13 Printable Distress Tolerance Worksheets and Handouts

Learning to cope with distressing situations is a fundamental skill that takes time and effort to master. Thankfully, our printable distress tolerance worksheets and handouts provide a quick and handy way to develop productive habits that put clients in control of their emotions and actions.

What is Distress Tolerance in DBT?

Distress tolerance, a core dialectical behavior therapy (DBT) module, is a powerful tool. It equips individuals with skills to manage their emotions and actions in a crisis.

Unlike trying to avoid or eliminate distress, these skills focus on teaching you to "tolerate" the emotional discomfort until it passes without resorting to unhealthy coping mechanisms. This approach is practical, instilling confidence in its users [*].

How Distress Tolerance Worksheets Can Help

Our distress tolerance worksheets provide a structured approach to weathering difficult emotions and challenging situations. By following this clear path, individuals can prevent the worsening of circumstances and find reassurance in times of distress.

Our worksheets can also help individuals accept that some situations are out of their control and accept reality as it is. Research shows that distress tolerance can help regulate anger and impulsivity [*].

13 Printable Distress Tolerance Worksheets and Handouts

Are you ready to make a positive difference in your and your child’s life? Here are 13 printable distress tolerance worksheets and handouts to help you manage challenging situations.

1. Distress Tolerance Handout

If you’re new to distress tolerance, our handout answers the fundamental question: What is distress tolerance? It outlines the goals of this exercise and how practicing distress tolerance skills can improve your emotion regulation and management.

2. DBT Distress Tolerance Skills Handout

Distress tolerance skills come in many forms. Our handout outlines tips and habits encompassing helpful distraction, improving the moment, radical acceptance, and self-soothing, among others. It provides a general overview of the avenues to enhance overall emotion regulation.

3. DBT Radical Acceptance Handout

As its name suggests, radical acceptance involves accepting things as they are and letting go of feelings of anger, frustration, regret, and bitterness. Our handout outlines why radical acceptance is helpful in times of crisis and offers coping statements you can repeat to get yourself in the appropriate mindset to move on.

4. DBT STOP Skill Handout

The DBT STOP skill is an acronym for:

• Stop. Don’t unthinkingly react. Take a moment to gather your emotions.
• Take a step back. Look at the bigger picture. See the situation for what it is.
• Observe. Gather the facts. Reflect on the situation and your immediate emotions.
• Proceed mindfully. Consider the situation, feelings, and the goals you want to achieve moving forward.

The STOP method is an excellent coping mechanism that focuses on mindfulness and is best for individuals who experience intense emotions.

5. DBT TIPP Skills Worksheet

DBT TIPP skills are distress tolerance techniques representing the following steps:

• Temperature. Get your heat down by washing your face with cold water or taking a cool shower.
• Intense exercise. Go for a sprint. Do a handful of situps or pushups. Give your energy an outlet.
• Paced breathing. Try 4-7-8 or square breathing. Follow a visual aid or a guide.
• Progressive muscle relaxation. Relax your muscles, starting at your hands or feet.

Every step of TIPP serves a specific purpose in helping individuals reach a calm and reflective state.

6. DBT HALT Skills Worksheet

Part of mastering emotion regulation and distress tolerance is being self-aware. The DBT HALT skill allows clients to practice just that by encouraging them to reflect on whether they are:

• Hungry
• Angry
• Lonely
• Tired

Our worksheet reminds us that we all have basic needs that require care and that satisfying them can be tremendously helpful in stressful situations.

7. DBT ACCEPTS Handout

The DBT ACCEPTS skill focuses on helping individuals manage stress in the moment. It’s a “toolbox” with skills that can be applied to different situations.

It aims to reduce distress and improve emotion regulation by equipping individuals with tools to address stressors in healthier and more productive manners instead of submitting to intense emotions. It asks individuals to reflect on how they feel physically and mentally, imparting a sense of control over every aspect of the situation.

8. DBT IMPROVE Worksheet

When something distressing happens, it’s not uncommon to want to escape the situation or pretend it never happened. However, the DBT IMPROVE skill encourages individuals to face the stressor and find ways to make it more tolerable.

This technique involves visualization and focusing on neutral sensations in the moment. It encourages mental breaks and the consideration of spiritual outlets or connections.

Overall, the DBT IMPROVE skill helps reduce emotional intensity and increases hope, motivation, and regulation.

9. Self-Soothe DBT Worksheets With 6 Senses Worksheet

Self-soothing by accessing the six senses helps individuals achieve relaxation and self-awareness without worsening the situation. With our worksheet, clients can reflect on what they hear, see, feel, taste, smell, and touch, allowing them to ground themselves and achieve a calm state.

Self-soothing equips you with tools we list in our worksheet to tolerate emotional discomfort until it passes naturally.

10. DBT Half Smile And Willing Hands Handout

The mind is deeply connected to the body in ways we may not realize. Our DBT Half Smile and Willing Hands handout underscores this connection by discussing how individuals can make small physical changes to achieve a calm state.

It provides simple instructions children can follow when they wake up in the morning and before bed at night to enhance their emotion regulation skills.

11. DBT Turning The Mind Handout

Sometimes, the mind longs to reject reality to indulge in negative, unhelpful feelings and impulses. Our DBT Turning the Mind handout helps individuals fight against these urges by providing steps to accept reality for what it is and redirect the mind to a more productive and positive state. It focuses on the path toward radical acceptance.

12. DBT Willingness vs. Willfulness Worksheet

Distinguishing between willingness and willfulness is crucial because it impacts your ability to manage distress, accept reality, and make positive changes in your life. When facing a difficult situation, willingness allows you to tolerate the emotional discomfort and focus on finding solutions. Willfulness, on the other hand, intensifies distress by making you fight against reality.

Our worksheet trains individuals to determine which can be most helpful in a given situation. It asks clients to reflect on what actions they can take to achieve radical acceptance.

13. Radical Acceptance Coping Statements Handout

Radical acceptance requires a lot of practice over time. However, repeating radical acceptance coping statements can put individuals in the right mindset to manage their stress responses and explore productive coping skills.

You can practice radical acceptance coping statements anytime, not during stressful moments. They can serve as a daily reminder that you are strong enough to overcome challenging situations and become the master of your emotions.

The Bottom Line

Everyone experiences stress differently, but everyone can handle it eventually. You can make it through emotional incidents without worsening the situation with the right tools.

Explore our other DBT worksheets and start making a positive impact on your life.

Sources:

1. Zvolensky MJ. “Distress Tolerance: Theory, Measurement, and Relations to Psychopathology.” Current Directions in Psychological Science, 2016.
2. 1Jamilian HR, Malekirad AA, Farhadi M, Habibi M, Zamani N. “Effectiveness of Group Dialectical Behavior Therapy (Based on Core Distress Tolerance and Emotion Regulation Components) on Expulsive Anger and Impulsive Behaviors.” Global Journal of Health Science, 2014.