The Dialectical Behavior Therapy Skills Workbook, 1st Edition

Chapter 2

Advanced Distress Tolerance Skills: Improve the Moment

In the last chapter, you learned many important skills that you can use in a crisis. These skills will distract you from painful situations and then help you soothe yourself and relax so that you can deal with the situation in a more effective way. Remember, your plan for handling a crisis is to distract, relax, and cope.

Now that you’ve been practicing the distress tolerance skills from the last chapter, you’ll be ready for the advanced distress tolerance skills found in this chapter. These techniques will help you feel more empowered when you encounter painful situations in the future, and they’ll help you build a more relaxing and fulfilling life for yourself.

After trying each technique, mark the ones that are helpful so you can identify them later.

Safe-Place Visualization

Safe-place visualization is a powerful stress-reduction technique. Using it, you can soothe yourself by imagining a peaceful, safe place where you can relax. The truth is, your brain and body often can’t tell the difference between what’s really happening to you and what you’re just imagining. So if you can successfully create a peaceful, relaxing scene in your thoughts, your body will often respond to those soothing ideas.

Make sure you conduct this exercise in a quiet room where you’ll be free from distractions. Turn off your phone, television, and radio. Tell the people in your home, if there are any, that you can’t be disturbed for the next twenty minutes. Allow yourself the time and the freedom to relax. You deserve it. Read the following directions before you begin. If you feel comfortable remembering them, close your eyes and begin the visualization exercise. Or, if you would prefer, use an audio-recording device to record the directions for yourself. Read them aloud using a slow, soothing voice. Then close your eyes and listen to the guided visualization you created.

Before you begin the exercise, think of a real or imaginary place that makes you feel safe and relaxed. It can be a real place that you’ve visited in the past, such as the beach, a park, a field, a church/temple, your room, and so on. Or it can be a place that you’ve completely made up, such as a white cloud floating in the sky, a medieval castle, or the surface of the moon. It can be anywhere. If you have trouble thinking of a place, think of a color that makes you feel relaxed, such as pink or baby blue. Just do your best. In the exercise, you’ll be guided through exploring this place in more detail. But before you begin, make sure you already have a place in mind, and remember—thinking of it should make you feel safe and relaxed.

Complete the following sentences about your safe place before beginning the visualization:

·               My safe place is ___________

·               My safe place makes me feel ___________

Instructions

To begin, sit in a comfortable chair with your feet flat on the floor and your hands resting comfortably, either on the arms of the chair or in your lap. Close your eyes. Take a slow, long breath in through your nose. Feel your belly expand like a balloon as you breathe in. Hold it for five seconds: 1, 2, 3, 4, 5. Then release it slowly through your mouth. Feel your belly collapse like a balloon losing its air. Again, take a slow, long breath in through your nose and feel your stomach expand. Hold it for five seconds: 1, 2, 3, 4, 5. Then exhale slowly through your mouth. One more time: take a slow, long breath in through your nose and feel your stomach expand. Hold it for five seconds: 1, 2, 3, 4, 5. Then exhale slowly through your mouth. Now begin to take slow, long breaths without holding them, and continue to breathe smoothly for the rest of this exercise.

Now, with your eyes closed, imagine that you enter your safe place using all of your senses to ground yourself in the scene.

First, look around using your imaginary sense of sight. What does this place look like? Is it daytime or nighttime? Is it sunny or cloudy? Notice the details. Are you alone or are there other people or animals? What are they doing? If you’re outside, look up and notice the sky. Look out at the horizon. If you’re inside, notice what the walls and the furniture look like. Is the room light or dark? Choose something soothing to look at. Then continue looking for a few seconds using your imaginary sense of sight.

Next, use your imaginary sense of hearing. What do you hear? Do you hear other people or animals? Do you hear music? Do you hear the wind or the ocean? Choose something soothing to hear. Then listen for a few seconds using your imaginary sense of hearing.

Then use your imaginary sense of smell. If you’re inside, what does it smell like? Does it smell fresh? Do you have a fire burning that you can smell? Or, if you’re outside, can you smell the air, the grass, the ocean, or the flowers? Choose to smell something soothing in your scene. Then take a few seconds to use your imaginary sense of smell.

Next, notice if you can feel anything with your imaginary sense of touch. What are you sitting or standing on in your scene? Can you feel the wind? Can you feel something you’re touching in the scene? Choose to touch something soothing in your scene. Then take a few seconds to use your imaginary sense of touch.

Last, use your imaginary sense of taste. Are you eating or drinking anything in this scene? Choose something soothing to taste. Then take a few seconds to use your imaginary sense of taste.

Now take a few more seconds to explore your safe place using all of your imaginary senses. Recognize how safe and relaxed you feel here. Remember that you can come back to this place in your imagination whenever you need to feel safe and relaxed. You can also come back whenever you’re feeling sad, angry, restless, or in pain. Look around one last time to remember what it looks like.

Now keep your eyes closed and return your focus to your breathing. Again, take some slow, long breaths in through your nose and exhale through your mouth. Then, when you feel ready, open your eyes and return your focus to the room.

Cue-Controlled Relaxation

Cue-controlled relaxation is a quick and easy technique that will help you reduce your stress level and muscle tension. A cue is a trigger or command that helps you relax. In this case, your cue will be a word, like “relax” or “peace.” The goal of this technique is to train your body to release muscle tension when you think about your cue word. Initially, you’ll need the help of the guided instructions to help you release muscle tension in different sections of your body. But after you’ve been practicing this technique for a few weeks, you’ll be able to relax your whole body at one time simply by taking a few slow breaths and thinking about your cue word. With practice, this can become a very quick and easy technique to help you relax. Before you begin, choose a cue word that will help you relax.

