Updated February 2022
The idea is that pain and distress are a part of life and cannot be avoided and
Life is worth living even if there is pain
Specific Distress Tolerance skills are skills that you that you can use to help you get through stressful emotional situations. Distress Tolerance skills are used in situations where your emotions have hijacked your body and mind and you’re feeling like you might do or say something impulsive that you’ll later regret. Those situations that put you into fight or flight mode. Situations where you stop breathing and thinking.
We all have those situations and yes, we’ve all done and said things we regret. It’s not about being perfect, it’s about moving forward and practicing new skills, trying on new behaviors for size and then practicing those new behaviors in your life so that you are happier.
The Distress Tolerance skills are things you can do so you don’t give in to the urge to act.
They give you room to think before you act.
So, instead of fighting your feelings and thinking, "oh, I shouldn’t be having these feelings" try these Distress Tolerance skills instead.
Bloom Where You Are Planted
Accepting reality is an important part of tolerating the distress of life. Accepting reality doesn’t mean that you approve of everything or that you roll over and be passive when you are disrespected.
The goal of reality acceptance is to accept reality as it is without “…throwing a tantrum or responding with willful ineffectiveness.” (Linehan, p. 451).
In addition, accepting reality is imbedded in the dialectic of acceptance and change. Life is challenging and there is pain, but it is still worth living.
But when challenged with a very triggering event, how do maintain your cool?
If you have an explosive personality, HOW can you get to the point of feeling like you can accept reality AND make changes in your life as well?
But, I can’t stop this from happening, you say!
Well, here are two simple skills to help you stop exploding in the moment, so you live a more skillful life. The goal is not to be perfect, nor to ignore your feelings, but to live a more skillful life. Most people can benefit from methodically learned emotional skills!
Use these skills to get through a situation without making them worse:
when you’re feeling an emotional tsunami
when all you can is STOP yourself from doing something destructive
when all you can do is know what NOT to do
when you can’t think of anything positive to do
to help you survive a crisis situation without making things worse
to help yourself survive terrible psychic pain
to quiet your fight or flight response.
when things feel unfair and all is stacked against you
when you feel overwhelmed and stuck in bad feelings
get through the next moment without self-harm
get through the next moment without super put-downs of yourself
So, the first thing about acquiring the ability to tolerate distress is to realize that pain and suffering is part of life and can’t be avoided or removed. And learning to detach from the situation and not judge yourself and others for their reactions helps move you through the immediate crisis.
When you are swamped by emotion, picture a big STOP sign in your mind.
STOP is a mnemonic to help you through an emotional tsunami.
STOP is used when you feel as if your emotions are swamping you and are about to take control.
When this happens, STOP for a moment before you act without thinking.
S Stop. Freeze before you act without thinking.
T Take a step back from the situation. Take a deep breath before reacting. Let the oxygen help your body slow down. Give yourself some time to think about things. Yelling back at someone might be your first response, but maybe not the best one.
O Observe. Take a look around at what is actually going on, assess how you are feeling and what you are thinking. Assess what others are doing and saying. Gather relevant facts before acting or jumping in verbally.
P Proceed Mindfully. Before acting or speaking, be mindful o you response, not impulsive. Think: What do I want is from this situation? What are my goals? Which choice will make things better or worse? Can I postpone a discussion until later? Would that be a better choice and help get me what I want in the long run?
TIP is a mnemonic to help you when you feel stuck in an emotional tsunami. TIP skills change your body feelings to help unstick your emotions.
T Temperature. Cold water on the face or ice on your wrist for 30 seconds increases the body’s relaxation response and can even set off our dive reflex. In particular, putting cold water on your face stimulates the diving reflex. Th diving reflex is caused by stimulating the vagus nerve, which innervates your facial muscles and innervate down into all your organs. It triggers your body’s response to submersion in cold water which slows your pulse and relaxes your body in order to conserve energy.
I Intense aerobic exercise. 20 minutes of intense exercise increases endorphins thus increases positive emotions
P Paced breathing, paired muscle relaxation. Slow breathing for 30 seconds and/or muscle relaxation for 40 seconds increases your relaxation response
Learning a skill takes time
The steps to learning such skills are:
learn them in a group or with a private therapist
practice the skill as homework and and
then slowly integrate the skills into use in real-life situations
which means being able to use them when under stress
be kind to yourself
remember to come to a place where you can tolerate and survive a crisis while accepting in a non-judgmental way, oneself and one’s situation
Linehan, M. (2014). DBT Skills Training Manual (Second Edition). New York: The Guilford Press.
Useful DBT Skills Training articles: