Contrary to what we may think, getting older is actually not all that bad. There may be financial and emotional challenges, and health conditions may change the way we live. But according to an abundance of research, older people have lower levels of negative affect, or disposition, than younger people. To better understand why this is, Amanda J. Shallcross of the Department of Psychology at the University of Denver recently led a study that looked at acceptance. She believes that acceptance to negative life events weakens the negative reactions to those events and causes them to impact a person’s affect less. In other words, as we age we are more accepting of things and, ultimately, less unhappy.

Shallcross used the emotional states of anger, anxiety, and sadness to explore her theory. She evaluated 340 participants ranging in age from 21 to 73 years old and subjected them to a stress-inducing experiment designed to cause negative affect. She measured their responses to the induction at the time of the experiment and several more times over the next six months. She found that the older individuals had more acceptance of the stressful condition and responded with less anger and anxiety than the younger participants. However, she did not find lower levels of sadness in the older participants.

These results suggest that as people age they learn to accept conditions in their lives. Perhaps anger and anxiety no longer serve their goals of forming intimate relationships, maintaining family bonds and social networks. They may alter their emotional responses to events in order to secure those relationships. As for sadness, Shallcross believes that older individuals may actually benefit from acceptance there as well. Because they experience more adversity, loss, and life challenges as they age, older individuals should have higher levels of sadness than younger individuals. But in this study, their sadness was equal to the younger participants. Again, Shallcross believes that this was the result of acceptance. “This skill may decrease levels of sadness to remain on par with those of younger individuals,” said Shallcross. “Thereby, net levels of sadness remain constant across age groups.” Overall, these findings demonstrate that acceptance is an important skill for maintaining a positive well-being. And most importantly, people do not have to wait until they are old to acquire that skill. It can be learned at any age.

Reference:
Shallcross, A. J., Ford, B. Q., Floerke, V. A., and Mauss, I. B. (2012). Getting better with age: The relationship between age, acceptance, and negative affect. Journal of Personality and Social Psychology. Advance online publication. doi: 10.1037/a0031180

Happy older couple outsideIn a world saturated with sexual imagery, appeals to the effects of sexual attraction, and arguments about the way sex affects society, it is difficult for some people to believe that not everyone harbors an interest in sex or feels sexual attraction. But asexuality undermines common beliefs that sexual feelings are universal. While there have always been people who felt little or no sexual desire or attraction to others, the concept of asexuality is relatively new.

Is Asexuality a Sexual Orientation?
It’s easy to confuse asexuality with celibacy or discomfort with sex, but asexuality is distinctly different. While celibacy may be a choice or a result of life circumstances, asexuality is driven by a lack of sexual attraction. People who are uncomfortable with or intimidated by sex generally still feel sexual attraction, even if they are unable to act on it. Asexual people, however, are not interested in sexual relationships with other people. They may still form long-term commitments and get married, but these relationships are typically built around mutual respect and affection rather than sexual attraction.

Asexual people frequently are faced with intrusive questions about why they are uninterested in sex, and some people point to the fact asexual people may later identify as a different orientation or may begin identifying as asexual after engaging in sexual relationships. Asexuality advocacy groups, however, point out that this does not mean that asexuality is not a distinct orientation. Heterosexual people occasionally engage in homosexual relationships, and some people change their sexual orientation later in life. Asexuality seems to function like other orientations, and people who identify as asexual emphasize the importance of respecting asexuality as an orientation, not a mental “disorder,” temporary choice, or product of sexual trauma.

The Path to Asexuality
There is a lot of sexual pressure in our culture. Many asexual people begin to identify as asexual only after having romantic relationships and sexual experiences. Sometimes asexual people have sex to please partners they care about, perhaps because of social pressure or because they haven’t yet learned to consider their own desires. The common denominator among asexual people, however, is no desire for sexual relationships.

This does not mean that asexual people aren’t affectionate or that they can’t engage in romantic relationships. Some asexual people show affection to their partners by massaging them, kissing them, holding hands, or participating in other nonsexual physical practices.

Asexual people who discover their orientation while involved in a romantic relationship often have a difficult road to navigate. There are a variety of ways to deal with disparities in sexual interest, and while some relationships end due to asexuality, partners sometimes agree to arrangements that allow both members of a couple to express their sexuality in a way that is comfortable for them.

