DBT Distress Tolerance Skills

What Are DBT Distress Tolerance Skills?

Distress tolerance is a key skill in Dialectical Behavior Therapy (DBT) that helps people cope with difficult emotions and high-stress situations—without being impulsive or reacting in ways that could make things worse.

Initially developed for individuals with borderline personality disorder (BPD), distress tolerance and other DBT skills are now used to treat a wide range of concerns, from mental health conditions to substance use disorders.

Instead of ignoring or suppressing emotions, distress tolerance skills provide healthy ways to endure emotional pain, reduce suffering, and maintain self-control. 

Learning distress tolerance can help you navigate moments of emotional crisis, strong urges to engage in harmful behaviors (including drug use), or situations that cannot be immediately changed.

Who Can Benefit from Distress Tolerance?

Distress tolerance can be beneficial for people who struggle with overwhelming emotions or stressful situations.

Examples of people who might benefit from distress tolerance include:

• People in addiction recovery, as these skills help manage cravings and avoid relapse.
• Individuals with anxiety, depression, or trauma, where emotional distress can feel overwhelming.
• Anyone facing life stressors, such as relationship conflicts, work challenges, or other major changes.

Developing distress tolerance can help you improve your emotional regulation and develop healthier ways of handling challenges.

Key Distress Tolerance Techniques

Distress tolerance techniques are specific strategies designed to help manage overwhelming emotions and crisis situations without resorting to impulsive behaviors.

Some techniques focus on immediate relief, while others help reframe difficult situations into something more manageable.

Practicing these crisis survival skills regularly can help them feel more natural, making it easier to stay in control and make better choices during intense moments of stress.

Crisis Coping Strategies

Crisis coping strategies are aptly named: they are the tools you might use to regulate your emotions during an emotional crisis, which can leave you feeling overwhelmed, panicked, or trapped in distressing thoughts.

Shifting focus or engaging in specific actions provides quick relief and creates space for clearer thinking.

Some of the most effective crisis-coping strategies include:

Stop Skill

The STOP skill is a simple but powerful way to prevent impulsive reactions and regain control before making a decision. This technique is especially helpful in addiction recovery, as it creates a pause between distress and action.

• S – Stop: Pause immediately. Don’t react on impulse.
• T – Take a step back: Physically or mentally remove yourself from the situation. Take a deep breath.
• O – Observe: Notice what’s happening—your thoughts, emotions, and surroundings—without judgment.
• P – Proceed mindfully: Choose a response that aligns with your goals and values rather than reacting impulsively.

Example: After a stressful day, someone in recovery craves to use. Instead of acting on impulse, they STOP—pausing, stepping outside for fresh air, acknowledging their emotions, and choosing to call a supportive friend instead of using substances.

Tipp Skill

TIPP skills use body-based techniques to quickly calm overwhelming emotions by engaging the nervous system and altering body chemistry. These methods help regulate stress hormones, heart rate, and overall physiological responses, especially effective in intense distress or crisis.

• T – Temperature: Changing body temperature can create an instant calming effect.
  • Example: Holding an ice pack, splashing cold water on the face, or taking a cold shower can reset the nervous system.
• I – Intense Exercise: Physical movement releases energy and reduces stress.
  • Example: Jumping jacks, running in place, or going for a brisk walk helps burn off emotional intensity.
• P – Paced Breathing: Slowing the breath signals the body to relax.
  • Example: Practicing deep, controlled breathing (such as inhaling for four seconds, holding for four seconds, and exhaling for four seconds) can lower stress levels.
• P – Progressive Muscle Relaxation: Tensing and relaxing muscles help relieve tension.
  • Example: Clenching fists for a few seconds, then releasing, or tightening and relaxing different muscle groups can help the body relax.

ACCEPTS Skills

The ACCEPTS skill helps shift focus away from emotional distress by using healthy distractions that allow time for emotions to settle. These techniques don’t ignore problems but provide temporary relief, making coping easier.

• A – Activities: Engaging in something enjoyable or productive.
  • Example: Reading, cleaning, drawing, or watching a favorite show to refocus attention.
• C – Contributing: Helping others to shift focus from personal distress.
  • Example: Checking in on a friend, volunteering, or offering a small act of kindness.
• C – Comparisons: Gaining perspective by thinking about different situations.
  • Example: Remembering past challenges overcome or comparing current struggles to those of others who have persevered.
• E – Emotions: Creating a shift by engaging with opposite emotions.
  • Example: Watching a funny video or listening to uplifting music to counteract sadness or anger.
• P – Pushing Away: Mentally setting aside distressing thoughts.
  • Example: Imagining placing worries in a locked box and choosing to revisit them later.
• T – Thoughts: Redirecting focus to something neutral or engaging.
  • Example: Counting backward from 100, doing a crossword puzzle, or recalling lyrics to a favorite song.
• S – Sensations: Using physical sensations to interrupt distress.
  • Example: Holding an ice cube, chewing mint gum, or using a scented lotion to create a grounding effect.

