Three Distress Tolerance Skills to Help Cope with Dissociation

While dialectical behavior therapy (DBT) isn't the primary treatment option for dissociative identity disorder (DID), there are DBT skills, like distress tolerance skills, that can help people manage their dissociation symptoms. These skills come in handy in a crisis or when we feel ourselves heading towards dissociation. So how do you use the distress tolerance skills of DBT for the dissociation of DID?

Although DBT wasn't specifically created for people with dissociative disorders, we can certainly use some DBT skills to cope with DID. Here are three distress tolerance skills to try when dissociation feels imminent.

1. The TIPP Distress Tolerance Skill

In DBT, the TIPP skill is used as part of crisis survival. If you feel your emotions getting out of control or feel yourself dissociating, you can use the TIPP skill to help ground you. The TIPP skill involves temperature change, intense exercise, and paced breathing/progressive muscle relaxation.

For temperature change, you can hold ice cubes, take a cold shower, or dunk your face in cold water. This helps to lower the intensity of your emotions and bring you back to the present. Intense exercise is helpful when you feel yourself numbing out (which can lead to dissociation) or to distract yourself from a trigger. Lastly, paced breathing and progressive muscle relaxation help change your focus to what is going on inside your body and can bring you outside of the emotions that may lead to dissociation.

2. The ACCEPTS Distress Tolerance Skill

DBT includes another distress tolerance skill called ACCEPTS which stands for

• Activities,
• Contributing,
• Comparisons,
• Emotions,
• Pushing away,
• Thoughts, and
• Sensations.

While not all of the parts of the ACCEPTS skill can be useful for those with DID, some of these methods of distraction as a distress tolerance skill can keep us from dissociating.

When practicing the ACCEPTS skill, we can distract ourselves from what may be triggering the dissociation by watching TV, reading a book, going outside to the beach or the park, listening to music, reaching out to someone, or doing something that jolts a physical sensation, like eating something cold or drinking a hot coffee.

3. Learn to Self-Soothe

Another DBT distress tolerance skill is self-soothing. With self-soothing, we try to use as many of the five senses -- taste, touch, smell, hearing, and sight in order to engage ourselves in the present moment. For those of us with DID or another dissociative disorder, staying in the present is important in order to decrease dissociation.

The best way to practice self-soothing is to create a self-soothe kit. The self-soothe kit can include anything and should be things that help to soothe you. Your favorite lotion, a small candle, mints or candy, a noisemaker, affirmation cards, grounding stones, clay -- the choices are up to you.

You can get a small pouch or box so you can have these items wherever you go. When you feel yourself becoming ungrounded or dissociated, you can pull out your self-soothe kit to comfort yourself and remind yourself that you are in the present moment.

Any of these DBT distress tolerance skills can help those with DID distract from triggers, keep us in the present moment, and decrease dissociation. So while DBT may not have been created for people with dissociative disorders, we can certainly learn a lot from the skills within.