Differences in Feelings and Expression
Asexual is not a type of person, just as heterosexual and homosexual people don’t represent specific “types.” The expression of asexuality varies greatly from person to person. Many asexual people experience strong attractions to others and enjoy spending time with specific partners. However, their attractions aren’t fulfilled by sexual interactions. Others experience regular sexual arousal, but feel no need to act on that arousal. Some asexual people find sex extremely off-putting, while others are simply disinterested.

References:

  1. Gordon, O. (2012, November 11). The moment I realized I was asexual. The Telegraph. Retrieved from http://www.telegraph.co.uk/women/9651265/The-moment-I-realised-I-was-asexual.html
  2. Overview. (n.d.). The Asexual Visibility and Education Network. Retrieved from http://www.asexuality.org/home/overview.html

For decades, research addressing the mental health of gay men has grouped bisexual and gay men together. This is a disservice to the LGBTQ community, and to bisexual men in particular. There are significant differences in behavior, identity, and attractions between gay and bisexual men. While gay men are attracted to other men and identify as homosexual, bisexual men can be attracted to either sex. And although it has been shown that disclosure of sexuality is beneficial to mental health for gay and bisexual men, bisexual men are more likely to conceal their sexuality than gay men. Therefore, they report lower levels of psychological well-being. This could be due to the fact that many bisexual men are in committed relationships to women and are torn between their desire for that relationship and their attraction to men. Or perhaps bisexual men are at war with their own homophobia.

To explore why bisexual men do not reveal their sexuality as often as gay men, Eric W. Schrimshaw of the Department of Sociomedical Sciences at the Mailman School of Public Health at Columbia University in New York recently conducted an online survey of 203 bisexual men. He asked them about their levels of social support, mental health, internalized homophobia, and general demographics. He found that the men with the highest incomes were most likely to conceal their sexuality. This was also the case for men in committed relationships with women or those who identified as heterosexual. Concealment was also associated with more frequent female sexual encounters for bisexual men. Overall, the men that concealed their sexuality had poorer mental health than those who disclosed their sexuality.

Schrimshaw believes that these findings underscore the delicate nature of sexuality for bisexual men. Internalizing homophobic beliefs and lack of emotional support may be more dangerous to the psychological well-being of bisexual men than concealment alone. However, concealment can indirectly affect those domains. Although disclosure appears to be beneficial for gay men, this may not always be the case for bisexual men. Rather than interventions that focus on encouraging men to disclose their bisexuality, “Interventions addressing concerns about concealment, emotional support, and internalized homophobia may be more beneficial for increasing the mental health of bisexual men,” said Schrimshaw.

Reference:
Schrimshaw, E. W., Siegel, K., Downing, M. J., Jr., and Parsons, J. T. (2012). Disclosure and concealment of sexual orientation and the mental health of non-gay-identified, behaviorally bisexual men. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0031272

Relationships-&-MarriageMarriage rates have steadily declined in the United States over the past several decades, and the American Psychological Association states that 40% to 50% of marriages will end in divorce. Marriage may be on the rocks, but few dispute that a happy and healthy marriage can contribute to happier and healthier individuals, as well as better outcomes for the children of such unions.

When relationship conflict inevitably surfaces, whether because of communication problems, differences in values, infidelity, or other issues, it’s important to remember that there are options for struggling couples. If you are experiencing difficulties in your relationship—be it long-term or new, monogamous or polyamorous, heterosexual or same-sex, or any other kind of romantic union—chances are someone else, or another couple, has been through a similar situation. The Internet is an excellent way to connect with other people who have gone to relationship counseling, and to solicit advice about improving or salvaging a relationship.

[fat_widget_relationships_right]

As with our previous top 10 lists (depression websites, ADHD websites, and grief and loss websites), we selected the 10 best resources on the web for 2012 related to marriage and couples counseling—GoodTherapy.org excluded—to help people better understand and cope with relationship issues. Among the criteria we used to select our top 10 websites are quality and depth of content, presentation, and functionality.

Recommend websites for our Top 10 awards here.

