The Dialectical Behavior Therapy Skills Workbook, 1st Edition

Chapter 1

Basic Distress Tolerance Skills Distress Tolerance Skills: What Are They?

At some point in our lives, we all have to cope with distress and pain. Either it can be physical, like a bee sting or a broken arm, or it can be emotional, like sadness or anger. In both cases, the pain is often unavoidable and unpredictable. You can’t always anticipate when the bee will sting you or when something will make you sad. Often, the best you can do is to use the coping skills that you have and hope that they work.

But for some people, emotional and physical pain feels more intense and occurs more frequently than it does for other people. Their distress comes on more quickly and feels like an overwhelming tidal wave. Often, these situations feel like they’ll never end, and the people experiencing them don’t know how to cope with the severity of their pain. For the purposes of this book, we’ll call this problem overwhelming emotions. (But remember, emotional and physical pain often occur together.)

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. This is understandable. When a person is in emotional pain, it’s hard to be rational and to think of a good solution. Nevertheless, many of the coping strategies used by people with overwhelming emotions only serve to make their problems worse.

Here’s a list of some common coping strategies used by people dealing with this problem. Check (check) the ones that you use to cope with your stressful situations:

·               ___ You spend a great deal of time thinking about past pains, mistakes, and problems.

·               ___ You get anxious worrying about possible future pains, mistakes, and problems.

·               ___ You isolate yourself from other people to avoid distressing situations.

·               ___ You make yourself feel numb with alcohol or drugs.

·               ___ You take your feelings out on other people by getting excessively angry at them or trying to control them.

·               ___ You engage in dangerous behaviors, such as cutting, hitting, picking at, or burning yourself or pulling out your own hair.

·               ___ You engage in unsafe sexual activities, such as having sex with strangers or having frequent unprotected sex.

·               ___ You avoid dealing with the causes of your problems, such as an abusive or dysfunctional relationship.

·               ___ You use food to punish or control yourself by eating too much, not eating at all, or by throwing up what you do eat.

·               ___ You attempt suicide or engage in high-risk activities, like reckless driving or taking dangerous amounts of alcohol and drugs.

·               ___ You avoid pleasant activities, such as social events and exercise, maybe because you don’t think that you deserve to feel better.

·               ___ You surrender to your pain and resign yourself to living a miserable and unfulfilling life.

All of these strategies are paths to even deeper emotional pain, because even the strategies that offer temporary relief will only cause you more suffering in the future. Use the Cost of Self-Destructive Coping Strategies worksheet to see how. Note the strategies that you use as well as their costs, and then include any additional costs that you can think of. At the end of the worksheet, feel free to add any of your own strategies that aren’t included as well as their costs.

The Cost of Self-Destructive Coping Strategies

The Cost of Self-Destructive Coping Strategies Continued

The costs of these self-destructive coping strategies are clear. All of them lead to your pain being prolonged into long-term suffering. Remember, sometimes pain can’t be avoided, but many times suffering can.

Take, for example, an argument between friends Maria and Sandra. For Maria, who doesn’t have overwhelming emotions, the argument was initially painful. But after a few hours, she began to realize that she and Sandra were both to blame for the argument. So by the next day, Maria was no longer upset or mad at Sandra. But for Sandra, who struggles with overwhelming emotions, the argument was replayed in her memory over and over again for three days. Each word and gesture was remembered as an insult from Maria. So the next time Sandra saw Maria, three days later, Sandra was still angry and she restarted the argument just where it had ended. Both women experienced the initial pain of the argument, but only Sandra was suffering. Clearly, Sandra carried her emotional pain with her for days, and it made her life more of a struggle. While we can’t always control the pain in our lives, we can control the amount of suffering we have in response to that pain.

To avoid this type of long-term suffering, chapters 1 and 2 will teach you distress tolerance skills. These skills will help you endure and cope with your pain in a new, healthier way so that it doesn’t lead to suffering. The new plan outlined in these two chapters will teach you to “distract, relax, and cope.”

About This Chapter

The first distress tolerance skills you’ll learn in this chapter will help you distract yourself from the situations that are causing you emotional pain. Distraction skills are important because (1) they can temporarily stop you from thinking about your pain and, as a result, (2) they give you time to find an appropriate coping response. Remember how Sandra carried her pain with her for three days? She couldn’t stop thinking about her argument with Maria. Distraction can help you let go of the pain by helping you think about something else. Distraction also buys you time so that your emotions can settle down before you take action to deal with a distressing situation.

However, do not confuse distraction with avoidance. When you avoid a distressing situation, you choose not to deal with it. But when you distract yourself from a distressing situation, you still intend to deal with it in the future, when your emotions have calmed down to a tolerable level.

