Distress tolerance skills help us tolerate distressing moments in our lives, by validating the distress while actively engaging in activities to ease it. One of the skills DBT prescribes is ACCEPTS. ACCEPTS is an acronym for active things we can do to support ourselves through these times.
A: Activities. Simply put, do something to get busy. Exercise, clean the house, engage in a hobby. Get moving! Do something that requires enough of your attention to distract you from your unpleasant feeling. In doing so, you’ll also feel productive!
C: Contributing. By giving our time and energy to others, we feel connected to our friends, family and community. This helps us build our positive emotions! In this pandemic, you may feel limited in what you can do. It’s important to remember that any little bit helps: shopping locally, tipping our delivery people well, video chatting with a friend who may be quarantined alone, sending a Venmo tip to our musician and comedian friends continuing to put their work out in the world. Now more than ever is a great time to contribute to others in any way we can.
C: Comparisons. This skill is a tricky one. On one hand, comparing ourselves to others can lead to negative self-image. We can feel scarce, rather than abundant in what we have. Comparison can also be problematic when we use it to compare suffering. All suffering is valid and warrants validation. Comparison, however, can be helpful when expressed from a place of gratitude. It can also be helpful when we compare ourselves to our previous selves, and recognizing the progress we have made.
E: Opposite Emotions. Actively do the opposite of what you are feeling. If you are feeling sad, watch a funny movie. If you feel anxious, do something that calms you down, such as meditation or gentle yoga. If you are feeling like you want to pull away from someone you love and trust out of embarrassment, fear, or shame, reach out to them.
P: Pushing Away. We do not have control over the first thought we have. Many of our thoughts are automatic. We do, however, have control over what follows our automatic thoughts. Our brain is incredibly powerful and can be used to reframe thoughts and use visualization to reduce unwanted thoughts and replace them with wanted thoughts.
T: Thoughts. Distract yourself with a positive thought. Say a prayer, count to 10, count your breaths, think about someone you love. Making a list ahead of time of our positive thoughts can also be helpful.
S: Sensations. Use a physical sensation to provide you with a distraction. This is helpful when we are feeling more dysregulated than usual; times when we feel we’ve tried everything in our bag of tricks, and nothing seems to be helping. Intense sensations, such as splashing cold water on your face, calms the brain for a brief period of time, giving us space to implement other calming tools. Other sensations can be taking a hot or cold shower, listening to loud music, or even listening to soothing sounds, such as rain falling or a meditation bell.
Taking care of our relationships is integral to our emotional wellbeing. But, we also want to care for ourselves in our relationships. By setting our boundaries and practicing self-respect, we improve our relationships and ourselves! FAST is an interpersonal effectiveness skill in Dialectical Behavior Therapy (DBT) that helps us do that.
Be fair to yourself by honoring your values and your boundaries. More importantly, don’t put others’ needs before your own. We have to be fair to ourselves and prioritize ourselves in order to be supportive of others.
Apologize when necessary, but don’t apologize when one is unwarranted. We apologize so often when one is not needed. Don’t apologize for your presence, for your opinions, or your thoughts. Rather than apologize when you don’t need to, express gratitude to the other person. (For example, instead of saying “I’m sorry for being late,” say, “Thank you for waiting for me!”).
S: Stick to your values
First, identify your values. Once you have identified what your primary values are, you can stick to them. Don’t abandon your values when in relationship with others. Honor your values – these are the things you feel shape your life! Values are important, and by honoring our values, we stay true to ourselves while in relationships with others.
Tell the truth! There is a saying therapists have: if a client is lying in session, they are lying to themselves. And the same might be true in our other relationships. Being honest in your relationships and with yourself helps honor others. It fosters relationships and builds safety in relationships.
How does the FAST skill work for you?
DBT provides many mindfulness tools. One of those tools is the Half Smile meditation.
The Half Smile meditation is a tool that can be soothing, silly, or comforting. It is a tool we can use to honor what we need in that moment.
What is the Half Smile Meditation?
The Half Smile meditation is a practice where we gently smile as we meditate. Here are the steps to practice the Half Smile meditation:
1. Sit in a comfortable position. You can sit with your legs crossed on the floor, or sitting in a chair with your feet firmly planted on the ground.
2. Start by taking slow breaths.
3. After a few breaths, and after you feel grounded into your seat, begin to smile. Do not create a full smile; rather, form a small half smile to the extent that you feel able.
4. Sit, half smiling, for as long as you wish.
Why the Half Smile Meditation is helpful?
Sometimes, we feel so sad that the last thing we want to do is smile. When we smile, however, we are sending a message of comfort and support to our brain. Thus, by doing a half smile rather than a full smile, we are engaging in an activity that might feel manageable when a full smile does not feel possible.
