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How to Prevent Relapse With the STOP Skill (DBT Distress Tolerance Skills)


Sober Recovery Expert Author

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Have you ever reacted to a crisis in a way that you later regretted? In retrospect, after learning all the facts, would you have handled the situation differently? Most of us have, or we wouldn't be human.

For those in recovery, crisis and chronic stress can be the perfect recipe for relapsefeeling angry, defensive, or judged. You may think others don't appreciate you or the efforts you're making towards positive changes in your life. Your personal relationships then suffer.

Utilizing the STOP skill helps prevent black and white thinking. You gain new perspectives and acceptance in all areas of your life.

Dialectical behavior therapy (DBT) teaches "distress tolerance" skills that can help you ride out a crisis and avert relapse when faced with an unbearable, stressful situation or life event. You can learn different responses that don't involve using or other destructive behaviors.

The STOP skill is the very first skill covered in the distress tolerance unit of DBT.

Applying the STOP Skill

When we are in the midst of a crisis or something has happened suddenly to derail us, we are used to reacting and feeling helpless and at the mercy of those circumstances.

Understanding and applying the STOP skill will help you learn to accept a distressing situation and work through it without using or relapsing.

Here is what each letter in STOP skill stands for:

S = Stop

As soon as you realize you may be "flying off the handle," STOP. Freeze. Refrain from allowing your emotions to take over (this will feel unnatural at first), and STOP everything you are doing immediately. You can even visualize a red STOP sign in front of you.

T = Take a step back

Step away from the situation, take a break, leave the room, BREATHE. At this point, you may be experiencing some physical symptoms of stress or anxiety. Allow those feelings to come and realize that it's just a response to the current stressor.

O = Observe

Once you are removed from the situation (whether physically or mentally), you can now access the circumstances from a fact-based and non-judgmental perspective. When you're in the midst of a crisis, you may not have all of the information, or you may be misinformed.

P = Proceed mindfully

Now that you have calmed down and can see a different perspective think about the next steps to take. What will make the situation better or worse? This involves moving into a "dialectal" state of mind and remembering that two opposite views can be true simultaneously.

For example, you may be very upset with your partner at this moment, and you also love them dearly. Both things are true. Utilizing the STOP skill helps prevent black and white thinking. You gain new perspectives and acceptance in all areas of your life.

Using the STOP skill will become easier the more you practice. Learning to react less impulsively will help strengthen your recovery and improve your relationships with others.

What is DBT and How is it Used in Addiction Treatment?

Dialectical behavior therapy, known as DBT, is a form of cognitive behavior therapy created in the 1970s by Psychologist Dr. Marcia Linehan. It was originally used to treat people diagnosed with borderline personality disorder.

Since then, it has shown favorable outcomes in treating addiction and substance use by diminishing cravings and avoiding impulsive and harmful behaviors. DBT is now also used to treat eating disorders, major depressive disorder, and anxiety. It was the first psychotherapy to incorporate mindfulness and Zen influences from Buddism formally.

How to Learn DBT Emotional Regulation Skills

DBT emotional regulation skills can be learned in individual counseling as well as in weekly support groups. The method can explore an individual’s past or history to move past their situation effectively. As with other common therapies, DBT focuses on changing and replacing negative thinking patterns with positive coping skills.

DBT usually involves homework outside of scheduled group sessions, such as writing daily journal entries or jotting down a list of emotions felt during the day.

The 4 Modules of DBT

1. Mindfulness

Mindfulness is the foundation of DBT. The core mindfulness skills taught are: observe, describe and participate. It's not second nature to respond to life and things that happen to us in a non-judgmental and mindful way. Yet this is exactly what we learn in the DBT core skills.

2. Interpersonal Effectiveness

In relationships with others, there is bound to be conflict at times. This is unavoidable, but you can learn ways to communicate more effectively. This particular set of DBT skills are similar to what is often taught in assertiveness and interpersonal problem-solving workshops.

3. Distress Tolerance

Focusing on changing distressing events and circumstances is a common approach to mental health treatment. DBT emphasizes learning to bear pain skillfully. This can be achieved through acceptance skills, including radical acceptance, turning the mind toward acceptance, and willingness versus willfulness.

4. Emotion Regulation

One fascinating note about how DBT skills differ from traditional counseling is realizing that just because you are feeling an emotion right now doesn't mean you are bound to that feelingeven in the following minutes.

Learning how to identify and label emotions properly helps you sit with your feelings and apply distress tolerance techniques. This is one facet of DBT that can be so useful in relapse prevention.

DBT vs. CBT: Is One Better Than the Other?

Cognitive-behavioral therapy (CBT) and DBT are two of the most widespread therapeutical methods in existence today. In treatment, these methods are used as a guideline for the activities or topics included in an individual or group therapy session. CBT is the more practiced and methodical approach, while DBT takes a more creative and emotional one. Both have many benefits and consequential drawbacks, so the debate still goes on as to which one is the best method.

CBT Strengths and Drawbacks

According to psychiatrist Ben Martin, CBT is a “short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking or behavior that are behind people’s difficulties, and so change the way they feel.” CBT also has homework assignments to complete outside of the established therapy times. These assignments provide additional reinforcement of the positive thoughts that eventually develop. The goal is to change an individual's thought process so that they will choose to react differently instead of relying on negative alternatives.

The drawback to this approach is that it is only effective for people with one specific disorder. Martin continues, “People who describe having particular problems are often the most suitable for CBT, because it works through having a specific focus and goal. It may be less suitable for someone who feels vaguely unhappy or unfulfilled, but who doesn’t have troubling symptoms or a particular aspect of their life they want to work on.”

Sometimes, feelings are nameless. They do not have to relate to a specific category. Someone can feel depressed but not know exactly why he or she feels that way. In this type of situation, other forms of treatment may be better.

DBT Strengths and Drawbacks

DBT on the other hand teaches the classic “I” phrases and derives benefits from meditation and mindfulness. According to the Linehan Institute, DBT is most effective for people with three different types of particular behaviors. Each of the three represents the severity or differences of each diagnosis. These behaviors are categorized as the following.

(a) Life Threatening Behaviors: Life-threatening behaviors are those most related to suicidal tendencies where someone is at immediate risk of dying. These can include self-harm and eating disorders as those can be potentially life-threatening.

(b) Therapy Interfering Behaviors: These are behaviors that “interfere with receiving effective treatment,” which includes “being late to sessions, canceling appointments, and failing to collaborate in working towards treatment goals.”

(c) Quality of Life Behaviors: These behaviors include mental conditions, relationship problems, and financial or housing crises.”

Like CBT, DBT requires homework. However, only DBT requires daily homework. The repetition of recording thoughts and repeating positive phrases is to establish a type of brain muscle memory, so that in a moment of crisis, practitioners turn to the DBT phrases instead of the negative thoughts that tend to induce addictive or harmful behavior. In all things, practice makes perfect, so if one does not have the will to practice DBT methods daily, then they will not fully benefit from the treatment.

If you or someone you know is seeking help from addiction, please visit our directory of treatment centers or call 800-891-8171 to start the road to recovery.

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