The second group of distress tolerance skills you’ll learn in this chapter are self-soothing skills (Johnson, 1985; Linehan, 1993b). It’s often necessary to soothe yourself before you face the cause of your distress because your emotions might be too “hot.” Many people with overwhelming emotions panic when faced with an argument, rejection, failure, or other painful events. Before you can address these problems with your new emotion regulation skills (chapters 6 and 7) or your new interpersonal effectiveness skills (chapters 8 and 9), it’s often necessary to soothe yourself to regain your strength. In situations like these, distress tolerance skills are similar to refilling the gas in your car so that you can keep going. Self-soothing is meant 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.

Self-soothing skills also serve another purpose. They’ll help you learn to treat yourself compassionately. 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. The second purpose of the self-soothing skills, therefore, is to teach you how to treat yourself kindly and lovingly.

How to Use This Chapter

As you read the following groups of skills, mark the ones that are helpful to you. This will make it easier to create a distraction plan for emergencies when you get to the end of this chapter. You’ll also be shown how to create a list of relaxation skills to help soothe yourself, both at home and when you’re away. Then, in the next chapter, you’ll learn more advanced distress tolerance skills.

Radical Acceptance

Increasing your ability to tolerate distress starts with a change in your attitude. You’re going to need something called radical acceptance (Linehan, 1993a). This is a new way of looking at your life. In the next chapter, you’ll be given some key questions to help you examine your experiences using radical acceptance. But for now, it will be sufficient to cover this concept briefly.

Often, when a person is in pain, his or her first reaction is to get angry or upset or to blame someone for causing the pain in the first place. But unfortunately, no matter who you blame for your distress, your pain still exists and you continue to suffer. In fact, in some cases, the angrier you get, the worse your pain will feel (Greenwood, Thurston, Rumble, Waters, & Keefe, 2003; Kerns, Rosenberg, & Jacob, 1994).

Getting angry or upset over a situation also stops you from seeing what is really happening. Have you ever heard the expression “being blinded by rage”? This often happens to people with overwhelming emotions. Criticizing yourself all the time or being overly judgmental of a situation is like wearing dark sunglasses indoors. By doing this, you’re missing the details and not seeing everything as it really is. By getting angry and thinking that a situation should never have happened, you’re missing the point that it did happen and that you have to deal with it.

Being overly critical about a situation prevents you from taking steps to change that situation. You can’t change the past. And if you spend your time fighting the past—wishfully thinking that your anger will change the outcome of an event that has already happened—you’ll become paralyzed and helpless. Then, nothing will improve.

So, to review—being overly judgmental of a situation or overly critical of yourself often leads to more pain, missed details, and paralysis. Obviously, getting angry, upset, or critical doesn’t improve a situation. So what else can you do?

The other option, which radical acceptance suggests, is to acknowledge your present situation, whatever it is, without judging the events or criticizing yourself. Instead, try to recognize that your present situation exists because of a long chain of events that began far in the past. For example, some time ago, you (or someone else) thought you needed help for the emotional pain you were experiencing. So, a few days later, you went to the bookstore and bought this book. Then today you thought about reading this chapter, and eventually you sat down, opened the book, and began reading. Now, you are up to the words you see here. Denying this chain of events does nothing to change what has already happened. Trying to fight this moment or say that it shouldn’t be only leads to more suffering for you. Radical acceptance means looking at yourself and the situation and seeing it as it really is.

Keep in mind that radical acceptance does not mean that you condone or agree with bad behavior in others. But it does mean that you stop trying to change what’s happened by getting angry and blaming the situation. For example, if you’re in an abusive relationship and you need to get out, then get out. Don’t waste your time and continue to suffer by blaming yourself or the other person. That won’t help you. Refocus your attention on what you can do now. This will allow you to think more clearly and figure out a better way to cope with your suffering.

Radical Acceptance Coping Statements

To help you begin using radical acceptance, it’s often helpful to use a coping statement to remind yourself. Below are a few examples and spaces to create your own. Check (check) the statements that you would be willing to use to remind yourself that you should accept the present moment and the chain of events that created it. Then, in the next exercise, you’ll begin using the statements that you chose.

·               ___ “This is the way it has to be.”

·               ___ “All the events have led up to now.”

·               ___ “I can’t change what’s already happened.”

·               ___ “It’s no use fighting the past.”

·               ___ “Fighting the past only blinds me to my present.”

·               ___ “The present is the only moment I have control over.”

·               ___ “It’s a waste of time to fight what’s already occurred.”

·               ___ “The present moment is perfect, even if I don’t like what’s happening.”

·               ___ “This moment is exactly as it should be, given what’s happened before it.”

·               ___ “This moment is the result of over a million other decisions.”

