# PWR-165 — Distress tolerance: learner worksheet Release: Revision 7T · Full Tutorial Edition Estimated time: Estimated 15 min reading; practical time is provider-set Difficulty: Intermediate Equipment: Basic stationery or digital tools — a therapist-led distress-tolerance skill within an agreed safety plan.; Written safety plan with warning signs, pause signal, support contacts, emergency route and prohibited triggers.; A private sheet for distress, urge, orientation, chosen action, support and later effect. Space: Desk / seated Automated structural checklist: 10 of 10 structural checks present Evidence quality/context: G4; Focused research depth Automated method-quality band: Comprehensive Method-rating basis: Structure coverage, instruction/check specificity, alternative distinctness, source troubleshooting, comparison depth and whether purpose/check fields are authored rather than derived. Editorial review: Pending manual editorial sign off ## Before you begin - [ ] I read the tutorial authority and stop conditions. - [ ] I have the required equipment/space or a declared accessible alternative. ## Canonical source context This lesson teaches a therapist-led distress-tolerance skill inside a written safety plan. The learner checks danger, names the next safe action, anchors to the present, allows the feeling without obeying an urge, waits for a short interval and reviews function. Tolerance never means enduring abuse, medical danger or escalating crisis. Target outcome: In a therapist-approved low-intensity scenario, the learner uses the planned skill for the assigned interval and completes or safely declines the next action without acting on a harmful urge. ### Authority and setup conditions - Prepare a therapist-led mild distress scenario and one agreed skill inside an individual safety plan - Before the first distress tolerance attempt, write the exact result you will score: Chosen safe action, support and later function while distress is present. - The therapist checks current safety, suicidality, self-harm, aggression, substance use, trauma, dissociation and medical symptoms. - Agree the maximum distress, interval and what ends the exercise immediately. ### Required or supplied materials - a therapist-led distress-tolerance skill within an agreed safety plan. - Written safety plan with warning signs, pause signal, support contacts, emergency route and prohibited triggers. - A private sheet for distress, urge, orientation, chosen action, support and later effect. ## 1. Check danger and leave if needed Ask whether there is immediate physical, medical, interpersonal or self-harm danger. Follow the safety plan if yes; do not begin the skill. Why: Distress tolerance is not a substitute for safety action. Success check: The learner and therapist agree the scenario is safe and low intensity. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The learner and therapist agree the scenario is safe and low intensity.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 2. Name the next safe action Choose one action for after the interval, such as send no message, sit with support or return to a neutral task. Why: A specific destination prevents “endure distress” becoming an endless goal. Success check: The action is safe, small and possible within the session. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The action is safe, small and possible within the session.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 3. Rate distress and urge separately Record distress 0–10 and the strength of the main urge 0–10, naming the urge without acting on it. Why: Feeling intensity and action pressure can change differently. Success check: Both ratings and the urge are visible before practice. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Both ratings and the urge are visible before practice.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 4. Orient to the present Use the approved anchor: state the date and place, feel the chair or support and identify three neutral objects. Why: Present orientation can reduce loss of context without demanding calm. Success check: The learner remains aware of place, time, therapist and pause signal. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The learner remains aware of place, time, therapist and pause signal.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 5. Use the agreed acceptance words Repeat the therapist-approved sentence, such as “This feeling is here; I do not have to act on the urge in this minute.” Why: The sentence separates experience from immediate action. Success check: The learner can state the feeling and retain choice about behaviour. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The learner can state the feeling and retain choice about behaviour.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 6. Wait for the short interval Run the agreed one- to five-minute timer while keeping access to the therapist and anchor. Do not extend it to prove toughness. Why: A bounded interval makes tolerance observable and protects against escalation. Success check: The timer ends at the planned point with safety and orientation intact. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The timer ends at the planned point with safety and orientation intact.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 7. Re-rate and choose Record distress, urge and orientation again. Complete the safe action, use more support or stop according to the plan. Why: Success is safe choice under distress, not necessarily a lower number. Success check: The decision follows the plan even if distress remains present. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The decision follows the plan even if distress remains present.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 8. Review later effect With the therapist, check rebound, avoidance, shame, sleep and function later in the day. Adjust the plan before another trial. Why: Immediate survival can carry delayed cost that matters for treatment. Success check: The next decision includes delayed effects and support used. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The next decision includes delayed effects and support used.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## Reflection What changed? ________________________________________________________________________________ What remains difficult? ________________________________________________________________________________ What will I repeat, adapt, ask for help with, or stop? ________________________________________________________________________________ --- Completion of this worksheet demonstrates tutorial participation only. It does not establish capability, qualification, safety clearance, diagnosis, treatment or independent validation.