DBT Distress Tolerance Skills to Help You During Emotional Crises

Everyone, including children and teens, faces different types of stress as they grow up. These pressures can be as small as everyday frustrations or as big as major life changes such as family challenges or coping with loss. Learning DBT distress tolerance skills to handle these emotions can make a big difference.

What are DBT Distress Tolerance Skills?

In Dialectical Behavior Therapy (DBT), distress tolerance skills are specific techniques that help people tolerate and survive crises without making things worse. Examples include engaging in intense exercise, doing an activity that requires focus, and positive imagery.

People with low distress tolerance skills are usually overwhelmed by stressful situations. As a result, they may try to cope with unhealthy or destructive means. On the other hand, those with high distress tolerance skills are more likely to respond to challenges in an adaptive manner.

Research shows that enhancing distress tolerance could improve physical and mental health since individuals are less likely to behave in ways that lead to more stress [*].

DBT Distress Tolerance Skills

There are several distress tolerance skills that can help children and teens during emotional crises. Here is a quick breakdown of some of the more popular distress tolerance skills:

TIPP

The first skill is TIPP, which stands for Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation.

Temperature. When we deal with emotionally stressful situations, our body temperature often rises. Cooling down physically by splashing your face with cold water or turning on the air conditioner can help you cool down emotionally as well.

Intense exercise. Intense exercises can match your intense emotions and help you work through them. Try doing a few laps in a pool, sprinting up and down the street, or even doing some fast-paced jumping jacks to tire yourself out. The increase in oxygen and endorphins can help decrease stress [*].

Paced breathing. Controlling your breath can significantly reduce the emotional stress and pain that you feel. Try box breathing, which is inhaling for four seconds, holding that breath for the same amount of time, and breathing out for four seconds. Keep doing this until you feel calm.

Progressive muscle relaxation. When muscles are tightened voluntarily then relaxed, they are more relaxed than they were before they were tightened. And the more relaxed your muscles are, the slower your breathing and heart rate will be.

Get the DBT TIPP Skills handout.

ACCEPTS

The DBT ACCEPTS acronym is a group of skills that helps individuals distract themselves from negative emotions until they pass. It stands for Activities, Contributing, Comparisons, Emotions, Pushing Away, Thoughts, and Sensations.

Activities. Engaging in any healthy activity such as reading a book, making food, going for a walk, or even chores like washing the dishes can keep you busy and distract you from the negative emotion. Once you finish one activity, move on to the next.

Contributing. You can contribute something kind and useful to another person while waiting to resolve the negative emotion. Not only will it get your mind off the problem, but you’ll also feel good about helping someone, and that can in turn help you deal with stress. Examples include helping a neighbor walk their dog or cooking a meal for someone.

Comparisons. You can draw comparisons between stressful situations you or other people have experienced before. Maybe your problem might not seem as severe when you think about others facing worse circumstances. This skill adds perspective to what you are experiencing right now.

Emotions. Try invoking the opposite emotion of what you are currently feeling. If you feel anxiety, you may practice meditation. If you’re feeling depressed, then it can help to go for a walk instead of holing up in your room. Adding the opposite action can reduce the intensity of your negative emotions.

Pushing Away. If you are struggling with dealing with something, it is perfectly acceptable to push it out of your mind temporarily. You can distract yourself with other activities and thoughts. You can even delegate time to ignoring and returning to the issue. It helps to know that it will eventually be addressed and you can relax for now.

Thoughts. Replace your negative or anxious thoughts with activities that keep your mind occupied. You can read, do a puzzle, or do one of your hobbies. Such distractions allow you to avoid destructive behavior until you can regulate your emotions.

Sensations. Your five senses can be used to self-soothe during times of emotional distress. Try taking a warm bubble bath, listening to relaxing music, eating your favorite snack, or even watching your favorite show to please your senses and cope with the current situation.

Get the DBT ACCEPTS handout.