·               ___ Other ideas: ___________

·               ___________

Exercise: Radical Acceptance

Now, using the coping statements that you checked, begin radically accepting different moments in your life without judging them. Naturally, it will be difficult to accept very painful situations, so start with smaller events. Here are some suggestions. Check (check) the ones you’re willing to do, and add any of your own ideas. Then use your coping statements to radically accept the situation without being judgmental or critical.

·               ___ Read a controversial story in the newspaper without being judgmental about what has occurred.

·               ___ The next time you get caught in heavy traffic, wait without being critical.

·               ___ Watch the world news on television without being critical of what’s happening.

·               ___ Listen to a news story or a political commentary on the radio without being judgmental.

·               ___ Review a nonupsetting event that happened in your life many years ago, and use radical acceptance to remember the event without judging it.

·               ___ Other ideas: ___________

·               ___________

Distract Yourself from Self-Destructive Behaviors

One of the most important purposes of dialectical behavior therapy is to help you stop engaging in self-destructive behaviors, such as cutting, burning, scratching, and mutilating yourself (Linehan, 1993a). No one can deny the amount of pain you are in when you engage in one of these behaviors. Some people with overwhelming emotions say that self-injury temporarily relieves them of some of the pain they’re feeling. This might be true, but it’s also true that these actions can cause serious permanent damage and even death if taken to an extreme.

Think about all the pain you’ve already been through in your life. Think about all the people who have hurt you physically, sexually, emotionally, and verbally. Does it make sense to continue hurting yourself even more in the present? Doesn’t it make more sense to start healing yourself and your wounds? If you really want to recover from the pain you’ve already experienced, stopping these self-destructive behaviors is the first step you should take. This can be very hard to do. You might be addicted to the rush of natural painkillers called endorphins that are released when you hurt yourself. However, these types of self-destructive actions are highly dangerous and certainly deserve your best efforts to control them.

Exercise: Distract Yourself from Self-Destructive Behaviors

Here are some safer actions that you can use to distract yourself from your self-destructive emotions and thoughts. Check (check) the ones you’re willing to do, and then add any healthy, nonharming activities that you can think of:

·               Instead of hurting yourself, hold an ice cube in one hand and squeeze it. The sensation from the cold ice is numbing and very distracting.

·               Write on yourself with a red felt-tip marker instead of cutting. Draw exactly where you would cut. Use red paint or nail polish to make it look like you’re bleeding. Then draw stitches with a black marker. If you need to make it even more distracting, squeeze an ice cube in the other hand at the same time.

·               Snap a rubber band on your wrist each time you feel like hurting yourself. This is very painful, but it causes less permanent damage than cutting, burning, or mutilating yourself.

·               Dig your fingernails into your arm without breaking the skin.

·               Draw faces of people you hate on balloons and then pop them.

·               Write letters to people you hate or to people who have hurt you. Tell them what they did to you and tell them why you hate them. Then throw the letters away or save them to read later.

·               Throw foam balls, rolled-up socks, or pillows against the wall as hard as you can.

·               Scream as loud as you can into a pillow or scream some place where you won’t draw the attention of other people, like at a loud concert or in your car.

·               Stick pins in a voodoo doll instead of hurting yourself. You can make a voodoo doll with some rolled-up socks or a foam ball and some markers. Or you can buy a doll in a store for the specific purpose of sticking pins in it. Buy one that’s soft and easy to stick.

·               Cry. Sometimes people do other things instead of crying because they’re afraid that if they start to cry they’ll never stop. This never happens. In fact, the truth is that crying can make you feel better because it releases stress hormones.

·               Other healthy, nonharming ideas:

·               ___________

·               ___________

Here’s an example of using alternative actions to distract your self-destructive emotions. Lucy often cut herself when she felt upset or angry. She had dozens of scars on her wrists and forearms. She wore long-sleeve shirts even in the hot summer because she was embarrassed when other people saw what she had done to herself. But after getting some ideas from this workbook, she made a distraction plan. So the next time she got angry with herself and felt like cutting, she looked at her plan for alternative actions. She had written down the idea of drawing on herself with a red marker. She drew a line exactly where she would have cut herself. She even used red paint to make it look like she was bleeding. She carried the mark on her arm for the rest of the day to remind herself how sad and overwhelmed she felt. But then, before she went to sleep, she was able to erase the “scar” and “blood” from her arm, unlike the rest of the marks from her permanent injuries.

Distract Yourself with Pleasurable Activities

Sometimes doing something that makes you feel good is the best way to distract yourself from painful emotions. But remember, you don’t have to wait until you feel overwhelmed by painful emotions in order to do one of these activities. It’s also helpful to engage in these types of activities on a regular basis. In fact, you should try to do something pleasurable every day. Exercise is also especially important because not only is it good for your overall physical health but it’s also been shown to be an effective treatment for depression in some cases (Babyak et al., 2000). Plus, exercise makes you feel good almost immediately by releasing natural painkillers in your body called endorphins (the same painkillers that are released when you cut yourself).

