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Distress tolerance is one of the four key areas, also known as modules, that make up the psychotherapeutic intervention known as dialectical behavior therapy (DBT). Psychologist Marsha M. Linehan developed dialectical behavior therapy in the late 1980s as a means 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 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. The philosophical perspective of dialectics, balancing opposites, influences the DBT process. DBT specifically focuses on providing therapeutic skills in four key areas, which are core mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. It is rare for an individual to only focus on the distress tolerance module of DBT, as the efficacy of DBT is based on exposure to and completion of each of the four modules. Each module highlights distinct and specific skills that build upon each other and are integral to one’s healing process. 

Distress Tolerance Skills

DBT 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. The skills in each module are introduced during the group therapy sessions and reinforced during the one-on-one therapy sessions. Distress tolerance skills, also known as crisis survival skills, include a variety of short-term coping strategies. The skills taught in this module of DBT are intended to help individuals learn tools and techniques to get through challenging situations when emotions are heightened and avoid destructive behavior. There are many different distress tolerance skills taught, 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 purpose of distress tolerance skills is to equip a person with the ability to effectively minimize the intensity of emotional pain. 


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. 

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