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DBT Distress Tolerance Skills for Crisis Survival

Distress tolerance skills are designed to help a person survive a crisis without acting on urges that could make the situation more dangerous or harder to repair.

Distress tolerance is one of the four DBT skills modules. It includes short-term crisis-survival strategies and reality-acceptance skills. These skills do not solve every problem, remove valid emotions or require someone to remain in danger. When a situation can be changed safely, problem-solving, communication or protective action may be more appropriate.

When to use distress tolerance

  • Emotional arousal is high enough that immediate action may be impulsive or unsafe.
  • The problem cannot be solved in the next few minutes.
  • A person needs time to regain enough control to choose an effective response.
  • Reality cannot be changed at present and continued mental resistance is adding suffering.

Do not use distress tolerance to delay emergency care, tolerate abuse, ignore safeguarding duties or avoid a solvable problem indefinitely.

Crisis-survival skills

  • STOP: pause before acting and observe the situation.
  • TIPP: use carefully selected body-based strategies to reduce acute physiological arousal.
  • ACCEPTS: use temporary, safe distraction to create time.
  • IMPROVE the Moment: make a painful moment more tolerable using meaning, relaxation, attention and encouragement.
  • Self-Soothe: use safe sensory experiences to support regulation.
  • Pros and Cons: compare the short- and long-term effects of acting on a crisis urge versus resisting it.

Reality-acceptance skills

Radical Acceptance means recognising facts that have already occurred or are currently true. It is not approval, forgiveness, resignation or a reason to stop seeking change, justice or protection.

A simple sequence

  1. Check immediate safety and medical needs.
  2. Name the crisis urge and likely consequences.
  3. Select one skill that matches the current level of arousal and context.
  4. Use the skill for a limited period.
  5. Reassess safety, facts and next action.
  6. Move to problem-solving, communication or professional support when possible.

Worksheets

References

Evidence and editorial note

Resource type: Educational overview of a DBT skill or skills module. It supports learning and practice but is not comprehensive Dialectical Behavior Therapy.

Evidence basis: Marsha M. Linehan’s DBT Skills Training Manual, Revised Edition (2025), official Behavioral Tech training information, current NICE guidance and peer-reviewed evidence reviews where treatment claims are discussed.

Review status: Written and evidence-checked by the CounselorAid editorial team. Last evidence review: 3 August 2026. No named independent clinical reviewer is being claimed. Please report factual or safety concerns through the contact page.

Important: This information cannot diagnose a condition, assess personal risk or replace care from an appropriately qualified professional. In an immediate crisis or medical emergency, use local emergency or crisis services.