Following is a list of over one hundred pleasurable activities you can use to distract yourself.

The Big List of Pleasurable Activities

The Big List of Pleasurable Activities Continued

Here’s an example of using pleasurable activities to distract yourself. Karen was feeling lonely and had nothing to do. As she sat alone at home, she began to think about how lonely she’d been her whole life and how she was hurt by her father when she was growing up. Very quickly, Karen was overwhelmed with very painful emotions. In fact, the memories also triggered physical pain in her shoulder. Karen began to cry and didn’t know what to do. Luckily, she remembered the distraction plan she had created. Exercise had always been a powerful tool for Karen, so she went for a long walk in the park while she listened to some of her favorite music. The activity didn’t erase her memories or remove her pain completely, but the long walk did soothe her and prevent her from being overwhelmed with sadness.

Distract Yourself by Paying Attention to Someone Else

Another great way to distract yourself from pain is to put your attention on someone else. Here are some examples. Check (check) the ones you’re willing to do, and then add any activities that you can think of:

·               ___ Do something for someone else. Call your friends and ask if they need help doing something, such as a chore, grocery shopping, or housecleaning. Ask your parents, grandparents, or siblings if you can help them with something. Tell them you’re feeling bored and you’re looking for something to do. Call up someone you know and offer to take them out to lunch. Go outside and give money to the first needy person you see. If you can plan ahead for moments like these when you’re overwhelmed with pain, call your local soup kitchen, homeless shelter, or volunteer organization. Plan to participate in activities that help other people. Join a local political activities group, environmental group, or other organization, and get involved helping other people.

·               ___ Take your attention off yourself. Go to a local store, shopping center, bookstore, or park. Just sit and watch other people or walk around among them. Watch what they do. Observe how they dress. Listen to their conversations. Count the number of buttons they’re wearing on their shirts. Observe as many details about these other people as you can. Count the number of people with blue eyes versus the number of people with brown eyes. When your thinking returns to your own pain, refocus on the details of the people you’re watching.

·               ___ Think of someone you care about. Keep a picture of them in your wallet or in your purse. This could be your husband, wife, parent, boyfriend, girlfriend, children, or friend, or it could be someone else you admire, such as Mother Teresa, Gandhi, Jesus, the Dalai Lama, Ganesha, and so on. It could even be a movie star, an athlete, or someone you’ve never met. Then, when you’re feeling distressed, take out the picture and imagine a healing, peaceful conversation you would have with that person if you could talk to them at that moment when you’re feeling hurt. What would they say to you that would help make you feel better? Imagine them saying those words to you.

·               ___ Other ideas: ___________

·               ___________

·               ___________

Here’s an example of distracting yourself by paying attention to someone else. Louis got upset by a fight he had with his boyfriend, Roger. Very quickly, Louis became overwhelmed by sadness as he started to remember all the other fights he and Roger had had in the past. Louis went to his desk, where he kept a picture of his mother. He sat down and started to talk to his mother as if she were there with him. He asked for strength and guidance to handle the situation with Roger. Then he imagined what she would say to him, and he started to feel better. Later, when he was able to think more clearly, he returned to what he needed to do that day.

Distract Your Thoughts

The human brain is a wonderful thought-producing machine. It turns out millions of thoughts every day. Most of the time, this makes our lives much easier. But unfortunately, we can’t fully control what our brain thinks about. Here’s an example. Imagine a picture of your favorite cartoon character, such as Bugs Bunny, Snoopy, Superman, or whomever. Close your eyes and see the character in vivid detail in your mind’s eye. Remember exactly what it looks like. Think about the character for about fifteen seconds. Got it? Now, for the next thirty seconds do your best not to think about the character. Try to block the character from your thoughts. But be honest with yourself and notice how often the character pops into your thoughts. It’s impossible not to think about the character. In fact, the harder you try not to think about it, the more power you give to the image and the more your brain keeps bringing it into your thoughts. It’s almost as if the harder you try to forget something, the harder your brain tries to remember it. This is why forcing yourself to forget about something that happened to you is impossible. It’s also why you can’t simply force yourself to get rid of emotions that you don’t want.

So, instead of trying to force yourself to forget a memory or thought, try to distract your thoughts with other memories or creative images. Here are some examples. Check (check) the ones you’re willing to do, and then add any activities that you can think of:

·               ___ Remember events from your past that were pleasant, fun, or exciting. Try to remember as many details as possible about these happy memories. What did you do? Who were you with? What happened?

·               ___ Imagine sexual thoughts that make you excited. Create sexual fantasies involving you and someone you know or someone you would like to know. Try to think of as many details as possible. What happens that’s so exciting?

