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Dialectical Behavior Therapy (DBT), developed by Marsha M. Linehan, is a cognitive-behavioural treatment that has been shown to be effective in treating a range of psychological disorders, particularly Borderline Personality Disorder (BPD) (Linehan, 1993). One of the essential components of DBT is the Distress Tolerance module, which includes the Self-Soothe skill. This skill is designed to help individuals manage intense emotional distress by engaging in activities that provide comfort, reduce emotional pain, and promote relaxation. This article delves into the theory behind the Self-Soothe skill, its application in therapy, and its empirical support while also considering the limitations and practical challenges associated with its use.
Theoretical Foundations of the Self-Soothe Skill
The Self-Soothe skill is rooted in the concept of distress tolerance, which is the ability to withstand negative emotions without engaging in impulsive or self-destructive behaviors (Linehan, 2015). DBT posits that individuals with high emotional sensitivity often struggle to tolerate distress, leading to maladaptive coping strategies such as self-harm, substance abuse, or binge eating. The Self-Soothe skill offers an alternative by encouraging individuals to engage in positive, soothing activities that activate the senses and provide relief from emotional pain.
Self-soothing is a natural coping mechanism that most people use in their daily lives, often without conscious awareness. For example, listening to calming music, taking a warm bath, or enjoying a favorite scent are common self-soothing activities. However, individuals with BPD or other emotional regulation difficulties may not readily use or even recognize these strategies, particularly in moments of crisis. The Self-Soothe skill in DBT is a structured approach that teaches individuals to consciously engage in soothing activities, thereby reducing the intensity of their emotional distress and preventing harmful behaviors (Neacsiu, Rizvi, & Linehan, 2010).
The Components of the Self-Soothe Skill
The Self-Soothe skill involves engaging the five senses—sight, hearing, smell, taste, and touch—to create a calming and comforting experience. Each sense can be targeted through specific activities that promote relaxation and emotional balance.
1. Sight
Visual stimuli can have a powerful impact on emotions. The Self-Soothe skill encourages individuals to focus on visually pleasing or comforting images to calm their minds. This might include looking at photographs of loved ones, watching a beautiful sunset, or surrounding oneself with aesthetically pleasing objects. The use of color, light, and nature can all contribute to a visually soothing environment (Linehan, 2015).
2. Hearing
Sound is another potent tool for emotional regulation. Soothing sounds can include listening to calming music, nature sounds like ocean waves or birds chirping, or even engaging in guided meditation. Music therapy has been shown to reduce anxiety, stress, and depressive symptoms by altering mood and promoting relaxation (Bradt & Dileo, 2014). In DBT, individuals are encouraged to create playlists of music that they find particularly soothing and to use them during times of distress.
3. Smell
The sense of smell is closely linked to memory and emotion, making it a powerful component of the Self-Soothe skill. Aromatherapy, which involves the use of essential oils, is one way to engage this sense. Scents such as lavender, chamomile, and vanilla are commonly used to promote relaxation and reduce anxiety (Herz, 2009). Individuals can use scented candles, essential oils, or even favorite perfumes to create a comforting olfactory environment.
4. Taste
Taste can be used to ground oneself in the present moment and provide a sense of comfort. This might involve savoring a favorite food or drink, such as a piece of chocolate, a cup of herbal tea, or a comforting soup. The key is to focus mindfully on the experience, savoring each bite or sip and paying attention to the flavors and textures (Linehan, 2015). Mindful eating, as part of the Self-Soothe skill, can help individuals reconnect with their bodies and reduce emotional distress.
5. Touch
Physical sensations play a crucial role in emotional regulation. The Self-Soothe skill encourages individuals to engage in activities that provide comforting tactile sensations. This might include taking a warm bath, wrapping oneself in a soft blanket, petting a dog or cat, or using a weighted blanket to provide a sense of security (McEwen, 2007). The sense of touch can also be engaged through activities such as massage, knitting, or holding a comforting object.
Integrating the Senses
The Self-Soothe skill is most effective when it involves multiple senses, creating a holistic soothing experience. For example, taking a warm bath (touch) while listening to calming music (hearing) and using scented bath salts (smell) can create a multi-sensory experience that deeply relaxes the body and mind. By integrating the senses, individuals can create personalized self-soothing routines that help them manage distress more effectively.
