The Distress Tolerance DBT skills makes up one of the core modules and components taught during Dialectical Behaviour Therapy. This module is designed to help individuals in crisis situations when they are unable to use other skills taught in the other modules of DBT.
During our DBT courses, when working with clients we like to use the concept of an emotional temperature gauge. On a scale of 1 to 10, with 1 being relaxed and skillful and 10 being explosive and out of control, distress tolerance skills can be very useful when someone is around a level of 7 to 9.
With distress tolerance DBT skills, we’re trying to avoid reaching a level 10 and blowing our emotional temperature gauge. In essence, the distress tolerance skills are available to help reduce the emotional temperature gauge, allowing us to then access other skills to proceed effectively and reduce harmful behaviours.
What is the Distress Tolerance Module in DBT?
The Distress Tolerance DBT Skills module specifically focuses on teaching our clients how to tolerate and cope with emotional distress, pain, and crisis situations in a healthy and constructive manner.
The Distress Tolerance module is based on the idea that there will be times when individuals cannot access other skills or cope with their emotional or situational circumstances. Therefore, the primary goal is to learn effective strategies to endure distress and avoid impulsive, harmful behaviours.
Here at Home Counties Therapy, when we have a new DBT client come join us we aim to have them join when we are working on the Distress Tolerance module. This is due to how effective these skills can be for someone at the start of their journey. The Distress Tolerance skills can drastically help with harm reduction while they start to learn about other skills from other modules.
The Distress Tolerance DBT Skills
There are 4 core skills which are taught during this module. Alongside this, there are also a further 3 distress tolerance DBT skills which are also available to use. This leaves us with 7 skills that we can choose to access during distressful situations.
The ACCEPTS Skill
The ACCEPTS skill is an acronym which offers 7 different techniques.
Activities can be seen as choosing to engage in something with distracts you from the distressful emotions or situation you are experiencing. This could be things such as working on a puzzle, painting, gaming, or doing crossword puzzles.
Contributing is a way of “getting out of ourselves” by focusing on someone else. This could be offering to help someone with a task they are completing, helping with the cleaning, or just doing something nice for another person that will brighten their day.
Comparisons is used to try and gain a different perspective on what you are experiencing. Try comparing your situation to worse situations you or others have experienced.
The emotions part of ACCEPTS is to look at things you can do that will create more positive emotions for you. For example, if you are feeling sad, try watching a comedy that will make you laugh and lift your mood. If you’re feeling nervous, try listening to soothing music and practice some relaxation techniques.
Pushing away is a way of mentally blocking out or choosing to not think about the distressing situation for a while. For this, you could try visually imagining the situation fading away like a cloud. Or by mentally say “NO, I will not think about this anymore”.
Work on using your thoughts to take your mind off of the distressing emotions or situation. This can be doing simple things such as reciting the A,B,C’s forward and backwards, reading a book, or thinking of a story.
Sensations can be a great way of reducing your emotional temperature gauge. Focus on things using your 5 sense of sight, smell, touch, hearing, and taste. This could things like holding an ice cube, burning a candle and watching the flame flicker (a bonus if it’s scented and you can also smell the candle), listening to music, or observing artwork.
Learn more about our DBT courses available in person or online.
IMPROVE the Moment
IMPROVE the moment is another acronym with 7 things you can try to help with distressful situations and emotions.
Imagery is using your imagination to take yourself somewhere different mentally. Imagine somewhere peaceful and focus on the things you see, hear and smell in your mind. Think of it as though you’re creating your own private oasis in your minds eye.
Try and give meaning to your suffering. What are you learning from the experience? How could what you are experiencing help others, or make you more resilient in the future.
Prayer can help give us strength in a situation. This not not have to be “prayer” in a religious context – but it can be more of a mantra you repeat to yourself. An example would the saying the serenity prayer.
“Grant me the serenity to accept the things I cannot change,
the courage to change the things I can,
and the wisdom to know the difference”
Try using relaxation techniques to calm your body and mind. This could be things such as progressive muscle relaxation, yoga, stretching, and deep breathing.
One thing in the moment
Fully engage yourself with one thing, task, or activity. By completely focusing on that one activity, we can stay grounded and in the present moment.
This doesn’t involve jetting off to a tropical location. Taking a vacation in this sense means to get away from your worries by doing something different and removing yourself from the situation. This could be getting out for a walk, starting a new TV series on netflix (and just watching the first episode!), popping to the shops and window shopping. The opportunities for a vacation can be as creative as you’d like.
Be your own cheerleader and mentally encourage yourself with words of support and confidence. Let yourself know “You can get through this”, “You’re doing great” or any other saying which you find encouragement in.
Self-Soothe with your Senses
Self-Soothing involves creating an environment that enriches your senses to help soothe negative emotions. This could be things such as taking a bath while listening to relaxing music and burning some candles. You could wrap yourself up in a blanket and watch a film you love, and you could even throw in some sweet treats while you’re at it.
Learn more about our DBT courses available in person or online.
TIP (Temperature, Intense Exercise, Paced Breathing)
The TIP skill is an excellent one to access when you’re emotional temperature gauge is rising. This one effectively involves changing your body chemistry through 3 things: Temperature, Intense Exercise, and Pace Breathing.
We can use changing our body temperature as a way to cool down quickly. Using a bowl of cold water, try submerging your face for about 30 seconds. You can also use ice packs, or a cold shower.
To help shift your emotions you can participate in intense exercise. This can really help “let out some steam” and lower your emotional temperature gauge. You could get out and try hill sprints, start doing jumping jacks, lifting weight, or something that would be considered as “intense” for your current capabilities.
Paced breathing is a technique that helps activate your parasympathetic nervous system. It’s this nervous system that helps your body relax after high periods of stress and emotion.
Paced breathing can be as simple as breathing in deeply for a count of 5 and exhaling for 7. Creator of DBT, Marsha M. Linehan has created a wonderful video explaining the process which we’ve included below.
Pros and Cons
This skill involves making a list of the pros and cons of tolerating the distress versus not tolerating it. It can help us weigh the consequences of the actions we want to act out on during a crisis.
While this is a core DBT concept, it can also be considered a distress tolerance skill. Radical acceptance involves fully accepting the reality of a situation, even if it’s painful, and letting go of the struggle against it.
One thing we like to say around here is “We don’t have to like it, but we can accept it”
Lastly, in the distress tolerance DBT skills, we have opposite action. When the urge to engage in a destructive behaviour is strong, opposite action involves doing something that is opposite to the emotional impulse. For example, if you feel like isolating when you’re distressed, opposite action might involve reaching out to a friend and keeping connected with others.
The Distress Tolerance DBT skills are incredibly powerful skills which can help us reach a point where we can tolerate distressful situations, reduce the chances of acting out in harmful ways, and get ourselves into a headspace where we can move forward using skills from the other DBT modules.
However, it is always important to remember that if you find yourself in a crisis situation and you are concerned for your safety or you are worried about someone who has expressed suicidal intentions, then you or they should contact 111 or their GP surgery. The Samaritans also offer a 24hr confidential helpline 116 123.
If you are interested in starting your own DBT journey, we offer in person DBT therapy in Buckinghamshire, and we also offer an online group DBT course. Reach out to us today using the form below if you’d like to learn more. Our clinical admin team will then get in touch for a no-obligation and confidential conversation about how DBT could benefit you.