Distress Tolerance Skills in DBT Trauma Work: IMPROVE the Moment, Rain Dance, and HALT

Kirby-Reutter

United States Department of Homeland Security

Key Points

  1. IMPROVE is an acronym that stands for imagery, meaning, prayer, relaxation, one thing at a time, vacation, and encouragement. Each of these activities helps to make the moment better or at least more bearable.
  2. The RAIN dance is a metaphor that stands for recognize, allow, inquire, and nurture. It teaches that we can dance with intense emotions rather than fighting them.
  3. The HALT skill is an acronym focused on preventative strategies. It stands for hungry, angry, lonely, and tired. We know that clients are more vulnerable when in these states.
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IMPROVE

IMPROVE is an acronym that represents a collection of skills. Maria was already doing most of them.

  • Imagery: she was already doing the safe place and the container.
  • Meaning: pain without purpose becomes suffering but, as long as we can find a purpose for what we’re going through, pain can become more bearable.
    • With Maria, the sense of purpose was easy to find. She said, “God has a purpose, and once I am through the asylum process I can request a visa to bring my daughter here.”
  • Prayer: Maria quickly found a prayer group with other residents. They meet daily for a brief prayer meeting. Prayer was something she was doing on her own.
    • In DBT, prayer refers to any spiritual or religious coping strategy or structured meditation practice.
  • Relaxation is any activity that automatically activates the parasympathetic nervous system and brings an immediate sense of relaxation.
    • For Maria, this was taking a long, hot shower.
  • “One thing at a time” was the perfect skill for Maria, because she realized it’s not possible to get through the asylum process in a single day.
    • When Maria thought of the process and all the hoops she’d have to jump through, it was overwhelming. When she realized it’s not possible for anyone to do all of this at once, and she can only do one step at a time, it gave her a sense of relief and focus.
  • Vacation: Maria was already going to the gym to play soccer and volleyball. That gave her a mini-break whenever she needed it.
  • Encouragement refers to helping clients learn to become their own cheerleaders, because we don’t always have all of the external cheerleaders that we need.
    • Maria was receiving verbal harassment from some of her roommates. She wasn’t getting encouragement from them, and couldn’t talk to her therapist 24/7. So she learned to become her own supporter. She used the self-talk, “I’ve survived so many challenges in life. With the help of God, I know I can get through this asylum process.”

The RAIN Dance

The RAIN dance is an important skill for Maria, especially because of her panic attacks. If we try to fight our emotions, we only make them more intense. So instead of having an adversarial relationship with emotions, it is better to dance with them. RAIN stands for:

  • Recognize: recognizing the emotion and its physical manifestations. Maria applied it to her panic attacks. It was easy for her to realize when she was about to have a panic attack, because she noticed heart palpitations and shortness of breath.
  • Allow: allowing emotions and physical symptoms to exist instead of judging or fearing them. Maria learned to imagine these symptoms as being like waves that come and go.
  • Inquire: assuming a posture of humility and curiosity instead of judgment and condemnation. Maria learned to ask herself some basic, gentle questions when she started to notice these symptoms. Is my life really in danger right now? Is this truly a matter of life and death, or am I simply being triggered by a trauma reminder?
  • Nurture: self-soothing and self-care through coping or stress management skills. Maria was already doing this. So when she noticed those symptoms, she would take a hot shower, do a muscle massage, and practice heart-focused breathing.

HALT Skill

Maria was taught the HALT skill, focused on preventative strategies to be less emotionally vulnerable, especially with her panic attacks. As we know from work with substance abuse, clients are most vulnerable when hungry, angry, lonely, or tired. It was important to make sure Maria had a plan in place to ensure she wasn’t in these vulnerable states, or at least reduce the amount of time she was in them.

  • Hungry: her appetite was low and she hadn’t been eating well for a couple of months. So Maria was asked to follow a meal schedule to adjust her state of hunger.
  • Angry: Maria decided to journal some of her emotions.
  • Lonely:she decided she would either pray or socialize with members of her prayer group.
  • Tired: she committed to following a sleep schedule, though sleep was difficult for her.

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Distress Tolerance Skills in DBT Trauma Work: IMPROVE the Moment, Rain Dance, and HALT

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