·               ___ Look outside at the natural world around you. Observe the flowers, trees, sky, and landscape as closely as you can. Observe any animals that are around. Listen to the sounds that they make. Or if you live in a city without much nature around you, either do your best to observe what you can or close your eyes and imagine a scene you’ve observed in the past.

·               ___ Imagine yourself as a hero or heroine correcting some past or future event in your life. How would you do it? What would people say to you?

·               ___ Imagine yourself getting praise from someone whose opinion matters to you. What did you do? What does this person say to you? Why does this person’s opinion matter to you?

·               ___ Imagine your wildest fantasy coming true. What would it be? Who else would be involved? What would you do afterwards?

·               ___ Keep a copy of your favorite prayer or favorite saying with you. Then, when you feel distressed, pull it out and read it to yourself. Imagine the words calming and soothing you. Use imagery (such as a white light coming down from heaven or the universe) that soothes you as you read the words.

·               ___ Other ideas: ___________

·               ___________

·               ___________

Here’s an example of using distracting thoughts. Joel was in a bad relationship that often reminded him of the way he was treated by his mother. She was always criticizing him and telling him he was wrong. When these memories overwhelmed him, Joel never knew what to do. Sometimes he would just scream at his friends or whoever else was around. But after creating a distraction plan, Joel thought of other ideas. The next time he had memories of his mother berating him, he went to his bedroom to lie down. Then he started to imagine himself as a child confronting his mother about her abusive language. He told her all the things he wished he could have said to her years ago. He told her she was wrong and that she should stop criticizing him. Joel controlled the details of the fantasy in the way he wished it could have happened years ago. Afterwards, he slowly felt better. He had escaped the cycle of letting his painful emotions overwhelm him.

Distract Yourself by Leaving

Sometimes the best thing that you can do is leave. If you’re in a very painful situation with someone and you recognize that your emotions are going to overwhelm you and possibly make the situation worse than it is already, then often it’s best to just leave. Remember, if you’re already overwhelmed by your emotions, it will be harder for you to think of a healthy resolution to your problem. Maybe it’s best to put some distance between you and the situation in order to give yourself time to calm your emotions and think of what to do next. Just walk away if that’s the best you can do. It will be better than adding fuel to the emotional fire.

Here’s an example of leaving to distract yourself. Anna was in a large department store shopping for a blouse. She wanted one of the clerks to help her find her size, but the store clerk was busy with other customers. Anna waited as long as she could and kept trying to get the clerk’s attention, but nothing worked. Anna recognized that she was getting angry very quickly. She was ready to tear the blouse in half. She didn’t know what else to do. In the past, she would have stayed in the store and gotten angrier, but this time she remembered to leave. She walked out of the store, did some shopping elsewhere, and returned to get the blouse later, when the store was less crowded and when she was feeling more in control of her behaviors.

Distract Yourself with Tasks and Chores

Strangely, many people don’t schedule enough time to take care of themselves or their living environments. As a result, tasks and chores go uncompleted. Here, then, is the perfect opportunity to do something to take care of yourself and your environment. The next time you’re in a situation in which your emotions become too painful, temporarily distract yourself by engaging in one of the following activities. Check (check) the ones you’re willing to do, and then add any activities that you can think of:

·               ___ Wash the dishes.

·               ___ Make phone calls to people you haven’t spoken to recently but not someone you’re angry with.

·               ___ Clean your room or house, or go help a friend with their cleaning or gardening project.

·               ___ Clean out your closet and donate your old clothes.

·               ___ Redecorate a room or at least the walls.

·               ___ Organize your books, CDs, computer desktop, and so forth.

·               ___ Make a plan for getting a job if you don’t already have one, or make a plan for finding a better job.

·               ___ Go get a haircut.

·               ___ Go get a manicure or pedicure, or both.

·               ___ Go get a massage.

·               ___ Wash your or someone else’s car.

·               ___ Mow the lawn.

·               ___ Clean your garage.

·               ___ Wash the laundry.

·               ___ Do your homework.

·               ___ Do work that you’ve brought home from your job.

·               ___ Polish your shoes.

·               ___ Polish your jewelry.

·               ___ Clean the bathtub and then take a bath.

·               ___ Water your plants or work in the garden.

·               ___ Cook dinner for yourself and some friends.

·               ___ Pay the bills.

·               ___ Go to a support meeting, like Narcotics Anonymous, Alcoholics Anonymous, or Overeaters Anonymous.

·               ___ Other ideas: ___________

·               ___________

·               ___________

Here’s an example of using tasks and chores to distract yourself. Mike called his girlfriend Michelle to go to a movie. Michelle had already made plans with her friends to do something else. Mike felt incredibly rejected and abandoned. He started yelling at Michelle, who hung up on him. This made Mike feel worse. He didn’t know what to do. Quickly, he began to feel light-headed and confused, and his emotions became very angry. But this time, instead of calling Michelle back and arguing, he opened his wallet and pulled out the distraction plan he had made (which you’ll also create at the end of this chapter). He had written down “get a haircut,” so he walked a half mile to his barber. Getting out of his house helped soothe his anger, and when he returned home, he had cooled down enough to call Michelle back to see if she was busy the next day.

