DBT Distress Tolerance Explained: Skills and Strategies
A practical guide to distress tolerance techniques that support emotional balance
January 26, 2026
Many mental health treatments focus on change—improving relationships, communication, or thinking patterns—to make life easier over time.
Dialectical behavior therapy (DBT) acknowledges a hard truth: Not every painful situation can be changed, at least not right away.
Sometimes, we face circumstances that feel overwhelming or beyond our control. That’s where distress tolerance comes in. Distress tolerance skills, a subset of DBT, focus on managing pain and crises rather than trying to avoid or change them.
Keep Reading To Learn
- What distress tolerance is
- How distress tolerance works
- Practical ways to apply distress tolerance to your daily life
Distress Tolerance Is a Core Tenet of DBT
DBT is a form of therapy that focuses on helping people manage their emotions, improve relationships, and lead more balanced lives.
At its core, DBT equips people with practical, life-changing skills grouped into four skill sets:
- Mindfulness
- Distress tolerance
- Emotion regulation
- Interpersonal effectiveness
This article focuses on the distress tolerance skill set, which helps people stay grounded and engaged when situations are difficult and change isn’t immediately possible.
How Does Distress Tolerance Work?
Distress tolerance skills help you get through hard moments without making things worse. Rather than trying to immediately fix a painful situation, these skills help you manage your emotions and ride the wave of discomfort until it passes.
Think of distress tolerance like a toolkit for survival during emotionally intense moments. Some tools help you accept reality as it is, even when it feels unfair. Others help you distract, soothe, or take small practical actions—like moving your body, focusing on your senses, or slowing your breathing—to shift your emotional state.
These skills can help you cope in the moment and support your well-being, but remember—they are meant to complement, not replace, professional mental health treatment.
The goal of distress tolerance is to reduce suffering and help you be your best self even in the hardest moments—so that when change becomes possible, you’re ready to act with clarity and control.
DBT: A Complete Guide
Learn how DBT works, its four core skills, and who benefits. Explore key applications and resources in this complete guide.
How Can I Incorporate Distress Tolerance Into My Daily Life?
While DBT skills are traditionally taught in group settings over the course of several weeks, DBT concepts can be helpful for anyone, any time.
Read the strategies below and consider times when they may have been helpful in your own life. Try to apply the skills the next time a distressing situation happens.
TIPP
When emotions feel intense, regulating your body and mind can help you respond calmly instead of reacting impulsively. TIPP is a set of skills designed to do just that. These skills work because they change your body’s physiology, which can help you feel more in control of strong emotions.
See How TIPP Works
TIPP stands for: temperature, intense exercise, paced breathing, and progressive muscle relaxation.
Temperature
When you’re overwhelmed or panicking, splash ice-cold water on your face. The cold lowers your heart rate and slows your breathing, which can help calm your body and reduce the intensity of your emotions.
Intense Exercise
The next time you feel like you could explode with anger, go for a run or use any form of exercise that is intense and accessible to you. Intense physical activity can help release built-up energy and shift your body’s state, which may reduce feelings of anger or anxiety.
Paced Breathing
Slow your breath and make your exhale longer than your inhale (e.g., inhale 3-4 seconds, exhale 4-5 seconds). Experiment to find what feels calming. This regulates your nervous system, helping your body and mind calm down.
Progressive Muscle Relaxation
Tense and release different muscles to notice the contrast between tension and relaxation. For example: curl toes, tense thighs, clench fists, shrug shoulders, tilt neck back—hold each for about 5 seconds and release. This signals to your body that it’s safe to relax, easing emotional intensity.
STOP
When emotions are high, pausing before you act can prevent regret and help you respond intentionally.
Walk Through a STOP Exercise
STOP stands for: stop, take a step back, observe, and proceed mindfully.
The next time you find yourself in a stressful situation—for example, you’re standing close to people who are arguing or realize you’re in the same checkout line as someone you’re uncomfortable with:
Stop
Pause instead of reacting to the argument or person.
Take a Breath
Breathe slowly to calm your body.
Observe
Notice how close they are, what’s happening around you, and how you’re feeling.
Proceed
Step back, move to a different line, or continue calmly without engaging.
