 Hi, and welcome back. Today I'm going to do a kind of skill based session which is using one of the sets of skills from Dialectical Behavior Therapy or DBT. Now we can go into the ins and outs of what that is and what it's for another time, but I wanted to talk today about Distress Tolerance Skills just because I think there's something that's kind of useful for everyone to be honest and they are something I'm having to use a lot personally at the moment because I am going through therapy for PTSD, Post Traumatic Stress Disorder, and it's bringing up a lot of difficult stuff. So I've been reminding myself of the Distress Tolerance Skills and I just kind of thought as I was doing that this is a really useful thing for people to know about. If you want to know more about DBT this is kind of the big bad guide, bad in a good way like bad, and yeah really worth looking up. There's also a kind of manual of worksheets and stuff that goes alongside it, but I think that's in the house and I'm in the shed and it's raining like you wouldn't believe outside, so you'll just have to believe me on that one. Anyhow so today I'm going to talk about Distress Tolerance Skills. Now Distress Tolerance is kind of as it sounds, it's basically about finding a way to manage with a really really difficult emotion or feeling or thought that's with you in order to kind of get through that thought, that feeling, that emotion to a point where you can then kind of move on, carry on with your day, begin to kind of perhaps if you need to think through that thought and manage it in a different way, but it's essentially these Distress Tolerance Skills are for the point at which everything becomes overwhelming and you feel like you can't manage anymore. Now DBT is absolutely full of acronyms and I don't know sometimes it feels like they're thrown in there just to confuse people like me who are dyslexic and struggle with spelling and all that kind of thing, but they can be kind of helpful. So today I'm going to talk to you about the Accepts acronym. Now for those of you who might find spelling as hard as I do, Accepts has two C's. So Accepts stands for Activities, Contributing, Comparisons, Emotions, Pushing Away, Thoughts and Sensations and I'm going to go through each of them in turn. I'm going to give you a little bit of an idea about what each of those skills is about and then the best thing really is to then go away and give them a go whether it's for yourself or working with someone else. But as with so many different kind of skill-based therapies, this is only as good as you make it. So it's about getting these ideas, using them as a starting point and then actually thinking how can I adapt this for myself, what might work, what might not and then going away and giving it a try. And as ever, planning during times of calm, during times when you're feeling quite collected and able to manage for the times when things might be more difficult so then you can draw on those skills having practiced them and a time of relative calm. Okay, so I hope that makes some kind of sense. So, accept. So we start with A, which is activities. Activities is just literally about preoccupying your mind, using something to help you get through this difficult thought, this difficult feeling, this overwhelming emotion by essentially getting on with something else. You might go walk your dog, go jump on the trampoline, you might paint or draw or sing. These are our kind of healthy coping, healthy managing strategies. So any activity which you find enjoyable or helps you pass the time in order to help you just to get through that moment. So that can be absolutely anything and that list is going to look different for different people. For some of us, those will be very, very kind of heavy exercise, engaged activities because we really need that in order to draw ourselves away from what we're thinking about. For other people, it might be something a bit more mindful, you might be something doing something more meditative like mindfulness or yoga or writing, for example, it really depends on you and it might change from situation to situation. Okay, number two, C is for contributing. Now, this is based on the idea that often we can feel a lot better if we take time to do something nice for someone else. And so this is where we're thinking about performing acts of kindness, doing something kind, contributing in some way. So we're giving ourselves that kind of sense of work. Again, there are lots and lots of different ways we can do that. We can do that by looking after plants or a pet. We can do that by engaging with voluntary activities. We could do that by listening to a child read. We could do that by calling in on a neighbor who might be lonely, lots and lots of different ways. But essentially thinking about what is a small kindness that I could do that would feel like it was helping someone else. And that can again really draw our mind away from the difficult things that we're experiencing in that time and really replace it with something quite positive instead. The next C is for comparisons. And this one is one we have to be careful with. So comparisons is about trying to put this moment into some sort of perspective and context. So it's when you are feeling like the world is absolutely ending that you've never felt this bad before and there's no way you can possibly get through this minute. And this is something I struggle with hugely. It can feel like that if you are really panicking if you struggle