1.            My cue word is ___________

To begin this exercise, you’ll need to find a comfortable chair to sit in. Later, after you’ve practiced this exercise for a few weeks, you’ll be able to do it wherever you are, even if you’re standing. You’ll also be able to do it more quickly. But to begin, choose a comfortable place to sit in a room where you won’t be disturbed. Make sure you’ll be free from distractions. Turn off your phone, television, and radio. Tell the people in your home, if there are any, that you can’t be disturbed for the next twenty minutes. Allow yourself the time and the freedom to relax. You deserve it. Read the following directions before you begin. If you feel comfortable remembering them, close your eyes and begin the relaxation exercise. Or, if you would prefer, use an audio-recording device to record the directions for yourself. Then close your eyes and listen to the guided relaxation technique that you created.

Instructions

To begin, sit in a comfortable chair with your feet flat on the floor and your hands resting comfortably, either on the arms of the chair or in your lap. Close your eyes. Take a slow, long breath in through your nose. Feel your belly expand like a balloon as you breathe in. Hold it for five seconds: 1, 2, 3, 4, 5. Then release it slowly through your mouth. Feel your belly collapse like a balloon losing its air. Again, take a slow, long breath in through your nose and feel your stomach expand. Hold it for five seconds: 1, 2, 3, 4, 5. Then exhale slowly through your mouth. One more time: take a slow, long breath in through your nose and feel your stomach expand. Hold it for five seconds: 1, 2, 3, 4, 5. Then exhale slowly through your mouth. Now begin to take slow, long breaths without holding them, and continue to breathe smoothly for the rest of this exercise.

Now, with your eyes still closed, imagine that a white beam of light shines down from the sky like a bright laser and lands on the very top of your head. Notice how warm and soothing the light makes you feel. This could be a light from God, the universe, or whatever power makes you feel comfortable. As you continue to breathe smoothly, taking slow, long breaths, notice how the light makes you feel more and more relaxed as it continues to shine on the top of your head. Now, slowly, the warm, white light begins to spread over the top of your head like soothing water. And as it does, the light begins to loosen any muscle tension that you’re feeling on the top of your head. Slowly the light begins to slide down your body, and as it moves across your forehead, all the muscle tension there is released. Then the white light continues down past your ears, the back of your head, your eyes, nose, mouth, and chin, and it continues to release any tension you’re holding there. Notice how pleasantly warm your forehead feels. Now, slowly, imagine that the light begins to move down your neck and over your shoulders, releasing any muscle tension. Then the light slowly proceeds down both of your arms and the front and back of your torso. Feel the muscles in your upper and lower back release. Notice the soothing sensation of the white light as it moves across your chest and stomach. Feel the muscles in your arms release as the light moves down to your forearm and then across both sides of your hands to your fingertips. Now notice the light moving down through your pelvis and buttocks and feel the tension being released. Again, feel the light move like soothing water across your upper and lower legs until it spreads across both the upper and lower surfaces of your feet. Feel all of the tension leaving the muscles of your body as the white light makes your body feel warm and relaxed.

Continue to notice how peaceful and calm you feel as you continue to take slow, long, smooth breaths. Observe how your stomach continues to expand as you inhale, and feel it deflate as you exhale. Now, as you continue breathing, silently think to yourself “breathe in” as you inhale, and then silently think your cue word as you exhale. (If your cue word is something other than “relax,” use that word in the following instructions.) Slowly inhale and think: “breathe in.” Slowly exhale and think: “relax.” As you do, notice your entire body feeling relaxed at the same time. Feel all the muscle tension in your body being released as you focus on your cue word. Again, inhale and think: “breathe in.” Exhale and think: “relax.” Notice your entire body releasing any muscle tension. Again, inhale … “breathe in.” Exhale … “relax.” Feel all the tension in your body releasing.

Continue breathing and thinking these words at your own pace for several minutes. With each breath, notice how relaxed your entire body feels. When your mind begins to wander, return your focus to the words “breathe in” and “relax.”

Practice the cue-controlled relaxation technique twice a day, and record how long it takes you to feel relaxed. With daily practice, this technique should help you relax more quickly each time. Again, remember that the ultimate goal of this technique is to train your entire body to relax simply when you think of your cue word, such as “relax.” This will only come with regular practice. Initially, you might also have to think of the white-light imagery and engage in slow, deep breathing to help yourself relax. But with practice this technique can help you relax in many distressing situations. You can also combine this exercise with the previous safe-place visualization. Engaging in cue-controlled relaxation first will help you feel even more safe and calm in that visualization process.

Rediscover Your Values

The word “values” can be defined as your ethics, principles, ideals, standards, or morals. These are literally the ideas, concepts, and actions that fill your life with worth and importance. Remembering what you value in life can be a very powerful way to help you tolerate a stressful situation. It can also be particularly helpful when you find yourself upset over and over again in the same situation or with the same person. Sometimes we forget why we’re doing something that’s hard, and this makes it difficult for us to continue. Maybe you have a job that you don’t like and you wonder why you keep going to work. Perhaps you’re going to school, and you don’t remember what your goals are. Or maybe you’re in a relationship that isn’t fulfilling, and you wonder why you keep maintaining that relationship. In cases like these, remembering what you value can help you tolerate stressful situations and also help you create a more fulfilling life for yourself. Use the following exercises to explore what you value in life.

Exercise: Valued Living Questionnaire

This first exercise will ask you to identify how you value ten different components of your life using the Valued Living Questionnaire (Wilson, 2002; Wilson & Murrell, 2004). As you read each component, ask yourself how important each of these areas is to your life—regardless of how much time or effort you now put into fulfilling the needs of that area. For example, maybe you highly value “self-care” regardless of the fact that you devote little time to it. Rate the importance of each component on a scale of 0 to 10, with 0 being not important at all and 10 being extremely important. Do your best to rate them honestly, according to your own true feelings, not to what you think you should rate them. You’ll then use your responses to the Valued Living Questionnaire in the following exercise, which will help you move toward engaging in what you value.

