'IMPROVE the Moment' DBT Worksheet
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Looking for an “IMPROVE the Moment” DBT skill worksheet to use in your private practice?
This article discusses distress tolerance skills, such as the DBT IMPROVE worksheet, and how therapists can use them to teach clients ways to manage stressful situations.
The acronym, IMPROVE, stands for: Imagery, Meaning, Prayer, Relax, One thing, Vacation, and Encouragement. Each letter is meant to prompt clients to develop distress tolerance and coping skills.
In addition to learning about the purpose of this useful tool, therapists can download a free “IMPROVE the Moment” DBT worksheet to save to their electronic health record (EHR) and share with clients.
What are DBT distress tolerance skills?
One of the four main pillars of dialectical behavior therapy (DBT) is distress tolerance.
DBT defines distress as moments when emotional intensity is at its highest and problems are not quickly solvable. This can include crisis moments, when pain is acute, or in situations where it’s easy to feel overwhelmed.
Distress tolerance skills can be implemented to help clients ride out these storms, avoid exacerbating the situation, and maintain the ability to respond effectively. They can help a client cope with distressing crisis moments and prevent them from responding according to intense emotional urges.
When implemented appropriately, DBT skills can improve distress tolerance and help clients better ride the waves of life. One helpful example of this is the “IMPROVE The Moment” DBT skill.
What does the IMPROVE acronym stand for?
Like other DBT skills, such as the DEAR MAN skill, the IMPROVE skill is an acronym.
The following is a breakdown of what each letter stands for. This breakdown is also included in the DBT IMPROVE worksheet that you can download at the top of this article.
I = Imagery
The first letter of the “IMPROVE the Moment” DBT skill encourages clients to use their imaginations to create helpful or soothing imagery in their minds. Just as negative predictions and imagery can negatively impact how a person feels, the same can be true for positive imagery.
Examples of these imagery-based skills include: imagining a beautiful and serene landscape, imagining oneself in a safe room where no threats exist, or reliving a happy memory from the past. Consistent engagement with these images can improve distress tolerance for clients.
M = Meaning
Searching for and finding meaning can be very helpful when distressed—making it a valuable part of the “IMPROVE The Moment” DBT skill. As such, clients will attempt to refocus and redirect the mind toward things that create a higher sense of meaning and purpose.
This can include identifying positive aspects of a difficult situation, reconnecting with core values, or recognizing things to be grateful for.
P = Prayer
Connecting with something beyond oneself can be an effective IMPROVE DBT skill. Whether it is the client’s “wise mind,” their higher power, or practicing mindfulness through meditation, seeking a higher consciousness can increase distress tolerance.
This may include reciting a mantra, connecting to their wise mind, or asking their higher power for strength or the ability to surrender their stressors.
R = Relax
Clients can engage in any activity that feels relaxing to them in a calm environment. Relaxation can take many different forms. Yoga, deep breathing, a hot bath, and gentle massage are some examples.
O = One thing
Multitasking or feeling overwhelmed with multiple priorities can feed distress. On the flip side, focusing on one thing at a time can help defuse distress.
Encourage clients to pick one activity that is engaging enough to fully capture their attention.
V = Vacation
The DBT IMPROVE skill is not asking clients to fly to an exotic destination—unless they are willing and able to. Instead, the “vacation” part of this exercise asks clients to find small moments to break from their distressing day-to-day life, or schedule.
For example, this might mean taking a break from work, turning off their phone, watching or reading something enjoyable, or going outside to appreciate a local nature spot.
E = Encouragement
The final skill in the IMPROVE acronym is encouragement. This encourages clients to identify positive or encouraging statements that they can re-iterate through self-talk, which can help shift their mindset or feelings positively and increase their ability to tolerate distress in the moment.
These can be statements as simple as “I can handle this” or “I am good enough as I am.” The words should feel authentic, believable, and meaningful to the client.
How to use the ‘IMPROVE the Moment’ DBT worksheet
Out of the many DBT skills worksheets available, the DBT IMPROVE PDF attached to this article can be a great starting point for clients needing some practical ways to improve their distress tolerance.
The worksheet describes each skill in the IMPROVE acronym and lists out several examples for each of those skills. Clients can choose one of the examples to try for themselves and check it off on the worksheet. The examples may even inspire clients to create their own variation of how they want to practice that skill.
The worksheet then prompts the client to select one skill to apply during a time of distress. Before applying the skill, they are prompted to check in with themselves, rate their level of distress, from 0 to 10 (10 being the highest), and write down any emotion, thought, or behavior they are experiencing.
After applying the DBT IMPROVE skill of their choice and putting it to use, the worksheet prompts them to rate their distress level again, and write down their emotions, thoughts, behaviors, or other changes observed. This gives clients a chance to experiment with the “IMPROVE the Moment” DBT skill and evaluate any effect it has during difficult moments.
Encourage clients to experiment with many different skills from the worksheet, until they find at least one or two that feel effective for them in their greatest moments of distress.
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