GoodTherapy | Addressing Anxiety and the Negative Feedback LoopDo you often feel anxious or have times of panic? Does your anxiety overwhelm you or interfere with your work, friends, or family? If so, you’re far from alone. According to the National Institute of Mental Health (NIMH), approximately 19 million adults in the United States experience ongoing anxiety. It cuts across all ages, ethnicities, education levels, and socioeconomic levels. Most of us feel it at some point. Anxiety comes in many flavors; it may erupt only in social situations, manifest as an obsession or compulsion, as a specific phobia, or it may be generalized.

Below are signs of two types of anxiety:

  1. Generalized anxiety symptoms: irritability/restlessness/worrying, muscle tension/fatigue, problems concentrating, sleep difficulties.
  2. Panic symptoms: racing heart/trembling, fear of losing control or dying, shortness of breath/chest pains, chills/hot flushes (not due to peri- or menopausal phase), dizziness/light-headedness/nausea, numbness/tingling/sweating.

It’s common to feel embarrassed about your anxiety, to feel alone, and to keep it a secret. It’s scary to think of asking for help. You may have been feeling anxious for long enough that it’s hard to remember a time when you didn’t live with it. Your anxiety may feel like an unpleasant but “normal” part of you. You do not have to live with this ongoing pain: You’ll be reassured to know anxiety can be effectively treated.

[fat_widget_anxiety_right]

Anxiety is caused by three overlapping events: a trigger or environmental cue (public speaking or party), mental reactivity (a negative thought/self-talk), and physical reactivity (breathing rapidly, clenching fists, etc.). These form a negative feedback loop, where one begets the other. In order to cope with their anxiety, most people avoid the trigger. Though avoidance helps in the immediate moment, it makes anxiety worse in the long term. Why? Two reasons: 1) It reinforces your belief that you’re helpless to deal with it, and 2) you don’t get positive experiences as basis for further success. Below are some basic strategies to help reverse the direction of the feedback loop, turning the dial from negative to positive:

GoodTherapy | Parenting and the Art of Benign NeglectA few months ago, I wrote a piece about “good enough” parenting that seemed to strike a chord for many readers. Some challenged the idea that “good enough” could lead to complacency and short-change our children, but most expressed an appreciation for the self-acceptance inherent in that model. This month, at the risk of stirring up even more debate, I want to talk again about an approach to parenting.

After the birth of my son, I realized that if I ever wanted to take a shower again, I was going to have to let him cry it out for a time. This was very hard, but it was an important first step in my parenting journey that led me to embrace the art of benign neglect. It soon became clear to me that I would not physically be able to attend to my child’s every need every moment of the day. He would have to wait sometimes. He would have to entertain himself sometimes. He would have to delay gratification. This wasn’t a conscious parenting choice; it was just our reality. As it turns out, it was a pretty good thing.

Once my post-childbirth head started to clear, I remembered some words of wisdom from one of my favorite grad school professors. She opened the year by making the bold statement, “Our kids don’t suffer enough. They should suffer more. Thank you.” This was my introduction to the woman who led courses in achievement motivation and social and moral development. I was struck, even intrigued, by her words. As I followed her courses, I began to get what she meant. It was not, however, until I became a parent that I truly understood the implications, and challenges, of this concept.

What my professor was talking about was not abject, crushing, demoralizing suffering, but a more tempered form of discomfort and struggle. She was not advocating throwing our kids into the deep end of life and letting them sink or swim. What she was talking about was allowing them to face adversity while they still had a safety net, letting them stumble over little obstacles as practice runs at life’s larger challenges. Noted psychologist Lev Vygotsky talked about the concept of scaffolding—a way of providing appropriate support to children to allow them to stretch beyond their current abilities. As parents practicing the art of benign neglect, that’s what we try to do. If we do everything for our kids, if we smooth out every bump in the road, if we do everything in our power to remove pain, challenge, and discomfort from their young lives, we deny them the opportunity to learn, to grow, and to develop the coping skills they will need as they become independent adults.

