distressDistress Tolerance Skills

The holidays usually mean lots of time with family and frankly, that can sometimes spell stress. Recovering from an eating disorder while trying to manage triggers and deal with family can really be an overwhelming endeavor. Many eating disorder treatment programs utilize Dialectical Behavior Therapy (DBT) to help clients develop skills for distress tolerance, mindfulness, interpersonal effectiveness, and emotion regulation. Treatment with DBT utilizes individual therapy and coaching as well as skills training to help clients develop mindful awareness, tolerate difficult situations, gain assertiveness skills, and regulate overwhelming emotions. DBT makes use of acronyms within these focus areas to help clients remember the important skills they are learning.

As so many holiday celebrations focus on family togetherness, it seems appropriate to talk about interpersonal effectiveness. Imagine that you are in recovery and have restored some weight. It has been a long time since you’ve seen your extended family and they are quick to point out that you’ve gained weight and look healthy. For someone with an eating disorder, these comments can be extremely triggering. Your first instinct in this situation may be to run away, or possibly even engage in behaviors as a way to comfort overwhelming emotions. A more effective way to handle these probably well-meaning relatives is to engage some interpersonal effectiveness skills and communicate what you want and need from them.

What Does the DEAR MAN Acronym Stand For?

The DBT acronym DEAR MAN spells out a way to directly communicate your needs and practice assertiveness:

Describe: Use facts and avoid judgment

Express: Use “I feel” statements to express your feelings about the problem.

Assert: This is a tough one….it involves simply stating exactly what it is that you want.

Reinforce: Describe why the other person would benefit by helping you.


Mindful: Pay close attention to your own biases and urges to engage in behaviors.

Appear Confident: Pay attention to body language, eye contact, and tone of voice.

Negotiate: Be willing to compromise; have a plan B ready.

Let’s stop here and see how we would apply DEAR MAN to the well-meaning relatives situation. You know they are going to make you uncomfortable, and you really need to head them off at the pass before you get triggered. Using DEAR MAN, here’s how that conversation might go:

Relative: “Wow! You’ve really put on some weight since I last saw you!”

You (DESCRIBE and EXPRESS): “Hi Aunt Lucy. While I appreciate your noticing, I have to tell you that I feel very triggered when people mention my appearance.”

You (ASSERT): “I have to ask you to please not make comments about my appearance.”

You (REINFORCE): “By avoiding these comments, it will really help me to maintain the recovery I have worked so hard to achieve.”

What if Aunt Lucy gets confused or offended? Maybe she doesn’t really hear what you are saying and makes a different comment about your appearance:

Relative: “Oh, I’m sorry! I just meant that you look so much healthier now. You really look much better with some meat on your bones!”

You (MINDFUL): At this point you may be getting angry…pay close attention to the feelings and urges that come up for you, square your shoulders, and go back to the beginning….go through DEAR again.

You (APPEAR CONFIDENT): Your message to Aunt Lucy may not really get through if you are speaking softly, looking down or away, or have one foot out the door to run. Take a breath, stand tall, and look Aunt Lucy in the eye as you present your message.

You (NEGOTIATE): If Aunt Lucy is still confused, you may want to offer a compromise: “I understand it might take some time to get used to this. Maybe when you see me you could just say it’s nice to see me. That would help so much.”

DEAR MAN can be used in any situation that requires asking for what we want and need. As you progress through the holidays and find yourself needing to draw on some assertiveness, I hope this simple acronym will help you to remember to apply this powerful, recovery-saving skill!