What are DBT Distress Tolerance Skills?

This blog post will answer the question ‘What is DBT Distress Tolerance Skills?’ and cover topics such as the different types of distress tolerance and how to use these skills.

What are DBT Distress Tolerance Skills?

Distress Tolerance Skills are a set of skills used as an intervention in Dialectical Behavior Therapy. Often, individuals face situations in life over which they do not have any control. 

Some of these situations could be emotionally distressing such as the death of a loved one, losing a job, and losing a relationship. The distress tolerance skills help to manage one’s emotions in such a crisis situation.

List of DBT Distress tolerance skills

Below is the list of DBT Distress tolerance skills:

• Radical Acceptance
• Turning your Mind
• Accepts
• TIPP skills
• Improve Skills
• Pros and Cons 
• Allowing your mind

What are the different types of distress tolerance skills?

The DBT Distress Tolerance Skills can be broadly categorised into two types. 

They are:

• Reality Accepting Skills and;

• Crisis Survival Skills.

These skills help a person to better manage the emotional crisis or distress that might arise from situations over which a person has little or no control as well as to accept them. 

These skills could also be beneficial to those who have low distress tolerance by enabling them to manage their emotional experience and reactions better.

What are Reality Accepting Skills?

Reality accepting skills are those which allow you to effectively live a life that you might have not imagined. Reality Accepting Skills include:

• Radical Acceptance: It refers to complete acceptance of a situation in your mind, heart and body. There are situations in life that cannot be changed but only accepted, for instance death of a loved one. 

There is no way you could bring that person back to life, instead you can accept the reality of life that this person will no longer be in your life and learn to live with it. 

• Turning the Mind: It refers to choosing the path of acceptance rather than denial or rejection. You could turn your mind towards acceptance by observing that you are finding it difficult to accept, making a commitment that you choose to accept the situation, continuing to renew this commitment again and again and developing a plan to accept the situation. 

One way of doing it could be to write down about things in your control and not in control in this situation.

• Willingness: Replace willfulness with willingness. Willfulness might look like refusing to tolerate and accept the crisis, refusing to make changes that are needed, giving up etc. Willingness is being willing to do what is needed in a particular situation.

• Half Smiling and willing Hands: Half smiling refers to making an upward movement at the corner of your lips just enough for you to notice. Willing hand refers to keeping your hands unclenched with the palms turned up and relaxed. 

Practice half smiling and willing hands when you first wake up in the morning, when you are free, when you are listening to music, when you are lying down, sitting or standing. 

Know that your body connects to your mind and altering your facial expression and body position could also alter your emotions.

• Allowing the mind: Mindfulness of Current thoughts: It refers to focusing on your current thoughts without judgment. You could do this by simply observing your thoughts and not analyzing or judging them. 

Be curious like a child about your thoughts, try to know where it is coming from, how are these thoughts changing etc. Observing your thoughts means simply observing but not necessarily acting on it. 

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What are Crisis Survival Skills?

These are skills that help tolerate and effectively manage emotional distress, painful emotions, urges and reactions when the situation is not in your control. 

A crisis situation is a highly stressful situation in a person’s life during which they experience a breakdown in their routine functioning. 

Crisis Survival Skills are used when one is experiencing high levels of stress and might want to act on their emotions, however acting on it might only further aggravate the situation. 

Crisis Survival Skills include:

• The STOP skill: STOP refers to;

S- Stop

T- Take a Step back

O- Observe

P- Proceed Mindfully.

It simply refers to stopping oneself from acting in an impulsive manner and to take a moment to observe what is happening and then respond. The key here is to respond and not react.

• Pros and Cons: This refers to evaluating the pros and cons of acting on your urges as well as of engaging in more helpful alternative behaviours. Doing this helps in making more informed choices and responsibility for one’s own action.

• TIPP:  Tipp refers to 

T-Temperature: it involves splashing some cold water on your face or using other techniques such as holding an ice cube or ice pack against your face, or letting the AC or fan blow on your face. 

It helps to change our body temperature (we often feel hot in a crisis situation). Cooling off our body helps to calm down faster.

I- Intense Exercise: it involves engaging in intense exercise that matches your intense emotions.

When you are highly emotional, engaging in walking, running, jogging, lifting weights and others help by exhausting your physical energy to engage in your emotions.

P- Paced Breathing: Research has found several benefits of breathing exercises. It helps to relax and calm down, reduce stress and emotional pain. 

One way through which you could pace your breath is through the belly breathing or diaphragmatic breathing. “Place one hand on your chest and the other on your belly. Inhale deeply through your nose for a count of four making sure your belly is expanding and not your chest. Exhale through your mouth for a count of four.”

P- Paired Muscle relaxation: When you are emotionally pumped up, your muscles become tense, one way of helping your calm down is by relaxing your muscles. 

Paired muscle relaxation refers to pairing muscle relaxation with breathing out. How could you do it? Using the belly breathing technique mentioned earlier, tense your muscles while breathing in and notice the tension in your muscles and as you are breathing out let go of the tension and notice the difference in your body.