When I think about the skills I want my son to develop, I want him to be secure. I want him to be confident in his own abilities. I want him to struggle through things, work them out on his own, ask for help when needed, and bounce back when things go wrong. I want him to be determined and resilient. In order to do all of this, sometimes I need to do nothing. I need to give him the chance to fail. I need to let him fall down, but be there to pick him up. This is what separates benign neglect from just plain neglect. I need to know where he is. I need to know what he is doing. I need to know that I’ve put the sharp knives out of his reach. It means, though, that sometimes I need to not intervene even when I so very much want to.

I see this in action when we are on play dates with friends. No parent wants his or her child to be pushing other kids or to be the kid being pushed around. Those practiced in the art of benign neglect will watch to see how events unfold. Do the kids sort themselves out when they scuffle? Are things escalating? Is anyone in danger of getting seriously hurt? Most of the time, the kids work things out on their own, learning valuable lessons and negotiation skills in the process. Sometimes, adult intervention just makes things worse. Other times, adult intervention is exactly what is needed to prevent full-scale descent into a Lord of the Flies scenario. When well-intentioned parents are ever-present, however, and intervene at the first hint of discord, our kids don’t get to learn how to work things out.

For the parents who are worried that if we don’t intervene our kids will learn poor strategies, hold those concerns for just a moment. Just because we do not intervene doesn’t mean we lose the teachable moment. Sometimes, our kids are more open to learning after an event rather than in the heat of the action. We can talk with them about their interactions. We can hear how they felt about it. We can talk about the consequences of the choices they made. We can teach them new strategies that they can try out next time. We can share wisdom and perspective, talk about our values and the way we want them to treat others, and we can encourage their independent growth. We can encourage them to think about why what they say and do is important, not because “we said so,” but for reasons that feel real to them. In short, we become resources for them and partners in their learning.

Practicing benign neglect as a parent is not about abdicating responsibility, ignoring limits, or letting go of all boundaries. On the contrary. It is about creating clear limits and boundaries, which all children need, yet allowing for enough freedom within those limits for true learning to occur. It is about watching and waiting and being intentional in the ways we intervene. It’s about allowing our children to feel some discomfort, letting them struggle, and helping them work through it. It is about loving them enough to let them experience the world in a way that lets them grow and learn, even when, with every fiber of our being, we want to shield and protect them from the bumps and bruises they will get along the way.

GoodTherapy | Getting Naked: It's Not Just About the SexI’ll never forget the first time my friend took me to Elysian Fields, a “nudist colony” in Topanga Canyon in the Santa Monica Mountains near Los Angeles. I was twenty-something and petrified; I’m not sure why. I guess I was convinced that everyone would be staring at me and evaluating my body. What a surprise to discover that when we’re naked we all look pretty much alike!

When it comes to human intimacy (or lack thereof), there are different types of nakedness. During one-night stands, getting naked means exposing a lot of skin—usually rapidly.

A client once told me that she figured she could strip and shower in the locker room with no problems, so why not strip and hook up with a partner she found attractive? She did this several times until she began to tire of the shallowness and yearn for a partnership with more depth—as she put it, “someone who I can be emotionally naked with.” Years later she found that person, and discovered that true nakedness was both challenging and rewarding.

Often, people assume that their sessions with me are going to be focused on what/when/where with their genitals. They’re often surprised when I suggest we discuss “the importance of getting naked.” A great deal of honesty and trust can be generated when you are nude with one another, something that rarely develops if the sole purpose of getting naked is to have intercourse.

If you and your sweetheart are new together, or trying to resurrect the newness and the thrill of physical intimacy, here are some thoughts and ideas for getting naked together:

Being comfortable in your own skin is an important part of being comfortable and intimate with your partner. If the idea of just being naked together is scary, you may want to consult a therapist. If it’s exciting, go ahead and try it!

GoodTherapy | Should You Date Someone with a String of Exes?Unless you are relatively young, it is highly unlikely that you will never date someone with an ex-spouse or ex-live-in-lover. The reality is that a large percentage of people have some history of broken relationships, whether they were long-term commitments or actual marriages. Regardless, should you be concerned about the number of exes a new love interest has? That was the question posed to several relationship experts in a recent article. Holly Parker, a psychology professor at Harvard teaches a class entitled “The Psychology of Close Relationships,” and she believes that when people date casually, the number of notches on someone’s relationship belt should not be a significant issue. However, if the dating progresses to something more serious, perhaps those notches should be examined a little more closely.

