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Distress tolerance is one of the four modules of dialectical behavior therapy (DBT). Dialectical behavior therapy is an evidence-based psychotherapy treatment that was originally developed by Psychologist Marsha M. Linehan, in the late 1980s, to help better treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). It is a form of evidence-based psychotherapy that is founded on the principals of cognitive behavioral therapy (CBT), but places greater emphasis on the psychosocial aspects of treatment. As explained by Behavioral Tech, DBT focuses on teaching four sets or modules of behavioral skills, which include:

  • Core mindfulness: the practice of being completely present and aware in any given moment 
  • Distress tolerance: increasing an individual’s tolerance of negative emotions as opposed to attempting to avoid or escape them
  • Emotion regulation: decreasing emotional impulsivity, learning to manage and shift intense, problematic emotions   
  • Interpersonal effectiveness: authentically advocating for one’s own wants and needs in a relationship in a way that is both self-respecting and non-damaging

The therapeutic approach consists of three different therapy settings, including weekly individual psychotherapy sessions, weekly group DBT skills therapy sessions, and as-needed phone coaching to provide additional support between the weekly individual and group sessions.

Distress Tolerance Skills

The purpose of the distress tolerance module is to help individuals learn tools and techniques to get through challenging situations when emotions are heightened. Distress tolerance skills, also known as crisis survival skills, help individuals learn how to cope with feelings that do not have an immediately known resolution. There are many different distress tolerance skills taught, some of which include the following, provided by Black Hills State University

  • Radical acceptance: simply accepting the state of things as they are, without working to change them.
  • 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. 
  • 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.
  • Self-soothing techniques: there are a variety of self-soothing techniques that can be used to ground oneself mentally and emotionally.
  • 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. 
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