Valued Living Questionnaire

Exercise: Committed Action

This next exercise will help you create a more fulfilling life for yourself by formulating intentions and committed actions based on your values (Olerud & Wilson, 2002). Maybe you already dedicate a lot of time to the components of your life that you value, or maybe you don’t. Either way, this exercise will help you think about ways to make your life feel more fulfilling based on what you think is important.

First, using the Valued Living Questionnaire, identify the components of your life that you rated between 5 and 10, from moderately important to extremely important. Then fill in the names of those areas on the Committed Action Worksheet that follows the questionnaire. (Make additional photocopies of this worksheet if you need more space.)

Next, identify one intention for each of those valued components, which will help make your life feel more fulfilling. For example, if you rated education highly, maybe your intention would be “to go back to school.” Or if you rated romantic relationships highly, maybe your intention would be “to spend more time with my spouse or partner.”

Then, finally, identify several actions you are willing to commit to doing that will move you toward your intention. Also, note when you’re willing to begin that commitment. For example, if your intention is to go back to school, the actions you list might include “getting a catalog of classes next week” and “signing up for a class within the next three weeks.” If your intention is to spend more time with your spouse, your committed actions might include “not working overtime for the next month” and “spending less time with friends for the next two weeks.”

Again, the purpose of these exercises is to fill your life with activities that are important to you. Creating a life that you value can often help you deal with other situations that are distressing and less desirable. Having a fulfilling life can give you something to look forward to when you’re doing something you don’t like, and it can make you feel stronger during times of distress.

Committed Action Worksheet

Identify Your Higher Power … and Make Yourself Feel More Powerful

Whether you believe in one God, many gods, a divine universe, or the goodness that exists within each human being, having faith in something bigger and more powerful than yourself can often make you feel empowered, safe, and calm. This is what people mean when they talk about believing in a “higher power” or seeing “the big picture” in life. Believing in something divine, holy, or special can help you endure stressful situations as well as help you soothe yourself.

At some point in life, we all feel hopeless or powerless. We’ve all experienced unfortunate situations during which we felt alone and needed strength. Sometimes unexpected circumstances hurt us or the people we care about. These situations often include being the victim of a crime, getting into an accident, having someone close to us die, or being diagnosed with a serious illness. Having faith in something special during times like these can often help you feel connected to a bigger purpose in life. And remember, your faith doesn’t have to involve God if that’s not what you believe in. Some people only put their faith in the goodness of the people they love. Yet basic beliefs like these are often powerful enough to help people find the strength and comfort to lead happy, healthy lives.

While you’re exploring your spirituality, remember that your spiritual beliefs can change over time. Sometimes a person is raised in a spiritual tradition that no longer makes sense or feels helpful. Yet, despite these feelings, a person will sometimes continue to attend the services of that tradition because he or she thinks “it’s the right thing to do.” The truth is, if your spiritual tradition is no longer giving you peace and strength, it’s okay to reexamine that faith and to change traditions if necessary.

Connect to Your Higher Power

Use the following questions to help you identify your beliefs and to identify some ways in which you can strengthen and use your beliefs on a regular basis:

·               What are some of your beliefs about a higher power or a big picture that give you strength and comfort? ___________

·               Why are these beliefs important to you? ___________

·               How do these beliefs make you feel? ___________

·               How do these beliefs make you think about others? ___________

·               How do these beliefs make you think about life in general? ___________

·               How do you acknowledge your beliefs throughout your daily life? For example, do you go to church, synagogue, or temple? Do you pray? Do you talk to other people about your beliefs? Do you read books about your beliefs? Do you help other people? ___________

·               What else would you be willing to do in order to strengthen your beliefs? ___________

·               What can you do to remind yourself of your beliefs on a regular basis? ___________

·               What can you say or do to remind yourself of your beliefs the next time you’re feeling distressed? ___________

Exercise: Higher-Power Activities

Here are some additional activities to help you feel more connected to your higher power, the universe, and the big picture. Check (check) the ones that you’re willing to do:

·               _____If you do believe in the teachings of a particular religion or faith, find related activities that make you feel more empowered and calm. Go to your church, synagogue, or temple for services. Talk to the man or woman who runs your services. Talk to other members of your faith about how they’ve handled difficult experiences. Join discussion groups formed at your place of worship. Read the books that are important to your faith. Find passages that give you strength, and mark them or copy them to keep with you in your wallet or purse so you can read them no matter where you are.

·               _____Remember that your higher power can also be something other than God. Your higher power can be a person who makes you feel stronger and more confident to deal with the challenges that you face. Think of someone you admire who can be your higher power. Describe that person. What makes that person special? Then, the next time you’re in a difficult or distressing situation, act as if you are that person, and notice how you handle the situation differently.

·               _____Look up at the stars. The light you’re seeing is millions of years old, and it has traveled from stars that are billions of miles away. In fact, each time you look up at the stars, you’re looking through a time machine and seeing the universe as it looked billions of years ago. Strangely, many of the stars you’re looking at have already died, but their light is just reaching your eyes on the Earth. Look up at the stars and recognize that whatever created them also created you, whether it was God or a cosmic accident. You are connected to the stars. Imagine yourself connecting with the universe. Sit in a comfortable chair, close your eyes, and imagine a white beam of light shining down from the universe. Like a laser beam, the white light shines on the top of your head and fills you with a feeling of peace. Now imagine the white light spreading all over your body, relaxing every muscle. Now imagine your legs stretching down through the floor like giant tree trunks, going all the way down into the center of the Earth. Imagine these roots tapping into the energy that drives the planet. Feel your body fill with confidence as your legs absorb the golden energy flowing up from the Earth.

·               _____Think about our planet Earth. Water is the most important substance for sustaining life on our planet. Yet if we were much closer to the sun, all the water on our planet would evaporate because the temperature would be too hot, and if we were much farther away, all the water would freeze because the temperature would be too cold. Somehow, we’ve been lucky enough to be in just the right place for life to form. Even if you don’t believe in a religious purpose, ask yourself what it means that you live on a planet with just the right climate and elements for life to exist. How did this happen, and what does it mean about your life?

