Distress Tolerance Skills in DBT for PTSD: The Five Senses, ACCEPTS, Heart-Focused Breathing, and Relaxation

Kirby-Reutter

United States Department of Homeland Security

Key Points

  1. Distress tolerance is using mindfulness to cope with distressing emotions. The five senses mindfulness exercise can also be used as a distress tolerance skill. In addition to being aware of what goes into each sense, the client chooses specific stimuli for self-soothing.
  2. The ACCEPTS acronym is a list of skills to promote healthy distraction. Maria focused on two of these skills: activities and thoughts. The point of distraction in DBT is not dissociation, but to engage in something mindfully.
  3. Heart-focused breathing is a guided exercise in which you ask the client to imagine that the air is flowing in and out of their heart. Then you ask them to focus on their safe place, then also a positive emotion, so their mind associates the breathing with a positive feeling. Muscle relaxation can be done through self-massage and other self-soothing activities like hot showers.
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Coping With the Five Senses

Distress tolerance is about using mindfulness skills to cope with distressing emotions. The five senses mindfulness exercise can also be used as a distress tolerance skill. In that case, in addition to being aware of what goes into each sense, the client may also have specific stimuli to self-soothe with each sense.

Maria identified the sunset for sight, her favorite songs for hearing, coffee for both smell and taste, and taking long, hot showers for touch. Now that she’s learned to engage in those activities mindfully, she can also use them as coping strategies throughout the day.

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