Distress Tolerance. STOP skills. Notes and thoughts etc ..... II, updated, remixed & remastered!
Updated: Sep 14, 2022
Distress Tolerance. STOP skills. Notes and thoughts etc revisited and revised.
When you feel that your emotions seem to be in control, stop!
Don’t move a muscle.
Just freeze especially those muscles around the mouth. Shut your mouth.
Freezing for a moment helps prevent you from doing what your emotions want you to do (which is to act without thinking). Stay in control. Remember, you are the boss of your emotions.
Name the emotion – put a label on it.
Take A Step Back
⬆️⬆️ Step back physically as well as metaphoricaly.
Step the fuck back.
When you are faced with a difficult situation, it may be hard to think about how to deal with it on the spot. Give yourself some time to calm down and think. Take a step back from the situation.
Get unstuck from what is going on. Take a deep breath and continue breathing deeply as long as you need and until you are in control.
Do not let your emotions control what you do. It is the rare incident, indeed, wherein we need to make a split-second decision about anything. Hence, it is okay to take our time to decide how to respond.
Observe what is happening around you and within you, who is involved, and what are other people doing or saying.
Listen to the Automatic Negative Thoughts (ANTs) that occur…remember those are based on an outdated Belief System that was programmed early on in life.
To make effective choices, it is important NOT to jump to conclusions.
Instead, gather the relevant facts so you can understand what is going on and what options are available.
Ask yourself, “What do I want from this situation?” or “What are my goals?” or “What choice might make this situation better or worse?” or “What act will allow for success?” Stay calm, stay in control, and when you have some information and how that may impact your goals, you will be better prepared to deal with the situation effectively. Remember your brain needs time to think all of this through.
This week's Monday sesh on STOP skills useful. Here's a few notes from the discussion.
S: The initial conversation about finding tools to utilize when in or entering a fraught situation that has or may trigger a dreaded borderline episode is familiar unwelcome territory.
Visual cues, signs and prompts. - I use these. I have signs and notes and reminders on my wall and in my mobile phone to remind me to practice my DBT skills and to remind me that I'm not a bad person.
Literal signs with stop written on it. - I'm going to create this after I've updated this blog entry. 🔴 To do !
Sign language prompts such as the time out gesture.
Frozen state of being. Completely stop. Just literally freeze in the moment. Freeze when provoked, stop, stay still, stay there, be still. Pick up any conversation or debate later or the next day when calm and level.
⬆ I'm getting good at this now. I wasn't. I was an awful human being. I would literally chase my ex around pursuing arguments and crazy shit in my head. I wish I had, had, someone to teach me and help me how to STOP 4, 5 years ago when I was properly getting very suicidaly ill. There was no help. And that's in large part why shes my ex. That still fucking needles me. Fuck you NHS.
The obvious but not so easy go to, very important skill, is to breath slowly, deeply, mindfully and correctly in meditation terms. It's a vital skill that has to be learned and practiced and it's not so easy to begin with. Once practiced a fair a bit, especially practiced when in a bad place, gets easier and becomes a key fixture in DBT coping skills. Practice.
The cold water and ice trick. Cold water and ice to the face and wrists helps shock you out of a meltdown moment on physical as well as mental level. The physical shock changes your physical chemistry and helps to apply the breaks pretty hard and therefore helps one to slow down, stop and think forward in an emergency. Have ice ready in freezer! This works. Cage the rage!
While on this subject, I need to jump in the sea more often and embrace the salt water and it's medicinal cold shock effect on the mind. Very good for depression. Body dismorphia prevents me from doing that somewhat but I must challenge that!
Imagery, mindful meditative go to imagery. This will need some practice and building on. But a go to imagery state of being, ready, available, is a good call.
I have this down to a degree but I really must practice more meditative imagery work. Just find the pause:
It's all about stopping in our tracks, freezing before boiling over and surfing the urge to kick off and letting the wave of rage ride and die out, without actually kicking off and making things even worse. In my case, hell, for me and for those around me.
