In my opinion (yeah, I’m biased), distress tolerance is probably the most useful day-to-day skill that DBT offers. I hear you shouting: WHY? (Geez, not so loud, you’ll wake the baby)
When you’re in the middle of a crisis, you’re in a twist and don’t know where to turn; these skills will help you sit with the discomfort of the stress and strain you’re under. They’re meant for short-term acceptance of what’s happening around you. And they NAIL it.
I’ll briefly explain each skill’s aim and include a link for further reading on each skill.
Let’s get to it.
Table of Contents
Radical Acceptance
We all find ourselves in situations that won’t change. You probably don’t like or approve of it, but when you accept it, you can feel peace, giving you space to move on.
Radical acceptance acknowledges that we all have choices, but sometimes it just comes down to choosing whether or not to accept the present situation, the reality. You can either choose to accept it and move forward or ruminate on it and stay miserable.
Here’s an example: Our friend Alex needs to go to the shop to buy some food, but it’s raining outside.
Instead of practising radical acceptance, Alex does the following:
He thinks to himself, “I can’t believe it’s raining. “This always happens to me when I need to go out.”
He feels frustrated and annoyed and thinks the rain is an unfair inconvenience. He paces around the house, frowns, and clenches his fist.
He then procrastinates, hoping that the rain will stop, but spends time complaining about the bad weather to anyone who’ll listen.
What actions are showing that he isn’t practising radical acceptance?
He refuses to accept the reality that it’s raining, which he has no control over.
When he complains and procrastinates, he’s resisting this situation instead of adapting to it. Refusing to accept the weather outside leads to stress and negative emotions, which could have been avoided with acceptance.
If Alex were practising radical acceptance, his thought process and reactions would probably be more like this.
He’d think to himself, “It’s raining, and that’s okay. I need to get food, so I’ll grab my raincoat and an umbrella.”
He accepts the situation and feels calm because he knows it’s beyond his control.
He then prepares to go out and puts on the appropriate rain gear. He goes to the shop and doesn’t delay. He focuses on the task rather than the inconvenience. (He also thinks about the amazing hot dogs that he’s going to make himself, and his tummy says yum to his brain.)
So, radical acceptance lets you fully embrace the reality of your situation, recognising that even though it might be painful, the most effective option is acceptance rather than resisting.
Pros and Cons
It can be difficult to make sensible decisions at each part of your day, especially if you’re feeling dysregulated and aren’t in a wise mind.
In times like these, making a quick pros and cons list can be super helpful to ensure we make the most effective decision.
A list of pros and cons can help you understand whether to act on an urge or tolerate it. It could take the form of just a couple of bullet points in your head, or you can sit down and write a long list on paper.
So, the pros and cons skill is there to help you fight your impulses and what might be negative outcomes from acting on those impulses.
Let’s think about Alex again.
Alex is stressed about work. He wants to eat junk food to eliminate some of that stress.
Let’s use the pros and cons to evaluate Alex’s options and help him decide wisely.
Acting on Crisis Urge
Pros:
- Immediate Relief: Alex would get quick comfort from junk food, which would help to numb his stress for a while.
- Temporary Distraction: Binge-eating would distract him from his stress for a while.
Cons:
- Health Consequences: Eating junk food will probably lead to weight gain and indigestion, making Alex feel kinda rubbish.
- Emotional Impact: Alex might feel guilty and ashamed after binge eating, which makes him feel worse than he already does.
- Financial Cost: Spending money on junk food isn’t going to send Alex on his next vacay.
Resisting Crisis Urge
Pros:
- Maintains Health Goals: By resisting the urge, Alex would stay on track with his health and wellness goals (and his PT will love him).
- Avoids Guilt and Shame: Not giving in to binge eating would help Alex avoid feelings of guilt and shame, maintaining a more positive self-image. (6-pack anyone?)
- Saves Money: Alex would save money by not buying unnecessary junk food.
Cons:
- Endures Stress for Longer: Alex would need to endure his stress without the immediate comfort of junk food.
- Doesn’t Numb Emotions: Resisting the urge means Alex has to face his emotions head-on, which can be challenging in the short term.
Making the Decision
By using the pros and cons list, Alex can see that while acting on his urge might provide immediate relief, it comes with significant long-term costs to his health, emotions, and finances.
On the other hand, although resisting the urge is harder in the moment, it aligns with his long-term goals and values. This insight can help Alex make a more mindful and wise decision.
