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#42: Distress Tolerance Overview Part 1

The Distress Tolerance skills in DBT offer creative ways to get through challenging situations without making things worse. Today’s episode is Part 1 of an overview of Distress Tolerance as a whole, with a special focus on change-oriented skills.

When emotional distress is high, there can be an intense desire to do something to make the distress stop. Very often, when we numb or distance ourselves from distressing emotions, we create new problems. The DBT skills discussed in today’s episode help you respond to hard emotions in ways that you won’t regret. These skills are also helpful when you need to get things done but you’re too overwhelmed to get started or think clearly.

Show Highlights

  • These skills help you get through crisis situations without making things worse
  • Don’t use these skills to solve problems or build the life you want
  • Checking in with yourself: what’s my distress level right now? Tuning in and knowing how you are doing gives you power and control to make different choices
  • These are all signs that your distress is rising: Heart beating fast, racing thoughts, tense muscles, shallow breathing, ruminating
  • Often when distress is high, the best action is no action
  • Reach for TIP skills when you are most upset
  • Distraction can be incredibly helpful and necessary when distress is high
  • Distraction won’t solve problems, but it gives you an opportunity to calm down enough to think about using other skills
  • Using your mind to get out of your mind
  • Contributing is a way to distract, and you get an added bonus of feeling good about helping others
  • Using the 5 senses to both distract and comfort yourself sends yourself the message that you are worth taking care of and being kind to

DBT Skills Discussed

Links & Resources

SUDs (Subjective Units of Distress) scale

Ask us a Question

We’d love to hear from you! Where are you getting stuck with your skills application? Ask us a question for the chance to have it answered on the podcast. Submit your question here. 

Please note that questions, and this podcast in general, are not a substitute for individual mental health treatment.


#42: Distress Tolerance Overview Part 1 Transcript

Marielle Berg 

Hello and welcome to The Skillful Podcast where we explore DBT and RO-DBT skills to help you reduce emotional suffering, improve your relationships, and become more present in your life. I’m your host, Marielle Berg, a psychotherapist at the Bay Area DBT and Couples Counseling Center.

Marielle Berg 

Hi Ed, how are you doing today?

Ed Fowler 

I am doing good. I’m looking forward to talking about Distress Tolerance.

Marielle Berg 

Me too. In today’s episode Ed and I are going to be taking a deep dive into Distress Tolerance. I know we’ve talked about these skills quite a bit on the podcast and went into or have gone into a lot of detail with specific skills. But we thought it might be a good time to kind of review when and why we use Distress Tolerance, and when not to use Distress Tolerance skills.

Ed Fowler 

I think this is helpful to think about Distress Tolerance, not just the specific skills, which is most of the episodes we’ve done on Distress Tolerance have been here are specific Distress Tolerance skills, here’s how to use them. And I do think it’s helpful to think about Distress Tolerance in the big picture. Where does it fit? When When is it helpful to use Distress Tolerance? When is it maybe not helpful, and you want to use some other set of skills?

Marielle Berg 

And in general, I think of Distress Tolerance as the skills we turn to when our Subjective Units of Distress our SUDs scale, which we will link to in the show notes, rises. Or maybe an easier way of saying this, for folks who are not familiar with the Subjective Units of Distress scale, is that we use these skills the more emotionally distraught we feel.

Marielle Berg 

So if you’re feeling pretty okay, or maybe just a little mildly irritated or upset, you likely don’t need Distress Tolerance skills. But as you get more upset, frustrated, angry, sad, overwhelmed, that’s when we want to start thinking about using skills to help you get through.

Ed Fowler 

We talk a lot about this concept of trying to make decisions and take actions from our Wise Mind, which is the balance of our Emotion Mind and our Reasonable Mind. And so Distress Tolerance is when we can’t access our Wise Mind, our emotions are way too strong. And in order to be able to think clearly to make balanced decisions, where we’re listening to our emotions, and also paying attention to facts and logic and that kind of stuff. If our emotions are too high, we can’t do that. And so we use Distress Tolerance to get back to Wise Mind.

Marielle Berg 

For folks who have not done DBT, but who may have done other types of therapy, they may have gotten the message that you just need to sit with hard feelings, you just need to tolerate it, which is it’s true, of course, in many ways. But the DBT skills give you something to do and give you different ways to approach being with those hard feelings. Because for many people, just being told, tolerate it, or if you’re feeling sad, just be with it, isn’t that helpful. Because if they knew how to be with it, then they would.