·               _____Go to the beach. Try to count the grains in a handful of sand. Now try to imagine how many handfuls of sand there are in the world, on all the beaches and in all the deserts. Try to imagine how many billions of years must have passed to create so many grains of sand. And again, recognize that the chemical elements that make up the sand also exist in you. Stand with your feet in the sand and imagine feeling connected to the planet.

·               _____Go to a park or to a field and observe the trees, the grass, and the animals. Again, recognize that whatever created all of that also created you. Remember that all living things are made of the same chemical elements. On a subatomic scale, there isn’t much difference between you and many other life forms. Yet you are still different and special. What is it that makes you unique from other life?

·               _____Think about the human body, especially your own. Each human being is more wonderful than a piece of artwork and more complex than any computer ever invented. Everything about you is largely determined by your DNA (deoxyribonucleic acid), the instructions that are found in every cell of your body. Yet amazingly, each set of instructions that creates every part of your body is composed of just four chemical elements that are repeated in different combinations. These different combinations are called genes, and these are the instructions you inherit from your parents that determine everything from your eye color to the structure of your heart. Incredibly, it only takes an estimated thirty to forty thousand genes to design a human being. Imagine trying to write so few instructions in order to create a body that thinks, breathes, eats, moves, and does everything else you do. Plus, remember that this same number of instructions is also responsible for creating approximately 100 billion neurons in your brain, 60,000 miles (!) of blood vessels throughout your body, 600 skeletal muscles, 206 bones, 32 teeth, and 11 pints of blood.

Take a Time-Out

Time-outs aren’t just for kids. We all need to relax in order to refresh our bodies, minds, and spirits. Yet many people don’t take time out for themselves because they feel like they’d be disappointing someone else, like their boss, spouse, family, or friends. Many people struggle with the constant need to please others, and as a result, they neglect to take care of themselves. But people who don’t take care of themselves lead very unbalanced lives. Many people ignore their own needs because they feel guilty or selfish about doing anything for themselves. But how long can you continue to take care of someone else without taking care of yourself? Imagine a woman who stands on a street corner on a hot, summer day holding a jug of cold water. She pours drinks for every pedestrian who walks by and, of course, everyone is grateful. But what happens when she’s thirsty and goes to get a drink? After a long day of helping everyone else and neglecting herself, the jug is now empty. How often do you feel like this woman? How often do you run out of time for yourself because you’ve spent all of it taking care of other people? Helping others is a good thing to do as long as it doesn’t come at the expense of sacrificing your own health. You need to take care of yourself, and that doesn’t mean you’re selfish.

Exercise: Time-Out

Here are some simple ideas you can use to take time out for yourself. Check (check) the ones you’re willing to do.

·               ___ Treat yourself as kindly as you treat other people. Do one nice thing for yourself that you’ve been putting off.

·               ___ Take time to devote to yourself, even if it’s just a few hours during the week, by doing things like taking a walk or preparing your favorite meal.

·               ___ Or if you’re feeling really brave, take a half day off from work. Go someplace beautiful, like a park, the ocean, a lake, the mountains, a museum, or even someplace like a shopping center.

·               ___ Take time to do things for your own life, like shopping, errands, doctor’s appointments, and so on.

·               ___ Other ideas: ___________

·               ___________

·               ___________

Live in the Present Moment

Time travel is possible. We all do it occasionally, but some people do it more often than others. People who time travel spend a large portion of each day thinking about all the things they should’ve done yesterday, all the things that went wrong in the past, and all the things they’re supposed to do tomorrow. As a result, that’s where they live, in the past or in the future. They rarely pay attention to what’s happening to them right now, so they miss living in the present moment—the only true moment in which anyone can really live. For example, notice what’s happening to you right now as you read this. Are you thinking of something else? Are you thinking of something that happened in the past or something that’s coming up in the future? What does your body feel like right now? Pay attention to it. Do you notice any spots of tension or physical pain? How are you breathing? Are you taking full, deep breaths, or are you breathing very shallowly?

Often, we don’t pay attention to what’s happening to us. We don’t pay attention to what people are saying to us or to the things that we read. We don’t even pay attention to who’s around us while we’re walking. And to make it even more problematic, we often try to do more than one thing at the same time, like driving, eating, and talking on the phone simultaneously. As a result, we miss a lot of what life has to offer and we often make easy situations more difficult.

But even worse, not living in the present moment can also make life more painful. For example, maybe you anticipate that the person with whom you’re talking is going to say something insulting, which makes you feel angry—even though the person hasn’t even said anything yet! Or maybe just thinking about past events makes you feel physically or emotionally upset, which then interferes with whatever you’re trying to do at the moment. Obviously, both types of time traveling can make any event unnecessarily painful.

In chapters 3 through 5 on mindfulness skills, you’ll learn advanced skills to help you stay in the moment. But for now, try the following exercises to help you live in the moment and tolerate distressing events more skillfully.

Exercise: “Where Are You Now?”

The next time you’re in a distressing situation, ask yourself the following questions:

·               Where am I right now?

·               Am I time traveling in the future, worrying about something that might happen, or planning something that might happen?

·               Am I time traveling in the past, reviewing mistakes, reliving bad experiences, or thinking about how my life could have been under different circumstances?

·               Or am I in the present, really paying attention to what I’m doing, thinking, and feeling?

If you’re not in the present moment, refocus your attention on what’s happening to you now by using the following steps:

·               Notice what you’re thinking about and recognize if you’re time traveling. Bring your focus back to the present moment.

·               Notice how you’re breathing. Take slow, long breaths to help you refocus on the present.

·               Notice how your body feels and observe any tension or pain you might be feeling. Recognize how your thoughts might be contributing to how you’re feeling. Use cue-controlled relaxation to release any tension.