Distract Yourself by Counting

Counting is a simple skill that can really keep your mind busy and help you focus on something other than your pain. Here are some examples. Check (check) the ones you’re willing to do, and then add any activities that you can think of:

·               ___ Count your breaths. Sit in a comfortable chair, put one hand on your belly, and take slow, long breaths. Imagine breathing into your stomach instead of your lungs. Feel your belly expand like a balloon with each inhalation. Start counting your breaths. When you inevitably start thinking about whatever it is that’s causing you pain, return your focus to counting.

·               ___ Count anything else. If you’re too distracted by your emotions, simply count the sounds that you’re hearing. This will take your attention outside of yourself. Or try counting the number of cars that are passing by, the number of sensations that you’re feeling, or anything else you can put a number on, such as the branches of a tree you’re looking at.

·               ___ Count or subtract by increments of seven. For example, start with one hundred and subtract seven. Now take that answer and subtract seven more. Keep going. This activity will really distract you from your emotions because it requires extra attention and concentration.

·               ___ Other counting ideas: ___________

·               ___________

·               ___________

Here’s an example of using counting to distract yourself. Dawn became upset when her mother told her to help set the table for dinner. “She’s always telling me what to do,” Dawn thought. She could feel her anger getting worse, so she went to her room and remembered that the last time this happened, counting her breaths had helped soothe her emotions. She sat down and did it again. After ten minutes, she felt calmer, so she went back to the dining room.

Create Your Distraction Plan

Now identify those distraction skills that you’re willing to use the next time you’re in a situation that’s causing you pain and discomfort. These chosen skills will make up your distraction plan. Remember, these are the first steps you will use in your plan to distract, relax, and cope. Write your chosen distraction techniques below. When you’re done, write them down again on a 3 x 5 inch note card or a sticky note to carry around with you in your wallet or purse. Then the next time you’re in a distressing situation, you can pull out the card to remind yourself of your distraction plan.___________


1.            ___________

2.            ___________

3.            ___________

4.            ___________

5.            ___________

6.            ___________

7.            ___________

8.            ___________

9.            ___________

10.        ___________

Relax and Soothe Yourself

Now that you’ve learned some healthy and effective ways to distract yourself when you become overwhelmed by painful emotions, you’ll need to learn new ways to help soothe yourself (Johnson, 1985; Linehan, 1993b). Remember, these next skills will give you the second step in your plan to distract, relax, and cope. The activities in this section will help you relax. Then, later in this book, you’ll learn specific skills to cope with problematic situations. These will include emotion regulation skills, mindfulness skills, and interpersonal effectiveness skills.

Learning to relax and soothe yourself is very important for many reasons. When you’re relaxed, your body feels better. It also functions in a healthier way. In a state of relaxation, your heart beats more slowly and your blood pressure is reduced. Your body is no longer in a state of constant emergency, preparing to either confront a stressful situation or run away from it. As a result, it’s easier for your brain to think of healthier ways to cope with your problems.

Included here are some simple relaxation and soothing activities that utilize your five senses of smell, sight, hearing, taste, and touch. These activities are meant to bring you a small amount of peace in your life. So if one of these activities doesn’t help you feel relaxed, or makes you feel worse, don’t do it. Try something else. And remember, each one of us is different. For example, some people will become more relaxed by listening to music and others will find that taking a hot bubble bath works for them. As you explore this list, think about what works best for you and be willing to try something new if it sounds exciting.

Self-Soothing Using Your Sense of Smell

Smell is a very powerful sense that can often trigger memories and make you feel a certain way. Therefore, it’s very important that you identify smells that make you feel good, not bad. Here are some ideas. Check (check) the ones you’re willing to do, and then add any activities that you can think of:

·               ___ Burn scented candles or incense in your room or house. Find a scent that’s pleasing to you.

·               ___ Wear scented oils, perfume, or cologne that makes you feel happy, confident, or sexy.

·               ___ Cut out perfumed cards from magazines and carry them with you in your handbag or wallet.

·               ___ Go someplace where the scent is pleasing to you, like a bakery or restaurant.

·               ___ Bake your own food that has a pleasing smell, like chocolate chip cookies.

·               ___ Lie down in your local park and smell the grass and outdoor smells.

·               ___ Buy fresh-cut flowers or seek out flowers in your neighborhood.

·               ___ Hug someone whose smell makes you feel calm.

