Facing Your Feelings

Facing Your Feelings

Facing Your Feelings

Module 3
Improving Distress

Introduction 2
Balancing Acceptance & Improvement 2
Improving Distress 2
Opposite Action 3
Distress Improvement Activities 4
Improving Distress Practice 7
Problem Solving 8
Module Summary 14
About the Modules 15

The information provided in the document is for information purposes only. Please refer to
the full disclaimer and copyright statements available at www.cci.health.gov.au regarding the
information on this website before making use of such information.

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Introduction
The previous module focused on developing ways of accepting emotional distress. This module takes a
very different focus of learning how to improve your distress when you experience it. To improve distress
we focus more on your behaviours, looking at what to do and what not to do when you experience
emotional distress. Depending on the type of escape methods you typically use (i.e., avoidance, numbing &
withdrawing, or harmful releases), the strategies we will suggest for improving your distress will vary
slightly. This module will focus on helping you discover a variety of things you can try to improve your
distress, so you can experiment and find out what works for you.

Balancing Acceptance & Improvement

Accepting and improving distress are quite different approaches, and maintaining a balance
between acceptance and improvement is the key to building distress tolerance. It is unhelpful
to be at either extreme (i.e., only accepting how you feel or only trying to improve how you
feel). To tolerate distress you really need to learn how to do both. Our aim is to help you
learn how to accept your negative emotions, and with that in mind, then work on improving your
emotional experience. Imagine if you only tried to improve your distress without being able to accept it
first, if this were the case then your efforts to find something to improve your negative feelings would be
pretty frantic and desperate. If instead you could accept your distress, then your efforts to improve the
distress would more likely be calm, considered and calculated.

We have purposely put Accepting Distress before Improving Distress in this series of Modules, as we don’t
want “improving” to become just another strategy for avoiding your emotions. In summary, you need to
feel the emotion first, accept it, ride through it, and then take action to improve it.

However having said that, if as you work through these modules the distress you experience is extremely
intense and unbearable emotional pain, then you may not be able to apply the acceptance strategies
outlined in the previous module just yet. If this is the case, then it is ok to move straight to this module
and focus on improving your distress (particularly the Distress Improvement Activities on page 5). This is
particularly relevant for people who engage in self-harm or drug and alcohol use to manage their distress. In
these situations, temporary distractions may be necessary to help you get through the intense distress you
might be experiencing, and avoid engaging in behaviours that are damaging to you.

Improving Distress
As we have seen, being distress intolerant can manifest is very different sorts of behaviours or escape
methods. Some people avoid certain situations that make them distressed, engage in reassurance seeking
or checking to alleviate their distress, or use distraction and suppression to stop their distress. Other
people numb and withdraw via engaging in alcohol
or drug use, binge eating or using sleep to escape Alcohol or Binge Eating
Drugs
their emotions. And other people may engage in
harmful releases, hurting themselves in some Sleep
physical way as a means of dealing with their Self Injury

distress. Although these behaviours are very Distress

different, and hence the strategies for improving Distraction &
distress can vary too, the common guiding principle Reassurance Suppression
for improving distress is to do the opposite of your Seeking or
Avoid
Checking
escape urge, and find specific activities that improve Situations
your emotional state.
Please Note: As mentioned in Module 1, whilst these modules may be helpful to people who use drugs, alcohol or self-harm as a
means of tolerating emotional distress, it is important to recognise that these are very serious problems in their own right that
can cause a person significant harm. We strongly advise seeking help from a GP or mental health professional to address these
concerns, rather than relying solely on these Modules to overcome the problem.

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Opposite Action
In Module 1, you identified your particular escape methods. Below is a table summarising the opposite
actions for each distress escape method we have covered. Look through the table and circle the opposite
action box corresponding to your particular escape method(s). There is also a box at the bottom for if you
engage in a particular escape method that we have not covered in these Modules. If this applies to you,
maybe you could try to think of what the opposite action would be.

