Panel: Understanding The Power of DBT For Distress Tolerance with Dr. Kiki Fehling

Jan 17
7 min read

Hey everyone, Roland Smart here, co-founder of TheraHive. I’m thrilled to bring you a recap of our Instagram Live session on Distress Tolerance in Dialectical Behavioral Therapy (DBT). For those who missed it, we had a fantastic panel discussion rich in practical insight on how you can better manage your emotions, each and every day. 

Meet Our Panelists:

  • Special Guest Dr. Kiki Fehling: A clinical psychologist and a board-certified DBT expert clinician, Kiki Fehling is currently on sabbatical but remains active in spreading DBT knowledge, especially through social media.
  • Dr. Jesse Finkelstein: As a Doctor of Clinical Psychology and a postdoctoral fellow at Columbia, Jesse is not only deeply knowledgeable in DBT but also co-founded TheraHive, a platform specializing in courses on evidence-based treatments, particularly DBT.
  • Dr. Alicia Smart: Running a DBT Center in Marin, California, Alicia Smart has dedicated her career to making DBT skills more accessible to a broader audience. Her work complements our mission at TheraHive beautifully.

For those who missed the live interaction, don’t worry! You can catch the full discussion on our YouTube channel and get insights into the practical applications of DBT in managing intense emotions and crises.

Distress Tolerance in DBT: Catch Up on the Recording Here:

Recap — Your DBT Distress Tolerance Questions Answered

Can someone provide a general overview of Distress Tolerance?

Distress Tolerance skills in DBT are tools for managing intense emotions or crises. Our panelists explain that these skills are necessary when "we're at the top of the temperature," during emotional peaks where rational thinking is clouded. They help in crisis situations, overwhelming emotions, and urges for ineffective behaviors.

How Does Distress Tolerance Help?

Distress Tolerance skills help by lowering the emotional temperature to a point where one can think more clearly and be in a rational or wise mind. They are critical for getting through situations without making them worse, especially in the absence of immediate solutions.

Can These Skills Help with Anxiety or Panic Attacks?

Yes, Distress Tolerance skills, especially TIP skills, are highly effective for physiological agitation common in anxiety and panic. They help in stopping rumination and worry and are beneficial in exposure therapy as part of acting opposite to anxiety.

Is Distress Tolerance Only for People with Severe Emotional Issues?

No, Distress Tolerance is not only for severe emotional distress. It can be useful even at lower levels of distress. Using these skills for self-care or coping with minor stressors is also effective.

Does it make sense to work on distress tolerance before any of the other modules in DBT?

It can depend on the individual's needs. Dr. Kiki Fehling mentioned starting with crisis survival skills, which are often "the biggest bang for your buck," but reality acceptance skills can be more challenging and may benefit from being learned later.

Does it matter what order you teach/learn Distress Tolerance skills in?

The order can be flexible, but it's often useful to start with crisis survival skills, as they provide immediate, practical benefits, before moving on to more complex skills like reality acceptance.

What are the Key Techniques in Distress Tolerance?

Key techniques include crisis survival strategies like TIP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation), and reality acceptance skills. Self-soothing and distraction are also important components.

How do you recognize when to use a Distress Tolerance skill, and which one?

Recognizing the need for a Distress Tolerance skill often comes from awareness of emotional intensity or urges to engage in ineffective behavior. The choice of skill depends on the situation and personal effectiveness. Not sure which skill to use? Try TheraHive Distress Tolerance Skill Guide.

What Distress Tolerance skill do you find yourself using the most?

Skills like paced breathing and self-soothing are favorites of our panel – they’re easily accessed and always there when you need them for an almost immediate impact.

How do Distress Tolerance skills relate to skills in other modules? Can you use them together?

Distress Tolerance skills often lay the groundwork for applying skills from other modules. They can be used in conjunction with mindfulness and emotion regulation skills, facilitating a more holistic approach to managing emotions.

Will these skills change my emotions, or just reduce their impact?

Distress Tolerance skills primarily aim to reduce the impact of emotions, particularly in crisis situations. However, some skills, like radical acceptance, can lead to changes in emotional experiences.

How is Distress Tolerance different from Avoidance?

Distress Tolerance is about managing emotions and crises without exacerbating them, not about avoiding them. It's about acknowledging and being with the emotions, albeit in a less intense form.

How long does it take to see results?

It depends! Results can vary. Some skills might provide immediate relief in specific situations, while others, like radical acceptance, might take longer to yield noticeable changes.

How important is regular or consistent practice?

Regular and consistent practice is crucial. The more these skills are practiced, especially in less intense situations, the more likely they are to be effectively used during crises.

The STOP skill is so critical AND there’s something kind of “chicken-or-egg” about it.

[Jump to this point in the video]

Navigating the STOP skill's chicken-or-egg dilemma requires integrating it into your daily life. Dr. Jesse suggests using environmental cues, like having 'STOP' written on Post-Its around the house, to trigger the memory of using the skill. Another effective strategy is incorporating cues into digital devices, like using pros and cons as phone wallpapers. Dr. Kiki Fehling emphasizes that mindfulness is foundational; hence, the STOP skill is essentially about observing and proceeding mindfully. It's a dynamic skill, often including elements like TIPP, observe, paced breathing, and opposite action. Fehling also uses the metaphor of 'going to the balcony' to illustrate taking a step back and observing from a broader perspective for more effective choices.

What’s the optimal way to learn Distress Tolerance skills?

Starting with accessible resources like educational videos and then scaling up to more structured learning, such as DBT groups or courses, is optimal. Practicing skills in everyday life enhances learning. 

Book a free consultation with TheraHive to learn how our program might help you.

Can you talk about the goal of Distress Tolerance … because I think there is a misconception that it’s going to help you feel good ….

The goal of Distress Tolerance is not necessarily to feel good but to get through difficult situations without making them worse. It's about managing distress in the moment, not eliminating it.

How do you know if a Distress Tolerance skill has worked?

A Distress Tolerance skill has worked if it helps in reducing the intensity of distress, even if the individual doesn’t feel good afterwards. Success is measured by the ability to navigate through a crisis without exacerbating the situation.

Want to advance further on your DBT journey?

This is just a taste of the power of DBT to help you manage your emotions, make better decisions, and live a better life. To take the next step, consider joining one of our group skills courses. 

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