Distress tolerance

Distress Tolerance skills were first popularized by Marsha Linehan as part of a treatment for Borderline Personality Disorder (Linehan, 2014). However, they are a useful tool for anyone to use to tolerate strong and overwhelming emotions, or to help cope with situations that can’t be easily changed or controlled.

Why do we need negative emotions?

Negative emotions are important signals that we need in order to function adaptively. They help us to understand our experiences.

Fear signals to us that something is unsafe so that we can avoid threats to ourselves. When we were evolving, fear helped to keep us alive. Our flight-or-fight response lets us spring into action to keep ourselves safe.
Sadness helps to signal what is important to us or that there are problems that need to be fixed.
Anger is also an adaptive emotion - it can help us to fight back when we need to or help us to fight for something that is important. Anger gives us the burst of motivation and energy we need in these situations.
Guilt is also useful because it signals to us that we have done something wrong so that we can learn from it and do better next time.

In fact, negative emotions are not only useful, they’re necessary for our mental health. Without these emotions, we would be unaware of problems that could harm us or prevent us from leading the life we want to live.

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How to use this resource

Read through the skills below so that you understand them. Then, try thinking about specific ways that you would implement them that would work for you. You can download a resource sheet that summarizes these skills for quick reference later. Try practicing some of the skills before you need them if they’re new to you (good ones to practice are paced breathing and paired muscle relaxation from TIPP, mindfulness exercises, awareness).

Specific Skills

Here is a quick guide of when you can use these skills and how not to use these skills. Read below to find out more about each one.

Acceptance, Willingness and Willfulness

You can use these principles all the time and they may help you to better tolerate a situation by accepting it and doing what is necessary in the moment.

Acceptance means that you stop fighting against reality and accept what is currently true. This does not mean give up or mean that you stop problem solving or improving where you can; it also doesn’t mean that you judge something as good or right. It means that you accept the pain that comes with life and you acknowledge the reality of your situation. Often, acceptance can be the first step to problem solving and distress tolerance.

Willingness means that you approach your situation by being willing to do what you need to. It doesn’t mean that you need to want to do it, but that you will do just what you need to in order to be effective. The opposite of willingness is willfulness - this is giving up, refusing to act, trying to fix every situation, refusing to tolerate a situation, and not doing what is effective in the moment.

Half-smile and open posture

These strategies help you trick your body into feeling a certain way by your posture even though it may conflict with what you’re currently feeling. If you’re feeling defensive or angry, try opening your hands and uncrossing your arms and maintaining an open posture. If you’re feeling stressed or overwhelmed try making your face into a soft half-smile. By putting your body in positions that are usually calm and inviting, you can help to bring yourself towards feeling those things too. For instance, you can practice half-smiling throughout the day by putting a reminder somewhere you’ll see it when you wake up, or by half-smiling while listening to music or resting.

Pros and Cons List

This skill is used to prevent giving in to our urges during a ‘hot’ moment. Writing a pros and cons list can help you weigh the cost and benefit of doing something that may harm yourself or others. The list can be used to “tip the scale” and keep you from taking steps forward when it’s best not to. Think of the positive consequences of tolerating the distress you feel and the negative consequences of coping in a harmful way to yourself.

Mindfulness

Mindfulness practices are useful for distress tolerance and can be woven into many of these skills. See our mindfulness page for more.

STOP

STOP is a skill that focuses on managing immediate reactive emotions and behaviors. When you are feeling “hot” and aren’t sure what to do next, you may want to try STOP. STOP will encourage you to take a moment to reflect before making next steps. Click here to learn more about each part of STOP.

TIPP

TIPP is a skill you can use to calm down your limbic system when you’re in a state of high arousal, or when you’re feeling overwhelmed (e.g. panic, anger, intense emotional pain). It involves a few different strategies you can use to “reset” your body by shocking it out of the state it is in or by calming it down with breathing or relaxation. Click here to learn more about each part of TIPP.

ACCEPTS

The ACCEPTS skill provides practices to use as a distraction in place of feeling negative. This skill can be used when you are experiencing stress or feeling overwhelmed. ACCEPTS includes long-term skills that can be used regularly until intense negative emotions subside. Click here to learn more about each part of ACCEPTS.

IMPROVE

This skill can be a good option when you are feeling stressed or overwhelmed in a more chronic manner or as a step after initially calming down from a crisis episode. These are strategies to help give you a break in the moment by seeking positive experiences. Click here to learn more about each part of IMPROVE.

Download a handout of all these skills here!