Using the pros and cons skill can help you urge surf and assist you in making decisions that improve your overall well-being. It allows you to weigh up immediate satisfaction against longer-term benefits. That, in turn, helps you to be more balanced and better able to face challenges in life.
TIPP
The TIPP skill in DBT is used when you’re feeling intense emotions and trying to tolerate the distress. It helps you manage your feelings by regulating some of your bodily functions.
It affects different parts of your nervous system and actually serves to calm you down.
It does this by:
- lowering your body temperature,
- lowering your heart rate,
- distracting you,
- helping you with your breathing
- decreases your emotional intensity.
T in TIPP stands for temperature, I stands for intense exercise, P stands for pace breathing, and the second P stands for progressive muscle relaxation.
You don’t have to do all four of these things one after the other. In fact, I think you’d struggle to do them simultaneously (try holding your breath while you’re jogging), but just as a quick synopsis, let’s go through them one by one.
For the T, which stands for temperature, you will change the temperature of some part of your body. For example, you could run cold water on your face or put your wrists underneath the cold water tap.
The I stands for intense exercise, and the idea is to get your heart rate up for about 20 minutes. So run, walk fast around your house, lift some weights, or even try a jump rope.
The P stands for paced breathing. You’d be controlling your breathing because it would effectively decrease your heart rate.
You’re just pacing parts of your breathing. Paced breathing is when you breathe out slower and then take a longer time when you breathe in.
So you breathe in for three seconds and then out for four. Then, after doing that a few times, you would breathe in for four seconds and breathe out for five.
Finally, the last P is progressive muscle relaxation.
You work from your head or your toes, tense your muscles as hard as possible, hold them for a few seconds, and then release them. You’d go through your entire body, muscle group by muscle group until you feel a bit calmer and more relaxed. And that’s it.
So, let’s take a look at how Alex would do this.
Alex feels overwhelmed and anxious because he has a big presentation at work tomorrow. His heart is racing, and he feels like he’s about to have a panic attack.
Practising the TIPP Skill:
T – Temperature: Alex goes to the bathroom and splashes cold water on his face. The sudden change in temperature helps calm his physiological response to stress.
I – Intense Exercise: Alex then does a few sets of jumping jacks and push-ups to release some of his body’s built-up adrenaline and tension.
P – Paced Breathing: After exercising, Alex sits down, closes his eyes, and practices paced breathing. He inhales slowly for four counts, holds his breath for four counts, and then exhales slowly for six counts. He repeats this several times until he feels more relaxed.
P – Progressive Muscle Relaxation: Finally, Alex engages in progressive muscle relaxation. He starts by tensing the muscles in his feet for a few seconds and then slowly releasing the tension. He moves up through his body, tensing and relaxing each muscle group, finishing with his shoulders and neck.
STOP
The STOP skill is designed to help in difficult situations by giving four easy-to-remember steps to follow. It helps with impulsivity and overwhelming emotions.
It’s a skill that you could use in a situation that is beyond your control, such as a crisis.
STOP is an example of a skill that can temporarily help you overcome a problem and regulate your emotions.
The word STOP is an acronym, and the first letter stands for STOP.
Just freeze in place, don’t react, or do nothing else. Your emotions will probably make you want to act but don’t do that. Effectively, don’t do anything when you’re in the middle of a crisis.
The T in STOP stands for taking a step back. This means you will either remove yourself literally or metaphorically, take a break, and let go.
Maybe this is taking a deep breath, checking in with yourself, or observing your feelings about what’s happening around you.
It doesn’t have to be an actual step away, but if you do that, it’s also okay. The whole point of this skill is that you’re taking some control back. You’re not just acting impulsively and reacting. You’re taking a moment to gather your thoughts.
The O in STOP stands for observe. This means observing how you feel, observing your thoughts, and concentrating on some mindfulness practice.
You’ll notice your feelings when they appear. You won’t read into the content of the emotions, the information your body is transmitting and telling you.
You’ll recognize that you’re having those emotions and feelings. Doing this allows you to reflect on what might be the wise-mind thing to do in this situation.
The P is for proceed mindfully. This might be taking some action mindfully or not doing anything, but again, you’re doing it all mindfully.
You’re making a decision based on some logic and reasoning. You’re not just reacting impulsively to the situation; you’re acting with awareness.
You’ve gone through this process in the previous three steps of checking in with yourself and thinking about how you actually feel in this situation.
So rather than flipping the table over when someone upsets you, you’ve taken these steps to take a more calm and measured approach to your feelings.
