Skills for a Psychiatric Pickle* (*dilemma) – Rapping about DBT

In DBT (Dialectical Behavior Therapy), we learn that if you can solve a problem that is distressing you, then problem solving is a great place to start.  But what happens when you find yourself extremely stressed out by a situation over which you have no immediate control or way of resolving?

We encounter situations like this all of the time, and they often involve waiting for results, waiting on another person to act, or something major that has happened that is completely beyond our control.

The DBT Distress Tolerance skills can come to the rescue when you’re in what I call a “Psychiatric Pickle*” (*dilemma).  These skill are also known as “Crisis Survival Skills” are are designed to be used when:
  • Your goal is to keep from making things worse for yourself (i.e. to avoid sabotaging)
  • You cannot change the situation at this time and need to somehow tolerate the distress that this is causing
In her video series, From Chaos to Freedom, Dr. Marsha Linehan teaches that these skills are highly effective in helping us to feel better and make better decisions when we are highly stressed and need to get through the moment.
One set of Distress Tolerance Skills is Distraction.  You can remember these skills by the acronym ACCEPTS:
A – Activities (reading, exercise, hobbies, cleaning, go to an event, get together with friends)
– Contributing (volunteer, do something nice or surprising – doesn’t have to be big)
-Comparisons (compare current situation to one that is worse than you’re in now)
– Emotions (distract from one emotion by creating another, i.e. through music, reading, movies)
P – Pushing Away (imagine temporarily putting the situation in a box on the shelf)
T- Thoughts (distract your thoughts by focusing on counting objects or something else that takes your focus)
S – Sensations (hold an ice cube, taste a lemon, take a hot shower)
Somebody out there created this rather awesome rap about this skill set.  What do you think of it?

The important thing to remember when you are practicing the Distract skills is that you must allow yourself to become completely immersed in the skill that you choose. For example, if you choose the activity of reading, pick something that will really pull you in and keep your attention — the goal is to get the focus OFF of your problem temporarily — after all, what is the point of causing yourself more suffering by ruminating when you can’t do anything about the issue in that moment?
The next time you find yourself in this pickle, show yourself some compassion by reducing your suffering through these Distract skills.
Take a look at the list of ideas and jot some down when you are NOT in a crisis, as it’s much more difficult to come up with ideas when you are emotionally triggered or activated.  Do you naturally turn to some of these things, like your hobbies, exercise, cleaning, or putting on mood changing music to help when you’re feeling distressed?  What else helps?
Thank you for reading.
More Soon.
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