Distress Tolerance skills are a set of Dialectical Behavioral Therapy skills that are strategies to help you get though difficult feelings and situations, and tolerate (deal with, sit with, accept) the things that you can’t immediately change. Emotions can be extreme and lead to behaviors that are ineffective. You may not be able to change the stressful situation you’re in, but you can change the way you feel. Distress Tolerance skills are aimed to make your response to distress more effective.
A key distracting skill is Wise Mind ACCEPTS. This acronym stands for:
- Pushing Away
It’s important to call on your Wise Mind while using ACCEPTS. Distraction can all too easily turn to avoidance. One TV episode meant to take your mind off things can easily turn into a whole season and a day gone. ACCEPTS is meant to escape your present distressing situation for a moment so that you can return to it with a better mindset, meaning in Wise Mind. Taking a moment can kick you out of Emotional Mind or even Rational Mind and help you find that Middle Path.
Throw yourself into an activity to take your mind off your situation. Whatever you choose, do it Mindfully. Lose yourself in it and try not to let your mind return to your distress until you’re finished.
Practice a hobby, watch a video, go for a walk, play a sport, cook, garden, go fishing, go shopping. The list is endless. The more active your activity, the easier it will be to forget your distress in the moment.
Make a list of your activities and put it up on your refrigerator, so you can find it in a hurry. Put some old faithful activities that always work on the list along with some new ones to try. If you’re having trouble coming up with options, check this list of activities and choose what sounds good.
Contributing helps you distract from your own pain by focusing your mind on someone else. Do volunteer work, babysit so a friend can go out, do something nice or surprising for someone, or simply reach out to a friend to check in or let them vent to you.
Not only will contributing take your mind off your distress, it will actually help you feel better about yourself as a whole. You don’t have to solve world hunger or do something huge. Just being polite to your checkout person is contributing and can improve both your moods.
Compare yourself to where you were a year or two or five years ago, a time when you weren’t coping as well as you are now. This isn’t about invalidating the pain of your situation but about reminding yourself that it has been worse in the past. Some people find this helpful, others do not. Just do what works for you.
Distract from one emotion by cultivating another. Read an emotional book, watch an emotional movie, listen to emotional music.
For this to work, you need to read or watch or listen to things that have an emotion opposite to one you are feeling. If you are sad, watch a comedy. Watch a scary movie. Listen to silly music. If you are sad or angry, watch a silly or funny movie, and bust up laughing. By doing so you have changed your emotion and put yourself in a different place.
Keep a playlist of songs that hype you up or a list of favorite TV episodes to watch when you’re down. Having these things on record will save you a step when you’re in distress and make it easier to actually practice the skill.
Push away a distressing situation by leaving it mentally for a while. This skill works well on situations you can’t solve right now but are causing you grief. It’s not to be used as avoidance of something that is solvable.
Block the situation in your mind. Each time it comes up, tell it to go away, or put some other thoughts in its place, perhaps some more pleasant thoughts. Refuse to think about it. Try putting the pain on a shelf or in a box to contain it and get it out of the way. Maybe put it in a locked box on a shelf in a closet. You can come back to it later but for now its inaccessible.
All of these are techniques to give you a break from dealing with the pain. They haven’t resolved the painful situation, but they have put it away for awhile so that you get a break and a chance to live some part of your life without it.
The idea behind Thoughts is that you can only truly focus on one thing at once. You can’t be thinking about that thing that’s bothering you if you’re engrossed in thinking about something else.
Some examples are counting to 10 or counting the tiles in a floor or the panes in a window or the stars in the sky, anything to keep your focus on the counting. Similarly you can name items around you. These are a good ones to use in a sudden emergency when you need to pull something out of your bag of tricks really quickly. They don’t require anything other than what’s around you.
Be sure to focus 100% on counting or naming so as to not let the distressing thoughts slip back in. That’s hard to do, however, so don’t get discouraged if your mind wanders. Just kindly nudge it back on track as soon as you notice the change.
The last skill in ACCEPTS is Sensations. A strong physical stimulus can jog loose your connection to your pain and distract you from it. This is a particularly great skill to use if your distress triggers self-injurious behaviors.
You might hold ice in your hand or apply it to the back of your neck, listen to loud music, take a hot, hard shower, a cold, hard shower, or swim in very cold water. After you try one of these activities, you may want to go on to another letter of ACCEPTS that works a different way.
Explore More DBT Skills
Mental Health Resources
Making DBT skills second nature takes practice. Use these flashcards on their page, download your own to print out, or purchase our pre-made set from our shop. Read More
DBT has its own lingo which can be hard to understand for beginners. Visit our homemade DBT Encyclopedia to figure out what a term means. Read More
Mindfulness practice is key to DBT. You don't have to meditate in silence everyday, though. Try these Mindfulness exercises to guide you. Read More
Diary cards help track your emotions, urges, behaviors, and skill use. They help you see patterns. Learn how to use them and get samples. Read More