She advises looking at the level of responsibility that the person took for the unsuccessful relationships. For instance, did they acknowledge that they played a part in the demise and if so, what did they do about it? Also, she believes that multiple failed relationships may indicate difficulty to commit, emotional problems, or other unresolved issues. These are all things that should be carefully weighed before someone decides to pursue a deeper level of commitment. Some of the red flags Parker advises people to watch for are emotional distance and/or narcissistic behavior. If they are focused more on their own needs than yours, it could be an indication that they will not be attentive to you, emotionally or physically. Parker also says to watch out for people who continually put the blame for previous relationships on their exes.

But don’t rule everyone out based on the number of exes in their past. New York psychiatrist Gail Saltz says, “There is no one-size-fits-all answer, because people get married and divorced for many different reasons.” Saltz thinks that it is unwise to generalize people by the number of relationships they had before they met you. But she does think it’s important to find out how those relationships ended, what changes the person may have made, and most importantly, how the person gets along with their exes now. Immaturity, infidelity, addiction, and abuse are just some of the weeds that can kill a growing relationship. Saltz believes it is better to find out what personality traits your new love may have or may have been subjected to before you venture down an unfamiliar road with an unfamiliar person.

Asa, Richard. Dating in an age of multiple divorces: Navigating the dating scene when your date already has two or three marriages behind him.(n.d.): n. pag. Chicago Tribune. 2013. Web. 16 Jan. 2013. http://www.chicagotribune.com/features/life/sc-fam-0115-dating-divorced-20130115,0,1797022.story

Steroid needle on a trackIn a highly anticipated interview with Oprah Winfrey, famed cyclist Lance Armstrong has finally come clean about the allegations of doping that have haunted him for much of his unparalleled career. Armstrong, who in August 2012 was stripped of his record seven Tour de France victories and banned from competitive cycling due to mounting evidence of performance-enhancing drug use, is just one in a long line of athletes—most notably baseball players—who have either confessed to using performance enhancers or whose images have been tarnished by credible allegations of doping.

It’s no secret that many athletes will go to any length for a competitive edge, but performance-enhancing drugs carry numerous health risks, including baldness, impotence, infertility, addiction, psychiatric issues, hypertension, liver problems, and numerous other issues.

In a world where athletes who use performance-enhancing drugs always seem to get caught, often with disastrous consequences for their careers, what would compel an athlete to risk not only his or her health but livelihood as well?

Perfectionism and Pressure to Perform
Competitive sports can be cutthroat. Fans, coaches, and sponsors have high expectations for athletes, and hold in high regard records and never-been-done-before, seemingly superhuman feats. These expectations are frequently unrealistic, but can place considerable pressure on athletes. People in the upper echelons of athletics are often perfectionists to begin with; after all, it’s not easy to make it to the top. These perfectionist tendencies can make performance-enhancing drugs seem not only justified, but necessary.

Particularly when the competition uses performance-enhancing drugs, a dedicated athlete might feel like he or she has no choice. If the competition has an unfair advantage, taking drugs may seem less like cheating and more like leveling the playing field.

Peer Pressure
Particularly as more and more athletes admit to the use of performance-enhancing drugs, it can seem like sport is full of doping. Athletes may experience peer pressure from friends, teammates, and coaches, who may suggest that they can’t keep up with their competitors if they don’t use drugs. Peer pressure can also come in indirect ways. When athletes are criticized by peers, they might feel like their only hope for improvement can come in a vial or pill. Coaches, teammates, and even physicians or trainers may be complicit in doping.

Financial Issues
Not all athletes are wealthy. Particularly among Olympic athletes, financial gain often comes in the form of sponsorships, not from the sport or league. Many athletes spend years paying coaches, trainers, and gyms, and may get deep in debt covering the costs of developing into one of the best at what they do. Athletes are much more likely to get cushy sponsorship deals and contracts when they break records or win competitions. Particularly when an athlete knows or believes that other successful people in his or her field are using performance-enhancing drugs, they might seem like the most attractive or likely way to get out of debt and into financial security.

