Tolerancja dolegliwości psychicznych
Marsha Linehan states, "DBT emphasizes learning to bear pain skillfully. The ability to tolerate and accept distress is an essential mental health goal for at least two reasons. First, pain and distress are a part of life; they cannot be entirely avoided or removed. The inability to accept this immutable fact itself leads to increased pain and suffering. Second, distress tolerance, at least over the short run, is part and parcel of any attempt to change oneself; otherwise, impulsive actions will interfere with efforts to establish desired changes.”I have experienced this whenever I find myself looking back at a situation and think, “I would never behave that way now.” I can see that since that time I have changed. I have grown. But at the moment, I did the best I could. These sorts of memories are nearly always accompanied by some sort of suffering I had to do before I grew. It is human nature to resist change, and it is only in hindsight that we can see that what we thought was devastating when we were going through it, proved to be very helpful in the long run. Unfortunately, we often have a hit a “bottom” before becoming willing to adapt. It’s a pattern that repeats throughout my entire life. Thus, I agree that the better I am at tolerating distress rather than avoiding it, the easier things will be.Marsha goes on to say, “Although the stance advocated here is a nonjudgmental one, this should not be understood to mean that it is one of approval. It is especially important that this distinction be made clear to clients: Acceptance of reality is not equivalent to approval of reality.“.... The distress tolerance behaviors targeted...are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: Distracting, self-soothing, improving the moment, and thinking of pros and cons.”I remember the first time I read these words I actually had conflicting thoughts. On the one hand It was an eye opening concept to think that accepting a situation was not the same as approving of the situation. My own parents had a problem with this concept and passed it along to me. For example: I became pregnant with my youngest son when I was single. My parents wanted me to have an abortion ( I was 30 and living 180 miles away). I told them I didn't want their approval just their support in my decision. They could not give it and did not give my son the same attention they gave his brother as a new born. I often have difficulty with reacting in a disapproving manner. It usually just makes me feel worse, because no one changes their behavior just because I have chosen to disapprove of what they are doing (can you imagine that :-).On the other hand my feelings about the distress tolerance skills was "Yea, sure!" But the reality is that when I put my faith in the skills and did them anyway they started to work.
DBT teaches us four sets of skills for tolerating (dealing with, getting through, accepting) the distressing events and activities in our lives.
· Distracting - Wise Mind ACCEPTS
· Self-Soothing
· Improving the Moment
· Thinking of Pros and Cons
We can think of these as Crisis Survival Strategies. Some of them will seem easy, some difficult. Out of these skills, you will probably want to try most everything, and then pick some that especially work or apply to you. I have certain ones of these that I use more than others. But it can really benefit you to try things that are new. You never know what might be a big help to you.
There are four groups of crisis survival strategies: Distraction, Self-Soothing, Improving the Moment, Pros and Cons. All of these are strategies that help us to get though difficult feelings and situations, to tolerate (deal with, get through, sit with, accept) the things that we can't immediately change. This is one of the keys to DBT skill usage, to find some of these skills and techniques that work for you, to practice them until they are part of your everyday life and you can call them up whenever you need them.