Sometimes, this activity can feel a little silly. And that’s ok! If you feel silly during this exercise, it might be an indication that you want or need a good laugh. Other times, a half smile can simply soothe and comfort us. With all mindfulness activities, participate in the activity and trust where the meditation takes you. Your only job is to notice what arises as you practice.
There are times in our lives when we have to ask for something, say no, or assert ourselves. And that can feel hard! Maybe sometimes we are interacting with a challenging person in our lives. Or maybe we struggle with regulating our own emotions when we have to have these difficult conversations.
DEARMAN is a DBT skill that helps us through these conversations. It is an interpersonal effectiveness skill that gives us a script for how to talk to others while respecting both our boundaries, and the person to whom we are speaking.
First, start out by describing the facts of the problem. And only the facts!
We scheduled a meeting for today, and you canceled our meeting 20 minutes before it started.
Simple, short, and only the facts.
Second, share your feelings about the situation.
I felt frustrated because I rearranged my entire day to meet with you.
I felt upset because I was looking forward to meeting with you.
I felt worried because I thought you had an emergency.
A: Ask, assert, or say no.
Next time, I need more notice before you cancel so I can rearrange my day.
In the future, can you let me know the day before if you need to reschedule?
Sometimes, this is simply saying thank you. Other times, it’s reinforcing the other person’s good behavior by modeling the behavior you want to see.
Thank you for being considerate of my time.
Thank you, and I will also give you the same courtesy.
Be present and focused as you speak. Don’t multitask. Focus your energy on being present to the conversation.
A: Appear Confident
This one can be hard! Remember that asserting ourselves can be intimidating. You are not alone in that feeing. Use the skills you have to appear confident in these conversations.
These conversations cannot be one-sided. If we ask something of others, we want to listen to their response as well. Sometimes, we have to negotiate with others. That’s part of being in relationship with others!
How to Maintain Healthy Relationships
Once we have established healthy relationships, it takes effort to keep them going. Relationships are not a “one-and-done” deal. Rather, relationships are like a garden: they require ongoing care, watering, fertilizing, weeding, and pruning.
DBT’s GIVE skill is a helpful tool in knowing exactly how to tend to our healthy relationships.
Approach others with a gentle manner. Avoid attacks and judgmental statements. When we approach one another in a manner of love and safety, we can make the most generous assumptions about one another before we even begin our conversation.
Act interested in what the other person is saying, without interrupting. This can be hard sometimes! If your spouse loves race cars, and you couldn’t even spot a race car on the street, it might be challenging to act interested in that topic. But, acting interested can involve asking questions to learn more, or even just taking time to learn about that topic as they speak.
Validate the other person’s thoughts, feelings, and wishes. Acknowledging and validating this allows one to feel heard, which increases our trust in one another.
E: Easy Manner
Have an easy manner. This allows you to connect more so that when something challenging arises when an easy manner might not be completely appropriate, we have built that security and trust with that person so we know we can sit in the challenge together. An easy manner can involve being lighthearted, smiling, going with the flow, or bringing a sense of humor into the relationship.
Like all skills, integrating these takes practice and awareness. Start by practicing with someone with whom you are close and intimate. If we can practice these skills with one person, we are able to generalize them to others in our lives as well.
We have two ways in which we think and process: emotionally and logically. While both are important, we cannot be completely logical, nor can we be completely emotional. When we are facing a challenging decision, or trying to figure out how to respond to a situation, it is important for us to integrate both our emotional mind and our logical mind. This is the skill DBT refers to as Wise Mind.
Emotion mind is the part of our mind that feels, loves, cares, gets angry, becomes passionate. Our emotions are powerful. With our emotions, we fall in love, we care for our pets, or we become activists about something we feel passionate. Our emotions guide us in reaching out to a friend we love, or caring for our family members. On the other hand, our emotions can be impulsive. We can act out in anger, only to calm down afterwards and wish we had responded differently. Our emotions are big, and when we feel them, they can be all-consuming.
Logic mind is the part of our mind that solves problems and processes the facts of a situation. Logic mind helps us make decisions based solely on facts, leaving out all emotion. Logic mind is helpful in that it can allow us to take a non-biased stance. But, operating only from logic mind is far from optimal because it disengages us from ourselves, from our loved ones, and from our communities. We can become robotic.
Wise Mind is the integration of these two minds. It is the optimal way in which we think and move through our worlds. Using our Wise Mind, we integrate both emotion and logic. Wise Mind is when we allow the hard hit of emotions to diminish, and we arrive at a grounded state of knowing. It’s the feeling when we know something deep in our gut to be the right thing for us to do. It is responding with both the calm, cool facts and the passion of our emotion.
Experiencing Wise Mind
According to Marsha Linehan, American psychologist and creator of DBT, states that we all have Wise Mind within us, we simply have to practice engaging our Wise Mind. Like any new skill, this takes practice! Here is one practice I use to engage my Wise Mind:
Riding the Wave of Emotion
This practice is actually its own DBT skill, but I find it helpful for engaging Wise Mind.