·               Notice any painful emotions you might be feeling as a result of time traveling, and use one of the distress tolerance skills to help you relieve any immediate pain.

Exercise: Listening to Now

Another exercise to help you refocus on the present moment is the Listening to Now exercise. Dedicate at least five minutes to help yourself refocus.

Instructions

Sit in a comfortable chair. Turn off any distractions, like your phone, radio, and television. Take slow, long breaths, in through your nose and out through your mouth. Feel your stomach expand like a balloon each time you breathe in and feel it deflate each time you exhale. Now, as you continue to breathe, simply listen. Listen to any sounds you hear outside your home, inside your home, and inside your own body. Count each sound that you hear. When you get distracted, return your focus to listening. Maybe you hear cars, people, or airplanes outside. Perhaps you hear a clock ticking or a fan blowing inside. Or maybe you hear the sound of your own heart beating inside your body. Actively and carefully listen to your environment and count as many sounds as you can. Try this exercise for five minutes and notice how you feel afterwards.

A variation of this listening exercise will help you stay focused on the present moment while you’re in a conversation with another person. If you notice that your attention is beginning to wander and you start thinking about your past or future, focus your attention on something that the person is wearing, like a button on their shirt, a hat they’re wearing, or their collar. Note to yourself what color the item is and what it looks like. Sometimes this can snap you out of your time traveling. Now continue to listen, and if your mind begins to wander again, do the same thing and try to keep listening.

Exercise: Mindful Breathing

Another exercise that will help you stay focused in the present moment is breathing. It sounds simple, but we often don’t breathe as well as we should. Think about it: who ever taught you how to breathe? If you’re like the rest of us, probably no one. And yet, you do it about fifteen times a minute or almost 22,000 times a day! Everyone knows that we breathe air to take in oxygen. But how much of the air you breathe is actually oxygen—100 percent, 75 percent? The correct answer is that the air you breathe is only about 21 percent oxygen, and when your body doesn’t get enough oxygen it can knock your biological system off balance. For this reason alone, taking full, slow breaths is important. But another benefit of breathing fully is that this simple technique can help you relax and focus. Many spiritual traditions combine slow breathing techniques with guided meditations to help people focus and relax.

Here’s a breathing exercise that many people find helpful. This type of breathing is also called diaphragmatic breathing because it activates the diaphragm muscle at the bottom of your lung cavity. Engaging the diaphragm helps you take fuller, deeper breaths, which also helps you relax.

Read the instructions before beginning the exercise to familiarize yourself with the experience. If you feel more comfortable listening to the instructions, use an audio-recording device to record the directions in a slow, even voice so that you can listen to them while practicing this technique. Set a kitchen timer or an alarm clock for five minutes and practice breathing until the alarm goes off. Then as you get more accustomed to using this technique to help you relax, you can set the alarm for longer periods of time, like ten or fifteen minutes. But don’t expect to be able to sit still that long when you first start. In the beginning, five minutes is a long time to sit still and breathe.

When using this new form of breathing, many people often feel as if they become “one” with their breathing, meaning that they feel a deep connection to the experience. If that happens for you, great. If not, that’s okay, too. Just keep practicing. Also, some people feel light-headed when they first begin practicing this technique. This may be caused by breathing too fast, too deeply, or too slowly. Don’t be alarmed. If you begin to feel light-headed, stop if you need to, or return your breathing to a normal rate and begin counting your breaths.

Instructions

To begin, find a comfortable place to sit in a room where you won’t be disturbed for as long as you’ve set your timer. Turn off any distracting sounds. Take a few slow, long breaths and relax. Place one hand on your stomach. Now slowly breathe in through your nose and then slowly exhale through your mouth. Feel your stomach rise and fall as you breathe. Imagine your belly filling up with air like a balloon as you breathe in, and then feel it deflate as you breathe out. Feel the breath moving in across your nostrils, and then feel your breath blowing out across your lips. As you breathe, notice the sensations in your body. Feel your lungs fill up with air. Notice the weight of your body resting on whatever you’re sitting on. With each breath, notice how your body feels more and more relaxed.

Now, as you continue to breathe, begin counting your breaths each time you exhale. You can count either silently to yourself or aloud. Count each exhalation until you reach “4” and then begin counting at “1” again. To begin, breathe in slowly through your nose and then exhale slowly through your mouth. Count “1.” Again, breathe in slowly through your nose and slowly out through your mouth. Count “2.” Repeat, breathing in slowly through your nose, and then slowly exhale. Count “3.” Last time—breathe in through your nose and out through your mouth. Count “4.” Now begin counting at “1” again.

When your mind begins to wander and you catch yourself thinking of something else, return your focus to counting your breaths. Try not to criticize yourself for getting distracted. Just keep taking slow breaths into your belly, in and out. Imagine filling up your belly with air like a balloon. Feel it rising with each inhalation and falling with each exhalation. Keep counting each breath, and with each exhale, feel your body relaxing, deeper and deeper.

Keep breathing until your alarm goes off, and then slowly return your focus to the room you’re in.

Use Self-Encouraging Coping Thoughts

There are many distressing times in life when we all need to hear some encouraging words to keep us motivated or to help us endure the pain that we’re experiencing. But there are many distressing times like these when you are also alone, and you need to encourage yourself to stay strong. Often, this can be done with self-encouraging coping thoughts. Coping thoughts are reminders of how strong you’ve been in the past when you survived distressing situations, and they’re also reminders of encouraging words that have given you strength. Coping thoughts are especially helpful when you first notice that you’re feeling agitated, nervous, angry, or upset. If you can recognize your distress early on, you’ll have a better chance of using one of these thoughts to help soothe yourself. Maybe there are even situations in your life that occur on a regular basis, when you can predict that one of these coping thoughts might be useful.

List of Coping Thoughts

Here is a list of some coping thoughts that many people have found to be helpful (McKay, Davis, & Fanning, 1997). Check (check) the ones that are helpful to you and create your own.

