Everybody encounters a variety of stresses throughout their lives. These pressures might range from minor inconveniences to significant occurrences like losing your job, divorce, or losing a loved one. Your capacity to withstand distressing situations can affect how you handle the issue, regardless of how intense the stress is. And your ability to manage challenging emotions can be significantly improved by developing your distress tolerance skills.
What are Distress Tolerance Skills?
Distress tolerance is an individual’s ability to manage emotional distress, whether perceived or actual. This involves making it through an emotionally stressful incident without making things worse.
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.
Developing distress tolerance skills can help one survive an immediate emotional crisis. It also helps a person accept the reality of their situation, even when they feel like things are out of their control. Distress tolerance skills can also help people who do not know exactly what they need or want during times of emotional crisis.
These skills are also often referred to as “crisis survival skills” since they enable a person to navigate a perceived or actual emotional crisis [*].
The Importance of Distress Tolerance Skills
DBT distress tolerance skills or crisis survival skills are important because they teach coping strategies that can avoid destructive behavior that may result from emotional pain. Sometimes, people will do whatever they can to avoid the pain that comes from feeling extreme emotional distress.
Distress tolerance skills can help lower the intensity of emotional pain. This allows an individual to use other DBT coping skills, like mindfulness, emotional regulation, and interpersonal skills.
8 Distress Tolerance Skills to Help You During Emotional Crises
There are eight distress tolerance skills that can help you during emotional crises. Here is a quick breakdown of each skill:
1. DBT TIPPS Skills
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 the intense emotions you feel 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 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.
Paired 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. Try doing this for different groups of muscles at a time can help you relax.
2. DBT ACCEPTS
The DBT ACCEPTS acronym is a group of skills that helps individuals deal with negative emotions until they can address and resolve them. It stands for Activities, Contributing, Comparisons, Emotions, Push away, Thoughts, and Sensation.
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 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 your 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.
Push 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.
Sensation. 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.
3. DBT IMPROVE the Moment
You may encounter an unpleasant situation that is small (such as spilling a drink) or big (breaking your leg) that you may not have control over. This may lead to intense emotions that can result in unhealthy coping behaviors. Using distress tolerance activities such as IMPROVE can help you tolerate negative emotions until they subside.
Imagery. Positive imagery can have a great effect on your negative emotions. Imagine yourself being able to deal with the problem at hand. Doing so may actually change the outcome from a negative one into something positive.
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. Whether you believe in a higher power or not, some form of prayer or surrendering your problems can alleviate the negative emotions that you feel.
Relaxation. Stressful situations can trigger our fight-or-flight response and make use 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.
4. The STOP Skill
One of the distress tolerance techniques that you can use first during an emotional crisis is the STOP skill.
S. Stop and do not react to the stimuli that you are facing. Remain still.
T. Take a step back and remove yourself from the situation. It helps to take a few deep breaths and avoid acting based on your current feelings.
O. Observe and take a few minutes to notice your environment, both internally and externally.
P. Proceed now that you have taken a few moments to stop and reassess how you will act with more awareness. Ask yourself what you can do to make the situation better or worse and act accordingly.
5. Pros and Cons
Something as simple as making a pros and cons list of acting on your urges can help counteract them. Make a list for acting on your current emotions and another list of pros and cons if you resist the urge to act on said feelings. Bring your list with you 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.
6. Radical Acceptance
Radical acceptance is about coming to terms with an undesirable or negative situation that will not change. 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 radical acceptance can prevent your pain from turning into suffering. You can use this skill along with IMPROVE to make it through to the other side.
7. DBT Self-Soothing
DBT self-soothing involves 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 help you 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.
8. DBT Half Smile & Willing Hands
Half smile and Wiling hands is a skill that capitalizes on the feedback loop between the mind and the body. When we assume a posture of openness with hands up and showing the wrists (willing hands) and a slight smile, our mind starts to follow what the body is signaling. We may feel distressed on the inside, but if our body suggests relaxation, patience, or willingness, then our inner emotions will follow.
How to Teach and Develop Distress Tolerance Skills
Given all these skills, you may be wondering what tools you can use to develop them. Here are several ways to improve your distress tolerance skills:
Handouts and Worksheets
DBT worksheets and handouts can be used alongside therapy sessions. Therapists can lead their clients in guided skill instruction using these tools.
Guided audio recordings are extremely helpful in practicing distress tolerance skills. There are many audio recordings available online that you can access, whether for free or by purchasing them. Practitioners can also pre-record their own audio recordings to guide clients through the DBT skills and techniques mentioned above.
One recommended book for DBT distress tolerance skills is The Dialectical Behavior Therapy Skills Workbook by McKay, Wood, and Brantley (2007). Clients can read chapters in between therapy sessions to build a better understanding of the skills they are working to develop.
Therapy sessions, whether individual or group, can help clients practice regulating their emotions and get through situations of emotional distress. The DBT skills list discussed above can be taught to clients as needed so they can cope when there is an emotional emergency.
The Bottom Line
Learning and practicing distress tolerance skills may seem daunting at first, but the benefits are overwhelmingly positive for people who need help dealing with emotional distress. It allows individuals to regulate their emotions rather than giving into urges that might lead to impulsive and unhealthy behaviors. These techniques can work whether or not you have a mental condition, and the right therapist can help you further develop these DBT skills.
- Linehan M. DBT Skills Training Manual. 20 October 2014.