Ed Fowler 

Right. I think it can be a really common thing to say, you know, just notice your feelings and be with your feelings. But if our feelings are really intense, really painful, that’s just going to feel more intense and more painful. And so the Distress Tolerance skills really are about when we’ve been with our feelings and they’re too much. And we need to like distract ourselves, take our mind off it, do something to help strong emotion come back down, rather than just being with something really painful.

Marielle Berg 

Yes, and so the skills aren’t about ignoring the problem or the feelings or denying it in some way. But they are about finding alternative ways to manage when those painful feelings feel unmanageable. And we have Distress Tolerance skills that are more change oriented, and Distress Tolerance skills that are more acceptance oriented.

Ed Fowler 

So just to kind of review a little bit, the change oriented skills are what we call in DBT the crisis survival skills. So skills that we use when we’re in a crisis situation, when our distress is really overwhelming.

Ed Fowler 

One thing is to notice, like we are in this kind of crisis situation, when we’re in a situation that is highly stressful, it’s short term, it’s not something that’s going to be ongoing. And it creates intense pressure to resolve the crisis now. This is where that impulsivity aspect can be really strong of like, I am feeling extreme emotion. And I want to make this go away as quickly as possible.

Ed Fowler 

So those kinds of situations, if we just act on that, then we end up doing things that are not going to be helpful long term. Maybe it’ll make the emotion go away, but we’re going to regret what we did in the long term. This is where, you know, behaviors like substance use, or yelling, or breaking things, or just completely shutting down and going under the covers and not doing anything, that’s not really going to be helpful long term, but it may help short term. We need something else in those kinds of situations.

Marielle Berg 

Yes, and so just to add to that, so we use these skills when you have intense pain that can’t be helped quickly. And you have again, as you just said, that strong urge to act. And know for myself, that when the more certain I feel that I am right in taking an action, the more I need to wait and pause.

Marielle Berg 

So that kind of certainty can often come with Emotion Mind, when distress levels are high. Like I must send that angry email now, I have to tell this person off, I need to take some action immediately to sort of let the emotion be expressed. But very often that is coming from an Emotion Mind place and not from a Wise Mind place, so you get immediate relief. But long term, as you said, and it doesn’t really solve any problems. And very often, then you have new problems to deal with.

Ed Fowler 

Exactly. And so that’s where we want to have things to do so that we’re not acting from that really reactive place.

Marielle Berg 

And another time to think about using Distress Tolerance skills, or when you’re feeling totally overwhelmed. But you still have to do things, like you still have to show up at work, or take care of the kids, or whatever kind of tasks need to be done. But you’re feeling too overwhelmed or too upset, and you don’t even know where to start. So you can use these skills to help kind of calm your system down enough, so then you can focus on doing what you need to do.

Marielle Berg 

Because for some people, or maybe for many of us, when Emotion Mind gets really strong, there can be a desire to avoid doing things. For other people, they might dive into work more, get hyper focused or hyper busy as a way to distract. And of course, there is some usefulness in distract, which we’ll talk about in a minute. It’s actually one of our big skill sets in Distress Tolerance.

Marielle Berg 

But I just think it’s worth noting, and for listeners to think about, that when you get more upset, you tend to avoid what needs to be done. And if so, think about using these skills. We don’t want to use these skills to try to solve life’s problems. These skills are not going to help you improve your relationships, or build what we call in DBT a life worth living, build the kind of life you want. These skills help you get through crisis situations without making things worse. And if you have done that you have succeeded. That’s it.

Ed Fowler 

And that’s it. Like it’s really, like Distress Tolerance is about, can I get through this present stressful situation. And where I hear people struggling, is when they have big picture things that they need to deal with and they’re using a lot of Distress Tolerance. It’s like well, that’s not going to solve problems. Problem Solving is very specifically an Emotion Regulation skill.

Ed Fowler 

And I also hear people struggling when they’ve got a big problem to solve. And they’re really trying to figure it out and think about it. And they’re getting more and more stressed and more and more anxious, and they can’t think clearly and they don’t know what to do and they just want to give up. It’s like okay, Emotion Regulation isn’t going to help here. Problem Solving isn’t going to help. You need something to let that stress come back down so you can be in more balance, think more clearly see a bigger picture. Distress Tolerance is about noticing, oh, I am too stressed right now to do anything other than let the stress come back down. And if I don’t do something while I’m letting the stress come down, the stress is going to stay high. I’m going to feel really overwhelmed.