Drop Escape Method Do Opposite Action

Situational Avoidance* Don’t avoid situations that distress you. Instead

gradually face these situations and stay in them,
until you have ridden through the distress.
Remember to reward your efforts when you are
done, by doing things that are active or soothing.

Reassurance Seeking or Checking Minimise or eliminate reassurance seeking or

checking behaviours. Try to cope independently
with the distress you feel, riding through these
feelings without resorting to checking things or
seeking the reassurance of others. Remember to
reward your efforts when you are done, by doing
things that are active or soothing.

Distraction & Suppression Don’t push away distressing feelings. Instead allow
and experience these feelings. Remember to
reward your efforts when you are done, by doing
things that are active or soothing.

Alcohol or Drugs Don’t numb the distress by using alcohol or drugs.

Instead allow and experience these feelings. Also
do things that are active or soothing, rather than
withdrawing from life.

Binge eating Don’t numb the distress by binge eating. Instead

allow and experience these feelings. Also do
things that are active or soothing, rather than
withdrawing from life.

Excessive sleep Don’t numb the distress by using sleep. Instead

allow and experience these feelings. Also do
things that are active or soothing, rather than
withdrawing from life.

Harmful Releases Self-soothe and be active in the moment, rather

than harming yourself.

* Note: This module deals with general avoidance driven by not wanting to feel emotional distress. If you identify very strongly with your
avoidance being specifically related to social situations, or fear of having a panic attack or fear of having a serious health problem, then you may
want to look at the ‘Shy No Longer’, ‘Panic Stations’ and ‘Helping Health Anxiety’ Information packages respectively to target these specific
problems.

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You will notice that most of the opposite actions initially require that you stay with, ride through, allow and
experience the distress, rather than escaping it. As such, the acceptance strategies of Module 2 will be
relevant in helping you do this. You will also notice that most of the opposite actions require engaging in
some activity that is either about being active in the moment, or about soothing yourself in some way. The
Distress Improvement Activities that follow this section will help you with ideas for activities that may help
you achieve these aims.

Also notice that for the first 3 escape methods (i.e., situational avoidance, reassurance seeking or checking,
distraction & suppression), distress improvement activities should be used as a reward after having faced
and stayed with the distress until it naturally subsides of its own accord. For the remaining escape
methods, engaging in distress improvement activities may be done sooner than this, as you do not
necessarily have to wait until you feel the distress subside.

It is also worth mentioning that doing these opposite actions can be challenging, and so words of
encouragement and compassion to ourselves may be important when we are finding it tough. It can be
useful to think “what encouragement would I give to
someone else feeling this way?”, “what would I say to
them and what tone would I use?” Some other
examples of helpful self-talk might be things like... “I
can stay with this feeling”; “it is good practice for me to “I can get through this!”
get comfortable being uncomfortable”; “I can get
through this”; “I can tolerate this”; “It will pass”; “this is
good for me in the longrun”; “I can focus on just getting
through this moment”; “I can breathe with this feeling”;
“this is helping me build my tolerance”...

Distress Improvement Activities

Finding small ways to participate and be active in the moment when distressed, or to self-soothe and self-
nurture when you are feeling distressed, are important for improving your emotional experience. Activities
that centre on the concepts of activating and soothing we will call ‘distress improvement activities’, and a list
of these is featured on the next page. The activities in the left-hand column are more about
participating actively in the moment (i.e., being involved, active and absorbed in something
that may improve your distress), whilst the activities on the right-hand side are more about
soothing yourself (i.e., activities that make us feel a sense of warmth and being cared for and
that help us get through things). You will notice there is a lot of overlap between activities
that are about activation and activities that are about soothing, so don’t get too caught up
in which column you pick activities from. Also, some of the listed activating and
soothing activities you may also find rewarding, and you can use them in this
way if needed.

The idea is not that you have to use each activity on the list, but that some may appeal to you to try and
others won’t. Also, by having such a large list, it may help you to brainstorm other distress improvement
activities that may work for you. Look at the list and underline any activities you may like to experiment
with when you are feeling distressed, and feel free to add other activities that come to mind in the space
provided. Remember, the aim of these activities is not to take your distress away, but to make
your distress more tolerable.