with any kind of anxiety disorder, or if you struggle with with flashbacks, or if you're the kind of person who struggles with dissociation, there's lots of different things that might happen. That mean that in that moment, this feels like the worst anything has ever felt. And in those moments, what we're trying to do is to draw comparisons. It's helpful if we can do the comparisons with ourselves at another time and remember that you got through every other minute like this every minute up till now, you have managed. And so remembering putting this minute in that perspective and saying, okay, this is really hard, really hard. But actually, it's felt this hard before. And yes, it was hard to manage but I got through. And also then thinking about how things might feel a bit later as well. So remembering that it's unlikely, if not impossible that my body can maintain this level of distress for a great long period of time. So what I need to do is to find a way to manage this minute, the next minute and the minute after that until things begin to calm. So drawing comparisons like that can be really helpful. Sometimes people find it helpful to draw comparisons with others as well. And so you might think about other people who have managed in other situations and it can be inspiring to think about people who've overcome adversity, to think about other people who maybe have experienced something similar to you. So I sometimes find, for example, so part of the issues that I deal with is having suffered a violent rape. And sometimes I find that hearing from other people who have also experienced that and they found it really difficult to get through the thoughts and the feelings that come out of that has been really helpful. Likewise, I've recently started a new therapy called EMDR. And that has left me feeling, yeah, it's been really tough. But again, having people come to me and say, yeah, I found that really tough too. The first few sessions left me feeling like I really couldn't manage. But actually, it got better. You will get your life back. It's worth persevering with it. So for me, those comparisons have been really helpful too. What we need to be a little bit careful of here is not to think that we're not good enough because other people can manage and we can't. Okay, so we're accepting, I'm finding this hard right now. And I'm trying to find a way through. And we use comparisons where they're helpful. But as soon as we start using them as a stick to beat ourselves with, then that's time to stop. But so giving things a bit of perspective with those comparisons. Okay, E, the E is for emotions. Now the idea here is that we want to try evoke the opposite emotion of whatever one we're feeling. So if we are in a stage of heightened anxiety, we want to try and find activities that help us calm. Again, these will be different for everyone. But for me, things that might help calm might be walking. It might be playing the piano or listening to a playlist of calming music. It might be burning scented candles or having a bath. So any of those kind of calming activities, some people find, you know, yoga mindfulness, it really just depends on you. But essentially, you're saying, Okay, I'm really anxious. I'm really, really anxious. What is the opposite of that? How can I evoke the opposite feeling and try and bring myself down from that anxiety? I'm trying to evoke calm. And again, we might use things like our box breathing techniques, trying to get our breathing really, really regulated and in check. You might be feeling sad. So you might find that you're feeling unbearably low and sad. And in that instance, then we're thinking, right, how do I evoke happy feelings? And that can feel quite tricky, because sometimes you want to kind of wallow and sit with the sadness. But actually, if we want to try and move past it, doing things like I don't know, watching some comedy. So one of my really good friends, Rachel Paris is a hilarious comedian. So I sometimes watch clips of her on YouTube, for example, if I want cheering up, or I might listen to upbeat happy music, music can really help to like, change us from one mood to another, just think carefully about the songs that you pick. You might find that, you know, I don't know, watching YouTube videos of cats or puppies is the thing that makes you happy or reading one of your favorite children's storybooks. Again, it's what works for you. But the skill here is in thinking, what's the emotion that I'm feeling right now, recognizing that emotion, and then thinking, what activities could I engage in that would flip that emotion on its head and try and switch me out of it and turn me into into feeling a different emotion. So that's the skill here is trying to turn that emotion over. Okay, next is P. Still keeping up with the spelling because I have a list to help me. Okay, P is about pushing away. So pushing away is a bit of a different skill. So this is about saying, wow, I am feeling this and it is horrible. I'm going to give myself permission to actually leave that over there for now. And sometimes it's that we want to be able to kind of fence that feeling for now and say, Do you know what? It's really inconvenient for me right now. So I'm having to do this quite a lot. Sometimes it's really inconvenient for me right now to be having vivid flashbacks of the time when I was raped because I am trying to hold a conversation on the phone or I am trying to have breakfast with my kids or whatever it might be. And so