Tool box
I Can't Stand It!!! Distress Tolerance and Recovery
One of my mother's favorite expressions was: "I can't STAND it!" She used it a lot, in fact she was in the habit of saying it, in a tone of voice that sounded just a bit panic-stricken, anytime she didn't like something that someone else was doing... and it was a signal for the rest of the family to jump in and do whatever she wanted done, so that she would calm down, and life could go on...
I think that many of us are in the habit of believing that we cannot tolerate (or that we just can't stand!) some things that really we are quite capable of not only tolerating, but overcoming!
So: I've been thinking lately about the topic of "Distress Tolerance" as it relates to recovery for substance abuse/dependence. I decided to write something up, because it's a central issue, and someone might find this helpful.
DISTRESS TOLERANCE
It’s well-known that some people have a higher tolerance for pain than others. These differences have been consistently demonstrated and measured in laboratory settings. Little is known about the reasons that such differences exist, but they are quite real.
Tolerance for physical pain is akin to a tolerance (or lack thereof) for emotional distress. Just as with pain tolerance, some people have especially good capacities for tolerating emotional distress, and others are (or feel) not nearly as capable in this area of functioning.
The capacity for tolerating distress is a major aspect of recovering from alcohol (or other drug) dependence. The central tasks for a person in recovery are to (a) tolerate the emotional pain involved in refraining from doing something (drinking) that s/he very badly wants to do; and (b) tolerate all the other pains and stresses of life, without turning to alcohol; and (c) tolerating the fears generated by her/his own mind, such as the anxiety s/he feels when s/he allows herself to worry that s/he might not be able to live a life without the “assistance” or “comfort” of alcohol.
Some of us are naturally lacking in distress tolerance skills (possibly because of difficult or traumatic childhoods); and many of us have failed to build strong skills in distress tolerance because we are in the habit of turning to alcohol as a primary method for dealing with stressful events, anxiety, etc. Regardless, anyone who embarks on a program to give up a life dependent on alcohol will need to strengthen her/his capacity for tolerating discomfort.
The good news is that distress tolerance is a skill (or a set of skills) that can be cultivated and learned. One of the major pioneers in clinical psychology, Dr. Marsha Linehan, developed a program that includes components in which individuals learn to develop their capacities to tolerate distress. Here is an outline of the commonly used methods used in contemporary psychotherapy to enhance distress tolerance:
1. Distraction: this method is very simple (not always easy, but simple). As soon as I notice that I have begun to feel overwhelmed with worry, sadness, fear, anger, a craving for alcohol, or some other very uncomfortable emotional state, I gently shift my thinking (and my behavior) to something else. It can be a very simple shift: for example, I can begin to deliberately count the tiles in a nearby floor, or ceiling; or, speaking silently to myself, I can describe all the books on a nearby bookshelf, including their titles, their authors, the colors of the jackets, etc. One of my own favorites, when I am outside, is just to look at the sky. Gradually, the emotional discomfort will begin to fade. Remember to be patient! None of these methods are “quick fixes.” It takes time for our minds to relax, for our brains to lower the levels of stress-induced hormones and neurotransmitters.
2. Acceptance: Sometimes our biggest struggles are internally generated. Often, it is not so much the situation itself that is so painful, but our fruitless attempts to change the un-changeable, or mental arguments about how things SHOULD be different, our endless efforts to figure out WHY things are the way they are… all of these are unnecessary add-ons to the difficulties that life presents us with. One of the major differences between people who live happy, meaningful lives and those who are bitter and unhappy is the capacity to accept setbacks and to make the best of difficult circumstances, instead of struggling against the things that cannot be changed.
One excellent role model in this area is the guy in the YouTube video, with no arms or legs… but with a fabulous outlook and love of life! [Here's the link: YouTube - How to get back up...Nick Vujicic (life without limbs):http://www.youtube.com/watch?v=2AkOJaWVvmE[/video]]YouTube - How to get back up...Nick Vujicic (life without limbs) ]
An example of someone who is NOT a good role model, because s/he is self-handicapping her/his own life, would be the person with a serious alcohol problem who continues to tell her- or himself that s/he SHOULD be able to “drink like a normal person”!
The “Serenity Prayer” is a great tool for enhancing acceptance. When we find ourselves in some kind of mental turmoil, we can begin sorting it out by quietly repeating: “Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Often, upon reflection, we will then realize that the turmoil arises out of trying to change something we cannot change.
3. Mindfulness: Both as a formal meditation practice, and as a way to approach daily life (awareness of the moment, and careful attention placed on whatever is going on right now), mindfulness is a skill par excellence. Much of our emotional distress arises out of a focus on the past (regrets that contribute to depression) and the future (anticipating disasters that contribute to anxiety disorders and panic). When we realize we have allowed our minds to dwell on the past or the future, shifting into the present can be calming, comforting, and effective in helping us to deal with life as it is (not as it was, or as it might be in case something awful happens). Re-focus on physical sensations: deliberately feel the sensations of your breath as it goes in and out, for example. Notice what your thoughts have been telling you (often it may be that your mind has tricked you into a dialog about drinking!). Notice the stress-related sensations you might be feeling in your chest, or belly, or shoulders.
It’s a good idea to practice these skills on a daily basis, so that they will become part of your repertoire, and readily available to call on when you really need them. You can, with practice, become a person who has a good capacity for tolerating emotional distress; and this will make a huge difference in the likelihood that you will be able to meet your goals for long-term (permanent!) freedom from alcohol abuse and dependence! So: if you find yourself saying to yourself (or to others!): "I can't STAND this!" then... think about it. Maybe you can...