ACCEPTS
The first of the four distracting skills is ACCEPTS. This is an acronym to help you remember "Wise Mind A C C E P T S"Distract with Activities:Do hobbies, watch a video, go for a walk, play a sport, cook, garden, go fishing, go shopping. What other activities can you think of that you can get involved in and distract yourself from your distress? Make a list of your activities and put it up on your refrigerator, so you can find it in a hurry.Distract with Contributing:Contribute. Do volunteer work. Babysit so a friend can go out. Do something nice or surprising for someone.What have you done this week to contribute? What can you do next week to contribute? Plan something in advance. This takes you away from your pain and puts your attention on your concern for someone else.Distract with Comparisons:Compare yourself to people coping the same as or less well than you. If you are doing better than you were a year or two or five years ago, make that comparison. The manual suggests that you compare yourself to others' suffering, watch weepy soap operas, read about disasters. Some people find this helpful, others don't. Just do what works for you.What do you think about comparisons?Distract with opposite EmotionsRead emotional books, go to emotional movies, listen to emotional music. For this to work, you need to read or watch or listen to things that have an emotion opposite to one you are feeling. If you are sad, watch a comedy. Watch a scary movie. Listen to silly music. I think that the reason this works is that it kind of jars your feelings loose. If you are sad or angry, watch a silly or funny movie, and bust up laughing, you have changed your emotion and put yourself in a different place.Distract by Pushing Away a distressing situation by leaving it mentally for awhile.Build an imaginary wall between yourself and the situation. Imagine yourself pushing it away with all your strength.Block the situation in your mind. Each time it comes up, tell it to go away, or put some other thoughts in its place, perhaps some more pleasant thoughts. Refuse to think about it. Try putting the pain on a shelf, or in a box, to contain it and get it out of the way. I use the technique of putting my distress in a locked box on a shelf in a closet. I can get it later, but right now I can let it go.All of these are techniques to give you a break from dealing with the pain all the time. They haven't resolved the painful situation, but they have put it away for awhile so that you get a break and a chance to live some part of your life without it.Distract with other ThoughtsSome examples are counting to 10 or counting the tiles in a floor or the panes in a window or the stars in the sky, anything to keep your focus on the counting. This is a good one to use in a sudden emergency, when you need to pull something out of your bag of tricks really quickly. Other ways of distracting with thoughts are reading, watching videos or movies, doing crossword puzzles or jigsaw puzzles, writing poetry, if you can keep your thoughts away from your pain. Can you think of some other ways of distracting with thoughts?Distract with other Sensations.You might hold ice in your hand or apply it to the back of your neck (I used to use a bag of frozen peas against the back of my neck - the sensation was kind of shocking, and it shook me out of my tangled up distressing feelings), put a rubber band on your wrist and snap it, listen to loud music, take a hot, hard shower, a cold, hard shower, or swim in very cold water. Any strong physical stimulus like this can kind of jog loose your connection to your pain and distract you from it. After you try one of these activities, you may want to go on to another distracting activities, such as one of the activities described in the last lesson.
The next time you feel like getting angry, stop and take 3 deep breaths, then count to 10Try some of the alternate rebellion ideas on this website.Create your own “holodeck” in your mind - like in Star Trek. In your private holodeck, create experiences that you would like to have happen in your life, like having a pleasant conversation with your child or spouse or being in nature and feeling peaceful. Imagine the things you want to happen in your life in the long term, like being in a peaceful committed relationship or publishing your own book.Create your own movie theater in your mind. Replay scenes from the day. Talk to the actor that is you and give her advice about the situation she is in as if it really was an actor.
SELF-SOOTHE
In DBT, there are four categories of Distress Tolerance strategies. These are:
· Distracting
· Focusing on the Pros and Cons
These are strategies that short circuit or help you to cope with overwhelming negative emotions or intolerable situations. They take a lot of practice, but as you get the hang of using some of these techniques, you will see your relationship to the negative emotions and intolerable feelings change. (This was the most amazing thing about DBT for me, that things I though could never change or that I could never learn to deal with did become better.) It takes time and practice, and so I urge you to give the techniques plenty of practice. You will find some things work better than others for you. And you will find that some things don't work at first, but over time and practice you will see some results.
