There are many therapy skills from Dialectical Behavior Therapy (DBT) for distress tolerance. This article will cover 3 of the most complete distress tolerance skills from DBT. These skills, when practiced consistently, will help you tolerate distress in many different situations.
What is DBT?
Dialectical Behavior Therapy is the full name for DBT. There are many therapy models out there designed to teach you specific concepts to improve your mental health, relationships, and life overall. Other models include Cognitive Behavioral Therapy (CBT), Narrative Therapy, Internal Family Systems and EMDR (Eye Movement Desensitization and Reprocessing).
DBT was developed by Marsha Linehan and has four main modules: Emotional Regulation skills, Interpersonal Effectiveness skills, Mindfulness and Distress Tolerance Skills. DBT has been found to help for many concerns including anxiety and depression.
What are Distress Tolerance Skills?
While DBT was designed to support specific mental health concerns, these skills including the distress tolerance ones, are helpful for everyone. Truly, the DBT skills allow everyone whether they have a mental health concern or not to better care for themselves and their lives.
Distress tolerance skills, for example, are invaluable for every person. These are the skills that help you feel better (or at least not worse) in tough situations. It’s inevitable in life that you will experience difficult emotions. It’s also human sometimes to react to painful or upsetting feelings in unhelpful ways. Distress tolerance skills allow you to cope effectively to not make the situation worse.
How Do Distress Tolerance Skills Help?
No matter where you are at in your life distress tolerance skills are for you. Without these skills, there’s a human tendency to make bad situations worse by how we react to them.
For example, if you get ghosted and don’t have these skills, you may sit obsessing about what’s “wrong” with you or text an unhealthy ex. These responses, while natural, will only make you feel worse.
However, if you practice the distress tolerance skills listed in this article, you may instead be able to realize that it’s true you were ghosted and it’s not a reflection of your worth. Next, you may decide to take a bath or watch a funny movie to soothe yourself. In the morning you may still be disappointed but you’ll have the peace and empowerment which comes from knowing you chose to cope well.
DBT Distress Tolerance Skill #1: Radical Acceptance
DBT skills can be thought based or action based (or both). Radical acceptance is a thought based skill. This is the skill of accepting reality for what it is. It’s not saying you’re happy about the situation only that it’s true.
We practice Radical Acceptance to manage difficult situations better because denying reality never changes reality. Instead, denying reality only intensifies your suffering. If you do not want to feel lonely, for example, you will not erase your loneliness with your judgment. Instead, you will feel both lonely and ashamed for this feeling.
Give Yourself Grace
While easy to understand, this life changing skill can be challenging to practice. Give yourself grace as you practice radical acceptance. If you could live in a state of total acceptance, 100% of the time, that’s true enlightenment! Most of us probably won’t get there in this life but we can practice.
Another important part of being compassionate with yourself and practicing radical acceptance is accepting the truth that difficult emotions and situations are a part of life. It happens to all of us and it isn’t a reflection of your worth. It happens simply because you are alive – it is what it is.
DBT Distress Tolerance Skill #2: Make a Self-Soothing Kit
Self-soothing is the skill of showing up for yourself in a kind and nurturing way when you’re upset. If you’re anxious, for example, you can self-soothe by taking deep breaths or using a weighted blanket. This is an action based skill.
When you make a self-soothing kit, it’s kind of like your one stop shopping kit to soothe yourself when you’re upset. All you need is a box or any other container and self-soothing items to put inside of it.
This is an especially helpful distress tolerance skills because when you’re very upset, you naturally will forget the things that calm you down sometimes. This happens to all of us at times and your self-soothing kit helps you overcome this natural barrier to feeling better when you feel bad.
Ideas for Your Self-Soothing Kit
When you make your self-soothing kit, you will want to consider your 5 senses (well 6 if you include movement). The more you can integrate your senses, the more soothing an activity may be for you.
For example, you could put a coloring book and markers in your kit. This helps you visually and with movement. If your markers are scented, you also get to soothe yourself with a nice scent.
Or you could put a bath bomb in your kit to remind yourself to take a bath. A bath integrates touch with the water temperature, sight if it’s a colorful bath bomb, sound with the running water, and smell if you use the bath bomb or bubbles for example.
For more ideas of what sort of items you might want to place in your kit, you can use the following handout to guide you.
DBT Distress Tolerance Skill #3: IMPROVE the Moment
This skill includes many coping skills which are both thought and action based into an easy to remember acronym. Using acronyms to help you remember the skills is common in DBT.
When you are overwhelmed or upset, you will want to IMPROVE the moment with these skills. IMPROVE stands for Imagery, Meaning, Prayer, Relaxation, One thing in the moment, Vacation, and Encouragement. Please read on for an explanation of each aspect of IMPROVE the moment.
For IMPROVE the moment, Imagery references the skill of visualizing a place where you can feel completely safe. For support, you can use a video to guide you.