Secrecy
Although many athletes are regularly drug-tested, dopers try to stay one step ahead of the science. Many athletes have devised novel ways to avoid being caught, and in a high-stakes world, it’s easy to believe you can outsmart the testing mechanisms. Indeed, many athletes have managed to do just that for years, so the risk might seem worth it to an athlete under immense pressure.

References:

  1. Oprah: Lance Armstrong confesses. (2013, January 16). ESPN. Retrieved from http://espn.go.com/sports/endurance/story/_/id/8845599/oprah-winfrey-confirms-lance-armstrong-admitted-doping
  2. Performance-enhancing drugs: Know the risks. (2012, December 12). Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/performance-enhancing-drugs/HQ01105
  3. Shermer, M. (2008, March 31). The doping dilemma. Scientific American. Retrieved from http://www.scientificamerican.com/article.cfm?id=the-doping-dilemma
  4. Shermer, M. (2009, September 07). Why athletes dope. The Huffington Post. Retrieved from http://www.huffingtonpost.com/michael-shermer/why-athletes-dope_b_278861.html

In recent years, support of psychodynamic psychotherapy for the treatment of schizophrenia spectrum and other forms of psychosis has diminished. This is not entirely a result of lack of validity or efficacy, but rather an investigative shift from traditional methods of therapy to more novel approaches. However, according to a recent study led by Bent Rosenbaum of the Department of Psychology at the University of Copenhagen in Denmark, psychodynamic therapy is still one of the most effective forms of treatment.

Rosenbaum compared treatment as usual (TaU) to TaU with supportive psychodynamic psychotherapy (SPP) in a sample of 269 adults admitted for psychosis. The participants were measured for global functioning and symptom severity before, during, and after the two-year treatment period. Rosenbaum found that the SPP group improved far more than the TaU group with respect to all levels of functioning and symptoms of psychosis. Over the course of two years of treatment, there were significant gains on social functioning and significant decreases on maladaptive symptoms for the participants in the SPP group.

These findings demonstrate that psychodynamic therapy and the core elements associated with that approach can still adequately serve the needs of many individuals with schizophrenia and other psychotic issues. Rosenbaum believes that when working with psychotic clients, clinicians should focus on the fundamental aspects of psychodynamic therapy. This includes overcoming obstacles to emotional processing, mental functioning relating to sense of self, and the development and maintenance of relational bonds. Cognitive development and attention to the present should also be incorporated to ensure maximum benefits for clients who struggle with these issues.

Rosenbaum hopes that this research will bring clinicians back to SPP and approaches of that kind. “It furthers recovery when it is used as a supplement to medical and social treatment modalities.” He added, “SPP should thus be taken into account as a modality in future research and treatment.” Doing so will open avenues of treatment for clients with varying levels of mental illness.

Reference:
Rosenbaum, Bent, Susanne Harder, Per Knudsen, Anne Koster, Anne Lindhardt, Matilde Lajer, Kristian Valbak, and Gerda Winther. Supportive psychodynamic psychotherapy versus treatment as usual for first-episode psychosis: Two-year outcome. Psychiatry: Interpersonal & Biological Processes 75.4 (2012): 331-41. Print

Hearts in a spiralDon’t wait for trouble to set in when it comes to the enriching elements of your life, such as sensuality and sexuality. Often, we are draining ourselves of the essence in our sexual, erotic selves through seemingly small, inconsequential thought and behavioral patterns.

This article addresses some of the most common drains to our sexual energy. I encourage you to use it as an awareness-raising exercise and to begin to investigate your own energy drains. In response to what you learn from your own self-reflection and investigations, you may begin to compile and act on antidotes to your drains.

So, what stories are you telling yourself? What habits need a little tweaking in order to replenish your sexual energy? I encourage you to monitor your own thinking and behavior patterns, and note what drains you and what replenishes you. Enjoy!

GoodTherapy | Distress Tolerance in Dialectical Behavior TherapyDialectical behavior therapy (DBT) distress tolerance skills address the tendency of some individuals to experience negative emotions as overwhelming and unbearable. People with a low tolerance for distress can become overwhelmed at relatively mild levels of stress, and may react with negative behaviors. Many traditional treatment approaches focus on avoiding painful situations, but in the distress tolerance module of DBT, clients learn that there will be times when pain is unavoidable and the best course is to learn to accept and tolerate distress.