Some of us may recognize these techniques as things that we already use. But many of us have never learned how to self-soothe, how to do those often simple things that makes us feel better. These are mostly very physical techniques, that use different body senses. Some of us have never had the feeling that we could do things to make ourselves feel better, calmer, feel relaxation or pleasure. I urge you to experiment with these techniques until you find some that are comfortable and helpful for you. And when you find these, practice them. Use them when you are feeling distressed, when emotions feel overwhelming, when situations feel like you can't stand them any more. Instead of doing something that hurts you, try something that gives you pleasure and comfort,SELF-SOOTHING has to do with comforting, nurturing and being kind to yourself. One way to think of this is to think of ways of soothing each of your five senses:
· Vision
· Hearing
· Smell
· Taste
· Touch
VISION:Walk in a pretty part of town. Look at the nature around you. Go to a museum with beautiful art. Buy a flower and put it where you can see it. Sit in a garden. Watch the snowflakes decorate the trees during a snowfall. Light a candle and watch the flame. Look at a book with beautiful scenery or beautiful art. Watch a travel movie or video.HEARING:Listen to beautiful or soothing music, or to tapes of the ocean or other sounds of nature. Listen to a baby gurgling or a small animal. Sit by a waterfall. Listen to someone chopping wood. When you are listening, be mindful, letting the sounds come and go.SMELL:Smell breakfast being cooked at home or in a restaurant. Notice all the different smells around you. Walk in a garden or in the woods, maybe just after a rain, and breathe in the smells of nature. Light a scented candle or incense. Bake some bread or a cake, and take in all the smells.TASTE:Have a special treat, and eat it slowly, savoring each bite. Cook a favorite meal. Drink a soothing drink like herbal tea or hot chocolate. Let the taste run over your tongue and slowly down your throat. Go to a potluck, and eat a little bit of each dish, mindfully tasting each new thing.TOUCH:Take a bubble bath. Pet your dog or cat or cuddle a baby. Put on a silk shirt shirt or blouse, and feel its softness and smoothness. Sink into a really comfortable bed. Float or swim in a pool, and feel the water caress your body.
Many of us may feel like we don't deserve these comforts, and may find it hard to give pleasure to ourselves in this way. Do you have these feelings?Some of may also expect this soothing to come from other people, or not wantto do it for ourselves. Have you experienced this feeling?You may feel guilty about pleasuring yourself in this way. It may take some practice to allow yourself to experience these pleasures. These are really simple human pleasures that everyone has a right to, and that will give us some good tools to use when we are feeling bad.
Try at least one of these self-soothing exercises this week. You may want to choose a whole group of things, say all the visual things, or you may want to choose a single thing to try. As you do what you have chosen, do it mindfully. Breathe gently, and try to be fully in the experience, whether it is walking in the woods or watching a flower or taking a bubble bath or smelling some fresh-baked bread.As you begin to overcome your feelings that perhaps you do not deserve this, or guilt, and start to enjoy one or more of these activities, you will be learning very useful tools to help you deal with negative feelings and difficult situations.
We have learned that there are four basic kinds of skills for learning to tolerate distress. These are:
· Distraction
· Self-soothing
We have already talked about Distraction and Self-soothing. Now we are going to begin talking about some skills for Improving the Moment. At times when you can't or don't want to use distracting or self-soothing skills, when you are in a difficult time or a stressful situation, there are a number of skills you can use for improving the moment. These will reduce your distress, sometimes just for a short time (though you can always repeat them), and sometimes for longer. We can learn to make ourselves feel better. If we can't change the situation we are in, or the struggles we are having, we can change the way we feel. It takes some practice to learn these skills, so be gentle with yourselves.
Using imagery, you can create a situation or a scene that is different from the one that you are now in. In a way, you can leave the situation. Envision in your mind a place that you would like to be - a safe place, a relaxing place, a beautiful place. Focus on this place. Relax, and let yourself feel that you are in this place. It usually helps to notice details of the place that you are in. See that safe place, maybe a room, that is fixed up just the way you want it. Or imagine that spot along the ocean, or being with a good, safe friend.Imagine things going well for you. Imagine that you know how to take care of the situation you are in. If you practice doing this, you will find that it begins to work for you. Things DO go better, and you CAN cope better. You can deal better with the crises in your life, if you practice feeling like you can take care of things.Create a safe, comfortable place for yourself. It will help if you do this in a quiet room or a quiet spot outdoors. Try to relax, and close your eyes if you feel safe. Settle into this comfortable, safe, beautiful place. Let your hurtful feelings drain or wash out of you, relieving you and making you more comfortable. Breathe slowly and gently as you do this.An image that I use is floating in Cape Cod Bay, with the sun shining and the waves gently bouncing me around. This makes me feel very peaceful and safe. I try to feel the waves and see the sun and the sky as I am doing this.When I have a conflict with someone, I tell myself that I can handle it, that I can do a good job, keep my cool, and deal with the situation in a good way. I keep telling myself this, and imagining myself doing it. It helps me to handle the situation effectively.
