DBT: Distress Tolerance Skills You Can Use Today

Introduction

In moments of high emotions, even a minor issue may seem completely unmanageable. You might experience strong urges to respond, leave the scene, shut down, or make a rash decision to make it go away. Trying to solve the whole issue right at this very moment does not seem like a realistic option.

In cases like these, DBT distress tolerance skills might prove helpful. These techniques are part of Dialectical Behavior Therapy (DBT), developed to teach people how to endure emotionally difficult times without escalating the issue even further. These techniques do not require denial of one's emotional state or pretending to be okay.

What Are DBT Distress Tolerance Skills?

Distress tolerance is one of the core concepts of Dialectical Behavior Therapy (DBT). Distress tolerance skills are aimed at assisting people in tolerating and managing their emotions and the challenging situations they are faced with when there is nothing to be done about it.

These skills do not try to change anything, and their purpose is not to remove the difficult emotions from a person. However, they might help you survive the situation by not reacting to it rashly. The difference between solving the issue and calming yourself to respond is significant. It is possible that sometimes the best thing to do is to cool down and take some time to analyze the situation.

Some of the distress tolerance techniques used within the framework of DBT include TIPP, STOP, ACCEPTS, Self-Soothe, IMPROVE the Moment, Radical Acceptance, and Pros and Cons techniques.

TIPP: A Fast Technique for Intense Distress

TIPP stands for Temperature, Intense Exercise, Paced Breathing, and Paired Muscle Relaxation. It is one of the most well-known DBT distress tolerance skills that can be applied in situations when you experience extreme emotional arousal.

Temperature refers to using a safe change of temperature, for instance, by exposing yourself to a cool object on your face for several seconds. Intense Exercise refers to engaging in intense physical exercise for a short period when you are able to exercise safely. Paced Breathing means slowing down your breathing. In Paired Muscle Relaxation, muscle tensing and relaxing are paired with controlled breathing.

The use of the TIPP technique is effective in situations when your body feels overwhelmed due to the intensity of your emotional reaction. By helping to calm down the state of your arousal, TIPP allows you to increase the capacity to respond rather than react.

STOP: Pause Before Reacting

In situations when you feel distressed, you might experience the urge to respond impulsively, either by saying something, sending a message, leaving a place, or making a decision. DBT STOP skill provides the possibility to create a gap between the emotional urge and your behavior.

STOP means not doing anything right away. Step back means separating from the situation both physically and mentally. Observe implies noticing everything going on around you and within yourself – thoughts, emotions, urges, and the circumstances. Proceed mindfully means deciding what to do next.

For instance, if you receive an upsetting message, the use of STOP will help you to pause before sending an answer while being in an agitated emotional state.

ACCEPTS: Temporarily Distract Yourself From Distress

ACCEPTS is a DBT distress tolerance skill involving temporary distraction from emotional pain. In ACCEPTS, the acronym includes the following techniques: Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, and Sensations.

In Activities, you might walk, organize something, watch a usual program, or perform another distracting activity. Contributing involves doing something useful for another person. Comparisons are related to reminding yourself that you have already coped with something similar or noticing that other people face tough situations too.

Emotions require changing the current emotions by performing an activity. Pushing away involves putting thoughts of distress aside until continuing to think about it worsens your feelings. Thoughts imply distracting yourself with something mentally interesting, while Sensations include the use of safe physical sensations to distract yourself.

ACCEPTS is a temporary coping mechanism. This does not mean ignoring the problem forever. Once the level of emotional intensity decreases enough, it will become possible to go back to the problem and solve it.

Self-Soothe Using Your Five Senses

Self-Soothe is a DBT distress tolerance skill aimed at creating soothing experiences during distress. The idea is very simple: deliberately engage with some safe sensory experiences.

To work with vision, you can observe a calm landscape, pictures, or another visually interesting object. With hearing, you might listen to quiet music or any other sounds to help you relax. Pleasant smells can work for smell, and some tasty drinks or food for taste.

Touching can include having a soft blanket in your hands or any comfortable fabric or other safe object to hold. You are not required to use all the senses simultaneously; it is sufficient to choose only appropriate ones.