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Distress Improvement Activities

Activate Soothe

Exercise Have a good meal

Walk Have a nice snack
Jog Favourite drink (non-alcohol)
Gym Have a picnic
Weights Light a candle
Exercise class Look at beautiful art or scenery
Boxing Watch the stars
Cleaning Go to a beautiful place
Washing Soothing or invigorating music
Dishes Enjoy sounds of nature
Vacuuming Singing
Dusting Be aware and let sounds come and go
Gardening Favourite perfume
Cooking Favourite lotion
Call a friend Enjoy smells of nature or flowers
Go out to lunch, dinner, a coffee Bubble bath
Shopping Shower
Favourite movie Massage
Favourite book Pat dog or cat
Favourite music Soak feet
Favourite TV show Brush hair
Books/movies/music that create a different emotion Do nails
Magazines Imagine a relaxing scene/safe place
Newspaper Imagine coping/distress flowing away/distress passing
Games Create meaning/purpose from distress
Puzzles Read/think of your spiritual values
Volunteer somewhere Focus on any positive aspects in your life
Give someone a present Pray
Do something thoughtful Relaxation tape
Make something for someone Tense and release muscles
Slow breathing
______________________________________ Count to 10
Smile
______________________________________ Laugh out loud
Take a break (stay in bed for 20mins)
______________________________________

______________________________________ __________________________________________

______________________________________ __________________________________________

______________________________________ __________________________________________

______________________________________ __________________________________________

______________________________________ __________________________________________

Adapted from Linehan (1993).

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The only way to get a sense of what distress improvement activities work well for
you, is to start experimenting with those that sound promising, and then evaluate
what impact they have on your distress. Below is a table to keep track of the
findings from your experiments. The next time you feel distressed you might try
one of the distress improvement activities you highlighted, recording the date you
tried it, what the activity was and the outcome. By outcome we mean what actually
happened when you tried it. Did it work well at improving your distress? Did it
make no difference? Or did it make your distress worse? Based on the outcome
you can then evaluate what you learnt from it, whether it is a worthwhile strategy to do again, or whether
you need to redo it because you are still unsure if it is useful.

Date Distress Improvement Activity Outcome Evaluation

What happened? What did I learn?
Should I use this activity again?
10/05/2012 Warm Shower Felt groggy after. Didn’t Not sure if this is the best activity
feel great, but probably to use. I could use it again, but I
less angry than I was. might try music next time.

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Improving Distress Practice
Now that you have some general ideas of things not to do when you feel distressed (i.e., my
usual distress escape methods), and things you can do to improve your distress (i.e.,
opposite actions and distress improvement activities), it is good to personalise and clarify
these ideas for your own situation. Below gives two examples of what a personalised list
might look like. The first example is of someone who numbs & withdraws by binge
eating and sleeping, and also engages in harmful releases by scratching themselves. The
second example is of someone who situationally avoids by not leaving the house, distracts
themselves when they do venture out, and seeks reassurance from their family to deal with their distress.
Following these examples is the opportunity to draft your personalised list of ideas. Use the examples
below, the “opposite action” section(s) you circled on page 3, and what you learnt from your distress
improvement experiments on page 6, to assist you with drafting your own ideas.

Example Improving Distress Ideas

What Not To Do What To Do
Scratching myself when I feel distressed. Allow the distress rather than trying to get rid of it.
Binge eating when I feel distressed. Try active and soothing activities like... listening to my
Sleeping when I feel distressed. favourite CD, rubbing nice moisturiser on my arms
where I would normally scratch, walking around the
block, taking a shower, calling my friend Emma, enjoying
a good coffee, sitting in the sunshine, reading an
inspirational book, patting my cat.
Encourage myself: “I can get through this”, “It will pass”,
“I can tolerate this feeling”.