Imagine your emotion as a wave. It gradually, or sharply, rises. It hits its peak, and then it begins its decline. All of our emotions follow this trajectory. When I attempt to engage Wise Mind, I first notice where on this wave of emotion I am. If I am at the peak, this is not the time to make moves! Rather, it’s a time to move through the emotion.
When you start to feel your emotion rise, pause. Take a deep breath. Simply notice what you are feeling and thinking. Then, when you reach the peak of your emotion, repeat the practice. Finally, when you start to feel the decrease in the intensity of your emotion, notice what you are thinking and feeling. Once you feel that the intensity of your emotion has passed, your emotional wave has crashed on the shore, notice how your thoughts and feelings shifted between each of those phases. This practice helps us see how we engage our emotion mind and our logic mind, and once the intensity of the emotion mind has decreased, we can integrate the two.
Listen to our podcast next week for more information on Wise Mind, as well as a guided Wise Mind practice:
When you embark on a journey to support your mental health, the most important
thing we can do right from the beginning is to ensure we are caring for our
emotional vulnerability. Part of being a human being involves experiencing pain. If
we, however, integrate daily tools to support ourselves (especially as we expose
ourselves to some vulnerable things), the journey becomes more manageable.
This is where the DBT skill, PLEASE, is handy. This skill probably won’t come as a
surprise to many people. But, if we don’t use this tool, it can feel that much more
challenging, maybe even impossible, to feel to true effectiveness of other tools and
skills we might use to support our mental health. PLEASE is a helpful acronym to
decrease stress and improve our wellbeing.
PL: treat Physical iLlness
Take care of yourself when you feel sick. Visit your doctor if you need to. If we feel
sick, we feel increased emotional vulnerability (and not the helpful kind of
E : Eat balanced meals
Food is fuel. So eat to support yourself during the day. Eat nutritious foods that
make you feel good!
A: Avoid mood altering drugs
Now, I’m not saying a glass of wine at the end of a day is out of the question. You
can absolutely have your glass of wine, your beer, a cigarette - just make sure you
aren’t using them to excess, or that you aren’t using substances to numb your other
feelings. Everything in moderation.
This is a big one! Simply put: if you aren’t getting adequate sleep most nights, make
the changes you need to get the rest you need. create a bedtime routine, turn off
screens before you wind down for bed, and, if necessary, talk to your doctor. Sleep
is so vital for our well-being!
I like to say “move your body,” to reduce any unwanted connotations the word
“exercise” has. Whichever way you say it, get moving in a way that feels good for
you. The intention in exercising/moving your body is to reduce stress, boost the
positive mood-boosting chemicals, and feel more grounded.
Again, this skill covers those things we already know! But, it’s helpful to remember
that without these things, any other work we do to support ourselves can feel that
According to Dialectical Behavior Therapy (DBT), there are six core mindfulness skills.
Understanding these skills helps us become aware of the mindfulness skills we are already using
throughout our day. These skills are also helpful in making mindfulness more accessible – it
makes mindfulness concrete, definitive, and behaviorally specific.
1. Observe: Simply notice what’s happening. Notice thoughts, emotional feelings, physical
sensations, and anything else that is happening. Simply become aware and pay
2. Describe: Put words on what you have observed. Observe and Describe often happen
3. Participate: fully participate in an experience. Often, when we start to practice
mindfulness, we become distracted or engaged in another activity. Rather, if we fully
participate, we understand the full experience and how jt might be helpful for us.
Therefore, if you’re watching your favorite show on TV as a form of self-care, watch that
show with your full attention. If you’re practicing a mindfulness meditation, be fully
present and participate in that experience.
4. Non-judgmental stance: reduce judgments. This one is challenging, because we
naturally judge things as “good” or “bad.” This skill, rather, helps us reduce judgments
and focus on the facts. Thus, if you observe that you’re feeling tightness and discomfort
in your chest due to anxiety, a judgmental stance would be:
“I feel awful. This is embarrassing. Everyone is looking at me, and it’s just making
me feel even worse.”
Whereas a non-judgmental stance would be:
“My chest is feeling tight, and it’s making it hard to breathe.”
5. One-Mindful: do one thing at a time. As a culture of multitaskers, this one is hard! But
this is an important one to practice. If you are watching TV, then only watch TV. Don’t
also play a game on your phone or scroll through Twitter. If you are eating dinner, then
only eat dinner.
6. Effectiveness: do what works. If something isn’t working for you, or if something is
making you feel worse, then try something else. It is OK to move on from something if it
doesn’t serve you.
For more on these mindfulness skills, follow along on our podcast: Taproot Therapy: A Mindful