Distress Tolerance


In DBT, Distress Tolerance skills are used when we are unable, unwilling, or it would be inappropriate to change a situation.  It's important to use the right skills at the right time.  In order to change a situation or emotion, we would use Emotion Regulation skills. 

Distress Tolerance skills are used to help us cope and survive during a crisis, and helps us tolerate short term or long term pain (physical or emotional pain).

Tolerating distress includes a mindfulness of breath and mindful awareness of situations and ourselves.


Radical Acceptance

Acceptance means being willing to experience a situation as it is, rather than how we want it to be.  Not to be willing (wilfulness) means trying to impose our will on a situation.  A willingness to accept things as they are, not as we think they should be.

Repeatedly 'turning the mind'.  To be in the actual situation you are in, rather than the situation you think you're in, or think you should be in.  Your mind is always going to give you other ideas, interpretations, reminding you of old strategies.  Each time your mind wanders and you notice these other thoughts and images, simply bring your attention back to this moment.  Not judging the situation to be good, or bad, or in any way.  Simply bringing your attention back to this moment, this situation, and being effective in this situation.

You may need to 'turn your mind' many many times in a short space of time. 

What Radical Acceptance is NOT:

  • Not judging the situation to be good

  • Not giving permission for the situation to go on forever

  • Not giving up your options



It can help to use memory aids to remind us of how we can help ourselves during distressing times:

 IMPROVE  the moment

I          Imagery – e.g. safe place visualisation

        find Meaning in the situation

        Prayer – meditation, spirituality, affirmations

R         Relaxation

        One thing at a time

        Vacation – take some time out of the situation, 'me' time, or imagining

            yourself on an idyllic beautiful holiday

E         Encouragement – positive and calming self talk




A       Activities (see distraction ideas below)

C       Contributing – helping others

C       Comparisons – comparing self with (better) self

E       Emotions – generate different emotions by watching movie/tv, listening to music etc

P       Pushing away – thinking about or putting our attention onto something else

T        Thoughts - new thoughts.  E.g. counting, playing 10 (10 colours in room,

            10 musical instruments, 10 fruits, 10 Bond films etc)

S        Sensations – use seeing, hearing, smelling, tasting and touching senses






Distraction helps us feel better by diverting our attention away from the distressing thoughts.  It works even better if you choose something that will really grab your attention and keep you absorbed in that activity.  Different things work for different people.  It’s worth trying and practising many of those listed, and more that you think of yourself, a few times each before giving up on it.



Home and garden

  • Mow the lawn

  • Clean the car

  • Do some gardening

  • De-clutter a room or part of a room

  • Purge your wardrobe (give to charity)

  • Clear out the spare room (give to charity)

  • Sweep the path

  • Cooking or baking something pleasurable

  • DIY

  • Bath the dog

  • Brush the cat

  • Clean the hutch/cage

  • Re-arrange the furniture in one room




  • Do a crossword or sudoku

  • Try out aromatherapy or reflexology

  • Visit the hairdresser – try a new style or colour

  • Watch television or a DVD

  • Play on the computer

  • Surf the internet

  • Watch the clouds whilst lying outside

  • Read a novel or new newspaper or magazine

  • Walk or sit on the beach or park



Getting out

  • Join a leisure centre or health suite

  • Go for a walk or jog

  • Get the old cycle out!

  • Visit a new church

  • Go to the library

  • Visit a museum

  • Check out what movies are on

  • Go to a concert

  • Browse an antiques or charity shop

  • Find out what free classes are on offer

  • Potter around window shopping

  • Go out for lunch

  • Go to the beach – whatever the weather!

  • Learn to drive, or take a trial lesson

  • Visit a nursery, garden centre or park

  • Visit a tourist attraction

  • Walk alongside the sea, river, reservoir or lake

  • Take a bus ride somewhere new

  • Visit an aquarium or zoo

  • Visit a car boot sale

  • Visit a nature reserve

  • Visit a historical or natural site

  • Visit an art exhibition

  • Go for a drive


Being creative

  • Take up a new hobby

  • Learn another language

  • Start an evening class

  • Write a letter or article for a magazine

  • Learn to meditate, do yoga or tai chi

  • Start a diary or journal

  • Write a short story or poem

  • Take up a musical instrument

  • Decorate a room, or a piece of furniture

  • Paint, draw, sculpt

  • Join a dance class

  • Surf the internet

  • Create a weblog or site

  • Sew or knit

  • Bake

  • Make an ‘emergency’ box for distressing times – put in any small reminder of what helps

  • Take photographs

  • Make a scrapbook

  • Sort out your photos



Self Soothing

  • Have an early night

  • Eat something you haven’t tried before

  • Listen to some favourite (calming or uplifting) music

  • Try a new newspaper or magazine

  • Have a bath or shower

  • Use aromatherapy oils

  • Massage your hands or feet

  • Write a list of things you have achieved, great and small

  • Soak your feet

  • Make a list of things that you can be thankful for

  • Paint your nails

  • Meditate, relax, yoga, tai chi, reiki

  • Cuddle a soft toy

  • Write a letter to yourself

  • Read a letter you’ve written to yourself to read at these times



Making contact with others

  • Telephone someone you haven't spoken to for a while

  • Join a self-help group

  • Join a civil rights group

  • Do some voluntary work

  • Write a letter to someone you haven’t written to for a while

  • Talk to a friend or family member

  • Phone the Samaritans or another helpline

  • Join an online support group or discussion forum

  • Email a friend


Express yourself physically

  • Bang a drum!

  • Scream, shout or sing loudly!

  • Rip up a phone book or newspaper

  • Dance energetically to loud music

  • Write – prose, poem, story, music, journal, diary, weblog, whatever comes into your head

  • Write a letter to someone, but don’t send it – shred or burn it outside

  • Run, walk, cycle, swim, go to the gym

  • Paint

  • Vacuum enthusiastically

  • Kick a ball against a wall

  • Punch or kick a cushion or pillow

  • Cry


Positive Self-Talk

  • I can get through this, I’ve managed before and I can now

  • I don’t need to do this, it’ll only make it worse afterwards

  • I’ll regret it and feel awful later

  • It helps for a few minutes, but then it just makes it worse in the long run

  • I don’t want to end up at the hospital again

  • I can cope for another hour – I can take one hour at a time

  • Positive Affirmations











MP3 guided imagery/relaxation downloads







More information:


MP3 guided imagery/relaxation downloads








Self Help Books

Sitemap & Search




Carol Vivyan