Distress tolerance, a cornerstone of dialectical behavior therapy (DBT), is pivotal for helping clients effectively manage overwhelming emotions and crises.
What is Distress Tolerance?
Involves accepting emotional pain and distress without trying to change or escape it. Rather than approving of the distress, acceptance provides a starting point for managing the situation. Distress tolerance is about acknowledging reality as it is in the moment, not judging or avoiding it.
These skills are not designed to solve problems directly but to prevent exacerbating them. They are essential for helping clients survive crises, distinguish between actual crises and mere discomfort, and avoid impulsive actions that may worsen their situation. Aiding clients to remain productive and focused despite emotional overwhelm.
Learn the Key Skills
- TIPP: Temperature, intense exercise, paced breathing, and paired muscle relaxation
- STOP: Stop, take a step back, observe, and proceed mindfully
- ACCEPTS: Activities, contributing, comparisons, emotions, pushing away, thoughts, and sensations
- Muscle Relaxation: Reduce physical tension linked to emotional stress.
Practical Tool: Distress Tolerance Skills — Client’s Guide
This handout introduces six tools: sensory engagement, ACCEPTS and IMPROVE methods, muscle relaxation, the RAIN dance, and the HALT skill.
Each skill targets emotion regulation and offers practical applications for managing distress effectively. These skills provide a diverse toolkit for clients seeking to develop emotional resilience in the face of challenging situations, allowing them to stay safe.
How to Use This Tool?
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- Introduce the Skills: Explain each skill’s objectives and practical applications, ensuring your clients understand their purpose and how they can be beneficial.
- Facilitate Skill Identification: Collaborate with clients to determine which skills resonate most based on their needs and preferences.
- Customize to Individual Needs: Work with clients to adapt the techniques to fit their circumstances and ensure the skills are relevant and effective for the client’s personal experience.
- Assign Skills as Homework: Encourage your clients to practice these skills outside therapy sessions and integrate them into their daily lives.
- Monitor Progress and Provide Support: Regularly review your clients’ progress in implementing these skills. Offer guidance, address challenges, and adjust strategies as needed.
Common Challenges and How to Overcome Them
Learning distress tolerance skills represents a major shift for many clients. They will likely face difficulties and roadblocks as they first integrate these techniques into their emotional toolbox. Therapists play a key role in anticipating challenges and supporting clients through the process.
Challenge 1: Resistance to Acceptance
- Challenge: Many clients struggle with the concept of acceptance, confusing it with approval or giving up.
- Solution: Clarify that acceptance simply means acknowledging the reality of a situation without judgment. Demonstrate it through exercises that differentiate acceptance from approval, like STOP.
Challenge 2: Trouble Applying Skills
- Challenge: Clients may find it hard to remember or apply these skills during intense emotional moments.
- Solution: Regular practice and role-playing scenarios can help. Encourage clients to start with simpler skills and gradually progress to more complex ones. Cue cards can serve as reminders for clients to use in high-distress situations.
Challenge 3: Unrealistic Expectations
- Challenge: Some clients expect immediate relief or a complete resolution of their problems.
- Solution: Setting realistic expectations is key. Emphasize that these skills are about managing distress, not eliminating it, and that improvement takes time.
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