Distress tolerance skills

So the past few days have felt pretty miserable and just a build of things today led me to seeking reassurance from stepping on the scales and I was horrified by the number I saw and all rational thinking went out the window and I kind of just lost it. There is so much self hate in me and I don’t even know where to put it. What doesn’t help is when people around you say you are being pathetic or that there’s more to life than being skinny or go do something usefull. It  annoys me so much because there’s more to the ED than being skinny. I don’t want to be skinny for fucks sake I just don’t want to feel so shit either. I DO NOT want to feel so addicted to food and so out of control and to crave purging  and its something you fight everyday. So for goodness sake please do not tell me off for eating too much or call me greedy.My head already does that job.

What people need to realise is when you have mental health problems you are NOT ungrateful. We are not ignorant or oblivious to the worlds problems.We know about people who have what you call “real ” illnesses like cancer.We full well know we are lucky in the grand scheme of things but being grateful does not stop us from being human, it does not stop us from feeling hurt and it does not make the way we feel any more bearable.It does not stop you from wanting to tear yourself apart because no matter what you do you feel like a pathetic,failiure.

Anyway rant over and moving onto distress tolerance skills. One of the wards I have worked on do DBT therapy so I did some reading on DBT and I think the skills are something everyone could use in their daily lives whether they have a mental health problem or not.

Distress tolerance skills can help us cope when experiencing emotional or physical pain and situations which we cannot change or that are out of our control.

Acronyms such as IMPROVE and ACCEPTS can help us remember the distress tolerance skills.

I- IMAGERY Visualise a safe place or imagine a situation where you have been distressed before but have managed to cope in a positive way.

M-MEANING Find meaning in the situation-Is there a silver lining or lesson to be learnt?

P-PRAYER I am not religious and use positive affirmations or mantras instead. You can use meditation or breathing techniques too.

R-RELAXATION Listen to music,just breathe and remind yourself you will be ok.

O-ONE THING AT A TIME Be aware of what you are doing now and take it one thing at a time.

V-VACATION Although it would be wonderful to just go off on vacation to some beautiful island this is not always possible but you can take a “mental vacation” by relaxing and having some self care time.

E-Encouragement Positive self talk, think about how much you have already overcome, look at quotes,remember recovery is far from linear.

Image result for dbt states of mind

The emotional mind is often in control in times of distress but remember that the wise mind can take over. You can acknowledge the situation you are in without placing judgements on yourself but also accept that you may need to change. This is the wise mind.

The wise mind ACCEPTS

A-ACTIVITIES Colouring,writting,drawing,dancing,playing loud music. Something where you will be fully immersed in the activity.

C-CONTRIBUTING Helping others

C-COMPARISSIONS Remind yourself of all the good things in your life, acknowledge the progress you have made, you may not be where you want to be but neither are you when you used to be.

E-Emotions.Acknowledge the emotions you are feeling without judgement. How can you replace the negative emotions with positive ones?Or may you just need to ride the negative ones out and accept that you cannot always change how you feel.

P- PUSHING AWAYMaybe you need to first calm down before you deal with the situation at hand.

T-Thoughts You may have more control over your thoughts than you think. Maybe you need to get them out. Can you write or talk to someone? Can you change your thoughts to more positive ones.

S-Sensations,what over things can you feel. Move out of your mind and into your body. What can you see,hear,touch,smell?Yoga is also a great way of moving out of the mind and into the body.


Radical acceptance is where you are willing to experience the given situation as it is without trying to change it.

Your mind may choose to want to wander to unhelpful coping strategies but try to bring yourself back to the moment and focus on one thing at a time.

Remember sometimes the more you fight a feeling/urge or situation the more intense your distress will be.


A example of mine  is if you have eaten whether it was a binge or normal meal and now you want to purge. You do not judge your actions or the situation to be good or bad ,you accept it as it is.You acknowledge that in the future you may need to do things differently to prevent a binge.You don’t give permission for it to go on for ever.You examine your options and decide you have the power to change.

This process of thinking can be applied to self harm.over exercising, restriction and many other problems.

Radical acceptance requires you to “TURN THE MIND”

Turning the mind is an activbe choice which requires commitment,You turn the mind away from judgements of the situation, judgements of yourself, you accept reality as it is.You may need to turn the mind a few times during a distressing period.


-You don’t form a judgement of the situation as being good

-You don’t give permission for the situation to go on forever (e.g. I purged once, I accept this but will continue to purge all day THAT IS NOT HELPFULL!)

-Not giving up on your options and not deciding you will be this way forever


There is so much more I could write about but I hope this was at least a little bit helpful. I wrote a post a while ago on helping yourself in times of anxiety and some ways to distract yourself. The link is here:




7 thoughts on “Distress tolerance skills

  1. myrecov

    “We are not ignorant or oblivious to the worlds problems.” – I found that I relate to how you feel about this part of your post a lot, and also when you say you have a lot of hate for yourself that you don’t know what to do with. My therapist always tells me that I am really mean to myself. I tell her I hate myself and she always tells me that it’s so sad.


    1. People seem to assume ED sufferes particularly those with bulimia or binge-purge anorexia have no care for anyone because they waste food by binging and purging.But it couldn’t be further from the truth.It really isn’t a choice and the stigma that people with eating disorders are vain or ignorant really needs to stop.
      I am sorry you hate yourself too and from another person’s point of view it is sad.I just hope people understand how hard we try to be accepting of ourselves but it doesn’t always feel possible.But small progress towards self acceptance is still progress.

      Liked by 1 person

      1. myrecov

        I agree with you 100% on everything you have said. I recently read that certain parts of a persons brain that has an eating disorder are enlarged and that studies do show that these illnesses have a strong basis in brain biology. And those biological origins of eating disorders may occur early in brain development.
        It comforted me, my mom would say that I don’t have a mental illness, but this tells me that it might be a chemical imbalance in the brain, and why our thoughts sometimes consume us, and the person we see in the mirror isn’t the person everyone else sees.

        Liked by 1 person

      2. I agree with that there is something in brain chemistry that makes people more predisposed to developing eating disorders.Also certain personality traits are more likely to develop certain eating disorders.The behaviours are so hard to give up because an eating disorder does serve a purpose in a sufferes life wether it’s a coping mechanism or a way of managing anxiety or depression.To me purging had always felt very much like an addiction.

        Liked by 1 person

      3. myrecov

        Yes, for me as well. I’ll do well for a while but I always give in to that voice inside, I wonder when it will quit.


      4. It’s hard for sure. Something I have found helpful when binge/purge urges are strong is saying “this is not what ula wants this is what bulimia wants” and repeating it to myself. It makes me more aware of what I am doing .

        Liked by 1 person

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