Example Improving Distress Ideas

What Not To Do What To Do
Avoiding leaving the house, because it makes me Face the distress by leaving the house, without
distressed. headphones, and not relying on family to reassure me.
Distracting myself when I do have to leave the house, by Stick with it until I feel my distress come down.
always listening to music on my headphones. Encourage myself: “I can cope through this distress”,
Constantly seeking reassurance from my family about “this is good for me in the longrun”, “breathe with this
anything distressing me. feeling”, “focus on the task I am doing”.
Reward my efforts with active or soothing activities, once
I have felt the distress subside (e.g., quality time with my
family, making a nice meal for myself, buying myself a
new book).

Personalised Improving Distress Ideas

What Not To Do What To Do

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Problem Solving
Once you have been able to tolerate rather than escape your negative emotions,
and your distress has somewhat subsided, it may be worth asking yourself
whether the distress you are experiencing is regarding a situation you can
actually do something about? That is, is your distress regarding something you
have some control over, and could take action with to improve how you are
feeling?

If the answer is ‘no’, then keep going with all that we have covered so far in
Module 2 and 3 to keep building your tolerance to the distress.

However, if the answer is ‘yes’, then once the distress has subsided, you might
be in a better position to problem solve regarding the situation that is distressing you. Problem solving
involves working your way through the problem in a systematic, step-by-step, structured manner. This
means identifying the problem that is distressing you, thinking through all the options for solving the
problem, looking at the advantages and disadvantages of the options most preferable to you, picking one or
more options to put into place, listing the steps required to put those options into action, and specifying a
plan for when you will take each step. Finally, it requires taking action to put your plan in place, then
evaluating the outcome, and reassessing if the problem has been solved or requires further action. As you
can imagine, problem solving is difficult to do when you are in the thick of distress, but is a good thing to
try once the distress is more manageable.

Below is an example of problem solving in action. If problem solving seems relevant to improving your
distress, space is then provided for you to follow the same problem solving steps.

Step 1: Identify/Define Problem

Try to state the problem as clearly as possible. Be objective and specific about the behaviour, situation,
timing, and circumstances that make it a problem. Describe the problem in terms of what you can observe
rather than subjective feelings.

Problem Definition
The gas and phone bills are due at the same time. I don’t have enough money to
cover both this month.

Step 2: Generate Possible Solutions/Options

List all the possible solutions. Be creative and forget about the quality of the solutions. If you allow
yourself to be creative, you may come up with some options that you would not otherwise have thought
of.

List All Possible Solutions

• Ring both companies – see if I can negotiate to pay it off gradually
• Prioritise – I can live without the phone for a while, but not the gas, so I will pay the gas
bill first
• Borrow money from family or friends to pay both bills
• Pay bills on my credit card – then pay that off later
• See a financial counsellor – they may be able to help me sort it out
• Get a second job
• Sell some of my possessions to pay the bills

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• Don’t pay the bills and move in with a friend instead

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Now eliminate the less desirable or unreasonable alternatives only after as many possible solutions have
been listed. Then, list the remaining options in order of preference.

Preferred Solutions/Options
1. Ring both companies – see if I can negotiate to pay it off gradually.

2. See a financial counsellor – they may be able to help me sort it out.

3. Prioritise – I can live without the phone for a while, but not the gas, so I will pay the gas
bill first.

4. Get a second job.

Step 3: Evaluate Alternatives

Evaluate the top 3 or 4 plans in terms of their advantages and disadvantages

Advantages Disadvantages
Potential I may be able to keep both the phone I will feel embarrassed having to ring
Solution #1 and gas on. the companies.
I will feel I have done something. I may not get what I want.
I will still have to pay eventually.
Potential They are experienced and will know I will need to do some research to find
Solution #2 what to do. a free service – this will take some
I’ll have support. effort.
Someone to help me.
Companies may listen to them.
Potential The gas will stay on. I won’t have a phone on hand if I need
Solution #3 I can still use the pay phone. it.
I will survive. I may have difficulties getting the
Problem will be reduced. phone reconnected in future.
Potential More money. I will be too busy – no time for myself.
Solution #4 This won’t solve the immediate
problem.

Step 4: Decide On A Plan

Decide on one, two or more of the plans. Specify who will take action, when the plan will be implemented
and how the plan will be implemented.