·               ___ “This situation won’t last forever.”

·               ___ “I’ve already been through many other painful experiences, and I’ve survived.”

·               ___ “This too shall pass.”

·               ___ “My feelings make me uncomfortable right now, but I can accept them.”

·               ___ “I can be anxious and still deal with the situation.”

·               ___ “I’m strong enough to handle what’s happening to me right now.”

·               ___ “This is an opportunity for me to learn how to cope with my fears.”

·               ___ “I can ride this out and not let it get to me.”

·               ___ “I can take all the time I need right now to let go and relax.”

·               ___ “I’ve survived other situations like this before, and I’ll survive this one too.”

·               ___ “My anxiety/fear/sadness won’t kill me; it just doesn’t feel good right now.”

·               ___ “These are just my feelings, and eventually they’ll go away.”

·               ___ “It’s okay to feel sad/anxious/afraid sometimes.”

·               ___ “My thoughts don’t control my life, I do.”

·               ___ “I can think different thoughts if I want to.”

·               ___ “I’m not in danger right now.”

·               ___ “So what?”

·               ___ “This situation sucks, but it’s only temporary.”

·               ___ “I’m strong and I can deal with this.”

·               ___ Other ideas: ___________

Coping thoughts can help you tolerate distressing situations by giving you strength and motivation to endure those experiences. Now that you know about coping thoughts, you can begin using them immediately. Write your five favorite coping thoughts on an index card or a sticky note and keep it with you in your wallet or purse. Or put your coping thoughts in conspicuous places where you can see them every day, like on your refrigerator or mirror. The more you see your coping thoughts, the more quickly they will become part of your automatic thought process.

Use the following worksheet to record stressful situations in which you use your coping thoughts to give you strength. Make copies of the worksheet, and keep one with you so that you can record the experience as soon as it happens. Recording the experience quickly might be awkward or inconvenient for you, but doing it this way will help you remember to use your self-encouraging coping thoughts more often. Read the example worksheet for ideas about when coping thoughts might be helpful to you.

Example: Using Coping Thoughts

Coping Thoughts Worksheet

Radical Acceptance

The word dialectic (in dialectical behavior therapy) means to balance and compare two things that appear very different or even contradictory. In dialectical behavior therapy, the balance is between change and acceptance (Linehan, 1993a). You need to change the behaviors in your life that are creating more suffering for yourself and others while simultaneously also accepting yourself the way you are. This might sound contradictory, but it’s a key part of this treatment. Dialectical behavior therapy depends on acceptance and change, not acceptance or change. Most of this book will focus on skills you can develop to change your life. But this section will focus on how to accept your life. In fact, it will teach you how to radically accept your life.

Radical acceptance is one of the hardest skills in this chapter to master because it will require you to look at yourself and the world in a different way. However, it’s also one of the most important skills in dialectical behavior therapy (Linehan, 1993a). (You’ll be exploring it further in chapters 3 through 5 on mindfulness skills.) Radical acceptance means that you accept something completely, without judging it. For example, radically accepting the present moment means that you don’t fight it, get angry at it, or try to change it into something that it’s not. To radically accept the present moment means that you must acknowledge that the present moment is what it is due to a long chain of events and decisions made by you and other people in the past. The present moment never spontaneously leaps into existence without being caused by events that have already taken place. Imagine that each moment of your life is connected like a line of dominoes that knock each other down.

But remember, radically accepting something doesn’t mean that you give up and simply accept every bad situation that happens to you. Some situations in life are unjust, such as when someone abuses or assaults you. But for other situations in life, you share at least some responsibility. There’s a balance between what you created and what others have created. However, many people struggling with overwhelming emotions often feel like life just “happens” to them, not recognizing their own role in creating a situation. As a result, their first reaction is to get angry. In fact, one woman said that anger was her “default emotion,” meaning that when she was just being herself, she was angry. Her excessive hostility caused her to hurt herself—by drinking heavily, cutting herself, and constantly berating herself—and it also led to her hurting the people she cared about by constantly fighting with them.

In contrast, radically accepting the present moment opens up the opportunity for you to recognize the role that you have played in creating your current situation. And as a result, it also creates an opportunity to respond to that situation in a new way that’s less painful for yourself and others. In many ways, radical acceptance is like the Serenity Prayer, which says: “Grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference.” In the exercise below, you will find some questions to ask yourself when you want to use radical acceptance. But first, let’s look at an example of how radical acceptance can help a person in a distressing situation.

Example: Using Radical Acceptance

Christine and her boyfriend John had a difficult relationship. John spent a lot of his free time at the bar drinking with his friends, and in response, Christine would get mad, threaten to leave him, and then do something destructive to “piss him off.” This occurred regularly for five years. Then one night Christine came home from work angry, and when John wasn’t around to talk to, she suddenly felt hopeless about their relationship. So she called John at the bar to tell him that she was going to kill herself because she couldn’t put up with his behavior any longer. John raced home to find Christine swallowing a handful of pills, and he made her spit them out. Then he made her promise that she wouldn’t do it again. She promised, and then John left, taking the keys to Christine’s car so that she couldn’t go anywhere. Now Christine got even angrier and called the police to report that her keys had been stolen. Then she walked up to the bar, found John’s car, and smashed his windshield with a brick. She would have broken the other windows too, but the police stopped her and arrested her. Needless to say, neither Christine nor John gave any consideration to using radical acceptance in this situation. Both of them were angry at each other, and by acting on their anger, they both ended up hurting themselves and the other person.

So how could this situation have occurred differently if radical acceptance had been used? Let’s consider the situation from Christine’s point of view. Instead of threatening to kill herself, maybe she could have used one of the distress tolerance skills you learned in the last chapter. Remember your strategy for dealing with distressing situations is to distract, relax, and cope. Maybe Christine could have screamed into a pillow and then gone outside for a long walk. Or maybe she could have called one of her friends to talk for a little while. Then after she’d cooled off a bit, maybe she could have asked herself the following questions and used radical acceptance to reexamine her situation.

