Distress Tolerance: Learn a DBT Skill that Curbs Self-Harm

Distress tolerance skills are coping skills taught in dialectical behavior therapy (DBT). Dialectical behavior therapy is a type of treatment that teaches patients how to regulate their emotions and respond to distress through skills training. Distress tolerance skills have proved to be especially effective in people struggling with self-harm and other self-destructive, maladaptive behavior. 

What Are DBT Skills?

Though DBT can seem complicated at first glance, DBT skills training is essentially composed of four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. 

Together, these skills teach patients how to recognize and honor their emotions, regulate their intensity, and respond to them without the use of maladaptive coping mechanisms.

Today, we will be taking a look at distress tolerance in DBT. 

What Is Distress Tolerance?

In DBT, distress tolerance skills teach patients who experience negative emotions in an especially overwhelming, disempowering way to accept and better tolerate distress. This helps minimize instances of patients responding to stress with negative behavior.

The goals of distress tolerance are to help patients learn how to get through a crisis without making them worse, to accept reality as is and thus enable them to move forward, and to become free of the demands of their own urges and emotions.¹

While there are several skills within the distress tolerance module, we will focus on four crisis survival skills designed to help people through distress: distracting, self-soothing, improving the moment, and pros and cons.²

4 Crisis-Survival Distress Tolerance Skills

Distracting Skill

Distress tolerance uses distraction to help patients shift their acutely negative thoughts and emotions to more neutral or positive ones. One way to remember these skills is with the phrase “Wise Mind ACCEPTS”:

• Activities -- Enjoyable and/or distracting activities
• Contributing -- Contributing and doing things for others
• Comparisons -- Comparisons with other's suffering or own past suffering for perspective
• Emotions -- Activities that induce different emotions from the current one(s)
• Pushing away -- Pushing away by mentally leaving the current situation and blocking related thoughts
• Thoughts -- Occupying and diverting attention with other thoughts, such as by doing a puzzle
• Senses -- Stimulating physical sensations using multiple senses, such as taking a hot/cold shower

Self-Soothing Skill

Self-soothing uses the five senses to calm and nurture. Below are just some examples of common activities, but feel free to tailor it to what works for you.

• Vision -- Look at beautiful/interesting things.
• Hearing -- Listen to music or nature sounds.
• Smell -- Use favorite soap or lotion, use essential oils, smell plants and flowers.
• Taste -- Eat favorite foods, try new foods.
• Touch -- Pet an animal, get a massage, put on comfortable clothes.

Improving the Moment Skill

Improving the moment uses positive mental imagery to improve the situation. One way to remember these skills is with the word “IMPROVE”:

• Imagery -- Relaxing, positive mental imagery, such as imagining everything turning out well
• Meaning -- Find or create meaning from pain situation
• Prayer -- Prayer to your higher power for strength 
• Relaxation -- Relaxing, such as by breathing deeply or stretching
• One thing -- Remain present by focusing on just one thing in the moment
• Vacation -- Take a mental break, or vacation, such as by going to the park or turning off your phone
• Encouragement -- Encourage and rethink the situation by talking to self in a positive manner

Pros and Cons Skill

Use the pros and cons skill when deciding between two courses of action. 

First, make a list of the pros and cons of acting on your urges. This includes behaviors such as self-harm. Then, make another list of the pros and con of resisting your urges. 

Carry this list with you and review the pros and cons often. When a crisis/urge hits, take out the list and go over it again and imagine the positive consequences of resisting the urge, the negative consequences of acting on the urge, and remember past consequences of when you have acted on the urge.

These skills will help you cope with and lessen painful emotions -- help you to tolerate distress -- and give you the tools to resist engaging in harmful behavior.

Sources

1. Bray, S., “Distress Tolerance in Dialectical Behavior Therapy.” GoodTherapy.org. January 17, 2013. 
2. Linehan, M., “Distress Tolerance Handouts.” DBT Skills Training Handouts and Worksheets, Second Edition. 2015.