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Application of the Self-Soothe Skill in Therapy
In DBT, the Self-Soothe skill is taught as part of the Distress Tolerance module, typically during skills training groups. Therapists guide clients in identifying activities that engage their senses and provide comfort. Clients are encouraged to create a “self-soothe kit”—a collection of items that they can use during times of distress. This kit might include things like a favorite book (sight), a playlist of soothing music (hearing), a scented candle (smell), a piece of chocolate (taste), and a soft blanket (touch).
Therapists also work with clients to help them practice the Self-Soothe skill in a variety of situations, from mild stress to more intense emotional crises. Over time, clients learn to use the skill proactively, recognizing when they are starting to feel overwhelmed and using self-soothing activities to prevent escalation (Linehan, 2015). This proactive approach can reduce the frequency and intensity of emotional outbursts and improve overall emotional regulation.
Case Example: Applying Self-Soothe in Practice
Consider the case of “Sarah,” a 35-year-old woman with a history of BPD and frequent emotional dysregulation. Sarah often found herself feeling overwhelmed by emotions, leading to impulsive behaviors such as binge eating and self-harm. During DBT, Sarah was introduced to the Self-Soothe skill and encouraged to create a self-soothe kit tailored to her preferences.
Sarah’s kit included a playlist of calming music, a lavender-scented candle, a journal where she could write her thoughts, and a soft scarf that she found comforting to touch. She was also encouraged to practice mindful eating by savoring a small piece of dark chocolate. Over time, Sarah learned to use these items when she felt emotionally overwhelmed, helping her to manage her emotions without resorting to harmful behaviors.
One day, after a particularly stressful interaction with a coworker, Sarah felt the familiar urge to binge eat. Instead of giving in to the urge, she decided to use her self-soothe kit. She lit her lavender candle, wrapped herself in her scarf, and played her calming music. As she sat with these comforting sensations, Sarah noticed her urge to binge gradually decreasing. She then used her journal to write about her feelings, further helping to process her emotions in a healthy way.
This case example illustrates how the Self-Soothe skill can be applied in real-life situations to manage emotional distress and prevent maladaptive coping behaviors. By creating a personalized self-soothe kit and practicing the skill regularly, clients like Sarah can develop healthier ways of responding to emotional pain.
Empirical Support for the Self-Soothe Skill
Research on DBT and distress tolerance skills, including Self-Soothe, has shown positive outcomes in reducing maladaptive behaviors and improving emotional regulation. Several studies have highlighted the effectiveness of distress tolerance skills in decreasing self-harm, substance abuse, and other impulsive behaviors associated with emotional dysregulation.
For example, Neacsiu et al. (2010) conducted a study examining the relationship between DBT skills use and treatment outcomes in individuals with BPD. The study found that increased use of DBT skills, including distress tolerance skills like Self-Soothe, was associated with reductions in BPD symptoms, including self-harm and emotional dysregulation. The findings suggest that regular practice of these skills can lead to significant improvements in emotional stability and overall functioning.
Another study by Rosenthal et al. (2008) explored the role of emotional responding in individuals with BPD and found that distress tolerance skills were crucial in helping these individuals manage intense emotions without resorting to self-destructive behaviors. The study supports the idea that the Self-Soothe skill, as part of the broader distress tolerance framework, can play a vital role in improving emotional regulation in this population.
Additionally, research on mindfulness-based interventions, which often incorporate self-soothing techniques, has shown benefits in reducing anxiety, depression, and stress (Kabat-Zinn, 2003). Mindfulness practices that focus on engaging the senses and promoting relaxation are closely related to the Self-Soothe skill, further supporting its effectiveness in managing emotional distress.
Limitations and Considerations
While the Self-Soothe skill is a valuable tool in managing emotional distress, it is not without limitations. One potential limitation is that it may be less effective in situations where the source of distress is external and ongoing, such as in cases of chronic interpersonal conflict or trauma. In such situations, the Self-Soothe skill may provide temporary relief, but additional therapeutic interventions may be necessary to address the underlying issues.