Find the pause. All of the STOP tools above were discussed in a lot of detail and were very useful to cover and this case, being revisited, cover again. It all gives me a better in depth understanding of how to practice and implement these tools in my day to day coping practices and how to deal with with loved ones more effectively by asking them to get involved with my STOP skills practice and therefore helping everyone understand my need for such DBT technique practices and getting everyone close to me on the same song sheet, so to speak. These tools are much like tools one may use in autism care environments. I have employed these tools looking after "Boyce", a bloke i used to co key work. I have seen these tools work for him and I find it intriguing that I could help him slow down and pause effectively (some times) to find a better way of coping with his distress yet here I am, having to learn these skills that I was never taught in childhood. That's a strange paradox.
These techniques are all aimed at bringing the brain out of intense amygdala activity as quick as possible. The brain chemistry broken bits can be trained to repair itself through neuro plasticity. This is the crux of DBT. Repair the neuro pathways, repair the emotional broken bits. I am literal broken. Apparently my amygdala and hippocampus has had it though to a degree thanks to vast amounts of cortisol eating away at them and shrinking them. Cortisol is released in the brain as result of stress, trauma.
Feel a bit fucked over about that.
It's all about broken brain though. And training the brain to pause when stressed out is key to BPD recovery. Thoughts: Discussing and learning these tools and techniques and knowing how and why they work in emotionally demanding situations in us EUPD brain damaged bunch of loonies (and that's no joke) has been pivitol in my understanding of some of my own past and current disastrous, maladaptive, destructive, abusive, self sabotaging, hell inducing behaviours, and quite frankly the abusive wrongs I have inflicted on others, especially the German.
This fills me with shame, still to this day. But I have to move forward (NB: I am). I can't fix that one though. No closure there. I just have to be better for other people in my life now. That's how I make amends.
Of course though, all of those insane, fucking mad, hellish behaviours and feelings and all of the rest of it were in me completely out of control, with me 24/7, eating me up from inside out and it put me inside my own mental, emotional and spiritual prison, inside my mind, that was never ever my fault, not of my own creation.
Cunts did this to me. Cunts. Abusive cunts sentenced me to years inside that prison and, in the main part, created this beast inside. Having a greater understanding of the DBT coping tools and practices to challenge my horrid personality traits has really really shed light on why I was what I was like and how to try not be, at all costs, in the here and now. I now know also, that I, the good side of me, was desperately trying my absolute best not to be the horrible abusive shit bag I was and potentially can be.
The good me is bigger than the bad me!
I was asking for help to STOP and slow down before I even knew these skills existed, years ago, persistently, for fucking years! I got fobbed off with bollocks. I asked for things (techniques) to be put into place to help me escape my madness and not just for me but for others around me too. I felt so guilty all the time. But she became an enemy. She wouldn't or couldn't help me. Now I'm getting it. Now I'm seeing it from her side of the fence. In short, she was right to leave me. Just not how she did it. Lots of issues to work on there yet, still, but I will never get closure on that one so I have been finding my own closure and have been making progress with that.
Dead to me. Has to be that way. Fucking, dead. This lesson has tapped deep into "those" things. I'm learning. I digressed. I needed too.
T: So, yep, once we have the stopping bit down, the next phase needs to happen. Time and Space. I'll get more concise now!
With time and space we have the opportunity to:
Choose our next step in wise mind.
Step back in our minds, in our thoughts and feelings and detach, defuse. Step back!
Take back some energy and power. Pull back. Recover.
Take time to surf the urge. Let the wave die down and peter out before reacting. Don't be reactionary.
Observe the situation. Not everything needs to be resolved right away. Some things, some aspects can wait. Is it really urgent anyway? Step back. Take time.
Wait for a calm wise mind state of thinking and emotion before continuing with the subject. Get it all in perspective first. Wait. Then go ahead.
Remember, what is hysterical is historical. Hysterical behaviours are learned maladaptive ill behaviours. Challenge those hysterical behaviours by taking time instead of going bananas! 🍌.
