Distress Tolerance Skills, Made Practical
Getting through the crisis peak without making it worse
What are distress tolerance skills and when do you use them?
Distress tolerance skills, primarily from DBT, are short-term tools for surviving a crisis — intense emotional pain, overwhelming urges, or acute situational stress — without making things worse. They don’t solve the problem; they get you through the peak so problem-solving becomes possible again. DBT as a whole has strong randomized-trial support, particularly for borderline personality disorder and emotion dysregulation.
Distress tolerance is one of the four DBT skill sets, and it does something that sounds simple but is hard to do: help you survive intense emotional pain without acting in ways you will regret. The key distinction is crisis survival versus problem-solving — when emotion is at flood level, the problem-solving parts of the brain are not fully online. These skills bring you back to the point where they are. Below are the core skills, each with the mechanism behind it and an honest read on the evidence.
Practices
- TIPP — change your body chemistry fast
Use Temperature, Intense exercise, Paced breathing, and Progressive muscle relaxation to drop overwhelm from the body up.
- ACCEPTS — structured distraction from crisis
Use Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, and Sensations to redirect attention during a crisis.
- IMPROVE the moment
Use Imagery, Meaning, Prayer, Relaxation, One thing, Vacation, and Encouragement to get through right now.
- Pros and cons before acting on an urge
List the pros and cons of acting on the crisis urge before you do it — to give the decision back to your wiser self.
- Radical acceptance in a crisis
Fully acknowledge that this is happening right now — stopping the war with reality to free energy for getting through.
- Self-soothe through the five senses
Deliberately comfort yourself through sight, sound, smell, taste, and touch while the crisis peaks.
- Turning the mind toward acceptance
Actively choose acceptance — not once, but each time the mind rebels — treating it as a repeated practice, not a state.
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Related concepts
- Dialectical Behavior Therapy (DBT) Skills, Made Practical
The four DBT skill sets, the mechanisms behind them, and an honest read on the evidence
- Radical Acceptance, Made Practical
Ending the second arrow — RAIN and the skills of accepting what is
- Acceptance and Commitment Therapy (ACT), Made Practical
The core ACT processes, the mechanisms behind them, and an honest read on the evidence