Another consideration is that the effectiveness of the Self-Soothe skill may vary depending on the individual’s sensory preferences and cultural background. For example, certain scents or sounds that are soothing to one person may not be as effective for another. Therapists should work with clients to identify self-soothing activities that are culturally appropriate and personally meaningful.
There is also the potential for over-reliance on the Self-Soothe skill, where individuals may use it to avoid dealing with difficult emotions or situations. It is important for therapists to emphasize that the Self-Soothe skill is just one part of a broader set of DBT skills, and that it should be used in conjunction with other strategies such as problem-solving, emotion regulation, and interpersonal effectiveness (Linehan, 2015).
Practical Challenges in Implementing the Self-Soothe Skill
Implementing the Self-Soothe skill in therapy can present practical challenges, particularly in group settings. Some clients may initially struggle with the concept of self-soothing, either because they are unfamiliar with the idea or because they have negative associations with self-care. In such cases, therapists may need to provide additional education and support to help clients understand the value of self-soothing and how it can be integrated into their lives.
Another challenge is ensuring that clients have access to the resources they need to create a self-soothe kit. This may require therapists to work creatively with clients, helping them find low-cost or readily available items that can be used for self-soothing. For example, a client who cannot afford essential oils might be encouraged to use natural scents, such as fresh flowers or herbs, as a substitute.
Therapists should also be aware of potential sensory sensitivities or triggers that could make certain self-soothing activities distressing rather than comforting. For example, a client with a history of trauma may find certain scents or tactile sensations triggering. It is important to tailor the Self-Soothe skill to each client’s individual needs and preferences, taking into account any potential sensitivities.
Finally, consistent practice is key to the success of the Self-Soothe skill. Clients may need encouragement to practice the skill regularly, even when they are not in a state of crisis. Therapists can help by incorporating self-soothing activities into therapy sessions, providing homework assignments that involve using the self-soothe kit, and reinforcing the importance of proactive self-care.
Conclusion
The Self-Soothe skill is a powerful tool within Dialectical Behavior Therapy that helps individuals manage emotional distress by engaging the five senses in comforting and relaxing activities. Grounded in the principles of distress tolerance, the Self-Soothe skill provides an alternative to maladaptive coping strategies, promoting emotional regulation and reducing the risk of impulsive behaviors.
Through the use of personalized self-soothing activities, individuals can learn to navigate emotional crises more effectively, improving their overall mental health and quality of life. While the skill is not without limitations and practical challenges, its benefits are well-supported by research and clinical practice.
As part of a comprehensive DBT treatment plan, the Self-Soothe skill offers a valuable resource for individuals struggling with emotional dysregulation, providing them with a practical and accessible way to care for themselves in moments of distress. By integrating this skill into therapy, clinicians can empower their clients to develop healthier coping mechanisms and achieve greater emotional stability.
The Self-Soothe Skill Book Recommendations
Here is a collection of the best books on the market related to the Self-Soothe skill:
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References
- Bradt, J., & Dileo, C. (2014). Music interventions for mechanically ventilated patients. Cochrane Database of Systematic Reviews, (12). https://doi.org/10.1002/14651858.CD006902.pub4
- Herz, R. S. (2009). Aromatherapy facts and fictions: A scientific analysis of olfactory effects on mood, physiology and behavior. International Journal of Neuroscience, 119(2), 263-290. https://doi.org/10.1080/00207450802333953
- Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144-156. https://doi.org/10.1093/clipsy.bpg016
- Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
- Linehan, M. M. (2015). DBT® skills training manual (2nd ed.). Guilford Press.
- McEwen, B. S. (2007). Physiology and neurobiology of stress and adaptation: Central role of the brain. Physiological Reviews, 87(3), 873-904. https://doi.org/10.1152/physrev.00041.2006
- Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M. (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy, 48(9), 832-839. https://doi.org/10.1016/j.brat.2010.05.017
- Rosenthal, M. Z., Gratz, K. L., Kosson, D. S., Cheavens, J. S., Lejuez, C. W., & Lynch, T. R. (2008). Borderline personality disorder and emotional responding: A review of the research literature. Clinical Psychology Review, 28(1), 75-91. https://doi.org/10.1016/j.cpr.2007.04.001
