Distress Tolerance Skills: 12 DBT Techniques to Get Through a Crisis

If you’re feeling overwhelmed, you don’t have to handle it alone. While distress is a part of life and isn’t something that can be avoided, some people feel more distress than others. If you’re one of them, learning distress tolerance skills can support you in the moment.

One component of dialectical behavior therapy (DBT) is distress tolerance skills. These skills won't make the distress disappear. Instead, they help you get through it without making things worse. Over time, these skills can help you feel steady again more quickly when distress arises. 

In this article, we’ll introduce  DBT techniques you can use to support you when things get difficult. While these skills can support anyone experiencing distress, they’re especially supportive for individuals with post-traumatic stress disorder (PTSD), borderline personality disorder (BPD), self-harm and thoughts of suicide, and substance use disorders.

What are distress tolerance skills?

Distress tolerance skills are techniques that help you get through intense emotions. Rather than trying to solve the problem, they help you tolerate the distress so that the feelings can subside naturally.

When to use distress tolerance skills

Distress tolerance techniques can help when emotions feel intense or overwhelming, and you need to get through the moment. You might use them when:

• Your emotions feel overwhelming or difficult to manage.
• You’re unable to problem-solve effectively in the moment.
• You’re experiencing strong urges to act impulsively or engage in harmful or aggressive behaviors.
• You’re distressed but need to keep functioning, such as at work or school.
• You need to create some emotional space before you can begin problem-solving.
• You’re facing a situation you can't solve or change right away.

Crisis survival skills

These skills are intended to help you tolerate emotional distress and prevent things from worsening until the intense emotions subside.

TIPP (temperature, intense exercise, paced breathing, paired muscle relaxation)

The TIPP skill can work fast because it changes what's happening in your body, not just your thoughts. With regular practice, these four techniques can calm you down within a few minutes. 

• T (Temperature): Briefly change your body temperature to help reduce intense emotional arousal. One approach is to place a cool pack or cold, damp cloth on your face for a few seconds while holding your breath. This can slow your heart rate down and help your body feel calmer.
• I (Intense exercise): Perform a short burst of intense exercise, such as jumping jacks, running in place, or lifting weights. This helps your body burn off extra adrenaline.
• P (Paced breathing): Inhale deeply through your nose, and then exhale slowly through your mouth. Try a pattern of breathing in for 5 seconds and then out for 7 seconds.
• P (Paired muscle relaxation): Tense a muscle group, then release it as you exhale. 

STOP

The STOP skill teaches you to pause before reacting or acting impulsively, helping you respond more intentionally. 

• S (Stop): Freeze and stop what you are doing. This prevents you from acting on your emotional urges.
• T (Take a step back): Disengage from the situation for a moment. Take a slow, deep breath.
• O (Observe): Notice how you feel and what is happening. Take a moment to look at the facts without judging or interpreting them. How do you feel? What are others saying or doing?
• P (Proceed mindfully): Think about your next steps. Consider what might improve the situation and what could make it worse.

Pros and cons

Pros and cons help you balance your immediate urges with long-term consequences. Start by describing the situation and then list the pros and cons of all options. For example, avoiding responsibilities or engaging in dangerous, harmful behaviors can have negative consequences, while taking a break before problem-solving can have positive ones. 

Distraction with ACCEPTS

ACCEPTS stands for seven health distraction methods you can use. These methods can temporarily redirect attention and help you get through the crisis.

• A (Activities): Participating in activities that require your attention, such as going for a walk, cleaning, or playing a game.
• C (Contributing): Doing something kind for someone else or volunteering to help others; helping a friend or family member.
• C (Comparisons): Comparing the current situation with a previous period when you felt differently.  
• E (Emotions): Doing something that triggers the opposite emotion of what you’re currently feeling. For example, if you’re feeling sad, you might try watching a funny video. If you’re feeling tense or agitated, you might try listening to relaxing music.
• P (Pushing away): Place the situation on an imaginary shelf to step away for a moment.
• T (Thoughts): Activities that occupy your mind, such as a puzzle, counting objects, or reading.
• S (Sensations): Activating physical sensations, such as eating a sour candy, holding an ice cube, or squeezing a stress ball.

Self-soothing with the five senses

Using the five senses to help calm the nervous system:

• Vision (sight): Observing a calming nature scene or looking at comforting photographs.
• Hearing (sound): Listen to the sounds of nature around you or calming music.
• Smell (olfactory): Breathe in fresh air, smell a scented lotion, or burn a scented candle.
• Taste (Gustatory): Sip a warm drink slowly or allow a piece of chocolate to melt in your mouth.
• Touch (tactile): Wrap yourself in a cozy blanket, take a warm bath, or pet an animal.