·               What events led up to Christine’s situation? She and John had been behaving and fighting like this for years. This night was nothing new. But she had come home angry about work, and she became even angrier with John because he wasn’t around.

·               What role did Christine play in creating this situation? Instead of trying to cope with her anger and frustration in a healthy way, she took her emotions out on herself and John. Also, Christine had had many reasons and opportunities in the past to end this relationship if she wanted to, but she had chosen to stay in this destructive relationship.

·               What role did John play in creating this situation? John had an alcohol addiction that had been interfering with their relationship for five years. This night, he also didn’t take the time to discuss Christine’s suicidal behaviors with her. Instead, he chose to return to the bar, which made her even angrier.

·               What does Christine have control of in this situation? She can end the relationship if she wants to, or she can choose a different way to cope with this distressing situation.

·               What doesn’t Christine have control of in this situation? Ultimately, it is John who has to seek help to stop his alcohol addiction. Christine can’t make him stop drinking. She also doesn’t have control of how John chooses to behave toward her in this situation.

·               What was Christine’s response to this situation? She tried to kill herself, and then she smashed John’s windshield.

·               How did her response affect her own thoughts and feelings? Her actions made her feel worse about herself and her relationship, and she kept thinking about why she was still in this destructive relationship.

·               How did her response affect the thoughts and feelings of other people? Christine and John were arrested, which made both of them feel worse than they already did about themselves and their relationship.

·               How could Christine have changed her response to this situation so that it led to less suffering for herself and John? She could have used other distress tolerance skills to cope with her pain and anger. She could also have used radical acceptance to reevaluate the situation so that she could choose to react in a different way. And perhaps she could even have chosen to leave John that evening, even temporarily, which might have been less painful for the both of them.

·               How could the situation have occurred differently if Christine had decided to radically accept the situation? If she had used some type of distress tolerance skills that evening, maybe she could have waited until the next morning to talk to John about how angry she felt at work and how upset his drinking made her feel. Or maybe if she had ended the relationship, she could have made space in her life for a healthier relationship or simply spared herself the reoccurring pain of a destructive relationship.

Exercise: Radical Acceptance

Now answer the same questions for yourself. Think of a distressing situation that you experienced recently. Then answer these questions that will help you radically accept the situation in a new way:

·               What happened in this distressing situation? ___________

·               What past events happened that led up to this situation? ___________

·               What role did you play in creating this situation? ___________

·               What roles did other people play in creating this situation? ___________

·               What do you have control of in this situation? ___________

·               What don’t you have control of in this situation? ___________

·               What was your response to this situation? ___________

·               How did your response affect your own thoughts and feelings? ___________

·               How did your response affect the thoughts and feelings of other people? ___________

·               How could you have changed your response to this situation so that it led to less suffering for yourself and others? ___________

·               How could the situation have occurred differently if you had decided to radically accept the situation? ___________

It’s very important to remember that radical acceptance also applies to accepting yourself. In this case, radical acceptance means embracing who you are without judging or criticizing yourself. Or, to put it another way, radically accepting yourself means loving yourself just the way you are, with all of your goodness and all of your faults. Finding the goodness inside of yourself might be a difficult challenge, especially if you’re struggling with overwhelming emotions. Many people with this problem often think of themselves as being defective, bad, or unlovable. As a result, they overlook their good qualities and add more pain to their lives. This is why radically accepting yourself is so extremely important.

Self-Affirming Statements

To begin building a healthier self-image, many people find it helpful to use self-affirming statements. The purpose of these statements is to remind yourself of the good qualities you possess in order to give you strength and resilience when confronted with distressing situations. This type of statement will remind you that hidden underneath your sometimes overwhelming emotions is a caring, loving person who is capable of handling a distressing situation in a healthier way.

Example: Self-Affirming Statements

Here are some examples of self-affirming statements. Check (check) the ones you’re willing to use, and then create your own:

·               ___ “I might have some faults, but I’m still a good person.”

·               ___ “I care about myself and other people.”

·               ___ “I accept who I am.”

·               ___ “I love myself.”

·               ___ “I’m a good person, not a mistake.”

·               ___ “I’m good and nobody’s perfect.”

·               ___ “I embrace both my good and bad qualities.”

·               ___ “Today I take responsibility for everything I do and say.”

·               ___ “I’m becoming a better person every day.”

·               ___ “I’m a sensitive person who experiences the world differently.”

·               ___ “I’m a sensitive person with rich emotional experiences.”

·               ___ “Each day I do the best I can.”

·               ___ “Even though I forget sometimes, I’m still a good person.”

·               ___ “Even though bad things happened to me in the past, I’m still a good person.”

·               ___ “Even though I’ve made mistakes in the past, I’m still a good person.”

·               ___ “I’m here for a reason.”

·               ___ “There’s a purpose to my life, even though I might not always see it.”

·               ___ “I radically accept myself.”

___ Other ideas: ___________

___________

Some people find it helpful to write their self-affirming statements on index cards and then post them throughout their homes. One woman wrote her statement on her bathroom mirror with an erasable marker so it was the first thing she saw in the morning. One man wrote his on a sticky note and kept it posted on his computer as he worked. You can choose to remind yourself of your self-affirming statement in any way that works. But choose a technique that will remind you many times throughout the day. The more often you can see the statement, the more it will help change the way you think about yourself.

Create New Coping Strategies

Now that you’re familiar with all the distress tolerance skills, you can create new coping strategies for your future. The easiest way to do this is to examine some of the distressing situations you’ve experienced in the past and to identify how you’ve coped with them. Often, people with overwhelming emotions go through similar distressing situations over and over again. So in some ways these situations are predictable. In this exercise, you’ll identify what those past situations were, how you coped with them, and what the unhealthy consequences were. Then you’ll identify what new coping strategies you can use in the future if you experience similar situations and what the healthier consequences might be as a result of using those new strategies.

