IMPROVE Skill (Distress Tolerance from DBT)

IMPROVE

IMPROVE the Moment is the next skill. The acronym IMPROVE makes life a little bit better when it is not going so well.

During a crisis, you have two options. You can sink into the distress or invest in behaviors that might improve how you feel in the moment.

The acronym

I: Imagery
M: Meaning
P: Prayer
R: Relaxation
O: One thing (or moment) at a time
V: Vacation
E: Encouragement

Imagery

Imagery is powerful because your mind can convince your body that you are elsewhere. A good example is being at the beach. When you’re actually sitting on the beach, your muscles are relaxed. When you imagine yourself at the beach (and you’re elsewhere), you can still get your muscles to relax, you convince your body that you are sitting there.

Ideas for imagery

Use an app or purchase a recorded guided imagery. You can also just use your own mind and create a guided imagery.

• Forest path
• Walk on the beach
• Favorite place
• Safe place
• Sunflower field
• Stroll by a stream
• Waterfall
• Garden of butterflies
• Sunset
• Star gazing
• Mountain summit hike
• Sitting by a campfire

Practice and enjoy the benefits! Also, imagine yourself doing well and practicing your skills.

Meaning

Viktor Frankl (1905-1997), one of the founders of existential therapy, once said “If there is a why, then a person can figure out the how.” [Look him up, his life was remarkable. He wrote the book “A Man’s Search for Meaning,” which is about being a psychologist in a concentration camp. He is well-known for this book, but he has several other accomplishments.]

List and contemplate your “whys” for working on any problem.

Examples: Why stay safe?; why practice your skills?; why improve your self-care?

Having meaning motivates you; your whys will motivate you to act.

Prayer

Prayer is a calming ritual, it also provides connection, guidance, and peace.

Pray where you are at, or go to your place of connectedness or worship. This skill is useful anywhere and at anytime. Connect to your spirituality.

Relaxation

Everyone needs relaxation. What do you do to relax? What do you think could be relaxing that you would like to try?

Schedule in some of those relaxing behaviors every day. Keep in mind that relaxing also takes practice.

Tips for practice: Be mindful of your breathing; be mindful of tense muscles and release the tension; sit in a quiet place.

One thing (or moment) at a time

Take on only one thing in the moment. When we try to juggle or do too many things at once, we become overwhelmed and or shut down completely.

Example: You don’t know how to make it through your day, but you know that you can make it through the next hour, or through the next 5 minutes. Focus on what is manageable.

Vacation

Take a break from your stressors or crisis. These breaks need to be planned, like scheduling a walk in the park in the evening, or watching your favorite movie before bedtime. Taking quiet time to reflect, meditate, or do deep breathing exercises are also good ideas.

Allow yourself to take a break when you feel that you need it.

Encouragement

You need encouragement during those tough times. The things that you say to yourself matter, they influence how you feel.

During your self-talk, say affirmations, coach, and cheer for yourself.

Write down 10 affirmations you can repeat to yourself throughout difficult times.

• This crisis will pass.
• I can do this!
• I have everything that I need to get through this.

Download affirmations to help get through a crisis here

https://finishstrongercounseling.com/2020/05/05/positive-affirmations-to-get-through-a-crisis-or-difficult-time/

Connoquenessing Valley Heritage Trail, PA

Wise Mind: ACCEPTS Skill (Distress Tolerance from DBT)

Wise Mind: ACCEPTS

The ACCEPTS acronym has skills that helps keep you busy and distracted when you would typically be preoccupied by a crisis. It is easy to dwell on what is going wrong, by focusing on the ACCEPTS behaviors, you can get yourself through hard times.

The acronym

A: Activities
C: Contributing
C: Comparisons
E: Emotions
P: Pushing Away
T: Thoughts
S: Sensations

Activities

Activities keep you busy and your mind off of problems and behaviors. The behaviors that you are focused on are healthy and helpful.

To start practicing this skill, write a list of activities you enjoy when life feels better. If you’re unsure or need ideas, go online and search for activity lists.

Add the pleasant activities into your schedule and mindfully do them.