Maybe in that instance, reacting is the right thing to do, but the point is you’ve taken time to think about how you really feel.
That’s what the STOP skill is for. It’s just to help you take a moment out from what’s happening, recognize what’s happening around you, and then proceed in the most effective way to deal with the situation.
Example: Using the STOP Skill
Alex just got a brutal and unexpected email from his boss. His heart is racing, his face is flushing, and he wants to hit reply and defend himself.
S: Stop
Alex doesn’t move. He doesn’t type. He doesn’t move. He waits.
T: Take a Step Back
Alex steps back from his computer. He gets up and walks away from his desk, giving himself physical space. He notices he’s breathing shallowly and starts taking deep, slow breaths.
O: Observe
Alex observes what’s happening inside and outside of him. He notices the anger and frustration building. He acknowledges his thoughts: “This isn’t fair” and “I need to defend myself.” He notices his body: clenched fists, tense shoulders, racing heart. Alex notices the room around him, the sound of the air conditioning and the feel of the floor under his feet.
P: Proceed Mindfully
Alex decides to proceed mindfully. He sits down and takes a few more deep breaths. He thinks about what’s the wisest thing to do. Instead of reacting instinctively, he drafts a calm and professional response to the email. He’ll review the draft later to make sure it’s measured and constructive before he sends it.
By using the STOP skill, Alex can manage his immediate emotional response in a way that’s more likely to be effective and maintain his relationships. This skill helps him pause, reflect and act from his wise mind rather than his impulsive and emotional mind.
ACCEPTS
ACCEPT is another acronym within the Distress Tolerance module, and ACCEPT is slightly different from the STOP skill in that you don’t have to follow it letter by letter sequentially. So, I’ll explain each letter’s meaning in the acronym, as that’s the simplest way to look at it.
A is for distract yourself with Activities.
C is for distract yourself with Contributing.
The other C is distract with Comparisons.
E stands for distract with different Emotions.
P stands for distracting with Pushing away.
T is for distract with other Thoughts.
S stands for distract with other Sensations.
So when you take any of those, the point is to distract yourself from a crisis, a difficult situation, and overwhelming emotions by doing something other than acting impulsively on your feelings and emotions.
For instance, the activities could be going for a walk, going to the bathroom, or getting yourself a drink.
Comparisons could be you thinking about a time when you didn’t feel this way or thinking about a time in the future when you won’t feel this way.
Sensations could be you petting your dog or your cat; it could be wearing some really comfortable clothes.
They’re just things that will temporarily remove you from the situation until the feelings and emotions have gotten over that major crest of a wave and are starting to come down, and you’re away from that peak.
Again, it’s just a framework to help you deal with the situation rather than reacting based on your feelings.
Example: Using the ACCEPTS Skill
Alex just found out his close friend is moving for a new job. He feels a big wave of sadness and anxiety at the thought of not seeing his friend as often.
A: Activities
Alex decides to do an activity to get out of his immediate feelings of sadness. He grabs his guitar and starts playing his favourite songs. This helps him shift his focus and get out of his emotions.
C: Contributing
Alex realizes helping others can also get him out of his own distress. He decides to volunteer at a local animal shelter for a few hours. Caring for the animals and interacting with other volunteers lifts his mood and gives him a sense of purpose.
C: Comparisons
Alex thinks about how others might be going through similar or even worse situations. He reminds himself that many people deal with friends moving away and find ways to cope and maintain their friendships despite the distance. This helps him feel less alone in his experience.
E: Emotions
To change his current state, Alex watches a comedy movie he loves. The humour and laughter help him feel better and lift his sadness.
P: Pushing Away
Alex decides to ignore thoughts of his friend’s move for now. He sets a specific time later in the evening to think about it and process his feelings so he’s not overwhelmed with emotions all day.
T: Thoughts
Alex uses mental imagery to distract himself. He imagines a beautiful beach with waves gently crashing on the shore. Focusing on this peaceful scene helps him shift out of his immediate feelings.
S: Sensations
Alex uses a sensory distraction by taking a hot shower. He focuses on the warmth of the water and the sensation on his skin. This grounds him in the present and reduces his emotions.
By using the ACCEPTS skill, Alex gets out of his immediate emotions. He can manage his distress healthily and gives himself time and space to process and approach the situation with a clear head later.
IMPROVE
Improve the moment is like the sister skill to accept. It’s another acronym; again, it’s a list of activities or exercises you can do to improve the moment you’re in.
