Distress Tolerance Skills                                                                                                                            10/9/2019
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              AnnaHink,MSW,LICSW                                                         • Audio&videocontrolsinlowerleftcorner
              ClinicianTrainer                                                                    Mute/Unmute                      Chattechnicalissuesor
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            LearningObjectives                                                             WhatIsACrisis?
            Afterthistraining,participantsshouldbeable                                   Aseriousproblemthat      Thereispressuretosolve
            to:                                                                                can’tbesolvedrightnow       theproblem,anditis
                                                                                                                               difficulttostoptrying
            • Understandthepurposeofdistresstolerance                                                             Crisis
               skills
            • Recallwhendistresstoleranceskillscanbe                                    Emotionsarehigh,sothe          It’sshortͲterm
                                                                                                 problemisdistressing      Ifitishappeningallthetime,
               usefulforyourpatients                                                         Highemotionsgenerally      itisnotacrisis.Itisyourlife!
            • ListtheDistressToleranceskills                                                  makethingsworse
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      Distress Tolerance Skills                                                                                                                                                                          10/9/2019
                CanYouSolveTheCrisis?                                                                               Checkpoint:
                                       •   Stickwithit                                                                • Whatkindofcrisesdoourpatientsruninto
                  IfYes…              •   Don’ttakeyoureyeofftheball                                                 intheirlives?
                                       •   Dowhatittakes!
                    IfNo             •  STOPtryingtosolveit
                                      •  Tryingtosolvetheunsolvablecanmakeit
                (ornotright           worseorsendemotionsthroughtheroof
                    now)…            •  FocusonDistressTolerance skills         DTskillsare
                                                                                 designedjustfor
                                                                                 anunsolvedcrisis
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                WhatAreDistressToleranceSkills                                                                     GoalsOfDistressToleranceSkills
                For?                                                        Patients                                   • Helppeoplesurvivethecrisisandnotmaking
                                                                                face                                       thesituationworse
                •Cravingsandtriggers                                         many
                •Painflares                                                stressors                                   • Notintendedtoimprovefeelings(though
                •Frustrationswithmedical                                                                                 sometimesbeingmoreincontrolhelps)
                  care/socialservices                                                                                      •   Anescalatedcrisismaymakethingsworseandmake
                                                                                                                                peoplefeelworse
                •Intenseemotions                                                                                       • Increaseconfidenceinmanagingfuturecrises
                •Relationshipconflicts
                •Dangeroussurroundings
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     Distress Tolerance Skills                                                                                                                                          10/9/2019
             Checkpoint:
                                                                                                                                    Yellingat
                                                                                                                                    someone
             • Whataresomenegativewaysourpatients                                                           Givingupon                  Usingdrugsor
                dealwithcrises?                                                                                     life                           alcohol
                                                                                                                                   Waysto
                                                                                                                                   Worsen
                                                                                                                                   aCrisis
                                                                                                                  Complainingso                    “Retail
                                                                                                                   muchfolks                    therapy”with
                                                                                                                  don’twantto                   moneyyou
                                                                                                                   talktoyou                    can’taffordto
                                                                                                                                                     spend
                                                                                                                                    Eatingtoo
                                                                                                                                   muchortoo
                                                                                                                                      little
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             TeachingDBTDistressTolerance                                                        BehavioralAssessment                                     Step1:
             The4Steps                                                                                                                                     Behavioral
                                                                                                    AskThreeQuestions:                                    Assessment
                                                  Step3:                                           1. Whattriggersthedistress?
                  Step1:         Step2:                         Step4:                              – Bebehavioral–whatweretheydoing?i.e.talkingwitha
                                                   Choose        FollowͲup,                            familymember,thinkingaboutusing,openingmail
                 Behavioral   MakethePitch    Strategy&     Evaluateand
                Assessment                       Determine     ProblemSolve
                                                 Homework                                           2.Howdidthepatientrespondtodistress?
                                                                                                        – Getthebehavioralresponse(i.e.,yelled/startedafight,
                                                                                                          stayedinbedallday)
                                                                                                        – Listenforhelpfulanddestructivebehaviors
                                                                                                    3.Howdidtheirresponsemakethingsworse?
                                                                                                        – Investigatefromthepatient’sperspective
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      Distress Tolerance Skills                                                                                                                                                         10/9/2019
              CaseExample:DS                                                                                Step1:BehavioralAssessment
                                                                                                              CaseExampleͲ DS
                                                                KeyComplaints                                1. Triggers
                 54y/owoman,liveswithhusband    “There’snothingIcandowhenI’m
                 inrecoveryfromOUDfor1month        inpain;I’marguingwithmy                           ൞ Intensebackpainflaresforhours
                      withchronicpainflare           husbandallthetime;Icanno
                                                                longerfunction                               2. Response
                                                                                                                  ൞ Bedbound                             ൞ isolatesself
                   Stoppedopioids1monthago.                                                                   ൞ Doesnoteatorhydrate ൞                 yellsat
                 Longstandinganxiety&depressive    RecentlytransitionedtoSuboxone
                            symptoms:                                                                       3. WhatMadeitWorse                            husband
                    BaselinePHQͲ9=10(mild)             AlsotakingVenlafaxine
                  BaselineGADͲ7=15(moderate)                                                                 ൞ “IfeelsoguiltyafterIyellatmyhusband.He’s
                                                                                                                       justtryingtohelp”
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              MakethePitch                                                                                  Step2:MakethePitch
                                                                              Step2:                        RevisitingCaseExampleͲ DS
              • Explaindistresstolerance                                 MakethePitch                         “Theseareskillstohelpyouwiththeintensepain
                   – Theseareskillstohelpyouwith...(triggers)                                             flaresyouexperience.You’vetoldmeyoutendtoneed
                                                                                                                  tostayinbedformanyhours,noteatordrinkwater,
                   – You’vetoldmeyoutendto... (response)                                                    isolateyourselffromyourfamily,andyellatyour
              • Explainthegoalofdistresstoleranceskills                                                    husband.
                   – Thegoalistonotmakethingsworseandgetthroughthe                                    Thegoalistonotmakethingsworse.Thisisvery
                     situationsafelyͲ differenttomakingyou“feelbetter”                                     differentthan‘feelingbetter.’DTskillshelpyoubring
                   – “DTskillshelpyoubringdownyouremotionssoyouthink                                   downyouremotionssoyouthinkmoreclearly.You’ve
                     moreclearly.”                                                                              toldmethingsareworsewhenyouyellatyour
                   – “You’vetoldmethingsareworsewhenyou(whatwere                                        husband.”
                     negativestotheirnormalresponse)
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