Distress Tolerance
This page provides a detailed look at all the distress tolerance skills that are overviewed here .
Download a handout of all these skills here.
Pro and Con List
This skill is used to prevent giving in to our urges during a ‘hot’ moment. Writing a pro and con 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.
Half-smile and open posture
These are strategies to 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. You can also practice half-smile throughout the day, for instance by putting a reminder somewhere you’ll see it when you wake up, by half-smiling while listening to music or resting, etc.
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, just 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.
Mindfulness
Mindfulness practices are useful for distress tolerance and can be woven into many of these skills. For instance, try using mindfulness in the Prayer part of IMPROVE if you’re not religious, or to help you observe the moment in STOP. 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.
Stop: When you are feeling so upset that you cannot focus on anything else: stop. If you are feeling like lashing out or reacting physically, stop in place. Try not to react to things in your immediate path and focus on staying in control.
Take: After you have stopped, it will be good to take a moment to reflect on your current situation. You can practice by taking a deep breath, counting backwards from ten, or taking a walk.
Observe: Observing your thoughts, emotions, and behaviors can also be helpful. Try observing yourself from the perspective of someone else. What are you seeing that you couldn’t see before? Are there things you could do differently to get a different outcome?
Proceed: After you’ve taken time to think mindfully, you can begin to plan your next steps. Thinking about our actions prior to acting can help us make good decisions that align with our long-term goals and values.
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's in or by calming it down with breathing or relaxation.
Temperature: shock your system with cold water by splashing your face, taking a cold shower, or holding ice cubes in your hands
Intense exercise: flood your body with adrenaline and endorphins and get your heart rate up with intense exercise. Run around the block as fast as you can, do jumping jacks or any other vigorous cardio-related exercise (be sure not to hurt yourself by pushing yourself too far).
Paced breathing: If you’re feeling out of control try gaining some control back by pacing out your breathing. This is a good strategy when you’re feeling panicked, afraid or angry. Try breathing in slowly to the count of 2-4 seconds, and then breathing out slowly to the count of 4-6 seconds; choose the count that works for you.
Paired muscle relaxation: paired muscle relaxation pairs breathing and muscle tensing and relaxation. Choose different portions of your body to tense while breathing in and relax while breathing out. For instance, breath in slowly while clenching your hands tight, then breathe out slowly while slowly relaxing your hands completely. Next try your arms, and so on.
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.
Activities: Try out things that require you to focus and concentrate. Activities can help get your mind off of your current situation. You may decide to do a hobby or practice a skill; clean up around the house; go on a walk; or complete a project that you’ve pushed off for a while.
Contributing: Do something nice for someone else. Rather than focusing on your negative thoughts and feelings, you can switch gears by directing your attention to someone else who may need help. For instance, you could help a friend, family, or stranger; volunteer with a local organization; or make someone smile.
Comparisons: Compare your present situation to a worse situation you’ve experienced. If this is the worst situation or you’re having a difficult time coming up with one, you could try to think of someone else who has experienced worse. The goal here is not to downplay your current situation, but to express gratitude for what you do have.
Emotions: Try something that will create an opposite emotion of the one you feel. When we are feeling intensely, it feels very natural to stay in that space, but it is important to try and create an opposite emotion. The new emotion may help bring us from a “hot” space to a neutral one.
Pushing Away: Get rid of the negative thoughts until you are ready to tackle them. Feeling intense negative emotions can make us feel like we will explode. Sometimes, it is useful to set aside our thoughts until we can deal with them in a calmer way. If it is too difficult, you can write down your thoughts and feelings and try to focus on something else for now.
Thoughts: Focus on your thoughts when your emotions are overwhelming. While emotions are adaptive and useful, they can also act as a barrier to “cool” thoughts. Try to use a mantra, phrase, or prayer to help guide your thoughts.
Sensations: Use safe physical sensations to focus on instead of your emotions. We can use this skill wherever we are because it only requires ourselves. For instance, try splashing cold water on your face, use an essential oil diffuser, or put on some calming music.
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.
Imagery: this is basically going to your “happy place”. Try imagining a scene that would be better than the current situation. Rather than using this to think negatively about your current situation or ruminating on how it could be different, try to immerse yourself in your imagined scene by richly filling out each detail - what does it look, feel, smell like to be there?
Meaning: Think about what you value and try to connect with that. You can do this in any way you like. It could be choosing to do an activity you value that you haven’t been able to do or haven’t felt like doing in a while- such as a hobby, seeing or calling your friends or family, or doing something kind for somebody else. It could also be a life change such as seeking out a volunteer opportunity that is fulfilling or choosing to stop activities that don’t align with your values. Meaning can also come from identifying the parts of your current experience that are unpleasant but that are meaningful in other ways, or ways you’ve grown as a person because of it.
Prayer: This doesn’t have to be religious prayer. Rather the goal here is to take some time out to gather strength to get through your situation, or to spend time in a different type of head space. This could be praying to a higher power, it could be meditation, or connecting to your inner self.
Relaxation: choose to engage in an activity that is relaxing for you, even if you don’t feel like it at this moment. Some options are yoga, going for a walk, listening to calm music, taking a bath, etc., but you know you best so choose something that relaxes you.
One Thing in the Moment: Mindfully engage in what you’re doing. This means letting go of worries about the past or the future, negative thoughts, or anything that doesn’t directly involve what you’re currently doing. Try some tips from the page.
Vacation: vacation doesn’t necessarily mean a trip to the Bahamas. This could be doing something that you don’t usually get to do or going into “vacation mode” even if you stay in your own house. Take the afternoon off, the weekend, or just a few hours depending on how much time you can spare and have a mini-vacation by releasing yourself of any responsibilities for that time frame and doing something enjoyable. This could be going to a new part of your town you haven’t explored before, taking a weekend stay-cation, watching a new movie with popcorn and snacks, anything!
Encouragement: You can do this! Encourage yourself. Avoid being self-critical. You can write a reminder note to yourself that you’re trying your best or talk to yourself like you’re speaking to a friend that you’d encourage in the same situation.
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