I is for improve with Imagery,
M is for improve with Meaning,
P is for improve with Prayer,
R is for improve with Relaxing,
O is for improve with One thing in the moment,
V is for improve with a brief Vacation,
E is for improve with self-Encouragement and rethinking the situation.
Now, as you probably picked up, not all of the letters represent the word exactly. But, you have to give it to the creators of DBT for trying their best to shoehorn the activities or exercises into the word’s letters to improve.
Nevertheless, remember, as part of this distress tolerance, this forms a toolkit. You don’t have to do every skill to be good at distress tolerance; there’s no such thing as good anyway. It’s whatever works for you.
So if you like closing your eyes, for instance, and improving with imagery, then do that.
Think of some beautiful scenery you’ve seen or a wonderful picture you’ve looked at. Go and look at that picture, take some photographs, and look at them on your phone.
It is the same with prayer or ways to relax if you need to take a brief vacation from a situation.
All of these things are totally okay. You don’t have to follow them one by one. Pick and choose whatever you like from the activities that will work for you.
Example: Using the IMPROVE Skill
Alex feels overwhelmed and stressed with a mountain of work and deadlines looming. He needs to manage his distress and improve his mood.
I: Imagery
Alex closes his eyes and pictures himself on a beach, waves lapping, the sun warm on his skin, and sand between his toes. This imagery helps him feel more relaxed.
M: Meaning
Alex reminds himself why he’s working so hard. He thinks about his career goals and how these projects will get him there. Meaning in his work helps him feel more motivated and less stressed.
P: Prayer
Alex takes a moment to connect with his higher self. He says a quiet prayer for strength and guidance to get him through this, which helps him feel safe.
R: Relaxation
Alex takes a break from work to do some deep breathing. He breathes in for 4 counts, holds for 4 counts and breathes out for 4 counts. This relaxation helps reduce his physical tension and anxiety.
O: One thing in the moment
Alex stops multitasking and focuses on one thing at a time. Instead of feeling overwhelmed, he does one task at a time. He starts with the most important task and gives it his full attention, which helps him feel more in control and not scattered.
V: Vacation
Alex gives himself a mini-vacation by taking a short walk outside. He leaves his phone behind and enjoys the fresh air and the view. This short break from work helps him come back with a clear head.
E: Encouragement
Alex encourages himself by repeating positive self-talk. He says to himself, “I can do this,” “I am enough,” and “I am making progress.” These affirmations help him feel more confident and stay positive.
Self-Soothe
Okay, so effectively self-soothing is calming yourself down during or after a tough or difficult situation.
When you self-soothe, you manage your response to stress and relieve some of your emotional pain. Self-soothing effectively teaches you to find healthy ways to comfort yourself rather than returning to difficult or harmful behaviours.
Remember that practising self-soothing helps improve your well-being and emotion regulation, reduce your dependency on others, improve your coping mechanisms, help you get along better with everyone, and support your mental health. So, there are lots of benefits to self-soothing.
You can use self-soothing in several different ways.
For instance, you can light a candle and look at how the flame dances; if it’s at night, you could go outside and stargaze.
You could find a connection by going through some of the photos on your phone and thinking about the happy times associated with them.
Additionally, you could mindfully listen, turn on a podcast, light some incense, eat something comforting, take a bath, or give yourself a little massage.
There are a plethora of things that you can do to self-soothe that will help you deal with your distress.
So again, self-soothing is useful for dealing with difficult crises. Remember that while these are good, they are just temporary fixes.
Other skills, such as mindfulness and interpersonal effectiveness skills in the other DBT modules, will help you in the long term.
Additional Reading on Self-Soothing:
Example: Alex Using Self-Soothe
Alex has had a crap day at work. He feels frazzled and needs to calm down and regain his balance. He decides to use the self-soothe skill and focus on his 5 senses to create a calm experience.
Vision
Alex looks at something beautiful and calm. He finds a picture of a peaceful beach on his phone and spends a few minutes just gazing at it. The calm waves and blue sky make him feel more relaxed.
Hearing
Next, Alex listens to some calming music. He puts on his favourite playlist of instrumental tracks and lets the music wash over him. The gentle sounds drown out the noise in his head, and he feels more peaceful.
Smell
Alex then lights a lavender-scented candle. He takes deep breaths, inhaling the calming scent, which calms his mind and body.
Taste
For taste, Alex makes himself a cup of herbal tea. He chooses chamomile. He takes slow sips, savouring the warm, soothing taste. Drinking the tea helps him slow down and feel more grounded.
