Distress Tolerance for Depression: DBT Grounding and Distraction Techniques


Center for Psychological Growth and Resilience, LLC

Key Points

  1. Grounding techniques are designed to shift attention away from ineffective and negating thoughts toward physical and environmental stimuli.
  2. Distraction involves activities combining physical and mental engagement, such as going for a walk, painting, or baking, to move the body and take the mind off negative thoughts.
  3. Self-soothing and radical acceptance can be used when working toward interpersonal effectiveness to manage distress about things that cannot be changed or controlled.
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Negative Self-Talk

Jackie’s third goal was learning to manage self-judgments and self-abasement that contributed to self-loathing. She found three skills particularly effective. Mindfulness alerted her to engagement in negative or ineffective self-communications. She then used the distress tolerance skills of grounding and distraction to shift her attention away from such thoughts toward her body or environment.


  • 5-4-3-2-1

This technique combines the observe, describe, one-mindfulness, and effectiveness skills. Observe and detail five things you see in your environment. Then describe four things you hear, three things you sense or feel, two things you smell, and one thing you taste. Watch when your attention wanders back to judgments, calling it back to observations. Jackie took the initiative to pair this with squared breathing. She breathed in for four seconds then held for four while describing to herself what she observed, then breathed out for four. This added layer forced her to focus on noticing and breathing rather than on thought processes.

  • Colors of the rainbow

This is similar to 5-4-3-2-1 as it involves external observation and directs attention away from judgments. You look for every item in your environment that corresponds with a color of the rainbow: red, orange, yellow, green, blue, indigo, violet (ROYGBIV). Jackie started with red then moved through the other colors, though the order of colors isn’t mandated.

  • Feet pressure

This exercise is dialectically both easy and tricky. Push your feet into the floor as hard as you can to notice the sensations. Pay attention to different parts of your feet and legs down to individual toes. Though this exercise was effective for her, on days when her knee pain was too intense, Jackie would clench her fists or run her fingernails over her forearms instead.


When grounding didn’t quite work for Jackie, she would employ distracting behaviors pairing mental with physical activity. Going for a short walk, painting, cleaning, or baking allowed her to move her body and get her mind off unhelpful thinking patterns.

Improved Communication

Jackie’s fourth treatment plan goal was improving communication with others. It gave her significant distress. Boundary setting and assertiveness were completely foreign to her. She remarked that it was often more comfortable for her to continue being derided by her mother and maintain caretaking patterns than to face the stress of changing those dynamics.

Distress tolerance skills were therefore vital in managing Jackie’s distress and concerns about relationship conflicts. Grounding techniques took her attention away from such rumination and toward finding meaning in the difficulty of changing her patterns.


When Jackie experienced distress after setting a boundary with her mother around weight judgments, she created her own “at-home day spa”, as she called it. She soothed herself by taking a bath, playing relaxing music, dimming the lights, and drinking her favorite tea. She found this so helpful that a lot of time in one session was spent building a list of other ways she could self-soothe to manage distress.

Radical Acceptance

When it came to interpersonal effectiveness and communication, radical acceptance was really important for Jackie to practice while she was changing those dynamics. Other goals could be met by changing what was within her control, but where other people are concerned we must often accept things we cannot change as they are not in our control.

Jackie couldn’t control other people in her life, particularly not her mother. So she had to balance her healthier setting of boundaries and practice of assertiveness against acceptance that she may nonetheless never see altered behavior and judgments from her parent.

Looking for practical everyday tools? This print-friendly handout is just what you need. Click on the following link to download the PDF:

Grounding and Distraction Techniques

This is a comprehensive handout designed to equip therapists with valuable tools for teaching clients how to manage negative self-talk, improve communication, and cultivate distress tolerance. By introducing grounding techniques such as the 5-4-3-2-1 method, colors of the rainbow, and the feet pressure exercise, therapists can guide clients to shift their attention to the present moment and the physical environment. The handout also explores the role of distraction techniques in redirecting attention away from negative thoughts, and emphasizes the importance of pairing mental and physical engagement. By integrating these techniques into therapy, clients are empowered to improve their communication, practice self-soothing, and manage negative self-talk, fostering meaningful change and growth.


This handout is designed to assist therapists in teaching clients grounding and distraction techniques for managing negative self-talk, enhancing communication, and promoting distress tolerance. It is important to explain to clients the purpose of grounding and distraction techniques and how they can shift attention away from unhelpful thoughts. Discuss the impact of negative self-talk on self-esteem, and emphasize the importance of recognizing and challenging negative self-communication patterns. Introduce grounding techniques such as 5-4-3-2-1, colors of the rainbow, and the feet pressure exercise. Teach clients the role of distraction in redirecting attention, and encourage them to engage in physical and mental activities as distractions. Explore the goals of improving communication and the use of grounding techniques in the process. Explain self-soothing as a way to manage distress and assist clients in creating personalized self-soothing routines. Discuss the concept of radical acceptance and its importance in managing distress and maintaining healthy boundaries. Tailor the instructions to each client’s unique needs and circumstances.

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Distress Tolerance for Depression: DBT Grounding and Distraction Techniques

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