DBT for Chronic Pain: Distress Tolerance and Emotion Regulation


United States Department of Homeland Security

Key Points

  1. DBT distress tolerance is about staying safe without making things even worse. The purpose is to replace ineffective reactivity with more effective reactivity.
    Distress tolerance is applied mindfulness and it’s a gateway to other DBT skills. If clients can first survive the moment without making it worse, they are more likely to access their capacity for higher-order problem-solving.A skills implementation plan helps clients quantify their distress on a scale of 0 to 10 and then determine a specific skills-based intervention for each level of intensity.
  2. Whereas DBT distress tolerance refers to short-term interventions, DBT emotion regulation refers to long-term lifestyle changes that foster a healthier emotional baseline.
    The ABC acronym helps clients develop healthier emotional habits by adding positives, building mastery, and coping ahead. SMART is another acronym that helps clients activate healthier behaviors by setting goals that are specific, measurable, attainable, relevant, and time-bound.
    Behavioral changes don’t need to be massive. They simply need to be just noticeable to initiate the necessary momentum for change.
  3. Additional techniques for stimulating behavioral activation include:
    • Having the client promise to do something they would have done anyway.
    • Prescribing the client a positive behavior that they’re already doing.
    • Helping clients evaluate the risks vs rewards of attempting a new behavior.
    • Using creativity to teach new skills, such as games and metaphors.
    • Asking clients, “What would happen if you accidentally used this skill?”

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DBT for Chronic Pain: Distress Tolerance and Emotion Regulation

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