Self-Soothing
Sometimes stress is unavoidable, and you have little control—like waiting for test results or navigating relationship tension. Use self-soothing when you need a quick, grounding way to calm your emotions and create a sense of safety in the moment.
Give Self-Soothing a Try
Find ways to self-soothe that engage your senses. DBT recognizes six senses, adding movement and balance to the traditional five:
- Sight: Take a walk and notice your surroundings, or look at a favorite photo or artwork. If you find reducing stimuli more soothing, try an eye mask or sitting in a dimly lit room.
- Hearing: Listen to calming music or your favorite song. If silence feels more grounding than sound, noise-cancelling headphones can help.
- Smell: Enjoy pleasant aromas, like perfume, coffee, or flowers.
- Taste: Eat slowly and savor each bite of a favorite food.
- Touch: Apply lotion, pet an animal, or feel textures around you to connect with your body.
- Movement/Balance: Try yoga, stretching, rocking, swinging, or other gentle, repetitive movements—like knitting, drumming your fingers, or stimming.
Pros and Cons
This skill helps you balance immediate urges with long-term consequences. Urges may drive impulsive actions, like yelling or drinking excessively, or avoidance, such as quitting a difficult but meaningful task. Resisting urges requires tolerating short-term discomfort. You want to use this skill when calm, not in the heat of strong emotions, so your decisions are deliberate rather than reactive.
Pros and Cons Step-by-Step
Consider a situation in which you’re likely to act on an urge. For example, let’s say you’ve committed to walking 20 minutes each day after work, but when the day ends, you’d rather sit on the couch and scroll on your phone. Here, the urge is to avoid the walk.
Make a list of the pros and cons of acting on this urge. Although you can make the list mentally, it is more impactful if you actually write down the pros and cons.
Step 1
List the pros and cons of giving in (acting on the urge)
Pros:
- Immediate comfort and rest after a long day
- Enjoyment from entertaining content or social connection
- No physical effort required
Cons:
- Missing out on stress reduction and mood boost from exercise
- Reinforcing a pattern of avoidance and breaking a promise to yourself
- Feeling disappointed in yourself later
- Missing long-term health benefits
Step 2
List the pros and cons of resisting the urge (doing the walk)
Pros:
- Immediate stress relief from movement
- Sense of accomplishment and self-respect
- Long-term health benefits
Cons:
- Initial discomfort of getting up and starting
- Missing out on immediate relaxation
Step 3
Review your lists when urges arise and make intentional decisions.
Radical Acceptance
Life can be unfair or painful, and resisting reality often increases pain. Fully acknowledging the situation—without necessarily liking it—can reduce distress and help you respond more effectively.
Get Started With Radical Acceptance
Start your morning with radical acceptance:
- When something isn’t how you want it to be (weather, a delay, a change in plans), say to yourself, “This is what’s happening right now. I don’t have to like it—and I can accept it.”
- Acknowledge what you can’t control (the change itself) and what you can (how you respond)
- Take a slow breath and focus on what you need to do next, calmly and intentionally.
- Notice how this mental shift affects your mood as you go about your day.
ACCEPTS
When you’re overwhelmed or stuck, adaptive strategies can redirect your focus and manage distress. While self-soothing is about comfort and calming through the senses, ACCEPTS focuses on distraction and shifting attention to cope with overwhelming emotions.
Give ACCEPTS a Try
ACCEPTS stands for: activities, contributing, comparisons, emotions, pushing away, thoughts, and sensations.
Activities
The next time you’re lying awake at night with worries, engage in an activity. Do a crossword puzzle to change your focus and pass the distressing time.
Contributing
If you’re being unkind to yourself and feeling low, make a point to help someone else. Kind acts don’t need to be grand gestures. Hold a door open for someone as a courtesy or let the person behind you in the grocery line take your place.
Comparisons
If the present moment feels unbearable, recall a time when things were worse and how you got through it. Or remember times that felt easier—what made them better? Good or bad, feelings are temporary, and even the toughest ones will change. This skill works best when it builds perspective and hope. It’s not meant to minimize your pain or compare it to someone else’s. If comparisons start making you feel worse, try a different skill instead.
