Distress Tolerance: Worksheet Pack

Were you able to remember and take each of the following steps? Insert an “x” in the box that best represents the effectiveness
	Yes	No
Stop
Take a step back
Observe
Proceed Mindfully

If you found the STOP skill helpful, how so?

How distressed did you feel

before and after the event?

Before

(1 - 10)

After

(1 - 10)

How effective was the skill at helping you tolerate distress?

Insert an “x” in the box that best represents the effectiveness

Not at all helpful

Not so helpful

Somewhat helpful

Very helpful

Extremely helpful

Willingness & Willfulness

Share information about your most recent use of this skill

Practice willingness, then complete the table below

Use a new page for each event that prompted you to use the skills

How much did you accept

before and after the event?

Before

(1 - 10)

After

(1 - 10)

How willful were you

before and after the event?

Before

(1 - 10)

After

(1 - 10)

Describe effective behavior you did to move forward toward a goal.

Notice willfulness; describe how you are not participating effectively in the world, or how you’re not doing something that needs to be done to move toward a goal.

How did you radically accept your willfulness? How did you accept what feels unacceptable?

Describe what you did that was willing.

How effective was the skill at helping you tolerate distress?

Insert an “x” in the box that best represents the effectiveness.

Not at all helpful

Not so helpful

Somewhat helpful

Very helpful

Extremely helpful

Turning the Mind

Share information about your most recent use of this skill

Practice turning the mind, then complete the table below

Use a new page for each event that prompted you to use the skills

How much did you accept

before and after the event?

Before

(1 - 10)

After

(1 - 10)

How long and how many times

did you practice this skill?

# of minutes

# of

times

Observe not accepting.

What did you observe?
What were you having trouble accepting?

Make an inner commitment

to accept what feels unacceptable.

How did you do this?

Describe your plan for catching yourself the next time you drift from acceptance.

How effective was the skill at helping you tolerate distress?

Insert an “x” in the box that best represents the effectiveness.

Not at all helpful

Not so helpful

Somewhat helpful

Very helpful

Extremely helpful

TIP Skills

Share information about your most recent use of this skill

Use may use additional pages for each use of this skill

Which TIP skills did you use?

Insert an “x” in the boxes below

Temperature

Intense Exercise

Paced Breathing

& Physiological Sigh

Paired Muscle Relaxation

How long and how many times

did you practice the skills?

# of minutes

# of

times

What caused you to try TIP?

Who was involved?
What happened?
When did it happen?
Where did it happen?

Share additional TIP details

How did you lower your temperature?
What exercise did you do?
How many cycles of paced breathing or physiological sigh did you do?
Which muscles did you pair?

How distressed did you feel

before and after the event?

Before

(1 - 10)

After

(1 - 10)

How effective was the skill at helping you tolerate distress?

Insert an “x” in the box that best represents the effectiveness

Not at all helpful

Not so helpful

Somewhat helpful

Very helpful

Extremely helpful

Self-Soothe

Share information about your most recent use of this skill

Complete the table below to record information for each technique that you used. Use a new page for each event that prompted you to use the skills

What prompted you to use SELF-SOOTHE?

What triggered the state of crisis?

Who was involved?
What happened?
When did it happen?
Where did it happen?

Specific skill	Did you use it? (insert “x” if used)	Describe how you used the skill	Effectiveness Rating (1 -5)*
Vision
Hearing
Smell
Taste
Touch

* 1 indicates “not at all helpful” and 5 indicates “extremely helpful”

Describe the outcome of using the skills:

How distressed did you feel

before and after the event?

Before

(1 - 10)

After

(1 - 10)

How effective was the skill at helping you tolerate distress?

Insert an “x” in the box that best represents the effectiveness.

Not at all helpful

Not so helpful

Somewhat helpful

Very helpful

Extremely helpful

Radical Acceptance

1. Describe a very important thing in your life

right now that you need to radically accept:

2. Describe a less important thing in your life

you are having trouble accepting this week

Refine your list. Check: the facts, for interpretations and opinions, and for judgments. Rewrite any items above so they are factual and nonjudgmental.

Focusing your mind on each “thing” separately, allowing your Wise Mind to radically accept that these are facts of life, check off the following exercises you did:

Behaviors	Did you use it? (insert “x” if used)
Observed that I was questioning or fighting reality
Reminded myself that reality is what it is
Considered the causes of the reality, and accepted that causes exist
Practiced accepting with my whole being (mind, body, spirit)
Practiced opposite action
Coped ahead with events that seemed unacceptable
Attended to my body sensations
Allowed myself to experience negative emotion
Acknowledged that life can be worth it, even when there is pain
Did pros & cons of accepting vs. denial & rejection
Other:

How much did you radically accept

before and after practicing this skill?

Before

(1 - 10)

After

(1 - 10)

How effective was the skill at helping you tolerate distress?

Insert an “x” in the box that best represents the effectiveness.

Not at all helpful

Not so helpful

Somewhat helpful

Very helpful

Extremely helpful

PROs & CONS

Describe the problem behavior you are trying to stop:
List pros and cons for acting on crisis urges (including urges to act and urges to quit), and create a separate list for resisting crisis behavior by tolerating distress and using skills. Use the back of this sheet if you need more
Read the pros and cons when an urge toward the problem behavior occurs.