·               ___ Other ideas: ___________

·               ___________

·               ___________

Self-Soothing Using Your Sense of Vision

Vision is very important to humans. In fact, a large portion of our brain is devoted solely to our sense of sight. The things you look at can often have very powerful effects on you, for better or for worse. That’s why it’s important to find images that have a very soothing effect on you. And again, for each person, it comes down to individual taste and preference. Here are some ideas. Check (check) the ones you’re willing to do, and then add any activities that you can think of:

·               ___ Go through magazines and books to cut out pictures that you like. Make a collage of them to hang on your wall or keep some of them with you in your handbag or wallet to look at when you’re away from home.

·               ___ Find a place that’s soothing for you to look at, like a park or a museum. Or find a picture of a place that’s soothing for you to look at, like the Grand Canyon.

·               ___ Go to the bookstore and find a collection of photographs or paintings that you find relaxing, such as the nature photographs of Ansel Adams.

·               ___ Draw or paint your own picture that’s pleasing to you.

·               ___ Carry a picture or photograph of someone you love, someone you find attractive, or someone you admire.

·               ___ Other ideas: ___________

·               ___________

·               ___________

Self-Soothing Using Your Sense of Hearing

Certain sounds can soothe us. Listening to gentle music, for example, may be relaxing. In fact, this entire chapter was written while listening to classical music. However, each one of us has our own tastes. You have to find what works best for you. Use these examples to identify the sounds that help you relax. Check (check) the ones you’re willing to do, and then add any activities that you can think of:

·               ___ Listen to soothing music. This can be classical, opera, oldies, new age, Motown, jazz, Celtic, African, or anything else that works for you. It might be music with singing or without. Go to a music store that lets you listen to music before you buy it, and listen to a wide variety of genres to determine what helps you relax. If you have a portable radio or an MP3 player, carry it with you to listen to music when you’re away from home.

·               ___ Listen to books on tape or compact discs. Many public libraries will let you borrow books on tape. Take some out to see if it helps you relax. You don’t even have to pay attention to the story line. Sometimes just listening to the sound of someone talking can be very relaxing. Again, keep some of these recordings with you in your car or loaded in your portable stereo.

·               ___ Turn on the television and just listen. Find a show that’s boring or sedate, not something like Jerry Springer that’s just going to get you angry. Sit in a comfortable chair or lie down, and then close your eyes and just listen. Make sure you turn the volume down to a level that’s not too loud. Years ago there was a show on public television featuring a painter named Bob Ross. His voice was so soothing and relaxing that many people reported falling asleep while watching him. Find a show like this that will help you relax.

·               ___ Listen to a gentle talk show on the radio. Remember—a gentle talk show, not something that’s going to make you upset or angry. Stay away from political talk shows and the news. Find something neutral in discussion, like Car Talk on National Public Radio or a gardening show. Again, sometimes just listening to someone else talk can be relaxing. Carry a portable radio with you to listen to when you’re feeling upset or angry.

·               ___ Open your window and listen to the peaceful sounds outside. Or, if you live in a place without relaxing sounds outside, go visit a place with relaxing sounds, such as a park.

·               ___ Listen to a recording of nature sounds, such as birds and other wildlife. You can often buy these in a music store and then take them with you to listen to on your portable compact disc player, cassette player, or MP3 device.

·               ___ Listen to a white-noise machine. White noise is a sound that blocks out other distracting sounds. You can buy a machine that makes white noise with circulating air, or you can turn on a fan to block out distracting sounds. Other white-noise machines have recorded sounds on them, such as the sounds of birds, waterfalls, and rain forests. Many people find these machines very relaxing.

·               ___ Listen to the sound of a personal water fountain. These small electronic fountains can be bought in most department stores, and many people find the sound of the trickling water in their homes to be very soothing.

·               ___ Listen to a recording of a relaxation exercise. Exercises such as these will help you imagine yourself relaxing in many different ways. Other recorded exercises can even teach you self-hypnosis techniques to help you relax. Recordings like these can be bought at some bookstores and online at self-help publishers, such as New Harbinger Publications. Go to and look under “Audio Programs.” Then you can take the programs with you to listen to when you’re feeling overwhelmed.

·               ___ Listen to the sound of rushing or trickling water. Maybe your local park has a waterfall, or the nearby mall has a fountain. Or maybe just sit in your bathroom with the water running.

·               ___ Other ideas: ___________

·               ___________

·               ___________

Self-Soothing Using Your Sense of Taste

Taste is also a very powerful sense. Our tongue has distinct regions of taste buds on it to differentiate flavors and tastes of food. These sensations can also trigger memories and feelings, so again, it’s important that you find the tastes that are pleasing to you. However, if eating is a problem for you, such as eating too much, bingeing, purging, or restricting what you eat, talk to a professional counselor about getting help for yourself. If the process of eating can make you upset or nervous, use your other senses to calm yourself. But if food soothes you, use some of these suggestions. Check (check) the ones you’re willing to do, and then add any activities you can think of:

·               ___ Enjoy your favorite meal, whatever it is. Eat it slowly so you can enjoy the way it tastes.

