• Distress Tolerance: What is it?

    Distress tolerance skills help us to learn to bear pain skillfully.


    The ability to tolerate and accept distress is ESSENTIAL because:

    • Pain and distress are inevitable. They are part of life and will happen. They cannot be entirely avoided or removed. Life is not pain free. If we try to avoid pain, it leads to more problems. It comes back to haunt us!
    • If we are in denial of pain, refuse to accept it, or try to hide from it, this will lead to more pain and suffering. If we can learn to experience, tolerate, and accept the pains of life, we can work to reduce the amount of suffering.



    There are two types of distress tolerance skills: crisis survival strategies and acceptance strategies.

    • CRISIS SURVIVAL STRATEGIES: STOP + TIPP skills, Wise Mind ACCEPTS, IMPROVE the Moment, Self-Soothe with the Five Senses
    • ACCEPTANCE STRATEGIES: Radical Acceptance, Turning the Mind


    Distress tolerance skills have to do with the ability to accept, in a non-judgmental way, both ONESELF and the CURRENT SITUATION.


    Tolerating distress means:

    • Looking at your environment without trying to change it or put demands on it to be different.
    • Experiencing your current emotions without trying to get rid of them.
    • Observing your thoughts + action patterns without stopping or controlling them.


    There are certain times when we need to distract ourselves from the pain because we are not able to process the situations or feelings in our emotion mind. We then use our crisis survival skills. We cannot always distract. We are then avoiding LIFE. We must face the problems and learn to process and cope at some point. This is PROBLEM SOLVING.

  • Wise Mind ACCEPTS

    Think of activities in each category that can help you move through a stressful emotion or situation.


    • Focus on a task you need to get done
    • Clean a room in your house
    • Play computer games
    • Go walking.
    • Exercise
    • Go out for a meal with a friend
    • Build or create something
    • Read a book or magazine


    • Find volunteer work to do
    • Help a friend or family member
    • Surprise someone with something nice
    • Give away things you don't need
    • Call or text an encouraging note to someone 
    • Make something nice for someone
    • Do something thoughtful for someone you care about


    • Compare how you are feeling to a time you felt different
    • Think about how others cope
    • Do a perspective taking exercise
    • Watch a TV show or movie about other's problems and observe how they handle situations


    • Read an emotional book or story
    • Watch emotional TV shows or movies
    • Listen to emotional music
    • Ideas: Scary movies, comedies, soothing music, funny greeting cards, etc.


    • Leave the situation for a while, knowing you will need to come back to it later
    • Put the situation in a "mental container"
    • Block the thoughts from your mind temporarily
    • Refuse to think about painful situations 
    • Deny the problem for the moment


    • Count to 10
    • Repeat words to a song in your mind
    • Count the colors in a painting
    • Work a puzzle 
    • Watch TV or read


    • Use your 5 senses to self-soothe
    • Squeeze a rubber ball
    • Listen to loud music
    • Hold ice in your hand or mouth
    • Go out in the rain or snow 
    • Take a hot or cold shower
  • IMPOVE the Moment

    Think of activities in each category that can help you move through a stressful emotion or situation.


    • Imagine relaxing scenes
    • Imagine everything going well
    • Imagine hurtful emotions draining out of you
    • Remember a happy time, imagine you're there
    • Make up a calm fantasy world


    • Find meaning in a painful situation
    • Focus on the positives of a painful situation
    • Repeat these positive aspects in your mind
    • Remember, listen to, or read about spiritual values


    • Open your heart to a supreme being, your higher power, or your own Wise Mind
    • Ask for strength to bear the pain
    • Turn things over to a higher power or supreme being
    • Engage in a spiritual activity


    • Take a hot bath or sit in a hot tub 
    • Massage your neck and scalp 
    • Practice yoga or other stretching
    • Breathe deeply
    • Change your facial expression


    • Focus attention on just what you are doing
    • Keep yourself in the moment
    • Put your mind in the present
    • Focus attention on the physical sensations 
    • Listen to a sensory awareness recording


    • Go to the beach or woods for the day
    • Turn off your phone for the day
    • Take a mental vacation in your mind
    • Take a one hour break from hard work 
    • Build a blanket fort for the day


    • Cheerlead yourself!
    • "I will make it out of this!"
    • "I am doing the best that I can."
    • "This too shall pass."
    • Find a phrase that works for you, repeat it!
  • Radical Acceptance



    In life, we can experience extreme pain due to trauma, difficult life circumstances, and loss. Everyone has and will experience suffering.


    Often when these situations happen, we become angry and upset in response. This can cause us to be judgmental or overly critical of ourselves and the situation. By doing so, we bring more pain and suffering into our lives. Then we become stuck and cannot move forward. Nothing gets better.


    But it can.


    Through practicing radical acceptance, we can build a relationship with our suffering. It might sound a bit backwards, but when we own our truama and the difficult emotions around it, we can reclaim our power. We can take control back of our lives and emotions, istead of allowing it to control us.


    This can be a complex skill to implement. And I admit, it was one that eluded me for many years.


    Why should I accept these negative things that have happened to me?

    Isn't that like saying these traumatic situations were okay?
    Is this approving of what happened to me?
    Why would I want to accept negative things?


    These are not uncommon or irrational questions.


    Acceptance does not mean approval. It does not mean you condone what happened. It does mean that you stop fighting the past and trying to change what happened. We cannot change the past, but we can control our future.



    When we find ourselves in pain, we have FIVE different choices we can make:


    1. Change the situation: This includes taking a realistic look of what your options are. What would you be willing to do to end your suffering in a healthy, effective, and non-harmful way? This can be making a plan to leave a bad relationship, quitting a dead end job, or finally seeking medical advice you know you need.
    2. Change how you see or view the situation: Can you find the silver lining or meaning in your pain? Our minds and thoughts can be powerful in overcoming a situation. Is it a terrible situation or one that is meant to teach us something?
    3. Accept the situation: Give up fighting reality! When you learn to accept the situation, you may still experience pain, but you are no longer adding additional pain to it.n You are willing to experience a situation without trying to change or escape it. You then learn how to relate to and cope with the difficult emotions around the situation.
    4. Stay stuck in your suffering: In order for radical acceptance to truly work, we have to do the deep work to continue to turn our minds over and over to acceptance. It's a complex process and won't happen overnight. You have the choice to accept things as they are, determine how to move forward, or stay stuck in your current situation and add to your pain and suffering.
    5. Make things worse: Yep. By staying stuck or avoiding dealing with and accepting the situation or trauma, you can definitely make things worse. You are adding to your pain by avoiding acknowledging it. This can cause additional emotional and physical issues in other areas of your life.

    Again, remember, acceptance does not mean approval. It does not mean we like the situation. It also does not mean we are giving up or giving in. When we recognize, acknowledge, and accept a problematic situation, we learn to take control of our lives and emotional health.



    The process of radical acceptance is similar to the stages of grief:


    1. Denial: Not believing our situation or reality is real
    2. Anger: Feeling frustration about why a situation has happened to us 
    3. Bargaining: Trying to make a deal with someone to change reality
    4. Depression: Feeling despondent about reality
    5. Acceptance: Acknowledging reality without fighting it

    These stages might not happen in order. It's also common to go back and forth between stages, while skipping others. In moving through this process, you will be moving towards more and more acceptance.


    Experience the pain. You do not need to be the story of your suffering.

    "Acceptance is the first step to

    overcoming the consequences of any misfortune."
    - William James

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    This website is intended for information and educational purposes only. No information presented is intended for counseling or treatment. Use of this website does not form a counseling relationship. For more information please contact me at blair@helpwithdbt.com