Marielle Berg 

And let’s talk a little bit more about the noticing part because that is really key. I think it can be common to not notice how stressed are upset we are. So sort of after the fact, too, maybe we’ve done some kind of behavior that we’re trying to stop, or that we wish we could take back. And then we realize like, Oh, I was not in my right mind when I did that. Or in DBT terms, I was not in my Wise Mind.

Marielle Berg 

So just the act of regularly checking in with oneself, and saying, or asking, like, how am I doing? What’s my stress level? Like, what are my emotions doing? How do I feel? Is really the first step in thinking about when and how to use Distress Tolerance. And I see this being so helpful for the people I work with.

Marielle Berg 

It’s sort of like a, you know, a regular taking of your temperature, your emotional temperature, how am I doing, because if you can do that regularly, and check in and notice, you’ll begin to become familiar with what it looks like for you, as you go from being just mildly upset or irritated, to more moderately upset or irritated to more severely upset or irritated, you’ll see that distress level rise, and you’ll see what it looks and feel likes for you in your body. Because for everyone is a little bit different.

Ed Fowler 

Developing this ability to rate our distress rate, our stress level, and that’s what the Subjective Units of Distress scale is. It’s like zero to 10, what’s my stress level, as we develop that ability to tune in to like, oh, here’s what’s happening, my heart is beating fast. My thoughts are really racing, I can’t stop thinking about this thing that’s bothering me. My stress level is at like a seven out of 10. It’s really high.

Ed Fowler 

Instead of, oh, my god, I gotta figure this out, I’ve got to figure out what’s happening. I’m going to solve this problem, I’ve got to figure it out. And we don’t realize I’m going to seven out of 10, I’m not going to be able to think clearly, I’m not going to be able to solve this problem. Being able to check in and get that emotional temperature actually gives us power. Instead of Oh, my emotions are so overwhelming. I never know what’s happening, the ability to tune in and say, Whoa, where am I right now, oh, I’m going to three out of ten, I’m actually having a nice day. But I’m checking in anyway, just to build that practice, or, Oh, I’m an eight out of 10, I need to stop everything and deal with this or else, I’m not going to be effective. That ability gives us control instead of just being at the mercy of our emotions.

Marielle Berg 

So it gives us emotional control. So we have a say in how we respond, instead of just automatically reacting. And so you know that expression zero to 60. So many people feel that like they’re doing okay, and then they’re, you know, the most upset or angry they’ve been and they don’t know what’s happened to kind of in between.

Marielle Berg 

So if you regularly check in and know as you said, like the physical components can be heart beating fast racing thoughts, holding your breath or breathing shallowly, maybe your neck or shoulder muscles tense up, maybe you start having really negative ruminative thoughts about yourself or others or you feel really helpless or hopeless. I mean, we can have a whole list of things for some people, they go to a place more shut down and being feeling numbed out, really sort of dissociated. So getting familiar with what it looks like, and what it feels like for you.

Ed Fowler 

So what we’re talking about, it really does utilize one of the primary Distress Tolerance skills, which is the STOP skill, which is the acronym for when we notice a bit of distress, right, we Stop, Take a step back, Observe and Proceed mindfully. So that’s a big part of this checking in with where are our emotions right now is using the STOP skill of just noticing. I’m feeling elevated, I’m feeling frustrated, I’m feeling shut down.

Ed Fowler 

Let me stop, take a step back from what’s happening. And then observe and notice, oh, I’m feeling really stressed. I’m feeling tense. I’m feeling hopeless. I’m feeling shut down, whatever it is, and figure out what would be the mindful thing to do right now. Is it to use some more Distress Tolerance skills? Is it to totally put that project I’m working on to the side and take a break from it? What might actually help instead of barreling forward with our emotions and saying, I don’t know I guess we’ll find out what happens and then end up being like, Well, why why did I do that? Why did I react so strongly? We want to stop and choose how we act.

Marielle Berg 

Many times when distress levels are high, the best action is no action. You know, don’t do anything. Which might sound kind of confusing. But given all we’ve talked about in terms of Emotion Mind versus Wise Mind, those actions you’re going to take in that moment are very likely going to be from Emotion Mind. So don’t do anything. And wait.

Marielle Berg 

In a similar category to the STOP skill that we just discussed, we have what we call the TIP skills, which is an acronym. And the STOP and TIP skills I think of as sort of the 911 for Distress Tolerance, like the things you want to reach for when you are at your most upset. Because they’re, they’re what we need in the moment. So the STOP skill is like don’t take any action, kind of freeze in your tracks.