actually giving myself permission say, I'm going to push away those thoughts and feelings. I haven't dealt with them and managed them so they're likely to resurface, but I'm going to manage them at a different point in the day when it's a bit more convenient. Now this sounds completely ridiculous. It sounds like it won't work, but do you know what it really does? And the more that you practice it, the better it can help. So I had a great difficulty for a long time dropping my children into school because there was, again, to do with another trauma. I found that seeing young children at the nursery school was something that evoked very difficult feelings for me. And as I would be walking past the nursery, dropping my children into school, I would start to get this huge, huge range of different thoughts and feelings that I couldn't manage. And so I worked with my therapist on it and we decided, right, do you know what? It's okay to experience those thoughts and feelings, but it's a really inconvenient time. You want to get through the school drop-off. So actually it's about saying, okay, I acknowledge these thoughts, I acknowledge these feelings and popping them over here, I'll return to them later. And actually sometimes it's about returning to them later and discussing them with someone who you trust, like your counselor or therapist if you have one. But sometimes it's just about finding a safe space later when you can manage that, when you're out, you know, walking your dog or when you've got paints or music or whatever it might be to help you manage those feelings. But saying, pushing it away for now, just pushing it out of my mind. So pushing away, fencing it off. Okay, tea is for thoughts. Now, this is about sort of the idea that a busy mind could help distract you from the thoughts which are in your mind that you don't like. So this is about trying to kind of replace, replace the thoughts that you're having with other stuff. So this might be counting down from a hundred backwards, or if you're really gonna that counting down from a hundred backwards in threes, or reciting the alphabet, or remembering your French verbs, or doing a Sudoku puzzle, anything that completely occupies your mind in a way that means it's very difficult for those thoughts to really take grip. And again, what you choose to do can be anything, but the idea here basically is I'm going to do something really mentally taxing, because if I'm doing something mentally taxing, those other thoughts, those other feelings, they're going to find it really hard to purchase because, you know, they take a lot of thinking about. And right now, I'm just really busy trying to work out what number to put on my Sudoku grid. Sudoku, Sudoku, I don't know how you say it. Anyway, you know the numbers thing, whatever it might be for you. Jigsaw's is another one that's good for that if you do a really complicated jigsaw or crosswords. Anyway, whatever works for you. Are you getting the idea through this video? It's whatever works for you. Okay, and then finally, the S from accepts, I have stuck with the acronym all the way through and I think I've spelled it right. The S for success, the S of accepts is about sensations. And so this is very simply about engaging our five senses in order to help us to manage. So we are thinking about what different activities might we be able to engage in, which really draw on our senses. Because when we really invoke our senses, then that can really help to draw our mind away. It can help to invoke feeling of happy or calm and help us to manage that distress. So this might be saying, right, I am going to have a bath with a, you know, rose flavoured bath bomb because I love that flavour. Or I'm going to burn scented candles to help invoke that sense of smell. It might be about taste. So things like really strong mint or chilli. So taste can draw your mind away from other things. It might be about feeling. So you might be kind of stroking a pet and having that kind of feeling of softness. Or you might go plant seeds and have the feel of the soil running through your fingers. You might take your feet off. No, you can't take your feet off. You might take your shoes off and go walk on the grass. So again, it's just thinking about the five senses. Thinking about what are the different things that I can do which will trigger those senses and really help me become very involved in a moment, kind of really mindfully use my senses in order to help take my mind away from the distress that I'm feeling right now. Okay, so that was, I hope, a helpful summary of one of the DBT Distress Tolerance Skills and it's the Accepts Set of Skills. I hope there's something in there that's helpful. This can be helpful for all kinds of different people. Do leave me comments telling me how you use any of this. Other ideas that you have too. And yeah, what situations you think you or someone that you care for might use it in. And yeah, I'll be practicing it a lot in the coming weeks myself too, to manage the, yeah, distress that I am experiencing as a result of therapy but as a result of therapy which is really going to help me get back on track in the long term. Okay, take care. Goodbye. Do please come back, subscribe and then you will hear about my other videos. Leave a comment down below because that makes me happy and reminds me that it's not just me and my rainy shed but there's a whole world out there. And if you liked it give it a thumbs up. Okay, thank you. See you next time. Bye.