Choose an activity and enjoy it now!

Contributing

Contribute to others. It is a way to take your mind off of your own problems, to feel connected and useful, and to create positive feelings.

Examples

Do a favor; acts of kindness; write a thank you note; bake brownies to share; volunteer locally.

Create a list of ways to contribute to others and begin right away.

Afterwards, journal about the experience, reflecting on your thoughts and feelings.

Comparisons

Draw healthy comparisons between yourself and others. There are people living without necessities, who have gone through tragedies, or who have tremendous obstacles to overcome. Remembering that other people are also suffering, often in worse ways, allows for you to gain perspective of what you’re going through. This perspective also increases your feelings of gratefulness.

Emotions

Emotions arise from the things we do. You can change your emotion by changing your behavior.

When you’re depressed, do behaviors that lift your spirits. When you’re anxious, do ones that are relaxing. When angry, do ones that are calming.

Check-in with your emotions in the moment, and if you find that you want change, then choose to participate in a healthy behavior to change your emotion.

Pushing away

Pushing away means that you decide to revisit the problem at another time. Imagine putting the problem in a box, locking the box, and placing it on a shelf for later.

Thoughts

You cannot think about two things at once, so choose to direct your attention to the most helpful thought.

Some ideas to try, crossword puzzles, read an interesting book, have an intriguing conversation, watch an action movie.

Do something to occupy your thoughts away from depressive thoughts, worries, and problems.

Practice in the moment.

Sensations

Direct yourself with healthy sensations.

Things to try, dance to loud music, eat a sour lemon slice, take a hot or cold bath, smell a strong scent, like peppermint.

These things wake up your senses in an invigorating way. Notice any changes in your experience.

Another idea, create a sensations toolkit, using your favorite ways to wake up your sensations. Use your tools.

Resource

Lane Pederson, PsyD, LP, DBTC

Occoquan Trail, Bull Run Regional Park, Fairfax County, VA

Distress Tolerance (DBT)

Distress Tolerance (Dialectical Behavior Therapy)

When people “cope” with stress and crisis, they find out ways (behaviors) that relieve stress, however, some of these ways come with heavy consequences. Examples of ineffective behaviors are drug and alcohol use, self-injury, gambling, spending money, and overeating.

We can learn distress tolerance skills to effectively manage the stress and crisis. These skills are more helpful than dealing with the consequences of the ineffective behaviors that make life worse.

Try it out

Make two lists, one is your ineffective coping behaviors, and the second is your healthy coping behaviors. If you’re struggling coming up with the healthy ones, keep thinking, because everyone has at least a few.

The goal is to work on eliminating the ineffective coping behaviors on the first list while developing the behaviors on the second.

This process is “doing more of what works”, replacing the ineffective with the healthy and effective.

Guidelines to improve distress tolerance skills

1. Practice the skills daily, even when you’re not feeling distressed. The skills tend to be enjoyable, so practicing shouldn’t feel like work.

2. Diversify the skills, try new ones, and practice every skill more than once because you don’t know which ones will “click” for you.

3. Organize a distress tolerance plan for when you’re in crisis and choose to follow the plan. It will keep you focused. Write down your organized plan on an index card. This would be your coping behaviors and any people who can provide support. Keep this card with you.

This index card plan works well for children while they’re away from home. Example: at school.

Distress tolerance skills to learn

• Wise Mind: ACCEPTS acronym
• IMPROVE acronym
• Self-Soothe skills: vision, hearing, smell, taste, and touch.
• Radical Acceptance
• Everyday Acceptance
• Willingness
• Bridge-Burning
• Ride the Wave: Urge-Surfing
• Grounding
• Pros and Cons

This is general information on distress tolerance and the skills to learn to better cope with stress and crisis, the next step is to learn the skills themselves, practice applying them, watch for improvements, and make necessary adjustments.

Wise Mind: ACCEPTS

https://finishstrongercounseling.com/2020/08/12/wise-mind-accepts-skill-distress-tolerance-from-dbt/

Resource

Lane Pederson, PsyD, LP, DBTC

Connequenessing Valley Heritage Trail, PA