Action Steps Who When

Contact gas and phone companies to negotiate options for Me Monday morning
paying the bills (pay off gradually or extend payment).

If that doesn’t resolve the problem, contact Centrelink to Me Monday afternoon

ask about free financial counsellors.

Visit financial counsellor for advice. Me Tuesday

If that doesn’t resolve the problem, pay gas bill and use pay Me Wednesday
phone temporarily.

Step 5: Implement Plan

Implement your plan as specified above.
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Step 6: Evaluate the Outcome
Evaluate how effective the plan was. Decide whether the existing plan needs to be revised, or whether a
new plan is needed to better address the problem. If you are not pleased with the outcome, return to Step
2 to select a new option or revise the existing plan, and repeat the remaining steps.

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Problem-Solving
1. Identify and Define Problem Area/Issue

Problem Definition

2. Generate Possible Solutions/Options

List All Possible Solutions Preferred Solutions/Options

1.

2.

3.

4.

5.

6.

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3. Evaluate Alternatives

Advantages Disadvantages
Potential Solution #1

Potential Solution #2

Potential Solution #3

Potential Solution #4

4. Decide on a Plan

Action Steps Who When

Step 5: Implement Plan

Implement your plan as specified above.

Step 6: Evaluate the Outcome

• How effective was the plan?
• Does the existing plan need to be revised or would a new plan be needed to better address the
problem?
• If you are not pleased with the outcome, return to Step 2 to select a new option or revise the existing
plan, and repeat Steps 3 to 6.

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Module Summary
• Maintaining a balance between acceptance and improvement is the key to building distress
tolerance. You need to feel the emotion first, accept it, ride through it, and then take action to
improve it.
• The common guiding principle for improving distress is to do the opposite of your distress escape
methods, and find specific activities that improve your emotional state.
• Acting opposite to your escape urge involves dropping your escape methods (i.e., situational
avoidance, reassurance seeking or checking, distraction and suppression, alcohol or drugs, binge
eating, excessive sleep, harmful releases, etc), allowing and experiencing the distress, and
participating in activities that are activating or soothing.
• Activities that are activating or soothing we call ‘distress improvement activities’, and you will need
to experiment with these activities when you are distressed to find out what works for improving
your distress.
• Once your distress is more manageable, it may be worth questioning if there is something you can
change about your situation to further improve the distress. If it is a situation you have some
degree of control over, then you can use the 6 problem solving steps as a way of working through
the problem systematically.

Coming up next …
In Module 4, you will put together and
practice your Distress Tolerance
Action Plan...

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About The Modules

CONTRIBUTORS
Dr Lisa Saulsman (MPsych1; PhD2) Paula Nathan (MPsych1)
Centre for Clinical Interventions Director, Centre for Clinical Interventions
Adjunct Senior Lecturer, School of Psychiatry and Clinical
Neuroscience, The University of Western Australia
1 2
Masters of Psychology (Clinical Psychology) Doctor of Philosophy (Clinical Psychology)

BACKGROUND
The concepts and strategies in these modules have been developed from evidence based psychological
practice, primarily Cognitive-Behavioural and Mindfulness-Based Therapies. These modules are based on
the approach that distress intolerance is a result of problematic cognitions (thoughts) and behaviours.

REFERENCES
These are some of the professional references that informed the development of modules in this
information package.
Leahy, R.L. & Tirch, D., & Napolitano, L.A. (2011). Emotion Regulation In Psychotherapy: A Practitioner’s Guide.
New York: Guilford Press.
Linehan, M. M. (1993). Skills Training Manual For Treating Borderline Personality Disorder. New York: Guilford
Press.

“FACING YOUR FEELINGS”

We would like to thank Bruce Campbell for the title of this module that forms part of the InfoPax series.
Saulsman, L., & Nathan, P. (2012). Facing Your Feelings: Learning to Tolerate Distress. Perth, Western
Australia: Centre for Clinical Interventions.

ISBN: 0 9757995 7 6 Created: May 2012

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