Emotions
When distressed, try fostering different emotions—for example, watch a comedy if you’re sad or listen to a sad song if you’re angry. Shifting emotions can help you manage how you feel and reveal underlying feelings, like sadness or grief, behind anger.
Pushing Away
If thoughts feel unbearable, push them away temporarily—imagine placing them in a box on a high shelf or tying them to a balloon to float away. Taking a short break can help you come back feeling more capable of coping.
Thoughts
When your mind feels overwhelmed, shift it to neutral, structured thinking—count objects around you, name all U.S. states, or solve mental math problems.
Sensations
If distressing thoughts are keeping you “in your head,” use intense or noticeable sensations to shift focus and ground yourself, such as holding an ice cube, standing barefoot in grass, squeezing a rubber ball, taking a hot or cold shower, or using strong tastes—like sour candy or something spicy—to help distract and bring your attention back to the present.
IMPROVE
Unlike strategies that aim to distract you from a stressful situation, these skills help you focus on what is good about the present. When you find yourself getting carried away by events that are not currently happening, use IMPROVE to ground yourself in the present moment.
Try IMPROVE
IMPROVE stands for: imagery, meaning, prayer, relaxation, one thing, vacation, and encouragement.
Imagery
The next time you’re feeling stressed, think of a relaxing place where you prefer to spend time, like your favorite coffee shop. Or imagine something positive, like someone you admire giving you a pat on the back for a job well done.
Meaning
Challenge yourself to find lessons or growth in setbacks. If you failed a test, for example, think about what led to it, what you could do differently next time, or why that test matters to you.
Prayer
When you’re distressed, ask your higher power for support, or set aside a few minutes to meditate. In times of distress, it is helpful to know you’re not alone. For many people, connecting to a higher power, the universe, or something else greater than themselves can be comforting.
Relaxation
When you’re hard on yourself for a mistake, do a body scan. Sitting or lying down, slowly notice each part of your body from toes to head, pausing as needed. Focusing on physical sensations can help you detach from past and future worries.
One Thing
If you tend to multitask, try focusing on just one thing. For example, when you’re on the phone, sit still—avoid scrolling on your phone, putting away the dishes, or making coffee. Giving full attention to one activity can help ground you in the moment.
Vacation
If you’re tense at your desk, stand up and walk through the office or outside if possible. Even a five-minute break can be restorative. Mental breaks, like watching a short video or reading an article, can also help reset your mindset.
Encouragement
Be your own coach. In challenging situations, use positive self-talk to help you through. Telling yourself, “You’ve got this” or “You’re almost there” gives you the motivation you need to make the most of it.
When Self-Help Isn’t Enough
Distress tolerance skills can be powerful tools, but there are times when additional support is important. Consider seeking help from a mental health professional if:
- Your distress feels overwhelming or doesn’t ease over time
- You’re having trouble functioning at work, school, or in relationships
- You find yourself relying on harmful behaviors to cope
- You’re experiencing persistent thoughts of self-harm or hopelessness
Reaching out for professional support is not a failure of coping—it’s a proactive step toward care, safety, and healing. Therapy can help you learn and practice these skills in a structured, supportive environment while addressing the underlying challenges contributing to your distress.
The Power of DBT
Anna Precht, PsyD, provides an overview of DBT and its application, offers tips for finding and working with a DBT provider, and answers questions about what to expect during and after treatment.
Moving Forward With Confidence
Life often throws challenges our way—some we can change, others we can’t. Distress tolerance equips you with practical, hands-on skills to face intense emotions, stay grounded, and get through difficult moments without making them worse.
You don’t need to master every technique or use them perfectly—even trying one skill in a difficult moment is a meaningful step forward. These tools are here when you need them, whether you’re facing a sudden crisis or navigating ongoing challenges.
Remember: Distress tolerance isn’t about eliminating pain or pretending everything is fine—it’s about building your capacity to move through hard moments with intention and self-compassion.
Each time you pause instead of react, accept what you can’t change, or soothe yourself through discomfort, you’re strengthening your ability to manage whatever life brings. You’re more resilient than you know, and these skills can help you prove that to yourself—one moment at a time.
Contributors
Treatment works—and it starts with one conversation. If you or your loved one is ready to take the next step, call McLean Hospital at 800.333.0338 and connect with care that makes a difference.
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