Touch
Finally, Alex focuses on touch. He wraps himself in a soft blanket and sits in a comfy chair. He also spends a few minutes petting his cat, feeling the softness of her fur. The tactile sensations of the blanket and the cat’s fur feel comforting and safe.
By using self-soothe, Alex calmed his mind and body. The multi-sensory approach helps him feel more grounded and less frazzled, and he can better handle the day.
Mindfulness of Current Thoughts
Mindfulness of current thoughts is like getting a label maker and sticking them to your thoughts as they come. That lets you rationalise them.
When you observe and describe the fact that you’ve had a thought, rather than thinking about the content of the thought, it’s easier to let that thought come and go.
When you use that label maker on your thoughts, you’re creating space from your thoughts.
It’s like a third party looks into your thoughts and comments.
So when you’re mindful of your current thoughts, you just let those thoughts come and go. It’s a great skill to utilise as part of your distress tolerance tools, and I highly recommend you look into it further.
Example: Alex Using Mindfulness of Current Thoughts
Alex has been feeling anxious all day, and his mind is racing with worries about a presentation at work. He decides to practice mindfulness of current thoughts to calm his mind and get some perspective.
Step-by-Step
- Find a Quiet Spot: Alex finds a quiet corner in his house where he can sit without distractions.
- Get Settled: He sits down, closes his eyes and takes a few deep breaths to centre himself.
- Notice Thoughts: Alex notices his thoughts as they come and go. He thinks, “What if I screw up?” and “I’m not prepared enough.”
- Non-Judgmental Awareness: Instead of engaging with or judging these thoughts, he just notices them. He thinks, “I am worried about the presentation.”
- Label Thoughts: Alex labels each thought as it arises. For example, he thinks, “This is a thought about failure,” or “This is a thought about being unprepared.”
- Let Thoughts Pass: He visualises each thought as a leaf on a stream, watching it come into view and then float away. He doesn’t hold onto any thought for too long.
- Come Back to Breathing: When Alex gets caught up in a thought, he gently brings his attention back to his breath, grounding himself in the present moment.
By noticing and labelling his thoughts, he can step back from his anxiety. He sees that his thoughts are not facts but fleeting mental events that don’t define his reality. He feels more centred and less worried.
Mindfulness of Current Emotions
Being mindful of current emotions is similar to being mindful of your current thoughts, except instead of your thoughts coming and going, you’re thinking about the emotions that you feel because of the thoughts. But it’s the same process.
You become aware of your emotions and feelings and label them, but you’re not being pulled into just feeling those feelings.
So, for instance, you could ask yourself, “How do I feel right now?” and then you stop and observe.
Once you’ve observed it, describe or label what you’re feeling. And again, you don’t tap into the content of the emotion. You’re just creating some space to step away from it.
You’re aware of having the feelings and the emotions. You don’t just react blindly to them.
So, the aim is to help with your emotion regulation using this skill as part of stress tolerance.
Remember, it can help you accept and sometimes reduce the suffering caused by interpreting your emotions and reading into their content.
Example: Alex Using Mindfulness of Current Emotions
After a tough conversation with a close friend, Alex feels many emotions. He decides to practice feeling his current emotions to process and understand them.
Step-by-Step
- Find a Quiet Spot: Alex sits in his favourite chair, away from anything else.
- Get Settled: He takes a few deep breaths and grounds himself in the present.
- Feel the Feelings: Alex turns his attention inward and feels his feelings. He feels sad, angry, disappointed.
- Non-Judgmental Awareness: He acknowledges each feeling without trying to change it. He thinks, “I’m feeling sad right now,” and “There’s anger here.”
- Label the Feelings: Alex labels each feeling as it arises. For example, he thinks, “This is sadness,” or “This is disappointment.”
- Physical Sensations: He pays attention to where these feelings appear in his body. He feels a tightness in his chest (sadness) and tension in his shoulders (anger).
- Allow the Feelings to Be: Alex allows himself to feel his emotions instead of pushing them away. He permits himself to feel sad and angry.
- Self-Compassion: Alex practices self-compassion by reminding himself it’s okay to feel these feelings. He puts his hand on his heart and thinks, “It’s okay to feel this way. This too shall pass.”
By feeling and accepting his feelings without judgment, Alex can understand and process them. He stays with his feelings instead of getting overwhelmed, feels more peaceful, and can move on after the tough conversation.
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So, there you have it—try these skills. Brushing up on your mindfulness might also be a good idea.
