to do, start now. Every step forward counts. Putting off an important goal will not help.

Actions Speak Louder Than Words: Definition: You show your distress by actions; otherwise, people won’t see your pain. Examples: “The scratches on my own will show what I feel” “I’d like my partner to find my body after I’ve killed myself.” Meanings that Heal: Break through the Silence. Put feelings into words. Language is the most powerful way for people to know you.

I Am My Trauma: Definition: Your trauma is your identity; it is more important than anything else about you. Examples: “My life is pain.” “I am what I have suffered.” Meanings that Heal: Create a Broad Identity. You are more than what you have suffered. Think of your different roles in life, your varied interests, your goals and hopes.

The Uniqueness Fallacy: Definition: You alone have a particular problem; no one else could possibly understand. Examples: “Unless you’ve lived through what I have, you can’t help me.” “Why bother talking? No one will get it.” Meanings that Heal: Reach Out. Give people a chance to help you. Find a safe person to talk to (therapist, AA sponsor) and try opening up.

No Future: Definition: The future is bleak; there is no hope. Examples: “My life is wasted already.” “I might as well give up.” Meanings that Heal: You Have Choices. No matter what has happened so far, you control the present and future. Notice your choices and choose wisely.

Life-or-Death Thinking: Definition: Things take on life-or-death meaning in your mind. Examples: “I’ll never get over the fact that she (or he) left me.” “I’ll die if I don’t get that job.” Meanings that Heal: Keep Perspective. That is the worst that can happen? If you suffer a loss, you can learn to mourn and move on. The possibilities in life are endless.

Confusing Needs And Wants: Definition: You want something very badly, so that means you have to have it. Examples: “I need to relax with heroin.” “I need to find a romantic partner.” Meanings that Heal: Recovery is the Need. You may want many things, but needs are few. You may want heroin, but you don’t need heroin. Needs are essentials: food, shelter, clothes- and your recovery!

Short-Term Thinking:  You focus only on your feelings today rather than tomorrow. Examples: “I’m more sociable when I drink.” “I’m buying that new outfit even if i can’t afford it.” Meanings that Heal: Think of the Consequences. Imagine how good you’ll feel about yourself tomorrow if you do what you know is right. Imagine how low you’ll feel if you give in to the moment.

Shoulds: Definition: You have rules about how the world should work. If the rules are violated, you feel angry. Examples: “My friend should invite me over.” “I should not have to deal with PTSD.” Meanings that Heal: Soften Your Language. Try to ease the tension (e.g., “I want my friend to invite me over.”). You may still want what you want, but you may feel more tolerant.

Instant Satisfaction: Definition: You seek immediate satisfaction. Life should be easy. Examples: “I need it now.” “I should always feel good.” Meanings that Heal: Work Hard. The most enduring satisfactions come from working hard and having patience: at your job, at relationships, at recovery.

Focusing on the Negative: Definition: You notice the negatives in a situation and ignore the positives. Examples: “That person is a total jerk.” “I can’t do anything right.” Meanings that Heal: Notice the Good. What went right? What is good about you? What was a positive aspect of the situation?

All-or-None Thinking: Definition: Things are either all good or all bad. There is no middle ground. Examples: “Life is only misery.” “I have no power.” Meanings that Heal: Seek a Balanced View. Life is more complex and interesting than “all or none.” Look at things with a balanced view; find the middle ground. Look at what went well, what went badly, and what was neutral.

Source: Lisa M. Najavits





Healthy VS Unhealthy Feelings



Thoughts and attitudes have an impact on the way you feel. Your emotions result more from the way you view things than from what happens to you. That simple idea can help you change the way you think and feel. In today’s lecture, you’ll learn more about the nuts and bolts of doing this.

However, before we go too far with this, we need to back track just a bit. When should we change our negative feelings? Are all negative feelings bad? Are some negative feelings normal and healthy? Should we try to be happy all the time?

