Distress Tolerance
After months of applying for jobs, Alex finally receives an interview invitation for a position they really want. The day before the interview, Alex receives an email stating that the company has decided to move forward with another candidate.
Alex immediately notices thoughts such as, “Nothing ever works out for me,” and feels a strong urge to send an angry email explaining why the company made the wrong decision. Instead, Alex closes the email, takes several slow breaths, and tells themselves, “I am disappointed, but sending an angry response will not help me get what I want.”
Alex decides to take some time before responding and chooses to go for a walk to clear their mind.
What distress tolerance skill is Alex using?
STOP
Define the 5, 4, 3, 2, 1 grounding technique in the correct order.
5 things I can see, 4 things I can feel, 3 things I can hear, 2 things I can smell, 1 thing I can taste
Brandon receives constructive criticism from his manager regarding a project. His immediate urge is to avoid the manager and stop contributing during meetings because he feels embarrassed.
After reflecting, Brandon realizes the criticism was appropriate and decides to engage more actively in future meetings rather than withdrawing.
What emotion regulation skill is Brandon using?
Opposite Action
Nathan is having a difficult conversation with a close friend about a disagreement. Although he strongly disagrees with his friend's perspective, he maintains eye contact, listens attentively, validates the friend's feelings, and avoids becoming defensive.
What interpersonal effectiveness skill is this?
GIVE
What color are the chairs in Erica's office?
Teal
Maria has been working hard on her recovery and recently learned that her driver's license suspension will continue longer than she expected. She feels angry and thinks, “This isn't fair. I shouldn't have to deal with this anymore.”
Maria spends several hours mentally arguing with the situation, replaying how unfair it feels. Eventually, she notices that her suffering is increasing while the situation remains unchanged.
She tells herself, “I don't have to like this. I don't approve of it. But this is reality right now.” She begins making a transportation plan for the next few months.
What skill is Maria using?
Radical Acceptance
Chris is preparing dinner after a stressful day. He notices he is simultaneously checking email, replaying an argument from work, worrying about tomorrow's schedule, and scrolling through social media.
When he realizes he is functioning on autopilot, he intentionally puts his phone away and focuses entirely on chopping vegetables, noticing colors, smells, sounds, and physical sensations.
Which DBT mindfulness skill is Chris practicing by focusing on only one activity at a time?
One-mindfully
Over the past several months, Marcus has struggled with depression and low self-confidence. Whenever he makes a mistake, he tells himself, "I can't do anything right." Because of these beliefs, he has stopped trying new things and avoids tasks that feel challenging.
His therapist encourages him to choose one small, realistic goal each day. Marcus starts by organizing one drawer, then progresses to cooking a meal, completing a workout, and eventually enrolling in a certification course he had been putting off for years.
Although none of these accomplishments completely eliminate his depression, Marcus notices that he feels more capable and confident over time. He begins thinking, "Maybe I can handle difficult things after all."
Which DBT Emotion Regulation skill is Marcus using?
Building a mastery
Taylor's friend says, "I've been so overwhelmed at work lately. I don't think I'm doing a good job." Taylor immediately wants to solve the problem but instead responds, "That sounds really stressful. It makes sense that you're feeling overwhelmed with everything you've been juggling." Only after acknowledging their friend's feelings does Taylor ask if they would like help brainstorming solutions.
What interpersonal effectiveness skill is Taylor using before offering advice?
Validation
What is Casey's favorite off work activity?
Golf
James receives a phone call from his doctor informing him that additional testing is needed for a medical concern. His heart begins racing. He feels dizzy, starts imagining worst-case scenarios, and wants to spend hours searching symptoms online.
Recognizing that his emotional intensity is escalating rapidly, James places a cold compress on his face, completes several minutes of jumping jacks, slows his breathing, and practices progressive muscle relaxation. Twenty minutes later, he feels significantly calmer and more capable of thinking clearly.
What distress tolerance skill is James using?
TIPP
Alex notices their mind is racing with worries, self-criticism, and random thoughts after a difficult conversation. Instead of trying to organize their thoughts or write a polished journal entry, they set a timer for 10 minutes and write continuously, putting every thought on paper exactly as it comes to mind. They don't stop to edit, judge, or make sense of what they're writing. When the timer goes off, Alex notices they feel more aware of their emotions and less overwhelmed by them.
What mindfulness technique is Alex using?
Stream of consciousness journaling
Over several weeks, Michael notices increased irritability, emotional sensitivity, and difficulty concentrating. Upon reflection, he realizes he has been sleeping poorly, skipping meals, consuming excessive caffeine, and exercising very little.
