“Teaching Notes

I. GOALS OF THIS MODULE (DISTRESS TOLERANCE HANDOUT 1)

Main Point: Distress tolerance skills enable us to survive immediate crises without making things worse, and to accept reality when we can’t change it and it’s not what we want it to be.

Distress Tolerance Handout 1: Goals of Distress Tolerance. This handout lists goals, not specific skills. Briefly review the three goals; provide enough information and discussion to orient participants to the module; link the module to participants’ own goals; and generate some enthusiasm for learning the distress tolerance skills. An important point is that crisis survival skills are needed for getting through crisis situations, but they are not intended to become a way of life. Over the long term, reality acceptance and problem solving have to be practiced if a client is to have a life worth living.

Explain the goals of distress tolerance skills to clients as follows.

A. Survive Crisis Situations without Making Them Worse

The skills in this module are ways of surviving and doing well in crisis situations without resorting to behaviors that will make the situation worse. They are needed when we can’t immediately change a situation for the better, or when we can’t sort out our feelings well enough to know what changes we want or how to make them.

Note to Leaders: If you plan on teaching the skills for addiction (Distress Tolerance Handouts 16–21), it can be useful here to define “addiction” as “any behavior you are unable to stop, despite negative consequences and despite your best efforts to stop.” Note that many repetitive behaviors qualify as addictions.

B. Accept Reality As It Is in the Moment

Acceptance of reality—of life as it is in the moment—is the only way out of hell. It is the way to turn suffering that cannot be tolerated into pain that can be tolerated. We can think of it as follows:

􀂄 Pain + nonacceptance = Suffering and being stuck

􀂄 Pain + acceptance = Ordinary pain (sometimes extremely intense) and the possibility of moving forward

Emphasize to participants that life is not all crisis. Although some clients may live as if their lives are a constant crisis, life in its totality is not all crisis. Living life as if it is always a crisis perpetuates the experience of crises, because it interferes with problem solving that will resolve problems over the long term; thus it can actually backfire and create more crises. At some point, therefore, we all have to experience and accept the lives that we have in front of us (so to speak). This is ultimately the only way to build a life worth living.

􀀹􀀃C. Become Free

We are truly free when we can be at peace and content with ourselves and our lives, no matter what circumstances we find ourselves in. In many ways, freedom is an outcome of mastering both crisis survival and radical acceptance. The crisis survival skills are the bulwark keeping us from giving in to cravings on the way to freedom. Radical acceptance skills produce the quieting of intense desire.

When we are free, we can look in the face of our cravings and desires and say “I don’t have to satisfy you.”

10. Distress Tolerance Skills: Distress Tolerance Handouts 1–2

Our intense emotions become like a passing tempest at sea, instead of a demand for action we must give in to.

Note to Leaders: The distress tolerance goal of becoming free is identical to the goal of freedom in practicing mindfulness from a spiritual perspective. The important point is that both mindfulness practice and reality acceptance practice lead inevitably to a greater sense of freedom. In a sense, mindfulness practice is a reality acceptance practice. If you have not covered this goal in teaching mindfulness, you can teach it now. If you have previously taught it, simply make the connection between the two sets of skills. (The teaching notes are very similar.)

From DBT® Skills Training Manual, Second Edition, by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan.

Permission to photocopy this material is granted to purchasers of this book for personal use only.”

This is where I began in January of 2018, 9 months after uprooting myself once again from all that was familiar. The main events of those 9 months will be covered in my book, along with my state of mind, rather, my state of mindlessness when I began DBT. Every day was a tight-rope-walk emotionally. I worked at being grateful, mostly that I had a roof over my head, though it was not where I’d hoped to live. Through my mindlessness I lost my housing voucher from New York and the long lists of people waiting for reasonable housing gave me one option, downtown Raleigh. I am still grateful to have a roof over my head besides my car. There are many not so well off.

DBT was like a foreign language in the beginning but I was told to practice, keep notes and a diary and it would become clear how DBT can benefit. I held out hope through the first months of twice a week therapy, homework I did not comprehend, diary cards to chart progress, meditations and mindfulness. Sometimes hope is enough to keep a body going, but this time my hope began to move me forward.

By the end of the first year I began to notice upsets upset me less, I no longer lived on the edge of an emotional cliff waiting for the first breeze to blow me away. I’d slowed down to a pace I could live at instead of always running about frantic that there was not enough time.

I have now been through the other three modules, emotion regulation, interpersonal effectiveness, and mindfulness twice each, and I will do one more year because all areas of my life have improved. I used DBT skills to help me be open to more family relationships, though the word family is and always has been, a frightening place for me emotionally.

I expect to have my book finished by the end of DBT