This week, try out Imagery as a way of improving the moment.Picture a place in your mind where you feel good and safe. Look at what is around you. This may be a cozy room, an outdoor spot, a place with a friend. When you feel distressed this week, picture this place. Hold on to the image. Feel yourself there, safe and comfortable. Stay there as long as you need to.How does it make you feel?How does it affect your feelings in the moment?If you are having a problem or conflict, picture yourself dealing with it effectively. Tell yourself that you can handle the situation.How does this affect how you actually handle the problem, or conflict?These skills need to practiced when you are not in a crisis, in order to be effective during a crisis. Try to practice for at least a few minutes each day.
Some of the techniques for improving the moment are cognitive techniques, that is, changing our feelings by changing how we think about ourselves and our situation. The way we think about our situation and ourselves in it has a lot to do with how we feel.Finding or creating meaning can be very helpful. It is not always easy, and may take some time and work, but it can be very helpful and comforting in a difficult situation.Finding meaning is like making lemonade out of lemons, which Marsha Linehan talks about in the manual. Making lemonade out of lemons involves taking some things not very tasty, sour, and doing something with them (squeezing them and adding sugar and water to the juice) to get something that is very tasty. This concept can be hard to accept. I know that in my early days of DBT, I wasn't very happy about this idea. But if you think about it, you can think of other situations where you "make lemonade out of lemons," make something good out of something not so good. And we do this to make ourselves more comfortable, to turn a bad situation around.Think about:
· being snowbound
· being stuck in the mud in your friend's driveway
· burning a batch of cookies
· losing the money for your Christmas gifts
What could you do to turn those situations around?
There are a number of ways that we can find or create meaning in our difficult situations. I will tell you of an experience I had several years ago. I had been in a several month long depression that didn't seem to be going away. I felt desperate and hopeless. My DBT instructor suggested that I try to find some meaning in my situation.In doing this, I read the book "Man's Search for Meaning" by Viktor Frankl. Frankl was a psychiatrist who survived a Nazi concentration camp and wrote about his struggle to find meaning there. This book can be very helpful to people struggling with this question, and it was very helpful to me. I highly recommend it.What I came up with for meaning in my situation was that I was doing the best that I could to get through it. I said this to myself many times a day, "I am doing my best to get through a difficult situation," and it gave me hope and something to live for. Someone else in the same situation could have come up with something different.You don't have to believe that there is a purpose to your suffering. If you have religious or spiritual beliefs, you may feel this way. But if you don't, you can still create meaning or purpose in your suffering.
What do you think the meaning or purpose of suffering is?Do you think there is a meaning?How can you create a meaning?
· Try focusing on the positive aspects of your suffering.For example, are you seeing something more clearly? Are you learning something? Are you letting go of painful memories or feelings? Has this brought you closer to friends or family members? Are you preparing for a change in your life? Are you closer to nature? Have you discovered a book or a poem that helped you?
· Find something that you can change to something positive. Make lemonade out of lemons.If you feel like yelling, try singing, loudly. Focus your angry energy into art (big splashes of paint on paper), on sculpture (pounding clay), photography (taking pictures of what makes you upset or what reminds you of it). Write about your sad or angry or painful thoughts. If you need company, cook dinner for a friend or go on a picnic. Come up with your own ways to make something positive of your distress or a little piece of it.
· Remember that by trying to find positive things about our distress, we are not denying that things are bad, or trying to say that distressing things are not distressing. We are trying to Improve the Moment, to find some things that help us feel better in the moment.
· Remember, listen to or read about spiritual values. This may be religion - some of you may have a religious background or religious beliefs. These may help you to find some meaning in your distress. For example, "God is seeing me through this."There are other forms of spirituality. Some people find it in nature. You may be comforted, as I have been, by seeing that the natural world keeps right on going, no matter what happens.Others may connect with a cosmic being, a creative force in the universe, animal spirits, a higher purpose in life. Open yourself to whatever it is you believe and look for the meaning that it gives you, the purpose, the focus and balance.
· When you find something, or create something, that gives meaning to you in your distress, hold on to it. Say it over to yourself many times a day. You will find it comforting. Remember it if you should need it again.
rosmam