Distress Tolerance Skills In Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is an evidence-based psychotherapy originally developed by Dr. Marsha Linehan to treat chronically suicidal adults diagnosed with Borderline Personality Disorder.

Although DBT was developed for the treatment of severely suicidal patients, DBT skills can be very useful for anyone who is trying to manage stressful, painful, or challenging situations in their lives.

A core component of DBT is radical acceptance.

Radical acceptance means that we are able to acknowledge situations in our lives that we have no control over and fully accept them as reality, rather than fighting against them by denying that they exist or complaining that they are unfair.

Radically accepting these situations in our lives, without judgement can often help in shifting our focus from how things “should be” to accepting things as they are. This slight, but powerful shift in perspective is often the first step in learning to manage emotions and tolerate distress.

In addition to radical acceptance, DBT teaches several DBT distress tolerance skills that are helpful in tolerating painful emotions without making the situation worse.

These skills are not meant to solve your problems (again, you may be facing problems that you have no power to change). Instead, they are designed to help you overcome overwhelming emotions that can often times emerge when we are faced with obstacles in our lives.

Types of Distress Tolerance Skills

1. Distract with “Wise Mind ACCEPTS”
2. Self-soothing with 6 senses
3. Improve the moment
4. Pros and Cons
5. TIPP
6. Distraction

Each skill focuses on a different way in which you can help manage stressful emotions and tolerate distress. Next, we will focus on how to use “Wise Mind ACCEPTS”:

Distract with “Wise Mind ACCEPTS”

Activities:

Engage in some kind of healthy activity and shifting your attention to that activity.

Examples include calling a friend, baking cookies, and going for a bike ride.

Contributing:

Contribute to someone else.

Surprise someone with a thoughtful gesture or volunteer. Doing things for other people causes us to feel better.

Comparisons:

Compare yourself to those less fortunate than you or to yourself at a time when things were worse. Try to come up with a list of things you feel grateful for that others may not have.

Your pain is still valid, but the focus here is to put it in perspective for the moment so you can tolerate what you are feeling now in the crisis.

Emotions:

Create a different emotional experience by listening to something that usually makes you laugh or feel happy. Listen to your favorite upbeat song or put a funny video.

Pushing Away:

For the moment, decide that you will put thinking about the crisis on the back-burner and chose to think about something else.

This does not mean we ignore our problems, it means we decide to come back to it at a time when we are more able to handle it.

Thoughts:

Replace your thoughts with any other thoughts that are neutral and unrelated to the situation. If you fill your head with other thoughts, there will be less room for thoughts related to the problem. You can do brain teasers, sing songs, imagine positive memories.

Sensations:

Distract yourself with physical senses. Our bodies are designed to focus on new or intense sensations. If you engage your body in a sensory experience, such as putting your face in cold water, holding an ice cube, soaking your feet in hot water, your thoughts will follow and focus on the experience.

Like any skill, the more you practice the better you will be at using Wise Mind ACCEPTS. Also keep in mind that you may try to use one of the ACCEPT skills and not find it helpful immediately. That does not mean you should give up! If you have given the skill a chance and it really does not seem to help regulate your emotions, move on to the next skill.

Written by  Joshua Rosenthal, PsyD