First Three Crisis Survival Skills: Accepts, Self-Soothe, and Improve
This week we begin the Distress Tolerance module. Distress tolerance skills teach how to tolerate the urge to act from emotion mind when experiencing intense emotions or a crisis situation. As opposed to emotion regulation, which changes our emotions, the distress tolerance skills help us weather the storm of things we cannot change, whether that’s forever or just in that moment. There are two types of distress tolerance
skills: Crisis Survival Skills (for the short-term) and Reality Acceptance Skills (for the long-term). This week we will be focusing on the purpose of crisis survival skills and covering the first three crisis survival skills: ACCEPTS, Self-Soothe, and IMPROVE.
Crisis Survival Skills:
The goal of the crisis survival skills is to help tolerate intense distress during a short-term crisis situation. Often when a crisis arises, we act from emotion mind, which can end up making the situation even worse. Crisis survival skills help us to tolerate the intense distress so that we don’t act on our emotions. These skills are NOT intended to fix a problem or make us feel totally better, but rather to lower distress enough so that we can then make choices that are driven by wise mind.
Distract with wise mind ACCEPTS:
Although the last few weeks we have been talking about using mindfulness to stay present and open to whatever arises in the moment, sometimes when we’re in a crisis, we need to distract ourselves temporarily so that we avoid dangerous or destructive behaviors. The purpose of ACCEPTS is to distract ourselves from the urge to act on an emotion while waiting for urges to come down on their own. Even though it may feel like intense distress and urges to impulsively react may last forever, intense emotions and urges always peak and then come down in time. Keep in mind that distracting does not fix situations and it does not make us feel better about situations, but it can be a useful tool to get through a moment of intense emotion without acting in ways that make the situation worse.
Activities: Engage in an activity that will capture your attention (read a book, watch TV, get on the internet, work out, call a friend, listen to music, play a game).
Contributing: Refocus your attention from yourself to others. Help someone in some way. As the Dalai Lama encourages, ask yourself, “how can I spread compassion and love?”
Comparisons: Compare yourself to those in worse situations than yourself or compare your present self to a time when you felt worse. This is not intended to elicit a sense of superiority, but rather think of this as a gratitude practice. What are you grateful for despite what is hard right now?
Emotions: Create different emotions by changing your activity. The goal is to generate opposite emotions through behaving in a way that seems contradictory to the emotion urge driven by the current painful emotion. For example, when you are feeling depressed, you may feel like withdrawing and staying in bed all day, but this behavior could perpetuate the depressed feeling. The opposite behavior would be to make plans with friends or family. If I am feeling down, I like to ask myself, “what is something that I could do that brings me joy?” Often times my answer is to FaceTime my 3 year old niece who lives in Montana ☺. What activities bring you joy?
Pushing Away: Push away or decrease contact with the painful situation. If you can, walk away from the situation or change your environment in some way. We don’t want to overuse this skill, but in a moment of intense distress, this can be helpful. For example, if you are about to yell at your child or partner, can you walk away and take the space that is needed to calm down before responding (vs. reacting) to the situation.
Thoughts: Fill your mind with other thoughts so that negative or upsetting thoughts cannot get in. Read, crossword puzzles, count to ten, name the colors in your room. This is similar to “Acivites” above, but this approach is focused on distracting through alternative thoughts vs. activities.
Sensations: Distract yourself with physical sensations. Extreme sensations, like taking the coldest shower you can, will be the most distracting. My favorite way to distract with physical sensations is the combination of a hard run followed by jumping in Green Lake. Or you can focus on utilizing your sensations to self-soothe (see below).
While ACCEPTS helps us to distract, the self-soothe skills are for comforting, nurturing, and being kind and gentle to ourselves through our physical senses. By doing kind things for ourselves, we can reduce our vulnerability to negative emotions and increase our resistance to acting on unhelpful emotion urges. Since it can be difficult to make choices from wise mind in the middle of a crisis or intense distress, making a kind of self-soothe “toolkit” when you are not in a state of crisis, can be helpful to have on hand if/when intense distress does arise. Below is an example of my own self-soothing sensations. (*hint do your best to practice your mindfulness skills by focusing your attention on observing the pleasant sensations of whatever self-soothing tool you are using).
IMPROVE the moment:
The purpose of IMPROVE the moment is to replace the immediate negative thing going on with something positive.
Imagery: Imagine something calming or peaceful, like your favorite place in the world, or a safe room full of comfortable things or people you love. Create a temporary safe space that you can go to. Imagine the painful emotions draining out of you like water out of a pipe.
Meaning: Find or create meaning in your life. Focus on whatever positive aspect you can think of that is coming out of the situation. As Viktor Frankl said, “he who has a ‘why’ to live, can bear almost any how.” Given he survived a Nazi concentration camp, I think he may know what he’s talking about.
Prayer: This can mean different things to different people. It may mean praying to a religious figure, the universe, or some other form of a higher power. It may also mean engaging in a loving-kindness meditation and offering yourself kind intentions (e.g. “may I find the strength to tolerate painful emotions”).
Relaxing Actions: Our bodies typically respond to stress and crisis through tensing in ways we may not even notice. We will be reviewing ways to downregulate our nervous system and release that tension next week (i.e. TIPP skill), but until then do whatever you already know helps to relax your body. And if you can’t think of anything, just BREATH.
One Thing at a Time: Remember that we only have to survive this moment. At times of intense emotions, we can begin to think that our entire lives are falling apart, rather than experiencing just this one crisis moment right now. We may have multiple problems having occurred in the past and/or occurring in the future, but the key to tolerating right now is remembering that we only have to survive this ONE moment. Remind yourself that “this too shall pass” because the only constant is change.
Vacation: Although a week long vacation to Hawaii is not always possible (especially right now!), you can still take breaks. It might be 10 minutes or 2 hours – take whatever time is needed and feasible for you to regroup. The key is to do something that you know is rejuvenating for you, whether that is taking a nap or doing something active.
Encouragement: Talk to yourself the way you would talk to someone you care about who is in crisis or the way you would want someone to talk to you.
As we are currently living amidst multiple individual and societal crises, I hope that the next time you are feeling overwhelmed, practicing ACCEPTS, Self-Soothe, and/or IMPROVE will be helpful to tolerate whatever difficulties you are experiencing in the moment. As we will be covering a lot of skills in the coming weeks, I also encourage you to take note of which skills (or parts of the skills) are effective and/or not effective to start developing your own personalized DBT skills toolkit. And remember, mindfulness is always the foundation from which we aim to practice the DBT skills -- with present moment and nonjudgmental attention and awareness.