Marielle Berg 

The TIPP skills are about using your body’s chemistry to kind of or working with your body’s chemistry to sort of settle your nervous system. And one of the most effective, which is the T in the acronym for TIP, which is TIP, is to tip the temperature of your face with cold water. This can really calm you down fast. I know we have talked about this in previous episodes, which of course, we will link to again, in the show notes if people want to review these skills in depth. It might sound ridiculous, but an ice pack over your eyes or even filling up a bowl of very cold water, dunking your face and holding your breath for 30 seconds or so can calm down your nervous system pretty quickly.

Ed Fowler 

And then the I in TIP is for Intense exercise. So doing some sort of exercise just for a couple of minutes to get your heart rate way up. So that your body actually has to work to bring your heart rate back down. And that’s inherently calming, and kind of gets us out of like the, so often, fast heart rate is a part of being in a lot of distress.

Ed Fowler 

And this like does something where we have to like, our body has to work to bring that back down. And so just jumping jacks, running around the block, walking really quickly. Anything that you can do to get your heart rate up, can then give you that opportunity to kind of focus your attention on that exercise, so that you’re not thinking about whatever it is that was bothering you. And your body inherently is going to have to put a little effort, or a lot of effort into getting back to balance and more calm.

Marielle Berg 

Because when we’re emotionally distraught, there’s always a physical component. And that’s the expression, when we talk about emotions, when we talk about the feeling that is so often located in the body, but we don’t always attune to that. And so these skills, the TIP skills help you work directly with your body’s nervous system. So we have the cold water, ice pack, this intense exercise that you just mentioned, Ed.

Marielle Berg 

And then the P there’s two different pieces of the P in TIP one is called Paced breathing. And this is one I use all the time. And so some people I know are not fond of breathing exercises or might sort of feel like they’re going to hyperventilate or might need more kind of coaching or guidance through it. But if you’re okay, with working with your breath, you can think about using paced breathing was which is essentially just slowing down your breath.

Marielle Berg 

So breathing deep into your belly, kind of shifting yourself away from that more shallow breathing that can happen when we’re upset. And for some people, you might breathe shallowly, more habitually. And it can help to even put a hand on your belly. And think about when you inhale, sending that air all the way down into your belly and kind of expanding it. And breathing in during that deep belly breathing to a count of five. And then breathing out, ideally through your mouth, letting your belly deflate and having all that air come out, and exhaling to a count of seven. So you could also Inhale to a count of four and exhale to a count of six.

Marielle Berg 

The whole point is to elongate the exhale, that elongated exhale helps settle your parasympathetic nervous system, which is the part of the nervous system that helps us relax and rest. And one round of this, like that deep belly breathing and that slow, longer exhale is not enough, I would say you need to do, you know eight to 10 of these to begin to settle your nervous system. So don’t give up too quickly.

Ed Fowler 

And again, I think that this can really have a big impact. And and so it’s it’s worth it to give it a shot and try it out and one of the things that people will say about paced breathing that can make it difficult is if you have a lot of racing thoughts, it’s hard to focus on breathing more slowly, exhaling more longley.

Ed Fowler 

Paired muscle relaxation can be another aspect to add to the paced breathing, if you want to do this, where you’re tensing and relaxing muscle groups, as you breathe in and breathe out, to give yourself a little bit more to do while you’re doing the paced breathing. So basically, it’s you’re doing the same paced breathing, breathing in deeply, breathing out slowly. And as you breathe in your tensing muscles, it can be one specific muscle, like make a fist, or it can be all the muscles in your body. Or ideally, you kind of go through your body and tense your fists, tense, your arms, tense, your feet, tense your legs, you tense, as you breathe in, you relax as you breathe out. And so then oftentimes, people will find that this is more helpful, because there’s a little bit more to do than just simply breathing.

Marielle Berg 

And with all the skills we just discussed, again, they are not going to solve problems. And if you are super overwhelmed, they are not going to make you totally calm and chill. So because sometimes people feel like, well, I tried, you know, I tried the ice. And yeah, I feel a little better, but I’m still pretty upset. And that is to be expected.

Marielle Berg 

And that’s why I call them the 911 of skills. Maybe it’s like, you know, applying a tourniquet to a bleeding limb. You know, we want to, I don’t know if that’s the best comparison here, or analogy, but you you want to, to stop the bleeding, you want to bring down that high distress to something that feels a little bit more manageable, even though you’re probably still upset, so you can think more clearly about other skills to use.

Marielle Berg 

And if you’ve done that, or if you’ve succeeded in bringing down your distress level from like a 10 to an eight, with an ice dive or paired muscle relaxation, or you did a bunch of jumping jacks, great. That worked. And then we might want to think about using some other Distress Tolerance skills.

Ed Fowler 

And so that’s where we have a bunch of other skills that are much more active, that tend to be a really nice follow up to STOP and TIP. So the skill sets are Distracting. And we have a lot of suggestions, and we’ve done an episode about this, where you can look at lots of different ways to distract yourself, so that you’re not thinking about your worries, but you’re doing something to take your mind off of it.

Ed Fowler 

Self Soothing, which is basically distracting by really putting attention on enjoyable physical activities, using your senses, to soothe yourself looking at something that’s really relaxing to you. Listening to really soothing music, smelling something and putting effort into smelling things that are pleasing to you, using your senses as a way to soothe yourself.

Ed Fowler 

And then the other skill set is the acronym IMPROVE, which gives just a hodgepodge of other things to do. So that you have something active to focus on while you’re waiting for distress to come down.

Marielle Berg 

So let’s let’s talk a little bit more about distracting, because I think distraction gets a bad rap.

Ed Fowler 

Right?

Marielle Berg 

It’s like not okay to do to kind of like quote unquote waste time playing a video game or watching a show or a crossword puzzle or doing like, I mean, the list really is endless, in terms of what we could do to distract that is not harmful, and different people are going to be drawn to different things.

Marielle Berg 

And yes, if we use distract as a way of life, like a way to cope with life, every day, that will create additional problems. We won’t create the life we want. But distraction used intentionally when we are feeling emotionally upset or overwhelmed, is incredibly effective. And the thinking behind it is just that you move your attention away from the thing that is upsetting you to something else. It gives your mind and your body your emotional being a break from whatever is upsetting you.

Marielle Berg 

Because so often when something happens that’s upsetting, maybe we had a difficult conversation with someone, or we found out some really hard news or I mean the whole list of life’s challenges. We ruminate on it. We think about it over and over. It can feel really consuming. And so distraction is finding something else to focus your attention on. And it really can work wonders.

Marielle Berg 

It’s again, it doesn’t solve the problem, when you are finished distracting you, whatever distressing news you found out about is still there, or whatever difficult conversation you had with someone still happens. But it gives you an opportunity to calm down enough to begin to think about other skills to use. And you can get really creative with distraction, I mean, you can do anything that works for you.

Ed Fowler 

And again, sometimes it’s doing the thing you know, will hold your attention. So if you know, playing a certain video game is really going to hold your attention, and it will take your mind off of your worries. And that’s going to be a really helpful one. Sometimes it’s about stretching and doing something that you’re it’s going to take a lot of concentration, because you’re not usually using that one, like that’s not a go to. And so it’s going to take more concentration.

Ed Fowler 

Anything that’s going to hold your attention, anything that can get, you’re basically using your mind to get out of your mind, will help you again, not increase your stress by thinking about the things that are worrying you. But being able to like, think about something else, anything else, put your mind on something else, put your activities on something else, so that you get a break.

Marielle Berg 

And I want to just highlight a couple of important, you know, subsets of Distraction that we might forget about that can be really helpful. And one of them is Contributing. Focusing your attention on someone else, or something else helping out in one way or another. Because that can be such a useful way to get ourselves away from whatever’s upsetting us. So that in that way, it’s a distraction skill. But it also can have this added benefit, where we feel better afterwards. We feel kind of good about making that connection or good about ourselves, because we helped out a friend or we volunteered somewhere, or we did something spontaneously nice for a stranger or someone we care about. So we get the added hit of a, you know, feel good endorphins, so to speak. So contributing can be really, really useful as a way to distract.

Marielle Berg 

And another one that we might not think about is Comparisons. So this can be helpful, when you are feeling super upset. And you remember, other times when you have been super upset, and you got through. Like kind of comparing it, comparing yourself, or comparing how you’re feeling to a time when you felt differently. Because when we get emotionally distraught or upset, we can really get this tunnel vision and forget like, oh, last week, I was doing so much better. I won’t always feel this way. And of course, you can use comparison. And this can be a tricky one. But there are so many people in the world who are suffering in very intense ways. And this is not to minimize our own suffering. But to get some perspective, that can be a useful way to use comparisons to not in the like, Oh, what do I have to complain about? But just being like, Oh, I, you know, I want to feel grateful for what I do have.