·               ___ Carry lollipops, gum, or other candy with you to eat when you’re feeling upset.

·               ___ Eat a soothing food, like ice cream, chocolate, pudding, or something else that makes you feel good.

·               ___ Drink something soothing, such as tea, coffee, or hot chocolate. Practice drinking it slowly so you can enjoy the way it tastes.

·               ___ Suck on an ice cube or an ice pop, especially if you’re feeling warm, and enjoy the taste as it melts in your mouth.

·               ___ Buy a piece of ripe and juicy fresh fruit and then eat it slowly.

·               ___ Other ideas: ___________

·               ___________

·               ___________

Self-Soothing Using Your Sense of Touch

We often forget about our sense of touch, and yet we’re always touching something, such as the clothes we’re wearing or the chair we’re sitting in. Our skin is our largest organ, and it’s completely covered with nerves that carry feelings to our brain. Certain tactile sensations can be pleasing, like petting a soft dog, while other sensations are shocking or painful in order to communicate danger, like touching a hot stove. Again, each of us prefers different sensations. You have to find the ones that are most pleasing for you. Here are some suggestions. Check (check) the ones you’re willing to do, and then add any activities that you can think of:

·               ___ Carry something soft or velvety in your pocket to touch when you need to, like a piece of cloth.

·               ___ Take a hot or cold shower and enjoy the feelings of the water falling on your skin.

·               ___ Take a warm bubble bath or a bath with scented oils and enjoy the soothing sensations on your skin.

·               ___ Get a massage. Many people who have survived physical and sexual abuse do not want to be touched by anyone. This is understandable. But not all types of massage require you to take off your clothes. Some techniques, such as traditional Japanese shiatsu massage, simply require you to wear loose-fitting clothes. A shoulder and neck massage, received while seated in a massage chair, can also be done without removing any clothes. If this is a concern for you, just ask the massage therapist what kind of massage would be best to have while wearing your clothes.

·               ___ Massage yourself. Sometimes just rubbing your own sore muscles is very pleasing.

·               ___ Play with your pet. Owning a pet can have many health benefits. Pet owners often have lower blood pressure, lower cholesterol levels, and reduced risk for heart disease (Anderson, Reid, & Jennings, 1992), and they experience other general health improvements (Serpell, 1991). In addition, playing with your pet and stroking the animal’s fur or skin can provide you with a soothing tactile experience. If you don’t have a pet, consider getting one. Or if you can’t afford one, visit a friend who has a pet or volunteer at your local animal shelter where you can play with the rescued animals.

·               ___ Wear your most comfortable clothes, like your favorite worn-in T-shirt, baggy sweat suit, or old jeans.

·               ___ Other ideas: ___________

·               ___________

·               ___________

Create a Relaxation Plan

Now that you’ve read the suggestions to help you relax and soothe yourself using your five senses, construct a list of techniques you’re willing to use. For ideas, review the activities that you checked. Be specific about what you’re going to do. Make a list of ideas to try at home and a list of ideas you can take with you when you’re away from home.


1.            ___________

2.            ___________

3.            ___________

4.            ___________

5.            ___________

6.            ___________

7.            ___________

8.            ___________

9.            ___________

10.        ___________

Keep this list in a convenient place that’s easy to remember. You might even want to copy this list and put it in places where you see it all the time, such as on your refrigerator, above your desk, on the mirror in your bathroom, or next to your bed. This way you’ll remind yourself to relax and soothe yourself as often as possible. It will also make it easier to soothe yourself when your painful emotions overwhelm you and prevent you from thinking clearly.

Now create a similar list to use when you’re away from home. Again, review the soothing skills you checked in the last few pages to give you ideas. But make sure that it’s possible to use these skills when you’re away from home. For example, don’t list “take a hot bath” because, most likely, there won’t be a hot bath available to you when you’re not at home.


1.            ___________

2.            ___________

3.            ___________

4.            ___________

5.            ___________

6.            ___________

7.            ___________

8.            ___________

9.            ___________

10.        ___________

Now copy these last ten ideas on an index card to remind you what to do when you’re away from home. Keep this list with you, in your car, in your wallet, or in your handbag. Then make sure you have whatever’s needed with you, such as candy, a portable radio, pictures, and so forth. This way you can practice relaxing when you’re not at home, especially when your painful emotions overwhelm you and prevent you from thinking clearly.


You’ve now learned some basic distraction and relaxation skills. You should begin using these skills immediately when you become overwhelmed with painful emotions. The next chapter will build on these skills and teach you more advanced distraction and relaxation skills.