IMPROVE the Moment

There is also another group of DBT distress tolerance skills aimed at making a difficult moment more tolerable. The skills are called IMPROVE, which stands for Imagery, Meaning, Prayer, Relaxation, One thing in the moment, Vacation, and Encouragement.

Imagery refers to the creation of a positive image in your mind. Meaning requires finding a personal meaning in what you are going through. Prayer can be religious or non-religious, but it is supposed to be personally meaningful for you. Relaxation implies engaging in any calming activities, including breathing.

"One thing in the moment" means focusing your attention on what is happening now instead of being overwhelmed by all the possible future situations. Vacation means taking a break from the situation if appropriate and possible. Encouragement involves making supportive self-statements reminding you that you can handle this moment.

This skill is particularly helpful when you can do nothing about the circumstances, but you need a tool to make them more tolerable.

Radical Acceptance

Radical acceptance involves acknowledging reality for what it is and not resisting the facts that cannot be changed. This technique is an important component of DBT distress tolerance, as resisting reality can make it even more painful sometimes.

Radical acceptance does not mean that you find acceptable or reasonable what happened. Moreover, it does not imply that you should give up the idea of changing the circumstances that can be changed. It just means accepting what has already happened or what is there now in order to respond to the reality more effectively.

For example, you may be deeply disappointed in some outcome of your actions, which cannot be changed anymore. Your constant wish that things could be otherwise does not help you accept what happened. Radical acceptance allows you to realize the reality of what happened to you and decide how to react further.

Pros and Cons for Managing Strong Urges

Emotions may lead to powerful urges to take action immediately. The DBT Pros and Cons technique will help you evaluate these urges and postpone acting on them until you carefully analyze them.

List both the short-term and the long-term consequences of taking the action that will satisfy your urge. Next, list the short-term and long-term consequences of enduring your urge and not taking the action.

This technique is especially effective when you have an urge to take an action that will bring you some relief right away, but will cause you trouble in the future. Writing down the consequences will allow you to see the patterns more clearly and create some distance from your emotion.

Which DBT Distress Tolerance Skill Should You Use?

Different types of situations require using different techniques of DBT distress tolerance. When your arousal level is very high both physically and emotionally, TIPP can help you lower the arousal level. In case you experience an urge to react instantly, STOP can be useful for you to create a pause for yourself.

For distraction purposes, there are several actions suggested by ACCEPTS. Self-soothing through experiencing sensory stimuli can be used if it helps you. IMPROVE can be used when you have no choice and should endure something uncomfortable.

Radical Acceptance is especially helpful when you are resisting the reality that cannot be changed right away. Pros and Cons can help you make a decision regarding acting on your urge or not.

A Simple DBT Distress Tolerance Practice You Can Try Today

When you start noticing intense distress, begin with STOP. Allow yourself a moment to not act impulsively. Step back and see what is happening and what you want to do right away.

Afterwards, practice slow, paced breathing. If your emotional arousal level still feels extremely high, consider using the TIPP method. When the level starts lowering, go for ACCEPTS/Self-Soothe so that you can give yourself some more space.

When the immediate discomfort starts becoming less intense, see whether your current situation fits Radical Acceptance or Pros and Cons. You will then be able to focus on the problem itself again.

The point here is not to eliminate all negative feelings. Your immediate aim is to pass through that uncomfortable moment in a safe way and not allow that intense emotion to dictate what you are going to do next.

Conclusion

Intense emotional discomfort can make any decision extremely difficult. Distress tolerance skills from Dialectical Behavior Therapy provide a great toolkit to find space between an overwhelming emotion and your reaction. Techniques like TIPP, STOP, ACCEPTS, Self-Soothe, IMPROVE, Radical Acceptance, and Pros and Cons offer various options depending on the situation.

It is not about avoiding problems and suppressing emotions. It is about getting through that hard moment so that you can come back to that problem later with fresh thinking.

Start by trying out a couple of those skills that look practical for you. Practice them in relatively comfortable situations so that they would be familiar when needed. Also, keep in mind that coping skills cannot be a substitute for professional help in case your emotional distress is chronic and interferes severely with your day-to-day life. Sometimes, solving a problem starts with learning to cope with it.

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