Hi, I'm Dr. Tracey
Marks, a psychiatrist, and I make mental health education videos. I've talked about dialectical
behavior therapy, or DBT, as the best treatment for
borderline personality disorder. But there are modified forms of DBT that can be helpful for other conditions like bipolar disorder,
anxiety, eating disorders, depression and post-traumatic
stress disorder. Today I'm going to teach you one of the many techniques
that's used with DBT to be able to manage your emotions. It's called distress tolerance. Distress tolerance is the skill of being able to accept the
emotion that you're feeling without resorting to coping behaviors that make your situation and
your overall condition worse. The top three categories
of negative emotions are sadness, anger, and fear. And we all have different
degrees of tolerance for these kinds of emotions. It's a normal reaction to wanna get rid of the negative emotions. But what you do to get
rid of these emotions makes all the difference in
what happens to the emotions. Let me explain. Suppose I lose my job. I'm going to be upset about that. It's not realistic to think that I can just take the news and say, "Oh, that's a shame, but
I'm happy to be alive." That's unnatural. We're built to experience a
wide spectrum of emotions, from happiness to
sadness to anger to fear. You may say a person
who's secure in themselves and in their faith has no reason to be fearful. But if a bear walks into the
room and bares his teeth at me, I will wet my pants and run. Being afraid and wanting to run is an adaptive response
for self-protection. So we're all wired to experience the full spectrum of emotions in response to both external
and internal experiences. Internal experiences would be what you're thinking about in your head. How you tolerate and experience
the different emotions is molded and shaped by your temperament, which is your nature, and your upbringing, which is how you were nurtured. I like to call your temperament your factory-installed reflex. It's basically what you were born with and is based on your genes. But you can be raised to believe that certain emotions like anger are bad and you should never show your anger. If you grow up believing this, then you're going to have serious issues dealing with and being or feeling angry. You may tell yourself
that you're not angry, but your mind knows that you are, and the anger will show up as anxiety. Or unprocessed anger can
show up as depression because that's more acceptable than demonstrating anger or even admitting that you're angry. So you have to be able
to accept and handle the range of emotions that you experience. If you have trouble with that, then on an unconscious level you will find a way to
manage that emotion. And here are some of the
maladaptive or not so great ways that we try and escape
the negative emotions when we can't accept them. Avoidance. This is avoiding situations or seeking reassurance from people. You can also make futile
attempts to distract yourself from the emotion. Numbing. You can use alcohol and
drugs to numb the feeling, or binge eating, or even over-sleeping so that you don't have to feel the pain. Another way to escape is to use self-harm, and this could be cutting
or punching yourself or even pulling out your hair. Escaping the distressing emotion only works in the short term. What you do to escape it can cause more problems
for you in the long term. So, what does it mean to
tolerate the distressing emotion instead of escape it? It means you accept it, make room for it, sit with it, and let it pass on it's own time. There are several techniques within DBT to help you tolerate distress. Here is one that's based on
the concept of mindfulness. I talk more about
mindfulness in this video. The link will be in the
corner and in the description. But in short, when you think mindfully, you focus on what's going on at the moment with acceptance and no judgment. It's just observation. And this is how you're going to treat your negative emotions. Here is a template for how
you can think about them. Let's go back to my
example of losing my job. I'm enraged because I
think my company lied to me about keeping me around
during the transition from one company to the next. And, to make matters worse, the job went to someone I trained. Now consciously I think, I'm so upset. But unconsciously, my real thoughts are, I hate my boss and I wanna
beat him down to the ground. But with my upbringing,
ladies don't think like that, and especially a Christian woman. That's evil to think such a thing. So I'm not consciously aware
of my aggressive impulses, that's what a therapist would help me see, and instead I bury my
anger in a pan a brownies and I pick out my eyebrows. Here's what I wanna do to process my rage, and this is a mindfulness exercise. Recognize and allow the emotion. This reflection is best made after I first hear the
news that I'm being let go. I wanna deal with this early before I get to the pan of brownies. So I would say I'm feeling angry at Bob. In fact, I hate him. But I'm not bad because
I have this feeling and I can allow myself to have it. I'm going to make space for it and I do not need to be afraid of it because I'm not going to
take action against Bob. I can control myself. So I don't need to get
rid of this feeling. So here I am, admitting to the worst possible
emotion that I can have about this situation. I wanna assume that I'm
gonna downplay it in my mind, so go ahead and blow it up and own it. I'm not just mad, I hate him. But there's no judgment here. It's just an emotion. That's it. I'm not going to act on it. I'm just gonna let it sit here with me. Next, you wanna watch the emotion. Let me watch this anger and
hate and see what it does. While I'm watching it, I'm
gonna call it what it is. Anger and rage. I don't have to get caught up in it. Where do I notice the emotion in my body? I notice it in my shoulders. I feel tense. But it's just an emotion,
nothing more, nothing less. I am not my emotions. I simply watch my emotions. A good analogy is to think of
the emotion as an ocean wave. I'm not gonna struggle
and fight this wave, I'm gonna go with it and float with it, I may even ride this wave to the shore. The next step is to be present. You're gonna turn your attention
to what you're doing now, what's in front of you, and there's two ways that you can do this. The first is to use your five senses. I'm going to notice what's going
on with all my five senses. What can I feel? What can I touch? What do I hear? What do I see in front of me? What do I smell? What do I taste? Another way you can be present is to turn your attention to your breath. My breath is my anchor for the moment. I take note of how I inhale and how I exhale. What do you do when
the emotion comes back? When the emotion returns, you say, that's okay, that's what emotions do. They come and they go. But I'm gonna watch it again. I'll let it sit here in the room with me, or I may float with it up and down again, just like the ocean wave. That's the exercise. You should write it down as a
script and say it to yourself. I have a template for
you in the description. These negative emotions do cause distress, but accepting this distress
doesn't mean that you enjoy it nor does it mean that you try and fake like it doesn't matter to you. Accepting the emotion is about changing the
way that you look at it. You see it for what it
is, and in my case, rage, and then I change how
I pay attention to it. It's like I'm detaching from
the sting of the emotion because I'm simply observing it as one of many emotions
that I can experience. So I don't have to fear
that it's gonna consume me because I'm over here and it's over there. And how I pay attention to the emotion changes how it affects me. Give it a try. I have a template for this
exercise in the description. See you next time.
