Distress Tolerance Basics
Distress tolerance is NOT about getting rid of all feelings. What is it about?
Getting through intense emotions/urges without making things worse
In ACCEPTS, the “A” stands for Activities. Give one example of a healthy activity you can do to distract.
Any reasonable activity: walk, draw, clean, puzzle, game, music, group, journaling, etc.
Name one way to self-soothe using Sound.
Any: music, nature sounds, fan noise, calming playlist, humming, etc.
In TIP/TIPP skills, what does the T (Temperature) skill usually involve?
Using cold (cold water, ice pack, cold splash) to quickly lower body temp.
When you do a pros and cons for using vs. not using, when should you usually do it – in a calm moment, or mid-relapse?
Before you’re fully acting on it – ideally in a calm or early urge moment.
In DBT, distress tolerance skills are especially for which kind of moments: low stress, medium stress, or crisis/high stress?
Crisis/high stress moments.
In ACCEPTS, what does the “C” for Contributing mean?
Doing something for someone else (helping, giving, supporting) to get out of your own head
Name one way to self-soothe using Smell.
Any: lotion, shampoo, coffee, candles, essential oils, fresh air, soap, etc.
Intense exercise is used to burn off what in your body?
Excess energy/adrenaline from strong emotions.
Name one short-term “pro” of using that people sometimes write down (even if it’s unhealthy).
Any: numb out, feel good for a moment, escape, not feel pain, etc.
Finish the sentence: “I can’t always control how I feel, but I can control what I ______.”
(my actions/behavior).
In ACCEPTS, “T” stands for Thoughts. What does this skill ask you to do with your thoughts?
Change your focus by doing something that takes up your thinking (counting, alphabet games, reciting song lyrics, etc.).
Self-soothe with Touch – give one example.
Any: holding a blanket, warm shower, petting an animal, lotion, holding ice, squeezing stress ball, etc.
Paced breathing usually means what kind of breathing – fast/shallow or slow/deep?
Slow, deep, controlled breathing (like breathing out longer than you breathe in).
Name one long-term “con” of using that people often forget in the moment.
Any: legal problems, losing kids, health issues, shame, relationships breaking, financial issues, etc.
Name two things that usually get worse if we don’t use distress tolerance and act impulsively.
Any two: relationships, legal problems, health, cravings/relapse, shame, guilt, conflict.
In ACCEPTS, “S” stands for Sensations. Give one example of a strong sensation you could use to distract.
Any safe intense sensation: holding ice, cold shower, spicy candy, squeezing a stress ball, strong smell, etc.
Self-soothe with Sight – what could you look at that might calm or comfort you?
Any: pictures of kids/family, nature, art, sky, calming show, something organized/pretty, etc.
Paired muscle relaxation means tensing and then relaxing what?
Muscles in your body (e.g., clenching fists, then slowly releasing).
In urge surfing, what do we imagine the urge as? (A solid rock or an ocean wave?)
As an ocean wave – it rises, peaks, and falls if you ride it out.
What’s the difference between emotion regulation and distress tolerance?
Emotion regulation is about changing emotions over time; distress tolerance is about surviving the moment without making it worse, even if the feeling doesn’t go away right away.
The “P” in ACCEPTS is “Pushing away.” What are you pushing away, and for how long?
You temporarily put the problem on a shelf in your mind/imagery, pushing it away for a short time to get through the moment (not forever).
Self-soothe with Taste – what’s one way to do this without using substances?
Any: hot tea, cold water, mint, favorite snack, gum, chocolate, etc.
Why do TIP/TIPP skills focus so much on the body instead of just thoughts?
Because strong emotions are partly physical (heart rate, breathing, adrenaline), and changing the body helps calm the emotion system faster so you can think more clearly.
In urge surfing, instead of fighting the urge or obeying it, what two things are you trying to do?
Notice and ride out the urge with curiosity and breathing until it passes.