• Distract with Wise Mind ACCEPTS: These skills help you manage distress during the process of trying to solve them. Accept stands for
  • A- Activities: Engaging in healthy and pleasurable activities can help you distract yourself from being preoccupied with negative emotions and crisis situations. 

Some of the activities that you could engage in are; watch TV, clean a room, Go out for a walk, Read a book, play sports etc.

• C- Contributing: This involves engaging in acts of kindness towards others. Several researches suggest that engaging in helping acts reduces stress and increases happiness. 

Some of the ways you could distract yourself by contributing is, finding volunteer work to do, help a family member or a friend, give away things you don’t need, make something for someone else etc.

• C- Comparison: it involves comparing the present crisis with something that was worse in the past or with someone else and finding reasons to be grateful. 

You could do this, by comparing yourself with those less fortunate, with a prior situation that was worse, or to people who are coping less well than you.

• E- Emotions: It involves identifying the emotion that you’re feeling at present and doing something opposite to it as a way of evoking a more positive emotion. For example, if you are feeling angry, watch a comic.

• P- Pushing Away: When the crisis is extremely overwhelming and you do not want to deal with it right away, you could push it away by distracting yourself with other things and setting a time to come back and deal with it. 

Some ways of doing it would be, to physically move out of the situation, to mentally block the crisis etc.

• T- Thoughts: It involves distracting oneself by consciously shifting focus to more neutral thoughts rather than ruminating over the negative thoughts. 

Some ways to distract yourself with thoughts are repeat a song in your mind, count numbers in your mind and so on,

• S- Sensations: Some ways through which you could distract yourself through your senses is by taking a warm bath, holding ice in your hands, getting wet in rain, watching a favorite movie, listening to your favorite music etc.

• Self-Soothe with the Five Senses: It involves soothing yourself using your five senses. Self-soothing can help you to relax and reduce the intensity of negative emotions by diverting your attention to more pleasurable experiences. 

You can soothe yourself through your eyes, ears, nose, tongue and skin.

• With vision: you can soothe yourself through vision by engaging in visual activities you enjoy such as, star gazing, looking at old pictures, looking at nature around you, watching the sunrise or sunset etc.

• With hearing: this involves listening to sounds such as favorite music, birds chirping, water flowing, hum your favorite tune etc.

• With smell: You can soothe yourself through smell by engaging in activities such as lighting scented candles, inhaling the aroma of coffee, using your favorite soap, shower gel etc…

• With taste: Indulging in food that you like could be one way of soothing yourself and to distract from negative emotions. Eat your favorite food, try different ice cream flavors, chew some peppermint etc.

• With touch: Enjoy how touch makes you feel. You can take a warm shower, have a massage, notice how holding a pen feels in your hand, hug someone you feel like, wrap yourself in a blanket etc.

• Improve the Moment: Often, the heightened distressing emotions that one feels withers away with time. During this process one can manage the emotional distress by improving the moment. Improve stands for 

• I- Imagery: Imagination is an effective way to cope with distressing emotions. Imagine that you are actually solving the crisis, imagine everything being alright, and imagine being relaxed.

• M- Meaning: One effective way of coping with a crisis is by making meaning of it. Try and reflect on what lessons have you learnt from this situation. 

• P- Prayer: prayer can bring hope and strength in trying times. Reach out to a supreme power, share how you have been feeling, Ask for strength to stay with this crisis.

• R- Relaxation: Our body is built to tense up during a stressful situation. This tension keeps us on the edge, hyper vigilant and so on. 

Engaging in relaxation exercises such as breathing, muscle relaxation and meditation can help reduce this tension and relax.

• One thing at a time: I would call this, to be in the present moment. Thinking about past events that led to the crisis situation or the future consequences will only lead to unnecessary stress in an already distressing situation. 

Focus on what you are doing at the moment be it reading, cooking, cleaning, bathing anything. 

• V- Vacation: It could be difficult to go on an actual vacation to a dream destination in a crisis situation. Instead take a mini physical vacation such as going out to a park, walking in the woods, visiting a relative etc. you could also go on an imaginary vacation to help distract yourself.

• E- Encouragement: Look for ways through which you could encourage yourself in these situations. Use some self-affirming statements such as “I got this”, “I can do this” to keep yourself motivated.

The goal or purpose of distress tolerance skills is to equip you with all the skills required to manage your negative emotions and accept a crisis situation and to improve your distress tolerance levels. Regular practice of these skills can help you with better emotional regulation and ability to engage in more mindful action.

Conclusion:

In this article we addressed the question ‘what is DBT Distress Tolerance Skills?’ We also outlined the types of distress tolerance skills and understood how we could use them.

What we recommend for Counselling

Professional counselling

If you are suffering from depression or any other mental disorders then ongoing professional counselling could be your ideal first point of call. Counselling will utilize theories such as Cognitive behavioural therapy which will help you live a more fulfilling life.

Frequently asked questions:DBT Distress tolerance skills

References: 

Distress Tolerance Skills: Your 6-Skill Guide to Navigate

Emotional Crises. (2017). Retrieved 10 June 2021, from https://www.sunrisertc.com/distress-tolerance-skills/ 

Linehan, M. (2015). DBT skills training handouts and

worksheets (2nd ed.). New York: The Guilford Press.