[fat_widget_right]

A key ingredient of distress tolerance is the concept of radical acceptance. This refers to experiencing the situation and accepting the reality of it when it is something the person cannot change. By practicing radical acceptance without being judgmental or trying to fight reality, the client will be less vulnerable to intense and prolonged negative feelings. Within the distress tolerance module, there are four skill categories:

  1. Distracting
  2. Self-soothing
  3. Improving the moment
  4. Focusing on pros and cons

These skills are aimed at helping individuals cope with crisis and experience distress without avoiding it or making it worse.

Skill No. 1: Distracting
The first skill, distracting, helps clients change their focus from upsetting thoughts and emotions to more enjoyable or neutral activities. This skill is taught with the acronym ACCEPTS:

A – is for activities and distracting oneself with healthy, enjoyable pursuits such as hobbies, exercise, and visiting with friends.

C – is for contributing and doing things to help others, through volunteering or just a thoughtful gesture.

C – is for comparing oneself to those less fortunate, finding reasons to be grateful.

E – is for emotion; identifying the current negative emotion and acting in an opposite manner, such as dancing or singing when one is feeling sad.

P – is for pushing away, by mentally leaving the current situation and focusing on something pleasant and unconnected to the present circumstances.

T – is for thoughts; diverting one’s attention from the negative feelings with unrelated and neural thoughts, such as counting items or doing a puzzle.

S – is for sensations, and distracting oneself with physical sensations using multiple senses, like holding an ice cube, drinking a hot beverage, or enjoying a warm foot soak.

Skill No. 2: Self-Soothing
The second skill in distress tolerance is self-soothing; clients can use the five senses to nurture themselves in a variety of ways:

  1. Vision: Look at beautiful things such as flowers, art, a landscape, or an artistic performance.
  2. Hearing: Listen to music, lively or soft, or enjoy the sounds of nature such as birds chirping and waves crashing. Savor the voice of a relative or friend.
  3. Smell: Use a favorite lotion or perfume, light a scented candle, notice the scents of nature, or bake an aromatic recipe.
  4. Taste: Enjoy a hearty meal or indulge in decadent dessert. Experiment with a new flavor or texture, and focus on the food’s flavors.
  5. Touch: Pet an animal or give someone a hug. Have a massage, rub on lotion, or snuggle up in a soft blanket.

Skill No. 3: Improving the Moment
In the third distress tolerance skill, the goal is to use positive mental imagery to improve one’s current situation. The acronym for this skill is IMPROVE:

I – is for imagery, such as visualizing a relaxing scene or a successful interaction. Imagine negative feelings melting away.

M – is for creating meaning or purpose from a difficult situation or from pain, i.e., finding the silver lining.

P – is for prayer—to God or a higher power—for strength and to be open in the moment.

R – is for relaxation, by breathing deeply and progressively relaxing the large muscle groups. Listen to music, watch a funny television show, drink warm milk, or enjoy a neck or foot massage.

O – is for one thing in the moment, meaning the individual strives to remain mindful and focus on a neutral activity in the present moment.

V – is for vacation, as in taking a mental break from a challenging situation by imagining or doing something pleasant. This could also be taking a day trip, or ignoring calls and emails for a few hours.

E – is for encouragement, by talking to oneself in a positive and supportive manner to help cope with a stressful situation.

Skill No. 4: Focusing on Pros and Cons
In focusing on pros and cons, the individual is asked to list the pros and cons of tolerating the distress and of not tolerating the stress (i.e., coping through self-destructive behaviors). It can be helpful to remember the past consequences of not tolerating distress, and to imagine how it will feel to successfully tolerate the current distress and avoid negative behaviors. Through evaluating the short-term and long-term pros and cons, clients can understand the benefits of tolerating pain and distress, and thereby reduce impulsive reactions.

The distress tolerance skills are valuable tools in helping individuals maintain balance in the face of crises, teaching them to accept the distress and cope with it in healthier ways. By practicing the skills of distracting, self-soothing, improving the moment, and focusing on pros and cons, clients can weather stressful circumstances and decrease painful feelings and destructive impulses.

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.