An Offering to The Age-Old Question: "...But What Do I Do?"
Several times a week I am met with the age-old question: “Okay, Madalyn, but… what do I DO?” And while I hope to remind my amazing clients of how profoundly resilient and capable they are in these distressing, helpless, uncertain moments, I also absolutely understand where this question comes from. What feeds our desire for clarity and direction more than uncertainty, fear, and distress? These moments often send us ping-ponging between feeling as though we have zero options in front of us or too many options to make sense of, with no clear direction either way. If you’ve ever found yourself in this space, wondering “What the hell do I do with this?” or “Well what now??”- I offer you DBT’s 5 Options in Distress.
Created in the 1980’s by researcher Dr. Marsha Linehan, Dialectical Behavior Therapy offers a skills-based, behavioral approach to the topics of mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. DBT’s 5 Options in Distress (in some handbooks referred to as 4 options), provides a framework to explore with curiosity and compassion: 1) What options feel the most familiar to me when in distress? and 2) What other options are at my disposal and may be more value-aligned long-term? It is human to feel as though we have no choice or power in moments of distress, AND ultimately YOU get to choose how you respond. So what are these options? Let’s use the (perhaps all too familiar) example of your internet crashing amidst a busy work day to follow what this may look like!
Solve the Problem- If there is an option for a quick solve, making the problem disappear- go for it! Marsha likes to explain, if you fall in a pool full of sharks, and there’s a ladder out of the pool, climb the ladder! The tricky part here is that as humans we typically are skilled at intuitively solving the solvable problems in front of us, and thus they do not cause us as much distress. If this is an option in your current situation, great! But if not, we have other options for you!
Example: Turn the internet back on.
Change my Perspective- We often get fused to our initial perspective, which can blind us to more effective ways to interact with the problem at hand. And what we know about perspective/thoughts is that how we interpret a situation hugely impacts the emotions, behaviors, and physical sensations that follow. First, identify your immediate perspective. Then ask yourself- how else could I interpret this? Come up with as many as possible!
Expert tip- The goal here is to practice cognitive flexibility- even if you don’t completely buy into your other interpretations. There is value in expanding our awareness of what other interpretations may offer us, even if we still notice resistance here.
Example- Initial interpretation- “This sucks, I’m doomed.” Other possible interpretations- An opportunity to take a break from staring at a screen. A moment of rest for my eyes. An opportunity to be more present with the sensory experience around me. A moment of pause from my routine. A moment to reflect with gratitude on all the times my internet works!
Radical Acceptance- The practice of radical acceptance is a complex skill all in itself, which I would encourage digging into. RA involves radically turning the mind towards acceptance of the reality in front of us- both the things we like and don’t like, the things we can control and can’t control. Acceptance does not mean that we agree with, condone, or like this reality. This is not an act of submission or throwing our hands in the air, rather its a commitment to working within the present reality rather than against it. Once we have radically accepted the reality in front of us, we open ourselves up to change within the pieces of our situation that we can control.
Example- I turn my mind towards the reality that my internet is out, with no current way to fix it. What CAN I control? I could… call my internet provider for assistance? Hop over to the local coffee shop/a friend’s house to use their internet? Ask for an extension on the work I was doing? Take a break for an hour to soothe my distress (Warm shower! Hot cup of tea! Walk around the block! Stretch my body!), and see if the internet works again after that? Call a friend for support through my distress?
Do nothing- We always have this option. There may be days we need to take this option- we’re human. AND often we notice that taking this option actually passively moves us into option number 5, making the situation worse or even creating new problems
Example- Ignore the problem completely, do not finish what I was working on or fix the internet. Sit and ruminate on the problem.
Make the situation worse- I’m sure we can all get creative with what this may look like for us, and I want to offer a non judgmental perspective here! When we are in distress, maybe especially heightened distress, we are often looking for a quick, short-term relief because of the discomfort of whatever it is we’re feeling. Numbing, escaping, lashing out, etc. may offer us that exact momentary relief or catharsis that we so desperately desire, so we can offer ourselves compassion for the moments that we have leaned into this option. AND, this option often takes us even farther away from our goals and values, creating even more long-term distress.
Example- Break my computer. Shout at my partner or the internet customer service agent. Numb my distress with substances or screen time. Give up on my work completely.
As someone whose job depends on reliable internet, this example hits close to home. AND, let’s expand this framework to our relational self-awareness- which option feels most familiar to me when confronted with challenges in my relationships? What feels familiar when in conflict with my partner? What feels familiar when I fear I’ve let down those around me? What might it look like to shift my approach and consider my other options? Let’s return to the question at hand- what do I DO? DBT’s 5 options provide a framework to help build insight into past behavior, tap into our own choice and agency in even the moments that feel the most out of our control, and build intentionality by taking a beat to consider our options before reacting. Next time you’re feeling stuck, I invite you to ask yourself what it might look like to follow through with each of these options? Which may be the most effective or value-aligned in this moment, and what might it look like to take one step in that direction- even if that first step is to stay put, take a deep breath, and offer yourself some compassion for tolerating a painful moment.
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Linehan, M. M. (2015). DBT® skills training manual (2nd ed.). Guilford Press.
Rathus, J. H., & Miller, A. L. (2015). DBT®skills manual for adolescents. Guilford Press.
