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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). Dialectical behavior therapy combines the practices of cognitive-behavioral therapy (CBT) with concepts derived from Buddhist meditative practice. DBT places greater emphasis on the psychosocial aspect of treatment. Marsha M. Linehan developed DBT in the late 1980s as a means to better treat chronically suicidal individuals diagnosed with borderline personality disorder (BPD). Since its inception, dialectical behavior therapy has been and remains the gold standard method of treatment for individuals diagnosed with BPD. Its efficacy has also expanded to other ailments, and according to Behavioral Tech, it is currently noted as helpful in treating mental health conditions such as bipolar disorder, eating disorders (e.g., bulimia nervosa, binge eating disorder, etc.), transdiagnostic emotion dysregulation, attention-deficit hyperactivity disorder (ADHD), depression, and more.

DBT Format

Dialectical behavior therapy includes three distinct therapeutic settings: weekly individual psychotherapy sessions, weekly group DBT skills training sessions, and intermittent phone coaching. DBT is made up of four distinct modules (core mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation) with roughly six weeks specifically allocated to focus on each module. The entire dialectical behavior therapy process usually takes around six months to complete. 

Distress Tolerance Module

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. Rather than becoming overwhelmed by or hiding from unwanted emotions, it teaches individuals sets of crisis survival skills to assist in finding meaning in, accepting, and tolerating distress. There are many different distress tolerance skills taught, some of which include the following, provided by Black Hills State University

  • 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 appropriate subsequent steps.
  • 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. 
  • Self-soothing techniques: there are a variety of self-soothing techniques that can be used to ground oneself mentally and emotionally.
  • 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.
  • 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. 
  • 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. 

Learning these skills can help an individual learn to acknowledge, process, and integrate emotions and situations in a non-evaluative and nonjudgmental fashion. 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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