Distress Tolerance

Distress in life is inevitable. There will be times in our lives during which we will face various types of anxiety and distress, be it in personal relationships or at work. Regardless of whether the stress is big or small, Distress Tolerance teaches us to navigate the hardships of life without being overwhelmed, resorting to impulsive reactions, or making spontaneous decisions that make the situation worse. Through the various subskills of DBT, Distress Tolerance, we learn to accept and manage stress, distract ourselves with positive activity, and improve a situation to build a mental foundation for a more balanced and fulfilling life.

Remember, Distress Tolerance skills help us cope with situations, but they need mastery through practice. These skills should only be applied when you cannot avoid a crisis and must face it. In such a case, Distress Tolerance also teaches you to accept reality and face it empowered with the tools of DT therapy.

The various subskills in Distress Tolerance are:

Common DBT Questions for Distress Tolerance Skills

  1. Can you describe a recent situation where you felt overwhelmed? What distress tolerance skills, if any, did you try to use?
  2. On a scale of 1-10, how would you rate your ability to tolerate distress without reacting impulsively? What factors contribute to this rating?
  3. Which TIPP skills (Temperature, Intense exercise, Paced breathing, Progressive muscle relaxation) have you found most helpful in managing acute distress? How often do you use them?
  4. Have you been able to implement any distraction techniques lately? What worked well, and what didn’t?
  5. How do you typically respond to a crisis situation? Are there any patterns you’ve noticed in your responses?
  6. Can you walk me through how you might apply the ACCEPTS skills (Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, Sensations) to a recent distressing situation?
  7. How have you been practicing radical acceptance in your daily life? What challenges have you faced with this concept?
  8. Can you give an example of a time when you successfully used self-soothing techniques? What senses did you engage?
  9. How do you typically weigh the pros and cons of tolerating distress versus giving in to urges? Can you provide a recent example?
  10. What role does mindfulness play in your distress tolerance practices? How do you incorporate it?
  11. Have you used any crisis survival strategies recently, such as the STOP skill? How effective were they?
  12. What aspect of distress tolerance do you find most challenging? What do you think you need to work on most?