If visualization isn’t something you enjoy or that comes naturally to you, there are other ways to use this skill. You could, for example, draw a peaceful relaxing place when you’re upset. (It’s not about your art skills just allowing yourself the space to imagine a safe place). Or you may look at pictures online of your favorite type of environment such as the ocean or the mountains.
Making Meaning Out of Difficult Situation
To make meaning in this DBT skill is to consider a way to change your perspective on a difficult experience that’s happening in your life. Instead of thinking that this is happening “to” you, for instance, how could this be happening “for” you?
(Note: You do not have to like every DBT skill these are options for you to explore. If you don’t want to make meaning out of a difficult situation, you don’t have to! Use the skills which resonate with you. Leave the rest for someone else.)
This skill honors that our attitudes about our challenges can add to our suffering or help us feel better.
Meaning Making Examples
If you got fired, for example, maybe the Meaning is that you are now free to pursue job options which are more aligned with your authentic self. Or you can start that business you’ve been pushing off. You may see it as your opportunity to live the life you truly want and value.
Or if you are struggling to find a healthy dating partner, this may be happening precisely because you are looking for someone healthy. It’s not easy to have the maturity, emotional availability, and communication skills to be a healthy partner. And because this is not the norm, you just have to look a little longer.
Related: Dating Apps Don’t Work. You Do.
Prayer for Distress Tolerance
This DBT skill is not specific to any religion or spiritual belief system. Instead, this is about asking for support outside of yourself or your current way of thinking in the moment.
If you do have a spiritual belief system, you may of course, pray to the Universe or God.
But if you don’t, you may consider asking your own future self for guidance. You can use this visualization to clarify your future self.
Or you may ask the most authentic version of yourself for help.
Related: How to Be Your Authentic Self
Relaxation to Feel Better
The part of IMPROVE for relaxation is exactly as it sounds. It encourages you to do something relaxing to feel better when you feel bad.
This includes taking a nap, watching ASMR, or using your self-soothing kit to name a few examples.
One Thing in the Moment
Mindfulness is a core concept in DBT. Very simply, mindfulness means to pay full attention to the present moment without judgment. This skill of one thing in the moment helps you practice being more present. It asks you to literally do just one thing at a time to reduce overwhelm.
For instance, if you’re cooking, just focus on that – the smells, sounds, and sights of the food you’re preparing. This helps reduce overwhelm that may come from also trying to talk to someone and/or listen to a podcast at the same time. Or if you take a walk, just do that. Focus on what you see and the sounds you hear.
Take a Vacation
The “v” in IMPROVE stands for Vacation. Of course, it’s not realistic that every time you’re upset or overwhelmed in life, you can book a trip.
Instead this skill encourages you to take mini-vacations to feel better. If you are stressed after work, you could stop by your favorite bookstore on the way home for a Vacation. Or if you are sad about a recent bad date, you could go to the park and watch the clouds for awhile.
Finally, the “e” in IMPROVE stands for Encouragement. This is the skill of being your own cheerleader and support. You can use affirmations or mantra to support yourself.
For example, if you tell yourself that “tomorrow’s a new day” this may be helpful to encourage yourself to go to sleep and try again tomorrow if today was rough. Or you may encourage yourself by saying to yourself that you have survived all your bad days before this one, so you can survive this one too.
It may feel cheesy at first but telling yourself “you got this” can really help when you feel down!
Practicing the DBT Skills for Distress Tolerance
Now that you have learned (or reviewed) some DBT skills for Distress Tolerance, you are invited to practice these skills whenever you feel difficult emotions.
These skills will hopefully help you feel better when you feel bad. And, if nothing else, not feeling worse when you feel bad is a success!
If you want more support and guidance on DBT skills including distress tolerance skills, a great resource to check out is The Dialectical Behavior Therapy Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation and Distress Tolerance.
About The Author
Krystal Mazzola Wood, LMFT is a practicing relationship therapist with over a decade of experience. Currently, Krystal sees clients at her private practice, The Healthy Relationship Foundation. She has dedicated her entire career to empowering people to heal from unhealthy relationship processes. She does this by teaching the skills and tools necessary to have a life filled with healthy and loving relationships.
This passion led her to write her best-selling books and create courses. Her books, The Codependency Recovery Plan: A 5-Step Guide to Understand, Accept, and Break Free from the Codependent Cycle and The Codependency Workbook: Simple Practices for Developing and Maintaining Your Independence have helped many people heal.
Her third book, Therapy Within Reach: Setting Boundaries, will be released September, 2023.
If you have any personal dating or relationship questions, Krystal is happy to provide advice using her expertise and compassion. If you feel comfortable, feel free to leave any questions in the comments of this post. Otherwise, you may send an email to email@example.com or DM her on Instagram. Your name and any other identifying information will always be kept confidential.
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