IMPROVE the moment

IMPROVE helps to shift your attention to bettering the present moment

• I (Imagery): Imagine a peaceful place or yourself solving the problem successfully. You might also choose to relive a happy moment.
• M (Meaning): Find a sense of purpose in the struggle. Ask yourself what you can learn from the situation. Remind yourself what is important to you and what your goals are. 
• P (Prayer): Connecting with a higher power or source of comfort. You do not need to be religious to follow this step. You may also connect with a spiritual guide, nature, a loved one who has passed, or your own wiser self.
• R (Relaxation): Try relaxation methods like deep belly breathing, yoga, stretching, meditating, or enjoying a warm bath. 
• O (One thing in the moment): Stop multitasking and focus on one thing at a time.
• V (Vacation): Give yourself a break from your responsibilities. This can be a short, 5-minute break where you close your eyes for a few moments or read a few pages in a book. You could also go to a nearby park or beach.
• E (Encouragement): Practice positive self-talk, such as “I can do this” or “The way I’m feeling will pass”.

Reality acceptance skills

These skills help you accept what is happening, so you are not fighting against unchangeable facts. 

Radical acceptance

Radical acceptance means accepting unchangeable situations without adding negative labels. This helps reduce needless suffering and can prevent us from getting emotionally stuck. Use your body language to help create this acceptance, such as by taking deep breaths or opening your palms. Radical acceptance takes practice, but it can help you to let go of trying to control what you can’t and move toward acceptance. 

Turning the mind

To practice turning the mind, start by noticing when you feel angry or resist reality and observe that you have options in how you react. Then, commit to “turning towards” accepting things as they are right now. Repeat these two steps every time you notice your mind starting to wander. As you become more proficient at this skill, you may also develop a plan for catching yourself when you start to drift. 

Willingness vs. willfulness

Willingness means accepting what is and taking necessary action. Willfulness, on the other hand, is about resisting something and trying to control it. To practice willingness, notice when you are feeling resistant. Choose to act willingly in that moment, and practice acceptance and doing what the situation requires.

Half-smiling and willing hands

This technique may help you adopt a more relaxed physical posture, which can send a calming signal to your brain. To practice half-smiling, relax your face, lift the corners of your lips into a slight smile, and soften your gaze. To practice willing hands, unclench your fists and let your hands rest comfortably on your thighs or at your sides with your palms open. 

How to practice distress tolerance skills before you need them

Practicing distress tolerance techniques when you are calm helps them be more accessible in moments of distress. Think of what it takes to learn a new instrument. If you only practice sporadically, you won’t perform well for an audience. Practicing distress tolerance skills works the same way. You can’t expect them to work when you need them most if you don’t practice them regularly.

Building a personal crisis skills list

A personal crisis skills list is a collection of strategies, activities, and reminders you can turn to when you’re experiencing intense distress. Creating your list ahead of time means you don’t have to figure out what might help when you’re already overwhelmed. Start by identifying the skills that have helped you cope with difficult emotions in the past. You might include DBT distress tolerance skills, grounding techniques, relaxation strategies, and supportive people you can contact. Keep this list in an easily accessible place, such as in your wallet or saved as a note in your phone.

What to do when a skill doesn’t work

If a DBT skill isn’t feeling supportive, it may be because the distress level is too high or you haven’t practiced it long enough. If you're comfortable, practice for another 10 minutes. If not, note that you should practice the skill when you feel less distressed. In the moment, you can switch to a different skill category. For example, if reality acceptance skills aren’t working, try practicing one of the crisis survival skills.

If distress is continuing to feel overwhelming or you are turning to potentially harmful coping behaviors, seek help. A trusted friend or family member can provide support. You can also reach trained crisis counselors anytime by calling or texting the Suicide & Crisis Lifeline at 988. If you're in immediate danger, please call 911 or go to the nearest emergency room.

Distress tolerance skills vs. avoidance

Distress tolerance focuses on staying present and learning to tolerate intense emotions, while avoidance means suppressing or avoiding difficult emotions. Avoidance may bring short-term relief, but emotions build up over time. This can lead to more anxiety and unresolved issues. Practicing DBT distress tolerance skills and avoidance can look similar. However, a major difference is that avoidance means indefinitely avoiding one’s emotions, thoughts, memories, or a situation, whereas distress tolerance helps people ride the waves of intense emotions until they subside.

How Willow Health can support your mental health journey

If your coping skills aren’t helping to get you through a difficult moment, you’re not alone. You can get more help through Willow Health’s Crisis Program or virtual intensive outpatient program (IOP) in New York State. Urgent intake appointments are available within 24 to 48 hours. 

In the crisis program, a clinician will work with you to create a personalized plan, which may include a combination of 24/7 crisis support, therapy, medication, and coaching. A crisis program is best for people whose symptoms are so overwhelming that it is difficult to care for themselves and keep themselves safe.

A virtual IOP offers a combination of group and individual therapy that you can access from your own home. It’s best for people who need more intensive support and structure than weekly therapy offers, but who are able to continue their daily responsibilities, such as attending work or school. Read more about what to expect in a virtual IOP. 

Sources

Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press. 

The Linehan Institute. (n.d.). What is DBT skills training? Retrieved September 18, 2026, from https://www.linehaninstitute.org/what-is-dbt-skills