Again, all of the above, as obvious as they seem to anyone who is well adjusted in life, has been really useful to have been discussed again, explained and put into DBT shape and perspective. I'll be practicing and building on these key skills.
After stepping back, it's time to observe, take note. Data collection time!
Notice what's going on around you. Observe. Really look and listen. Take note.
Check out your environment.
What's going on inside? Internal senses, emotions. Be mindful of how you feel. Accept it. Note the emotion.
What thought patterns do you recognize or spot going on in your mind? Note it.
Bring in the wise mind. Welcome it in. Tap into some calm wise mind head space.
Evaluate. Take note.
It's a good comparison to use the word ZEN. These practices are based in zen Buddhism and not in a cliche plastic hippy dippy way but in a very real spiritual sense. It's all about finding peace at the end of the day.
Stepping back and observing and evaluating is a Zen state of wisemind. This is not smug or special or spiritual elite or hippy dippy or any other labels some people might attach to Zen models of wisemind. It's just healthy. Wise. Logical. These are aspirations I hold dear to help me over how ever much time I have on this planet be happier and constructive. And Kinder. Goals. Life goals.
P: Proceed mindfully:
Move forward not backwards and not stuck. Proceed without causing damage to people or things. Take back control:
What do I want, need, desire, goals?
What might make this situation worse or better?
What are the available sensible options?
Have I surfed the urge entirely?
Do I need to pacify until a latter point before debating any points I feel need to be debated? Is it better to pacify to keep the peace even if temporary until the dust settles?
Sometimes it's better to go to bed angry, not broken. Stop. If only I had the help when I was begging for it. If only I had been mindful of this last point as well as all the rest of the points, way back when. If I had been, things would have been very different. I know now though. #humility #peace #quiet #placate #temporary #accept #mindful
HA! hee hee 😗
Helpful resources and exercises :
More at the end ⬇️⬇️
She knows! ⬇⬇
Distress Tolerance Skills
DBT emphasizes learning to bear pain skillfully because pain and distress are part of life and cannot be entirely avoided. Tolerance is necessary during any behavior change because impulsive behavior would interfere. Distress tolerance is the ability to perceive the environment as it is, without demanding that it be different.
pain + non-acceptance = suffering pain + acceptance = ordinary pain
Radical acceptance is the complete and total acceptance of reality. This means that you accept the reality in your mind, heart, and body. You stop fighting against the reality and accept it.
Things to Remember:
Radical means all the way – completely.
You let go of the bitterness.
Reality is as it is – rejecting it does not change it.
There are limitations about the future.
Everything has a cause.
Life is worth living – pain cannot be avoided.
Marsha Linehan had this to say (transcript):
Have you ever wondered why some people get destroyed by suffering, and other people, when they suffer, they don't get destroyed.
In fact, some people not only don't get destroyed by suffering, but they...they seem to become even stronger just by going through suffering. Have you ever thought about that? Well, I didn't think about for a long time because I was brought up believing that suffering is something everybody can go through. So I was just brought up thinking that. So I always thought it was true. That if you wanted to go through it, you could. Then when I started working with people who suffer a lot, both as a psychotherapist but also I've worked a lot with the poor and with the homeless, I started realizing, hey wait a minute, I'm not so sure this is true. Everybody doesn't go through suffering. Some people get destroyed by suffering. Despite their best efforts, some people simply get destroyed. So I started asking myself what was the difference. I mean, what was the difference between the person who gets destroyed and the person who doesn't. Why is it that when some people get knocked down, they keep going. They get knocked down, they get up, and they go again. Other people, they get knocked down and they just stay down; they never get up. So I thought to myself, well, I need to find the answer to this question. Mainly 'cause I work with a lot of people who suffer, and I work with a lot of people who seem to be getting destroyed by it. So I thought, well, if I can find the answer to that question, I could teach it and I could help the people that I work with. So