Week 4

Distress Tolerance

Overview: This week, the facilitator will continue to build off skills learned during Weeks 1-3 and introduce the group to Distress Tolerance. Last week, group members learned about the power of emotional regulation in lowering risk behaviors. Distress Tolerance takes emotional regulation a step further and explores a member's capacity to tolerate and cope with difficult emotional feelings (Hossenian & Nooripour). Discussion will address:

1. The importance of managing emotional distress.

2. What does it mean to be tolerant or resilient?

3. What it feels like in the body to feel distress or emotional discomfort.

4. Consequences of using risky behaviors to escape emotional distress.

5. The ACCEPT Distress Tolerance skill.

Following Schiller's Relational Model (Schiller, 2007), the group may likely have developed into the 4th stage of challenge and change.

Week 4:

• Check-In - 25 minutes

• Meditation - 5 minutes

• Diary-Journal review - 20 minutes

• Introduce Distress Tolerance Skill - 20 minutes

• Group Activity - 30 minutes

• Take-away/closing - 20 minutes

Description: This session is about getting to know the level of tolerance each member currently has to withstand emotional discomfort. Group members will be asked to share how they rate their ability to tolerate emotional distress and provide a real-world example for how they cope when emotional challenges arise in their life. There is evidence that suggests adolescents in middle school do not have the skills to cope with stress effectively (La Touch-Howard & Antonia, 2012). This group will further explore ways to build on and increase the capacity to tolerate emotional discomfort. Facilitator will introduce group to the DBT ACCEPT skills that invite members to participate in an activity to build resilience and tolerance to emotional discomfort.

Purpose: The purpose of this session is to help members to increase their capacity to build tolerance and greater resilience in how they experience emotional discomfort and stress. Low levels of distress tolerance has been shown to lead to risky and unhealthy behaviors in adolescents (Touch-Howard & Antonia, 2012). Building on previous mindful DBT activities, this week, the group will engage in a distress tolerance activity that seeks to explore what it feels like to be in discomfort, build coping skills and tolerance for working through that emotional discomfort (Zastrow & Hessenauer, 2019). Building-up tolerance offers individuals the space they need to problem-solve and get through an issue that is causing discomfort. Members will learn that they are capable of withstanding distress and have the capacity to tolerate stressful situations with ease. This session is an opportunity for members to acquire new coping skills and truly learn they have a greater capacity to handle emotional discomfort.

Step by Step Guide for Facilitating Week 4:

Step 1: Check-in: ( 25 minutes)

As noted in Week 3, each session opens with a Check-in.

Example Check-in Prompt: Delighted to see everyone again this week! Thank you for your continued commitment in showing up for yourself and the group! Today's Check-in: This week, we are learning about Distress Tolerance. Please share a stressful experience and how you were able or not able to cope and manage the situation. Please share any coping strategies you may have used. If you were not able to cope well, please share the strategies you used to deal with the emotional or stressful situation.

Step 2: Meditation: (5 minutes)

Link to Meditation Emotional Strength and ACCEPTANCE (Blocker Yoga, n.d.):

https://www.youtube.com/watch?v=tAzrfa2v4Mc

Step 3: Diary/Journal Review: (20 minutes)

This portion of the session is dedicated to diary and journal review. This review allows members to share personal experiences and reflect on the skills they have learned since Week 1. Members are asked to share with the group 1 event that illustrates how they were able or not able to cope during an emotionally distressful experience. Members are also encouraged to offer mutual aid (Cohen & Graybeal, 2007) feedback, support and praise to members for their efforts.

Step 4: Introduce Emotional Regulation Skill: ACCEPTANCE. ( 20 minutes)

The ACCEPTANCE skill introduced centers on the power of tolerating difficult emotions. The idea here is to keep you mind occupied on other things until the emotion passes. Here are a few example of ACCEPT activities (sunrisetc, 2022):

A stands for: Activities! The idea here is to keep you mind occupied on other things until the emotion passes. Find activities that can help take the mind off of an emotionally stressful situation. An example of activity could be:

1. Going to the movies.

C stands for: Contributing! The idea here is to contribute to your community, family or friends. Do something in service to someone else. Acts of service are appreciated and valued and also make us feel positive about ourselves. An example of contributing could be:

1. Shovel a neighbor's driveway.

C stands for: Comparisons! The idea here is widen your lens to a broader perspective. Is the circumstance you are experiencing something you have experienced and survived before? Are the circumstances less tragic than say, the Ukraine War, or hunger issues in Africa? Can you gain a better perspective about how serious the situation may be? This activity does not seek to diminish or invalidate feelings or emotions, but to seek a new perspective on the current circumstance.

E stands for: Emotions! The idea here is to ask yourself...can you invite the direct opposite emotion to the table. If you are feeling anxious, can you think about something that feels very calm? If you are feeling doubt or self-conscious, can you think of a time when you felt very confident and empowered? The goal her is to bring forth the opposite emotion with full intention.

P stands for: Push Away! The idea here is to practice self-compassion and acceptance that you may not be able to deal emotionally or physically with the current circumstance. In this situation, it is perfectly acceptable to push the situation away or place it on a shelf, for the time being, until you are better able to deal with the situation.

T stands for: Thoughts! The idea here is to occupy your current thoughts with something that can take your attention away and keep you from engaging in risky behavior. Example of thought distracting activities could be:

1. Try doing a cross-word puzzle.

S stands for: Sensation! The idea here is to draw on your 5 senses. An examples of some sensory activities could be:

1. Take a hot shower with a eucalyptus shower steamer.

Step 5: Group Activity: (30 min)

Building off the session theme of learning about ACCEPT activities, guide members to experience the following sensory activity...making glow and the dark sand (Underwood, 2022):

This activity handout is located at the bottom of this page. A link to this activity can also be found here (Underwood, 2022): https://www.growingajeweledrose.com/2014/02/glow-in-dark-sand-recipe.html?m=1

Step 6: Take-away and closing: (20 minutes)

In closing the session, members are encouraged to share their take-aways from the activity. Some questions to consider asking:

1. How did the sand feel between the hands when you mixed it with the paint in the ziplock bag?

2. Were you able to stay present during the activity?

3. Did you have fun?? :-)

Always thank the members again for showing up, sharing of themselves, participating, offering any feedback and simply being themselves. Continue to remind each members that they bring value to the group. Lastly, what has been shared this week, remains in the container of the group and shall not be shared with anyone outside of the group.

Closing Quote to share: “Accept everything about yourself – I mean everything, You are you and that is the beginning and the end – no apologies, no regrets.” ~ Henry A. Kissinger

HANDOUT: Distress Tolerance Skills Worksheet: https://www.therapistaid.com/therapy-worksheet/dbt-distress-tolerance-skills/dbt/adolescents

GOAL: This week's goal is to help members get more comfortable feeling emotional discomfort and stress. Members will also learn helpful ways to increase tolerance and resilience for handling emotions and moments of stress (Zastrow & Hessenauer, 2019). Members will also learn better ways to cope, so they do not hurt themselves or others during emotional distressful situations.