But as you’ll notice, you’ve been given two different New Coping Strategies worksheets. This is because you’ll need different coping strategies to use in situations when you’re alone or when you’re with someone else. For example, when you’re alone and feel overwhelmed, it might be most effective to use cue-controlled relaxation or mindful breathing techniques to soothe yourself. But these techniques might be awkward or impossible to use when you’re with someone else. So you’ll need to be prepared with other skills for those situations.

Here’s an example of preparing for both kinds of situations. Carl identified a distressing situation that occurred when he was with someone else. He wrote: “When I’m with my brother, he always corrects everything I do.” This is a good situation for Carl to examine because it’s predictable that the next time he’s with his brother, Carl will experience a similar distressing situation. Next, Carl identified how he usually coped with that situation with his brother, using his old coping strategies. He wrote: “We fight. I eat too much. I scratch myself. I think about all the times he’s insulted me in the past.” Then Carl recorded the unhealthy consequences of his actions: “We both get angry. I gain weight. I get cuts all over my face and arms. I feel horrible for days thinking about the past.” Obviously, none of Carl’s strategies has had any long-term benefits. Next, Carl identified new distress tolerance skills he could use the next time this situation arose with his brother. Under “New Coping Strategies,” Carl wrote the most appropriate distress tolerance skills for this type of situation. He chose them from the skills he found helpful in the last two chapters. He wrote: “Take a time-out. Use my new coping thought: ‘I’m strong and I can deal with him.’ Radically accept myself and the situation in a new way.” Then he predicted what the healthier possible consequences of these new strategies would be: “We won’t fight as much. I won’t eat as much. I’ll feel stronger. Maybe I can deal with the situation better in the future.” Obviously, the consequences of using his new distress tolerance skills would have been much healthier for Carl.

But these coping strategies are probably different from the strategies he might choose when he’s in a distressing situation by himself. So Carl also filled out the worksheet for coping with distressing situations when he’s alone. The situation he selected was: “Sometimes I feel scared when I’m alone.” Again, this is a good situation for Carl to examine because it’s predictable that he will experience this same overwhelming feeling the next time he’s alone. The old coping strategies that Carl used to deal with this situation were: “I smoke pot. I go to the bar and drink. I cut myself. I spend money on my credit card.” And the unhealthy consequences of these actions were: “I feel sick after smoking or drinking too much. I get into fights at the bar. I bleed. I spend too much money for things I don’t need.” Next, in order to prepare for the future, Carl chose new coping strategies to deal with this situation: “Use mindful breathing. Remember my connection to the universe. Use safe-place visualization. Remember what I value.” And finally, the healthier possible consequences that he predicted were: “I won’t feel as anxious. I won’t hurt myself. I’ll have more money. I’ll feel more relaxed.” Again, it’s easy to see that Carl’s new distress tolerance skills are much healthier for him than his old coping strategies. The same results can also benefit you if you take the time to prepare for predictable situations in your own future.

Create New Coping Strategies for Distressing Situations with Someone Else

Create New Coping Strategies for Distressing Situations When Alone

On each worksheet, pick four distressing situations from the past and examine how you coped with them. Identify the unhealthy coping strategies you used and what the consequences were for you and anyone else who was involved. Then record which new distress tolerance skills could have been used to cope with those situations in a healthier way. Review chapters 1 and 2 and pick the distress tolerance skills that you found to be helpful. Consider these to be options for the “New Coping Strategies” column as you’re completing the two worksheets. Most importantly, be specific. If you write, “Use a new coping thought,” write what that thought is. Or if you write, “Take a time-out,” include what you’re going to do. Be specific so you don’t forget in the future. Finally, record what the healthier consequences would have been if you had used your new distress tolerance skills.

Use the examples provided to guide you, and make photocopies of the worksheets if you need additional space.

Create an Emergency Coping Plan

Hopefully, you’ve been practicing the new distress tolerance skills from chapters 1 and 2 and you now have a good idea about which ones work best for you. Or maybe using the New Coping Strategies worksheet in the last section helped you predict which ones are going to work best for you. Now you’ll be ready for the next step, which will help you create a personally tailored plan for dealing with some common distressing situations, both when you’re with other people and when you’re alone.

For situations when you’re with other people, list four coping strategies that you think will be the most effective for you. Again, be specific and include as many details about that strategy as you can. Begin with your most effective strategy, then the second most effective strategy, and so on. The plan is that you’ll try the first strategy to see if it helps you cope with the distressing situation; then if it doesn’t, you’ll move on to the next strategy, and so on. Again, refer to any distress tolerance skills you found helpful in chapters 1 and 2, your New Coping Strategies worksheet in the last section, and any experience you have using the distress tolerance skills so far.

MY EMERGENCY COPING PLAN FOR DEALING WITH SITUATIONS

When I’m Upset and Dealing with Other People

First, I’ll ___________

___________

Next, I’ll ___________

___________

Then, I’ll ___________

___________

Finally, I’ll ___________

___________

MY EMERGENCY COPING PLAN FOR DEALING WITH SITUATIONS

When I’m Upset and Alone

First, I’ll ___________

___________

Next, I’ll ___________

___________

Then, I’ll ___________

___________

Finally, I’ll ___________

___________

Then, when you’ve finished making both plans, copy each of them on a single note card and keep the plans with you in your wallet or purse. This strategy will provide you with constant reminders about your new distress tolerance skills, and you’ll no longer have to rely on your old, ineffective strategies. Plus you won’t have to try to remember what to do the next time you’re feeling angry, hurt, or upset. You can simply pull out your card and follow your own Emergency Coping Plan.

Conclusion

Remember to practice your new distress tolerance skills as often as possible, and don’t get frustrated if you don’t get them right on the first try. Learning new skills is hard, and it often feels awkward. But anyone can learn these distress tolerance skills, and they have already helped thousands of people just like you. Good luck.