Skip to main content

Psychologist Marsha M. Linehan developed dialectical behavior therapy (DBT) in the late 1980s as a means to more effectively treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). It is a form of evidence-based psychotherapy that is founded on the principles of cognitive-behavioral therapy (CBT) but places greater emphasis on the psychosocial aspects of treatment. DBT combines standard CBT techniques for emotional regulation and reality-testing with concepts derived from Buddhist meditative practice such as awareness, mindfulness, and attentiveness to current situations and emotional experiences to encourage acceptance. DBT specifically focuses on providing therapeutic skills in four key areas, which are core mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. DBT consists of three different therapy settings, including weekly individual psychotherapy sessions, weekly DBT skills training group therapy sessions, and as-needed phone coaching to provide additional support between the weekly individual and group sessions. The skills in each module are introduced during the group therapy sessions and reinforced during the one-on-one therapy sessions. 

Distress Tolerance Skills

Distress tolerance skills, also known as crisis survival skills, include a variety of short-term coping strategies. Distress tolerance involves accepting reality rather than refusing to tolerate stress. When teaching distress tolerance to teenagers, psychologist, Dr. Kirby Reutter asserts that it is helpful to first stabilize acute symptoms through concrete, practical crisis management skills prior to teaching more abstract skills. There are many different distress tolerance skills taught in DBT, some of which include the following: 

  • Self-soothing techniques: there are a variety of self-soothing techniques that can be used to ground oneself mentally and emotionally.
  • TIPP skills: TIPP is an acronym for Temperature, Intense Exercise, Paced breathing, and Paired muscle relaxation. TIPP skills quickly calm the limbic system and lower the state of emotional arousal. 
  • Distraction: in moments of intense overwhelm, temporary distractions (e.g., calling a friend, reading a book, watching TV, etc.) can provide brief relief from the distressing situation. 
  • Weigh the pros and cons: noting the pros and cons can help an individual pause and take a moment to think logically about a situation and the subsequent steps.
  • STOP skill: STOP is an acronym for Stop, Take a step back, Observe, and Proceed mindfully, which can help an individual avoid engaging in impulsive behavior.
  • Radical acceptance: is simply accepting the state of things as they are, without working to change them.
  • IMPROVE skills: the acronym IMPROVE stands for Imagery, Meaning, Prayer, Relaxation, One thing in the moment, Vacation, and Encouragement, all of which can help with improving the moment. 

The skills taught in this module of DBT are intended to help teenagers learn tools and techniques to get through challenging situations when emotions are heightened and avoid engaging in destructive behavior.

The information above is provided for the use of informational purposes only. The above content is not to be substituted for professional advice, diagnosis, or treatment, as in no way is it intended as an attempt to practice medicine, give specific medical advice, including, without limitation, advice concerning the topic of mental health. As such, please do not use any material provided above to disregard professional advice or delay seeking treatment.