We all experience crises in our day-to-day life. Sometimes these crises are big, like a death, and sometimes they are small, like traffic. DBT distress tolerance skills help you get to a more manageable emotional place for crisis survival.
Skill 1: TIPP
When to use it: When you’re at your emotional breaking point.
How to use it: TIPP is an acronym to help you remember these four ways to bring yourself down from the emotional ledge:
- Temperature — Change your body temperature by splashing water on your face or holding an ice cube to help you cool down—both physically and emotionally.
- Intense exercise — Do intense exercise to match your intense emotion. It’s hard to stay upset when you’re exhausted.
- Paced breathing — Something as simple as controlling your breath can have a profound impact on reducing emotional pain. Practice your favorite breathing exercise to reduce your body’s fight or flight response.
- Paired muscle relaxation — Tighten a voluntary muscle, relax it, and allow it to rest. The muscle will become more relaxed than it was before it was tightened. Relaxed muscles require less oxygen, so your breathing and heart rate will slow down as well.
What it does: The distress tolerance skills in TIPP will get you a step closer to wise mind, where you will be able to make constructive choices and cope productively.
Skill 2: ACCEPTS
When to use it: When you need to tolerate a negative emotion until the right time to address or resolve the situation.
How to use it: Use the acronym ACCEPTS to help you remember the following skills:
- Activities — Engage in any healthy activity that keeps your mind off the negative emotion.
- Contributing — Do something kind for another person. An act of service will brighten your day and keep your mind off the problem.
- Comparisons — Put your life in perspective. Is there a time when you’ve faced more difficult challenges than you’re facing today? Is there another person who has suffered more than you? The goal of this exercise is not to add more distress and emotional pain to your current situation, but to add a different perspective to what you’re experiencing.
- Emotions — Invoke the opposite emotion of your current distressed feeling. If you’re feeling depressed, watch a funny video. If you’re feeling anxious, try 15 minutes of meditation.
- Push Away —When you can’t deal with something yet, it’s okay to push the problem out of your mind temporarily. Set a time to come back to the issue. You know that it will be addressed, and you can relax in the interim.
- Thoughts — Replace negative, anxious thoughts with activities that busy your mind to help you avoid self-destructive behaviors.
- Sensation — Use your five senses to self-soothe during times of distress. Anything that appeals to your senses can help you cope with the present situation.
What it does: The dialectical behavior therapy skills in ACCEPTS help you tolerate your distress until the appropriate time to resolve the situation.
Skill 3: IMPROVE
When to use it: When you don’t have control over a situation, but need to tolerate the emotions it invokes.
How to use it: Use the IMPROVE acronym to remember the following techniques:
- Imagery — Imagine yourself dealing successfully with the problem, being in wise mind, and feeling accomplished when the situation is over. By doing so, you may actually change the outcome of the problem in your favor.
- Meaning — Try to find meaning in painful situations. What can you learn from this experience? Find a reason, or a possible reason, to assign your present suffering.
- Prayer — Prayer can be to any higher power, including God or the universe. Surrender your problems and ask to tolerate the situation a little longer.
- Relaxation — Engage in intentional relaxation to counteract the fight or flight instinct.
- One thing in the moment — Let go of the past and future. Find one thing to do and focus your entire self to that task. A one-track mind helps emotions feel less overwhelming.
- Vacation — Imagine yourself somewhere else, like taking a stroll around the lake. Just like a real vacation, you’ll hopefully “return” better able to tolerate your circumstances.
- Encouragement — Give yourself encouragement by repeating phrases that are meaningful to you, such as “I’ve got this”. You’ll be amazed at your ability to motivate yourself.
What it does: The IMPROVE skill will help you tolerate and improve your emotional state until the intensity subsides.
Skill 4: PRO AND CON LIST
When to use it: When you’re not in wise mind, and need to make a sensible decision.
How to use it: Make a list of the positive and negative aspects to each option you have. When you’re finished, compare the lists and determine which option has more positive aspects.
What it does: This skill helps you fight impulsive urges and their negative outcomes.
Skill 5: SELF-SOOTHE
When to use it: When you need to reduce the intensity of negative emotions.
How to use it: Use your senses to focus on other things. Here are some examples:
- Sight — Use your vision to focus on something else. Count how many colors are in the room, or scroll through photos on your phone.
- Sound — Listen for birds chirping or the sound of traffic outside. If you prefer soothing sounds, there are many apps you can install on your phone to play on the go.
- Taste — A small treat can give you something pleasurable to focus on while you’re getting through a tough moment. A piece of gum or a few mints will do the trick.
- Touch — Embrace your sense of touch by running your fingers along a seam in your clothing, or using a fidget toy. When appropriate, wrap yourself in a blanket or take a bath.
- Smell — Focus on whatever scent is in the air. Try to identify the scent or break it down into its components. For easy access to a scent you find calming, put a few drops of your favorite essential oil onto a cotton ball and keep it with you in a plastic bag.
- Movement — DBT introduces a sixth sense of movement. Your emotional state can be altered by your body’s movements, so take a walk around the block or dance to your favorite song!
What it does: Your senses are a tool you’ll always have with you to reduce the intensity of a situation. Try focusing on only one sense at a time to incorporate mindfulness into the self-soothing skill.
Skill 6: RADICAL ACCEPTANCE
When to use it: When you have an undesirable situation that’s not going to change.
How to use it: Choose to accept that this is reality, and you will have to learn to move forward regardless.
What it does: Radical acceptance acknowledges that we all have choices, and it sometimes comes down to choosing whether or not we are going to accept the reality of our situation. You can choose to stay miserable about it, or you can choose to accept the situation and move forward.
DBT’s distress tolerance skill training may seem daunting, yet emotion regulation gives you more control over urges to engage in an impulsive behavior. No matter who you are or what you’re struggling with, you can improve your mental health and ability to tolerate difficult situations.
Author Bio: Brad Simpson DSW, LCSW is the Executive Director of Sunrise Residential Treatment Center. He has worked with families, couples, and adolescents in acute inpatient, intensive outpatient, outpatient and residential settings. He is Intensively Trained in Dialectical Behavioral Therapy (DBT) and served as the regional representative for the Mountain West Region of SMART Recovery for 3 years.
The opinions and views expressed in this guest blog do not necessarily reflect those of www.rtor.org or its sponsor, Laurel House, Inc.
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Brad, thank you for your amazing post for our readers offering descriptions of distress tolerance skills and techniques. I love the piece as it’s easy to understand, with great options that are manageable to practice and do. As Resource Specialist, I plan to include your post as I offer help to families and individuals via email as I believe it is an excellent piece.
Thank you for this post. I am new to this mental illness. My 20year old son has just been tested for several things just yesterday. We go next week to get his results. He already has been diagnosed with bipolar,adh, social depression, and worst of all he has attempted suicide.
My heart aches for him. I appreciate any and all information, and help I am his mom and I will do all I can to help him. Thank you for this information I will be putting it on my Twitter.
Donnie,
I’m a parent too and know what a heartache it can be to have a son or daughter with mental health issues. Keeping yourself informed is one good way of dealing with the helplessness you sometimes feel in a situation like this.
Thank you for reading our blog and commenting. Please feel free to contact our Resource Specialist Denise if you would like help finding resources for your son. This is a free service we offer to users of our website.
Jay