I believe that some negative feelings are healthy and some negative feelings are unhealthy. For every negative emotion, there’s a healthy and an unhealthy version. Healthy sadness is not the same as clinical depression. Healthy fear is not the same as neurotic guilt. Healthy, constructive anger is not the same as unhealthy, destructive anger. And so fourth.

For example, if a loved one dies, it’s healthy to grieve and to share your feelings with friends and family members. Your sadness in the expression of the love that you felt for that person, and the feelings of loss will naturally disappear after a period of time. Clinical depression is very different.

What are some of the differences between healthy sadness and depression? I have listed them below. Think about this question a little bit before you look. What’s your perception?

(Note: The paperwork that i received in class came with a table to obviously separate the comparing example. So, I had to tweak the format a little bit. The first sentence in each example is the healthy version of the emotion being discussed. The second sentence is the unhealthy version of the emotion being discussed.)

Characteristics of Healthy Sadness VS Characteristics of Depression

  1. You are sad but don’t feel a loss of self-esteem. VS You feel a loss of self-esteem
  2. Your negative feelings are an appropriate reaction to an upsetting event VS Your negative feelings are far out of proportion to the event that triggered your bad mood.
  3. Your feelings go away after a period of time. VS Your feelings may go on and on endlessly.
  4. Although you feel sad, you do not feel discouraged about the future. VS You feel demoralized and convinced that things will never get better.
  5. You continue to be productively involved with life. VS You give up on life and lose interest in your friends and career.
  6. Your negative thoughts are realistic. VS Your negative thoughts are exaggerated and distorted, even though they seem valid.

What are some of the characteristics of healthy, constructive anger? How does it differ from destructive, unhealthy anger? I have listed characteristics of both below. Again, think about the differences before you look. What’s your perception?

Characteristics of Healthy, Constructive Anger VS Characteristics of Unhealthy, Destructive Anger

  1. You express your feelings in a tactful way VS you deny your feelings and pout (passive aggressive) or lash out and attack the other person (active aggression).
  2. You try to see the world through the other person’s eyes, even if you disagree. VS You argue defensively and insist there’s no validity in what the other person is saying.
  3. You convey a spirit of respect for the other person, even though you may feel quite angry with him or her. VS You believe the other person is despicable and deserving of punishment. You appear condescending or disrespectful.
  4. You do something productive and try to solve the problem. VS You give up and see yourself as a helpless victim.
  5. You try to learn from the situation so you will be wiser in the future. VS You don’t learn anything new. You feel that your view of the situation is absolutely valid.
  6. You eventually let go of the anger and feel happy again. VS Your anger becomes addictive. You won’t let go of it.
  7. You examine your own behavior to see how you may have contributed to the problem. VS You blame the other person and see yourself as an innocent victim.
  8. You believe that you and the other person both have valid ideas and feelings that deserve to be understood. VS You insist that you are entirely right and the other person is entirely wrong. You feel convinced that truth and justice are on your side.
  9. Your commitment to the other person increases. Your goal is to feel closer to him or her. VS You avoid or reject the other person. You write him or her off.
  10. You look for a solution where you can both win and nobody has to lose. VS You feel like you’re in a battle or a competition. If one person wins, you feel that the other person will be a loser.

We all have circumstances where we react in the wrong way when we are angry. No one is perfect. However, it is always a good idea to be open minded and willing to improve the way we handle situations to decrease our anger and to increase the quality of the relationships we have with others.

It is common for some people to be sad in a healthy way. However, the population of people with depression is extremely high. If we can pin point the unhealthy feeling we have, we then have a great chance to get some help and to change the way we feel. The feelings of depression are awful and they are very hard to live with.

Remember this: No one deserves to or has to live miserably. We have the power to change the way we think and feel if we want that bad enough and are open to suggestions. It is essential to always remain teachable. It is impossible to be happy all the time. But there is a remarkable strength in knowing how to identify our feelings and being able to go through them and deal with them so we can come out on the other side.