DBT distress tolerance skills

DBT distress tolerance skills are crisis-survival and reality-acceptance techniques that help you tolerate intense emotional pain without acting on harmful urges. They are one of the four core DBT skill modules, and they're what you reach for when a situation can't be fixed in the moment but your emotions are demanding action.

Crisis survival skills

These skills lower the intensity of the moment so you can get through it safely:

• STOP — Stop, Take a step back, Observe, Proceed mindfully. A momentary pause before you react.
• TIPP — Temperature, Intense exercise, Paced breathing, Paired muscle relaxation. Body-based skills that bring emotional arousal down fast. (See Front Range Treatment Center's in-depth guide to TIPP skills.)
• Distraction (ACCEPTS) — Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, Sensations. Ways to shift attention until the wave passes.
• Self-soothing — comforting yourself through the five senses (a warm drink, calming music, a soft blanket).
• IMPROVE the moment — Imagery, Meaning, Prayer, Relaxation, One thing at a time, Vacation, Encouragement.
• Pros and cons — weighing the costs and benefits of acting on the urge versus tolerating the distress.

Reality acceptance skills

When the pain comes from something you can't change, these skills reduce the added suffering that fighting reality creates:

• Radical acceptance — fully acknowledging reality as it is, rather than fighting it.
• Turning the mind — the repeated choice to accept, again and again.
• Willingness — doing what the moment requires, instead of willful resistance.

How distress tolerance fits with the other skills

Distress tolerance is one of the four DBT modules, alongside mindfulness, emotion regulation, and interpersonal effectiveness. Mindfulness is the foundation; distress tolerance gets you through the crisis; emotion regulation reduces the crises over time. New to DBT? Start with what DBT skills are.

Learn distress tolerance in a live class

Reading about the skills is a start — practicing them with a group and an instructor is how they stick. Our Introduction to DBT Skills course covers distress tolerance and all four modules, live over Zoom.

Common questions

What are the DBT distress tolerance skills?

DBT distress tolerance skills are crisis-survival and reality-acceptance techniques that help you get through intense emotional pain without making the situation worse. The main skills are STOP, TIPP, distraction (ACCEPTS), self-soothing with the five senses, IMPROVE the moment, pros and cons, radical acceptance, turning the mind, and willingness.

When should I use distress tolerance skills?

Use them in a crisis — when emotions are so intense that you cannot problem-solve, and when acting on the urge would make things worse. They are short-term survival tools, not a replacement for longer-term change skills like emotion regulation.

What is the difference between distress tolerance and emotion regulation?

Distress tolerance helps you survive a painful moment without making it worse when you cannot change the situation right now. Emotion regulation works over time to reduce how often and how intensely difficult emotions show up in the first place.