I started to try to figure it out. So I thought a lot about it. I also did a lot of reading. I decided, alright, the thing to do is I'll try to read as much as I can about people who have lots of suffering in their lives, tragedies and traumas, and the people who somehow make it, and I'll try to figure out, what's the difference between the people who make it and people who don't make it. The purpose of this program is for me to teach you what I've learned. In all the readings that I've done, all the thinking that I've done, and all the people I've talked to. What we're going to focus on in this program is how to make it; how to keep yourself from being destroyed. Even how to grow or to build when a life that you're living feels like it's not worth living. We're going to talk about 3 sets of skills, or 3 sets of behaviours. Three things to practice. These seem to be what the people who grow all have in common. So, there's a lot of information that's going to be coming your way in this particular program. You may want to take some notes. Most people find that pretty useful. So if you want to take some notes, I recommend that you do. The thing to do right now is to get up and put this program on pause. Go get yourself some paper; get a pencil or a pen; come back; hit the start button; get yourself all comfy again and get ready to go. Now while you're doing all of that, I'm going to get myself all organized. I'm going to get all organized and be ready to teach the skills when you get back. One more thing. If you just so happen to have my skills training book, when you get up to go get paper, go get your skills training manual. If you don't have the manual but you've got the handouts, well go get your handouts. Bring them back. And when you come back and sit down, you're going to want to open your book up and you're going to find the following handouts. You're going to find "Basic Principles of Accepting Reality." And there are two pages. On the first page you're going to have Radical Acceptance, Turning the Mind. We're going to be going over those skills. And on the second page you're going to have Willingness and Willfulness. We're going to go over those too. And when you get back, I'll be back. I'll be ready so I hope you are. Let's go. There may be an infinite number of really painful things that can happen to you. But there are not an infinite number of responses you can make to pain. In fact, if you sit back and think about it, there are only four. There are only four things you can do when painful problems come into your life. What do you think they are? Think for a minute. A problem is in your life, pain, suffering, something you don't want in it. How can you respond? Well the first thing you could do is you could do is you could solve the problem. You can figure out a way to either end the painful event or you could figure out a way to leave the situation that's so painful. That's the first thing you could do. Solve the problem. What's the second thing you could do? You could try to change how you feel about the problem; to figure out a way to take a negative in your life and make it into a positive. Alright, so that's the second thing you could do. What's your other option? You could accept it. So that's the third thing you can do. You could just accept the problem. OK. That's not everything you could do. There is a fourth alternative. What do you think it is? You could stay miserable. That's the only other option you've got. So you've got to either solve it, change how you feel about it, accept it, or stay miserable. The skills I'm going to talking about, you could call them 'Reality Acceptance Skills'. And there are three: radical acceptance, turning the mind, and willingness. We're going start with the first one, radical acceptance.
Can you think of any really serious problems, really serious pain, serious traumas, things that make you really unhappy that you can't change? Maybe you've had a child who's died. People who have had a child who's died never get over it. Maybe you have a permanent disability. What are your options?
You can be miserable or you can accept the reality that you've got it. Maybe you've had a really painful childhood. You know, a lot of people have to live with that; you just have to live with the fact that those happy childhoods you see on TV aren't in your life and there's nothing you can do about it. Maybe you didn't get a job that you really wanted - there's nothing you can do about it. These are just not the kind of things you can start being happy about. So what are your options? You can either be miserable or you can figure out a way to accept the reality of your own life. So what's Radical Acceptance?
