1. Introduction
Distress tolerance is a vital skill set within Dialectical Behavior Therapy (DBT), especially for individuals who struggle with intense emotions, impulsive behaviors, or chronic mental health conditions such as borderline personality disorder (BPD), anxiety, and depression. These skills are designed to help people survive crisis situations without making things worse—bridging the gap between emotional chaos and skillful action.
This article explores how distress tolerance works in DBT, practical strategies you can implement today, and why building this skill can significantly improve your ability to navigate high-stress situations.
2. What Is Distress Tolerance?
Distress tolerance refers to the ability to endure and accept emotional discomfort without resorting to harmful or impulsive behaviors like substance use, self-injury, yelling, or avoidance. Unlike other DBT modules like emotion regulation or interpersonal effectiveness, which aim to create long-term change, distress tolerance is about immediate survival and short-term coping.
These skills do not eliminate pain or solve the problem but allow individuals to manage emotions until they are calm enough to act effectively.
3. The Goals of Distress Tolerance Skills
- Prevent impulsive or self-destructive behaviors during emotional crises
- Reduce suffering while maintaining self-respect
- Create mental space for problem-solving
- Support long-term resilience in the face of chronic stress or trauma
4. Key Distress Tolerance Skills in DBT
DBT organizes distress tolerance tools into two main types: crisis survival skills and reality acceptance skills.
Crisis Survival Skills:
- TIPP (Temperature, Intense Exercise, Paced Breathing, Progressive Muscle Relaxation): These fast-acting biological strategies help calm your body’s stress response. For example, holding an ice cube or doing vigorous jumping jacks can reduce physiological arousal.
- Distract with ACCEPTS: Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, and Sensations. These distraction techniques help you shift focus away from the source of pain until you’re ready to face it.
- Self-Soothing: Engage your five senses to calm the nervous system—light a candle, listen to music, drink herbal tea, wrap yourself in a cozy blanket.
- IMPROVE the Moment: Imagery, Meaning, Prayer, Relaxation, One thing in the moment, Vacation (brief mental break), and Encouragement are strategies to make a painful moment more bearable.
Reality Acceptance Skills:
- Radical Acceptance: Acknowledging reality as it is, without resistance, even when it’s painful. This doesn’t mean approval, but letting go of the suffering that comes from denying or fighting what we cannot change.
- Turning the Mind: The practice of recommitting to acceptance over and over, even when the mind pulls away.
- Willingness vs. Willfulness: Willingness means doing what works and staying open to change, while willfulness is resisting or acting out against what’s needed.
5. Why These Skills Matter in Crisis
When emotions run high, rational thinking often shuts down. In these moments, distress tolerance skills are essential. Rather than acting on urge or panic, individuals can rely on structured tools to “ride the wave” of emotion. Research shows that DBT’s emphasis on skills like TIPP and Radical Acceptance helps reduce self-harm, emotional outbursts, and suicidal ideation.
For example, the Substance Abuse and Mental Health Services Administration (SAMHSA) notes that emotional regulation and distress tolerance are crucial components in evidence-based treatment for BPD and suicidality (https://store.samhsa.gov/sites/default/files/d7/priv/sma09-4420.pdf).
6. Applying Distress Tolerance in Everyday Life
Distress tolerance isn’t just for moments of extreme crisis. It can help with everyday stressors like arguments, work pressure, or intrusive thoughts. Practice is key—try the following:
- Create a distress tolerance toolkit: Keep items on hand that soothe or ground you (e.g., stress ball, essential oil, calming playlist).
- Schedule time to practice skills: Integrate breathing exercises or distraction techniques into your daily routine.
- Use a DBT diary card: Track which skills you used, how well they worked, and what you could try next time.
7. Seeking Professional Support
Distress tolerance skills are most effective when taught in a structured environment with feedback from a DBT-trained therapist. Group skills training sessions allow individuals to learn from others and receive support. If you’re in crisis or need help finding services, visit https://findtreatment.gov or contact the 988 Suicide & Crisis Lifeline.
8. Conclusion
Mastering distress tolerance is like building an emotional emergency toolkit. When you can sit with discomfort, use healthy distractions, and accept what you cannot change, you reclaim your ability to cope effectively—even when life is at its hardest. These skills don’t erase the pain, but they empower you to respond with intention, resilience, and grace.