Ed Fowler 

And so with with any of the ways that you might distract, we need to use them judiciously. Because for instance, comparison can be so helpful. And sometimes it won’t. Sometimes it’s like, oh, well, you know, like, my worries are nothing who cares? Why am I even worrying about this? That’s stupid. I’m so dumb. Why do I worry about things? And it’s like, okay, is that going to help you come down from really stressful thoughts? No. So that’s where sometimes these tools can be really valuable, and sometimes not.

Ed Fowler 

The advantage is, you can use anything to distract. Anything that will hold your attention while you wait for the distress to come down a bit, that isn’t going to make things worse. And so that’s where if you have particular behaviors, that you know, yeah, that’ll distract me, and I will feel so guilty, I will feel ashamed, I will regret what I did. That’s not a helpful distraction, and we’re trying to stay wise. But anything that you can use that will help you just occupy your thoughts occupy your attention, waiting for the stress to come down so you can come back to it more in Wise Mind and figure out what’s really going to help.

Marielle Berg 

And before we end for today, let’s just talk a little bit more about Self Soothing, because you mentioned that a short while ago Ed. So Self Soothing is also a distract skill. But as you said, we are using our five senses, to distract our attention away from the thing that’s upsetting us. And I feel like self soothing also has an added benefit where we’re kind of communicating to ourselves that we are worth taking care of. Kind of worth being kind to and worth being gentle with.

Marielle Berg 

So you know, again, you can think about, you know, smelling something like flowers or lavender, you know, a scented candle or soap or tea or coffee, anything that’s pleasing to you intentionally going and taking a whiff of that. Being out in nature and absorbing smells, if there is nature nearby and easily accessible, you can do it with taste, eating a small piece of something that’s really delicious. You can you do it with touch, you know, a soft blanket. And they slow motion or you know, a foot massage, I mean, the again, the list is really sort of endless with you can do it with sound. So, you know, music is a great one for this. Singing, if you can hold a tune, which I can’t. And of course, with sight, looking at anything that you find pleasing.

Ed Fowler 

And so again, the point is, rather than sitting and focusing on what you’re stressed about, or rather than feeling stuck, because sometimes when we’re really distressed, we just feel shut down. And rather than just feeling shut down and unable to do anything, doing something that’s going to be soothing, both distracts us, and also has this added benefit of it’s something pleasant. And again, it’s whatever works for you.

Ed Fowler 

So figuring out what are your go to things, and where might you stretch? So for me, like I know listening to music can be really soothing. Drinking, something that’s very flavorful, can be soothing. I don’t use my sense of smell a lot for self soothing, and so if I need something to mix it up, getting a candle and smelling a candle or going and trying to like smell a bunch of different lotions, may be something that I would reach for, so that I know it will hold my attention a little bit more.

Marielle Berg 

That’s interesting. I like that, thinking about like, what are you drawn to, and maybe trying a different sense. Just to expand your your options. I definitely use a sense of smell quite a bit like, I love the smell of fresh coffee. And I mentioned lavender earlier because I love that, we could do a whole list of all the smells that I like, but I actually don’t use music that often. So that’s one maybe for me to try out.

Marielle Berg 

But so just we, just for listeners to be thinking about what senses do you tend to go towards and not eliminating them from your list of things to do when you’re feeling emotionally overwhelmed, but maybe again, adding things to your toolbox, maybe you want to try out looking at things that are pleasing, like works of art online, or flowers or anything that you find attractive, so maybe using a sense that you don’t use that often.

Ed Fowler 

So there are a lot of other Distress Tolerance skills that are focused on acceptance. And we’ll talk about those in a in another episode. And we also want to talk in more detail about when not to use Distress Tolerance. But for now, I would say I think it’s helpful to think about noticing your own levels of distress. So you’re getting more used to being aware of where am I in terms of stress level, and thinking about if my stress is really high? What might I do with these really active skills, again, trying to get to your stress level being low enough that you can think clearly and that’s our goal. So playing with that a little bit and then we’ll talk in more detail in a later episode about ways to use acceptance for Distress Tolerance, and when not to use Distress Tolerance.

Marielle Berg 

Alright, until next time.

Ed Fowler 

Thank you.

Marielle Berg 

Thanks for listening to today’s episode. To learn more, or if you’re in the Bay Area and want to get started with therapy, you can find us online at bayareadbtcc.com. That’s BayAreaDBTCC.com.