Problem Behavior	PROs	CONs
Acting on Crisis Urge
Resisting Crisis Urge

Identify which pros and cons are short-term (just for today) or long-term (beyond today). Then ask your Wise Mind: Would you rather have a good day or a good life? Make a mindful choice about your behavior.

If this worksheet helps you choose skillful behavior over crisis behavior, be sure to keep it where you can find it and review it again when you are in crisis.

Mindfulness of Current Thoughts

Share information about your most recent use of this skill

Describe your efforts to observe your thoughts in the past week; practice every day, at least once, first saying ”the thought [describe thought] went through my mind.”

Check off (put an “X” next to) any of the following exercises you tried:

Used words and voice tone to say a thought over and over, in a voice different from mine, as a dialogue on a TV comedy show			7. Shuttled back and forth between scanning for physical sensations and thoughts.
Relaxed my face and body, accepting my thoughts as sensations.			8. Stepped back from my mind, as if atop a mountain.
Refocused on sensations I was avoiding by worrying.			9. Asked, “where’d the thought come from?”
Stopped viewing my thoughts as facts.			10. Imagined my thoughts as items coming down a conveyor belt or train cars on a railroad track.
Practiced loving my thoughts.			11. Labeled the thought as thought.
Allowed my thoughts to come and go, observing my breath.			12. Other:

Describe thoughts you were mindful of during the week, stating each thought as it went through your mind:

Thought

Strategies you used

(or use # from above)

How effective was the skill at helping you be more mindful, or less reactive?

Insert an “x” in the box that best represents the effectiveness.

Not at all helpful

Not so helpful

Somewhat helpful

Very helpful

Extremely helpful

IMPROVE the Moment

Share information about your most recent use of this skill

Complete the table below to record information for each technique that you used. Use a new page for each event that prompted you to use the skills.

What prompted you to use IMPROVE?

Who was involved?
What happened?
When did it happen?
Where did it happen?

Behaviors	Did you use it? (insert “x” if used)	How many minutes? (insert # of minutes)	Effectiveness Rating (1 -5)*
Imagery
Meaning
Prayer
Relaxation
One Thing
Vacation
Encouragement

* 1 indicates “not at all helpful” and 5 indicates “extremely helpful”

Describe the outcome of using the skills:

How distressed did you feel

before and after the event?

Before

(1 - 10)

After

(1 - 10)

How effective was the skill at helping you tolerate distress?

Insert an “x” in the box that best represents the effectiveness.

Not at all helpful

Not so helpful

Somewhat helpful

Very helpful

Extremely helpful

Half-Smiling & Willing Hands

Share information about your most recent use of this skill

Describe your practice with half-smiling and willing hands this week, practicing at least once per day - when you’re both emotionally distressed and not.

Check off any of the following exercises you did:

I half-smiled...	Did you use it? (Insert “x”)	I half-smiled...	Did you use it? (Insert “x”)
when I first woke up		8. with willing hands when my feelings were hurt
during free moments		9. with willing hands when I didn’t want to accept something
with willing hands while listening to music		10. with willing hands when I started getting really angry
with willing hands when irritated		11. when I had negative thoughts
in a lying-down position		12. when I couldn’t sleep
in a sitting position		13. with another person
when walking down the street		14. Other: ____________________

Describe your practice of half-smiling and willing hands (1 = not effective, 5 = very effective):

Describe the situation
What strategies did you use?
How effective was this at helping you be more mindful and less reactive on a scale of 1-5?

Describe the situation
What strategies did you use?
How effective was this at helping you be more mindful and less reactive on a scale of 1-5?

Distracting with Wise Mind ACCEPTS

Share information about your most recent use of the ACCEPTS skill

Complete the table below to record information for each technique that you used. Use a new page for each event that prompted you to use the skills.

What prompted you to use ACCEPTS?

Who was involved?
What happened?
When did it happen?
Where did it happen?

Behaviors	Did you use it? (insert “x” if used)	How many minutes? (insert # of minutes)	Effectiveness Rating (1 -5)*
Activities
Contributions
Comparisons
Emotions
Pushing Away
Thoughts
Sensations

* 1 indicates “not at all helpful” and 5 indicates “extremely helpful”

Describe the outcome of using the skills:

How distressed did you feel

before and after using the skill?

Before

(1 - 10)

After

(1 - 10)

How effective was the skill at helping you tolerate distress?

Insert an “x” in the box that best represents the effectiveness.

Not at all helpful

Not so helpful

Somewhat helpful

Very helpful

Extremely helpful

Chain Analysis

Use this sheet to complete a Chain Analysis of your Target Behavior. Start by identifying the following:

Target Behavior:

Prompting Event:

Vulnerability Factors:

(Continued on next page)

Use this chart to identify the links in the chain between your Prompting Event and Target Behavior. Write the links on the left side and an alternative behavior or skill you could use in the future on the right side.

Links (in the chain) (thoughts, emotions, feelings, events, actions)	More skillful behavior/ skills to use