I Can't Stand It!!! Distress Tolerance and Recovery
One of my mother's favorite expressions was: "I can't STAND it!" She used it a lot, in fact she was in the habit of saying it, in a tone of voice that sounded just a bit panic-stricken, anytime she didn't like something that someone else was doing... and it was a signal for the rest of the family to jump in and do whatever she wanted done, so that she would calm down, and life could go on...
I think that many of us are in the habit of believing that we cannot tolerate (or that we just can't stand!) some things that really we are quite capable of not only tolerating, but overcoming!
So: I've been thinking lately about the topic of "Distress Tolerance" as it relates to recovery for substance abuse/dependence. I decided to write something up, because it's a central issue, and someone might find this helpful.
DISTRESS TOLERANCE
It’s well-known that some people have a higher tolerance for pain than others. These differences have been consistently demonstrated and measured in laboratory settings. Little is known about the reasons that such differences exist, but they are quite real.
Tolerance for physical pain is akin to a tolerance (or lack thereof) for emotional distress. Just as with pain tolerance, some people have especially good capacities for tolerating emotional distress, and others are (or feel) not nearly as capable in this area of functioning.
The capacity for tolerating distress is a major aspect of recovering from alcohol (or other drug) dependence. The central tasks for a person in recovery are to (a) tolerate the emotional pain involved in refraining from doing something (drinking) that s/he very badly wants to do; and (b) tolerate all the other pains and stresses of life, without turning to alcohol; and (c) tolerating the fears generated by her/his own mind, such as the anxiety s/he feels when s/he allows herself to worry that s/he might not be able to live a life without the “assistance” or “comfort” of alcohol.
Some of us are naturally lacking in distress tolerance skills (possibly because of difficult or traumatic childhoods); and many of us have failed to build strong skills in distress tolerance because we are in the habit of turning to alcohol as a primary method for dealing with stressful events, anxiety, etc. Regardless, anyone who embarks on a program to give up a life dependent on alcohol will need to strengthen her/his capacity for tolerating discomfort.
The good news is that distress tolerance is a skill (or a set of skills) that can be cultivated and learned. One of the major pioneers in clinical psychology, Dr. Marsha Linehan, developed a program that includes components in which individuals learn to develop their capacities to tolerate distress. Here is an outline of the commonly used methods used in contemporary psychotherapy to enhance distress tolerance:
1. Distraction: this method is very simple (not always easy, but simple). As soon as I notice that I have begun to feel overwhelmed with worry, sadness, fear, anger, a craving for alcohol, or some other very uncomfortable emotional state, I gently shift my thinking (and my behavior) to something else. It can be a very simple shift: for example, I can begin to deliberately count the tiles in a nearby floor, or ceiling; or, speaking silently to myself, I can describe all the books on a nearby bookshelf, including their titles, their authors, the colors of the jackets, etc. One of my own favorites, when I am outside, is just to look at the sky. Gradually, the emotional discomfort will begin to fade. Remember to be patient! None of these methods are “quick fixes.” It takes time for our minds to relax, for our brains to lower the levels of stress-induced hormones and neurotransmitters.
2. Acceptance: Sometimes our biggest struggles are internally generated. Often, it is not so much the situation itself that is so painful, but our fruitless attempts to change the un-changeable, or mental arguments about how things SHOULD be different, our endless efforts to figure out WHY things are the way they are… all of these are unnecessary add-ons to the difficulties that life presents us with. One of the major differences between people who live happy, meaningful lives and those who are bitter and unhappy is the capacity to accept setbacks and to make the best of difficult circumstances, instead of struggling against the things that cannot be changed.
One excellent role model in this area is the guy in the YouTube video, with no arms or legs… but with a fabulous outlook and love of life! [Here's the link: YouTube - How to get back up...Nick Vujicic (life without limbs):http://www.youtube.com/watch?v=2AkOJaWVvmE[/video]]YouTube - How to get back up...Nick Vujicic (life without limbs) ]
An example of someone who is NOT a good role model, because s/he is self-handicapping her/his own life, would be the person with a serious alcohol problem who continues to tell her- or himself that s/he SHOULD be able to “drink like a normal person”!
The “Serenity Prayer” is a great tool for enhancing acceptance. When we find ourselves in some kind of mental turmoil, we can begin sorting it out by quietly repeating: “Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Often, upon reflection, we will then realize that the turmoil arises out of trying to change something we cannot change.
3. Mindfulness: Both as a formal meditation practice, and as a way to approach daily life (awareness of the moment, and careful attention placed on whatever is going on right now), mindfulness is a skill par excellence. Much of our emotional distress arises out of a focus on the past (regrets that contribute to depression) and the future (anticipating disasters that contribute to anxiety disorders and panic). When we realize we have allowed our minds to dwell on the past or the future, shifting into the present can be calming, comforting, and effective in helping us to deal with life as it is (not as it was, or as it might be in case something awful happens). Re-focus on physical sensations: deliberately feel the sensations of your breath as it goes in and out, for example. Notice what your thoughts have been telling you (often it may be that your mind has tricked you into a dialog about drinking!). Notice the stress-related sensations you might be feeling in your chest, or belly, or shoulders.
It’s a good idea to practice these skills on a daily basis, so that they will become part of your repertoire, and readily available to call on when you really need them. You can, with practice, become a person who has a good capacity for tolerating emotional distress; and this will make a huge difference in the likelihood that you will be able to meet your goals for long-term (permanent!) freedom from alcohol abuse and dependence! So: if you find yourself saying to yourself (or to others!): "I can't STAND this!" then... think about it. Maybe you can...
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