IMPROVE

Sometimes, you might lose a game, or experience something more serious, like a family change, that you can't control. It might make you feel really upset. Instead of reacting in a way that doesn't help, you can try activities that make the present moment easier to face.

Imagery. Positive imagery can have a great effect on your negative emotions. Imagine yourself surrounded by nature, perhaps sitting by a peaceful lake with birds singing and trees swaying gently in the breeze.

Meaning. Meaning can be found in painful situations. Ask yourself what you might learn from this experience. It could be that you will become more empathetic or build better relationships. Try to assign a possible reason for your present difficulties.

Prayer. Some form of prayer or surrendering your problems can reduce the negative emotions that you feel.

Relaxation. Stressful situations can trigger our fight-or-flight response and make us tense up. Try doing relaxing activities such as taking a walk or having a hot bath to calm your psychological distress.

One thing in the moment. Worrying about future consequences or adding old issues to the situation will not solve your current problems. Try your best to stay in the present by focusing your entire being on one task. Having a one-track mind during overwhelming situations makes them more bearable.

Vacation. Take a break by going on a vacation, even if it is just in your mind’s eye. You can stay there for as long as you like and revisit it when needed. When you return, hopefully, you can better tolerate the negative circumstances you’re experiencing.

Encouragement. Self-encouragement can be just as effective as hearing encouragement from external sources. Saying phrases such as “I can do this” or “Things will be alright” can reassure and encourage you to make it through this tough time.

Get the IMPROVE The Moment DBT handout.

Pros and Cons

This technique encourages individuals to weigh the potential positive and negative outcomes of their actions when facing strong emotions or impulses.

Create a list of pros and cons, bring it with you wherever you go, and review it often. Doing so will remind you of the possible negative consequences of acting on impulse and allow you to choose a different course of action this time around.

Get the DBT Pros And Cons Skill handout.

Radical Acceptance

Radical acceptance is about coming to terms with an undesirable or negative situation that will not change. Some of these situations might include receiving a lower grade than expected, parents going through a divorce, or spraining your ankle before a sports competition.

Radical acceptance teaches us that we have a choice: to continue to be miserable about the situation or to find the space we need to move on. Practicing it can prevent your pain from turning into suffering.

Get the DBT Radical Acceptance (PDF) handout.

Self-Soothing

DBT self-soothing involves using the five senses as you shift your attention from a stressful situation to something completely different.

Take a short break to do grounding exercises that allow you to identify a few things you can see, hear, smell, taste, and touch or feel. The skill can help you reconnect and be present rather than focusing too much on the moment of crisis.

Get the DBT Self-Soothing 5 Senses (PDF) handout.

How to Practice DBT Distress Tolerance Skills

Distress tolerance skills can be integrated into daily routines. Since these skills may vary in complexity depending on the age of the child practicing them, parents can offer help and support.

Here are some ways to practice DBT distress tolerance techniques at home:

• Focus on learning and mastering one skill at a time. You might need to break down a skill into smaller steps.
• Since kids and teens learn best through observation, make sure to use DBT skills yourself to normalize them.
• Schedule short, 5 to 10-minute sessions for meditation, taking a walk outside, or guided imagery.
• Provide examples of challenging situations and engage in decision-making and problem-solving together.
• Praise your child's efforts in using DBT skills, even if they don't always succeed.

The Bottom Line

This DBT skills list is proven to help people, including kids and teens, manage various emotional challenges. However, they require consistent practice to be truly beneficial.

As a parent, you can support your child’s learning by including distress tolerance activities in their routines, giving gentle reminders to practice each skill, and even modeling them yourself!

Want to explore more DBT distress tolerance skills? Check out our DBT Worksheets Collection!

References:

1. Larrazabal, M. A., Naragon-Gainey, K., & Conway, C. C. (2022). Distress tolerance and stress-induced emotion regulation behavior. Journal of Research in Personality, 99, 104243. https://doi.org/10.1016/j.jrp.2022.104243
2. Exercising to relax. (2020, July 7). Harvard Health. https://www.health.harvard.edu/staying-healthy/exercising-to-relax