Distress Tolerance Skills: Surviving Emotional Crises

The pain is unbearable. The urge to do something, anything, to escape the feeling is overwhelming. You want to scream, to run, to hurt yourself, to make it stop. In these moments of crisis, the choices you make can help you through or make everything worse.

Distress tolerance skills, a core component of Dialectical Behavior Therapy (DBT), are designed precisely for these moments. They’re not about solving the problem or feeling better permanently. They’re about getting through the crisis without causing additional harm. When you’re drowning in distress, these skills can be your lifeline.

What Is Distress Tolerance?

Distress tolerance is the ability to survive emotional crises and accept situations you cannot change, at least in the moment. It bridges the gap between having a problem and solving it.

When to Use These Skills

Distress tolerance skills are for:

• Intense emotional crises
• Moments when you might act impulsively in harmful ways
• Situations you cannot change right now
• Times when problem-solving isn’t possible or effective
• Short-term survival, not long-term solutions

The Goal

The goal isn’t to feel good. It’s to:

• Get through the crisis without making things worse
• Avoid destructive impulsive behavior
• Survive until the intensity naturally decreases
• Make it to a place where you can think more clearly

Crisis Survival Strategies

TIPP Skills

TIPP changes your body chemistry quickly to reduce emotional intensity:

T – Temperature:
– Hold ice cubes
– Splash cold water on your face
– Take a cold shower
– Hold a cold pack to your face

Cold activates the dive reflex, slowing heart rate and calming the body.

I – Intense Exercise:
– Run in place
– Do jumping jacks
– Sprint up stairs
– Any intense physical exertion for 10-20 minutes

Exercise burns off stress hormones and releases endorphins.

P – Paced Breathing:
– Slow your breathing
– Make exhales longer than inhales
– Breathe out slowly (like through a straw)
– Aim for 5-6 breaths per minute

Slow breathing activates the parasympathetic nervous system.

P – Paired Muscle Relaxation:
– Tense muscles while breathing in
– Relax muscles while breathing out
– Work through major muscle groups
– Combine with slow breathing

Releasing tension signals safety to your nervous system.

STOP Skill

When you’re about to act impulsively:

S – Stop:
Don’t move. Don’t react. Just stop.

T – Take a Step Back:
Remove yourself from the situation if possible. Take a breath.

O – Observe:
Notice what’s happening. What’s the situation? What are you feeling?

P – Proceed Mindfully:
Consider your options. What would be effective? Then act with awareness.

Pros and Cons

When tempted to do something harmful:

List pros and cons of:
1. Acting on the crisis urge
2. Not acting on the crisis urge

Consider both short-term and long-term consequences for each.

This engages your thinking brain when emotions are driving you toward impulsive action.

Distraction Strategies

When you can’t solve the problem immediately, distraction can help you survive until intensity decreases.

ACCEPTS

A – Activities:
Engage in activities that require focus: exercise, cleaning, games, hobbies, work.

C – Contributing:
Help someone else: volunteer, do a favor, make something for someone.

C – Comparisons:
Compare your situation to others less fortunate, or to times you coped worse but survived.

E – Emotions:
Generate different emotions: watch a funny video, listen to uplifting music, read something moving.

P – Pushing Away:
Mentally put the situation aside for now. Imagine putting it in a box. Build an imaginary wall. Leave the situation mentally.

T – Thoughts:
Occupy your mind: count tiles, name things in categories, do puzzles, memorize something.

S – Sensations:
Use intense sensations to distract: ice, spicy food, loud music, strong scents.

Wise Mind ACCEPTS

Use activities aligned with your values and what truly helps you, not just random distraction.

Self-Soothing Strategies

Comfort yourself through your five senses:

Vision

• Look at beautiful things
• Watch nature
• Look at art or photographs
• Notice colors and light

Hearing

• Listen to soothing music
• Nature sounds
• Calming voices
• Silence

Smell

• Pleasant scents
• Aromatherapy
• Flowers or fresh air
• Cooking or baking smells

Taste

• Mindfully eat something pleasant
• Hot tea or cool water
• Favorite foods (in moderation)
• Something with strong flavor

Touch

• Take a warm bath
• Soft fabrics
• Pet an animal
• Comfortable temperature

Self-Soothing Tips

• Prepare a self-soothe kit in advance
• Know what works for you specifically
• Don’t overuse any one approach
• Combine senses for greater effect

Improving the Moment

When you can’t change the situation, you can change your experience of it.

IMPROVE Skills

I – Imagery:
Imagine a safe, peaceful place. Picture the crisis passing. Visualize yourself coping.

M – Meaning:
Find purpose in the suffering. What can you learn? How might this help others? What values does surviving this represent?

P – Prayer:
If spiritually inclined, pray. Ask for strength. Connect with something larger than yourself.

R – Relaxation:
Relax your body: progressive muscle relaxation, yoga, stretching, massage.

O – One Thing in the Moment:
Focus only on the present moment. Do one thing at a time with full attention.

V – Vacation:
Take a brief mental vacation: a bath, a walk, a few minutes of escape. Not avoidance, just a brief respite.

E – Encouragement:
Talk to yourself like a good coach. “I can get through this.” “This will pass.” “I’ve survived hard things before.”

Radical Acceptance

Sometimes the most powerful distress tolerance comes from acceptance.

What Radical Acceptance Means

• Accepting reality as it is, not as you want it to be
• Stopping fighting against what has already happened
• Accepting with your whole self, not just intellectually
• Not the same as approval or giving up

How to Practice

1. Observe that you’re resisting reality
2. Remind yourself that reality can’t be changed (what is, is)
3. Consider what led to this moment
4. Practice accepting with your body (relax, unclench)
5. Allow disappointment or sadness about reality
6. Repeat acceptance when resistance returns

What Radical Acceptance Addresses

The equation: Pain + Non-Acceptance = Suffering

Pain is unavoidable. Suffering from fighting against unavoidable pain is optional.

Building Your Distress Tolerance Toolkit

Create a Crisis Plan

Before crisis hits:

1. Identify your warning signs
2. List effective skills for you specifically
3. Identify people you can call
4. Create a self-soothe kit
5. Write coping statements
6. Keep the plan accessible

Know What Works for You

Different skills work for different people. Experiment to find your go-tos:

• Which TIPP skills help most?
• What distractions actually work?
• What’s in your self-soothe toolkit?
• Which IMPROVE skills resonate?

Practice Before Crisis

Skills are harder to use in crisis if you’ve never practiced:

• Use skills in moderate distress first
• Make skills automatic through repetition
• Build the habit of reaching for healthy coping

Accept Imperfect Use

In crisis:

• Skills may not work perfectly
• Some distress may remain
• That’s okay; the goal is survival, not comfort
• Any use of skills is better than impulsive harmful action

When to Seek Additional Help

Distress tolerance skills are powerful, but they have limits. Seek professional help if:

• Crisis is frequent or constant
• Skills aren’t enough to keep you safe
• You’re having thoughts of suicide or self-harm
• You need to develop more comprehensive coping
• Underlying issues need to be addressed

Moving Forward

Distress tolerance skills won’t solve your problems or make pain disappear. But they can get you through moments when the intensity feels unsurvivable. They can bridge the gap between crisis and clarity. They can keep you from making things worse when you’re already at your worst.

These skills are like a life raft. They don’t take you where you ultimately want to go, but they keep you afloat until you can get there. And sometimes, just staying afloat is enough.

This article is for educational purposes only and is not a substitute for professional mental health treatment. If you’re struggling, please reach out to a qualified mental health provider. Arise Counseling Services offers compassionate, professional support for individuals and families throughout Pennsylvania.