DBT: What are Distress Tolerance Skills?

Natalia DeSouza, LPC

Dialectical behavioral therapy (DBT) is a form of therapy developed by Dr. Marsha Linehan, Ph.D., ABPP. DBT is taught in four different modules: mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation. In this blog post, we will be discussing parts of the distress tolerance module, which focuses on skills to help navigate uncomfortable situations and painful emotions, along with managing the urge to react in unhelpful ways. 

The distress tolerance module focuses on teaching ways to navigate emotions during a crisis. A crisis could take many forms, including:

• Moments of physical/psychological pain
• Moments of intense emotions that can lead us to go into a panic-like state
• An overwhelming situation that requires attending to
• Moments of overstimulation
• Any situation that may drive one to react on emotion versus responding mindfully

One of the skills taught in this module is the ACCEPTS Skill, which helps by allowing us to take a short emotional and/or physical break from the crisis at hand and come back to it at a later moment when we feel more regulated and able to attend to the situation. Taking some time to regulate and re-group should not be mistaken for the avoidance of the crisis at hand for a long period, as the latter could worsen and prolong the crisis. 

The ACCEPTS Skills is an acronym for short distracting techniques that can help regulate the nervous system, which can allow us the time to calm ourselves, and come back to the issue at hand with a clearer mind. The goal is to momentarily separate from whatever is causing distress, as a way to replace any impulsive urges/behaviors/reactions that could lead to more pain and more distress. You can do this through:

A– Activities: Participating in activities can help us channel those painful emotions. Examples could include cleaning your home, taking a walk, watching an episode of your favorite TV show, talking to a friend, reading a chapter of a book, working on a puzzle, or drawing/painting. 

C– Contributing: Instead of focusing on your pain, it can be helpful to shift the focus. Examples could include volunteer work, helping a loved one with a difficult task, donating items in your home, or doing something kind for a loved one or a stranger. 

C– Comparisons: Compare by thinking about all the past challenges you have struggled with and have been able to overcome, and/or think of those who have gone through similar challenges as yours. It is crucial to approach comparisons with self-compassion, as it can help us to gain some perspective on the crisis at hand. 

E- Emotions: Try to observe the emotion happening inside you as a response to the crisis. This could be sadness, anger, fear, or another emotion. Then, try to find ways to bring about opposite emotions such as calm, joy, and security. Examples could include playing with your pet, laying under a weighted blanket, or practicing mindful breathing techniques. Sometimes, when we focus too much on uncomfortable emotions, it could make them feel more intense and unmanageable.

P– Pushing Away: In times when the emotion is too overwhelming to be attended to, try to soothe yourself by physically avoiding the triggers that could remind you of the current crisis. You can also emotionally avoid reminders of the crisis through thought blocking and emotion blocking, which could be a mental visualization of you pushing the trigger away, or even telling yourself, “Not right now.” 

T- Thoughts: Focus your thinking on something neutral such as counting back from 100, counting the number of bricks on a wall, repeating the lyrics of your favorite song, or making a mental grocery list.

S– Sensations: We can use our five senses to help ground and regulate the nervous system. 

• Vision: Notice your surroundings and name what you see, observe nature, or look at pictures of family and loved ones.
• Hearing: Listen to soothing sounds such as the sound of rain, or your favorite playlist.
• Smell: Smell your favorite perfume, air freshener, candle, smell the foods in your home, or step outside and take a breath of fresh air.
• Taste: Treat yourself to your favorite dish or snack, or eat citrus fruits such as an orange. 
• Touch: Pet an animal, wrap yourself in a soft blanket, take a hot/cold shower, hold an ice cube in your palm, or squeeze a stress ball. 

The more we practice any new skill, the more effective and automatic it can become over time.

An important reminder about the ACCEPTS Skill is that it is not intended to be used for everyday stressors or to avoid attending to stressors at all. These distraction skills are meant to support you in managing a crisis by allowing you to take a step back, and come back to it when you feel more prepared. Other DBT modules and skills can be used for different situations and challenges. 

If you would like to get support from a therapist and learn more about putting DBT modules into practice, please reach out to Symmetry Counseling to arrange an appointment for therapy in Chicago. We are here to help.

Bibliography

Linehan, M. M. (2014). DBT (R) skills training handouts and worksheets, second edition (2nd ed.). Guilford Publications.