What do I mean by the word 'radical'? Radical means complete and total. It's when you accept something from the depths of your soul. When you accept it in your mind, in your heart, and even with your body. It's total and complete. When you've radically accepted something, you're not fighting it. It's when you stop fighting reality. That's what radical acceptance is. The problem is, telling you what it is and telling you how to do it are two different things. Radical acceptance can't really be completely explained. Why not? Because it's something that is interior - it's something that goes on inside yourself. But all of us have experienced radical acceptance so what I want you to do right now is to try to focus in on sometime in your life when you've actually accepted something, radically - completely and totally. So let's think about it. When might that be? Well, think back in your own life to either something you've lost, perhaps someone you've loved has died, or something that you really wanted that you didn't get - a job you really wanted and you didn't get it. Think about something you wanted that you either didn't get or something that you had that you've lost. Now, sit back, close your eyes and go back in time to right before you found out that you've lost what you had or right before you've found out that you weren't going to get what you wanted. Imagine that again. Kind of go back there. And then go through that period were you weren't accepting it, and then move to imagining when you did accept it. So kind of like, relive that. Most people can find some place in their life where that's happened to them and where they've accepted it, and that's what I mean by radical acceptance. I'm guessing some of you tried that exercise and you just couldn't think of any time when you've accepted something. So you couldn't imagine what it felt like cause you couldn't even remember a time when you have done it. Don't worry about it. Just try it another time - maybe after the program, today, tomorrow, or some other day. Just see if you can go back to a time when you've accepted. But for the moment, let me tell you what it might feel like. Often when you've accepted you have this sense of letting go of the struggle. It's just like you've been struggling and now you're not. Sometimes, if you have accepted, you just have this sense of being centered, like you feel centered inside yourself somehow. You may have a lot of sadness. Acceptance often goes with a lot of sadness actually, but even though you've got sadness, there's a feeling like a burden's lifted. Usually if you've accepted, you feel, well, ready to move on with your life. Sort of feel free, ready to move. So that's what it feels like.
Let's keep going. Pain is pain. Suffering, agony, are pain plus non-acceptance. So if you take pain, add non-acceptance you end up with suffering. Radical acceptance transforms suffering into ordinary pain.
There are three parts to radical acceptance. The first part is accepting that reality is what it is. The second part is accepting that the event or situation causing you pain has a cause. The third part is accepting life can be worth living even with painful events in it.
The above transcript is from a Marsha Linehan DBT session and is long, to long to copy and paste the transcript here and edit it etc. To much. So, follow the following link and check this amazing insightful session out. There are 7 parts all interconnected and all of it should be read to really understand how radical acceptance is not only a spiritual practice but also a science, all pertinent to the healing and recovery process from BPD through DBT.
Dr. Petruzzelli is pretty cool and I like her blogs and this is a good example pertaining to radical acceptance @
Have a butchers at her work and this article. She's real. Excerpt:
Shit happens in life.
Shit happens in work.
Shit happens in sport.
Shit happens in training.
Shit happens in racing.
Shit. Just. Happens.
⬆⬆ That's the opening paragraph. It gets better. A good read.
and here she has some awesome podcasts on DBT and such:
Radical Acceptance and Forks In The Road.
DBT Skill: Turning the Mind
Imagine you are at a fork in the road. To one side is a path of rejection and continued suffering. To the other side is acceptance. Here is where one must make a choice.
Acceptance of reality as it is requires an act of CHOICE. It is like coming to a fork in the road. You have to turn your mind toward the acceptance road and away from the 'rejecting reality' road.
You have to make an inner COMMITMENT to accept.
The COMMITMENT to accept does not itself equal acceptance. It just turns you toward the path.
You have to turn your mind and commit to acceptance OVER AND OVER AND OVER again.
Sometimes, you have to make the commitment many times in the space of a few minutes.
We naturally want to turn away from (avoid in my case) painful situations and turn back toward comfort. Avoiding pain is often an automatic reaction, like pulling your hand away from the hot stove. But psychological pain is not like physical pain. Accepting painful psychological realities requires mental effort and commitment.
Turning the mind is the decision to not give up and turn to comfort or give in and turn to denial. Turning the mind is the effort to deal with painful psychological realities without avoidance.
The remedy for suffering is commitment to acceptance again and again and again.
Life can be worth living, even when there is pain.
The remedy for suffering is commitment to acceptance again and again and again. Commitment implies a whole-hearted dedication to a purpose. Commitment binds you to a course of action.
An enormous amount of evidence indicates that the commitment to behave in a particular way or, more generally, commitment to a task, job, or relationship is strongly related to future performance.
Committed people finish the task, do the job, and stay in the relationship. People are more likely to do what they promise to do especially when the going gets tough.
This is my quest. A bit late in the game but better late than never.
I'm on it.