Michael takes the step to begin addressing these physical vulnerabilities. What DBT skill is Michael using?
PLEASE
Rebecca has been covering extra responsibilities at work for nearly three months after a coworker left the company. She is consistently staying late, skipping lunch breaks, and completing tasks that are outside of her normal job description. Although she feels overwhelmed and resentful, she has not spoken with her supervisor because she worries about being seen as difficult.
After discussing the situation in therapy, Rebecca schedules a meeting with her supervisor. During the meeting she calmly explains the additional responsibilities she has been handling, describes how the workload has affected her ability to complete her primary duties, and requests either additional support or a redistribution of responsibilities. When her supervisor initially responds by saying, "Everyone is busy right now," Rebecca stays focused on her request, restates her concerns, and continues advocating for herself without becoming defensive or apologizing for bringing up the issue.
What interpersonal effectiveness skill is this?
DEAR MAN
What caffeinated beverage does Hannah drink every morning?
Aroma Joe's blueberry rush
Emily learns that her divorce proceedings have been delayed for another three months. She feels devastated and notices urges to isolate, drink alcohol, and spend the night replaying every mistake she has ever made.
Recognizing that she cannot solve the problem tonight, she focuses on getting through the next few hours safely. She calls a supportive friend, watches a favorite comedy, organizes a closet she has been avoiding, and listens to music while coloring.
The next morning, she reports feeling emotionally exhausted but proud that she did not make the situation worse.
What distress tolerance skill is Emily using?
ACCEPTS
After receiving unexpected criticism from their supervisor, Jordan immediately wants to quit their job and send an angry email. At the same time, another part of them wants to ignore their feelings completely and pretend the feedback didn't bother them. Instead, Jordan pauses, takes several slow breaths, acknowledges feeling hurt, considers the facts of the situation, and decides to schedule a meeting with their supervisor to better understand the feedback before taking any action.
What DBT concept is Jordan using to balance emotions with logic and choose the most effective response?
Wise Mind
Rachel has struggled with depression for several months and notices she has gradually stopped engaging in activities she once enjoyed. She rarely leaves home, avoids hobbies, and spends most evenings in bed.
Although she does not feel motivated, she schedules enjoyable and meaningful activities into her week, including hiking, painting, and spending time with supportive friends.
What DBT skill is Rachel doing?
Accumulating Positive Emotions
Sophia's family wants her to attend a holiday gathering where several relatives have historically made hurtful comments about her recovery. Sophia carefully considers her options and decides not to attend.
When family members pressure her, she respectfully communicates her decision without attacking them, apologizing excessively, or abandoning her values simply to avoid conflict.
FAST
What is the name of my dog?
Hank
Casey has been sitting in the emergency room for several hours waiting to hear about a loved one. There is nothing more they can do to change the situation, and they notice their anxiety continuing to build. Instead of pacing or catastrophizing, Casey imagines a peaceful beach, silently repeats an encouraging phrase, focuses only on getting through the next five minutes, practices relaxation breathing, reminds themselves that they can tolerate this moment, and briefly distracts themselves with a crossword puzzle.
What DBT skill is Casey using?
IMPROVE
Taylor is sitting in a meeting when a coworker says, "We may need to revisit some of the work from last week." Immediately, Taylor thinks, "They're talking about me. I messed everything up. Everyone probably thinks I'm incompetent." Taylor notices these thoughts, silently labels them as "worrying" and "mind-reading," and returns attention to what is actually being said in the meeting.
What mindfulness skill is Taylor using?
Observe and Describe
Morgan sends a text message to a friend asking if they want to make plans over the weekend. Several hours pass without a response. Morgan immediately thinks, "They are ignoring me. They must be upset with me. I probably did something wrong." Before reacting or sending an angry message, Morgan pauses and asks: "What evidence do I actually have? Are there other possible explanations? Is my emotional reaction matching the facts of the situation?" Morgan remembers that their friend has been busy with work and may simply not have seen the message yet.
What DBT emotion regulation skill is Morgan using to determine whether their emotions fit the reality of the situation?
Check the Facts
Dan and their partner have very different opinions about how to spend their vacation. Dan wants to visit a busy city, while their partner wants a quiet cabin in the mountains. At first, Dan thinks, "Either we do exactly what I want, or this trip will be miserable." After pausing, Dan recognizes that both preferences are valid. They suggest splitting the vacation between two destinations, acknowledging that they can enjoy parts of both experiences without either person "winning."
Which DBT concept is Dan using to move away from all-or-nothing thinking and strengthen the relationship?
Walking the Middle Path
Who created DBT?
Marsha Linehan