Grounding Techniques

Grounding techniques help bring focus to the present moment by using physical sensations or surroundings to create a sense of stability and control.

• Example: Using the “5-4-3-2-1” method—naming five things seen, four touched, three heard, two smelled, and one tasted—can bring attention back to the present moment.
• Example: Holding onto a textured object, like a smooth stone or a piece of fabric, can provide a physical anchor to reality when emotions feel overwhelming.

Breathing Exercises

Breathing techniques help regulate emotions by slowing the heart rate, calming the nervous system, and creating a sense of control during moments of distress.

• Example: Practicing deep breathing, such as inhaling for four seconds, holding for four seconds, and exhaling for four seconds (box breathing), can help calm the nervous system, lower your heart rate, and reduce feelings of panic.

Self-Soothing Skills

Self-soothing techniques are all about using the five senses—sight, sound, touch, taste, and smell—to create a sense of comfort and calm.

By practicing self-soothing techniques, it becomes easier to ground yourself in the present and avoid turning to unhealthy coping mechanisms (e.g., self-harm or drug use). These strategies are especially useful when feeling anxious, overwhelmed, or emotionally drained.

Unlike crisis coping strategies, which focus on distraction or quick relief, self-soothing is about gently lowering emotional intensity and providing the body and mind with a sense of safety.

Some simple ways to self-soothe include:

• Sight: Focusing on calming or enjoyable visuals
  • Example: Watching a nature video, looking at pictures of loved ones, or sitting outside to watch the sunset.
• Sound: Using audio to create a calming atmosphere
  • Example: Listening to a favorite song, nature sounds, or a guided meditation.
• Touch: Engaging in comforting physical sensations
  • Example: Wrapping up in a warm blanket, taking a hot shower, or holding a soft object like a stuffed animal or smooth stone.
• Taste: Choosing flavors that bring comfort
  • Example: Slowly sipping a warm drink like tea or cocoa, savoring a piece of chocolate, or chewing mint gum for a refreshing sensation.
• Smell: Using scents to trigger relaxation
  • Example: Lighting a scented candle, using essential oils, or inhaling the scent of freshly brewed coffee or a favorite lotion.

Improving the Moment

Improving the moment techniques help make a difficult situation more manageable by shifting perspective or adding small comfort elements.

Instead of focusing on distress, improving the moment encourages creating a sense of peace, hope, or meaning—even during a challenging situation.

These techniques don’t change the situation, but they can help reduce distress and make it easier to respond more healthily. By practicing these skills, it becomes easier to cope with difficult emotions while maintaining a sense of control.

Some ways to improve the moment include:

• Imagery: Visualizing something peaceful or inspiring
  • Example: Imagining a relaxing place, such as a beach or forest, and focusing on the details—how the air smells, the sounds of nature, the warmth of the sun.
• Meaning: Finding purpose in distressing situations
  • Example: Reminding yourself that struggles can lead to growth or reflecting on how overcoming challenges has made you stronger in the past.
• Prayer or Reflection: Connecting to inner strength or spiritual beliefs
  • Example: Engaging in prayer, repeating a mantra, or meditating on words that bring comfort and guidance.
• Relaxation: Intentionally calming the body and mind
  • Example: Practicing progressive muscle relaxation, stretching, or taking slow, deep breaths.
• One Thing in the Moment: Staying fully present
  • Example: Focusing on a single activity, like washing dishes or folding laundry, and noticing every detail—the texture, movement, and sensations.
• Vacation: Taking a short mental or physical break
  • Example: Stepping outside for fresh air, reading a few pages of a book, or watching something lighthearted to reset your mindset.
• Encouragement: Using positive self-talk
  • Example: Repeating phrases like “I can get through this,” or reminding yourself that emotions are temporary and will pass.

Radical Acceptance Skills

Radical acceptance is the practice of fully accepting reality as it is—even when it’s painful or difficult.

Radical acceptance doesn’t eliminate pain, but it prevents unnecessary suffering. Letting go of the struggle against reality makes it easier to focus on what can be done next and move forward with greater emotional balance.

Holding onto anger, frustration, or denial often makes distress worse, while reality acceptance can create space for healing and problem-solving.

Some ways to practice radical acceptance include:

• Reminding yourself: “It is what it is.”
  • Example: If a past mistake or painful experience cannot be undone, acknowledging it rather than dwelling on “what ifs” can reduce unnecessary suffering.
• Noticing resistance to reality
  • Example: If thoughts like “This isn’t fair” or “This shouldn’t be happening” are causing distress, shifting to “This is hard, but I can handle it” can help bring more peace.
• Practicing mindfulness to stay present
  • Example: Focusing on breathing, grounding techniques, or gentle movements (like stretching) can help shift focus from frustration to acceptance.
• Looking at the bigger picture
  • Example: Recognizing that while this moment is difficult, it is only temporary and won’t last forever.
• Committing to acceptance, even when emotions resist
  • Example: Repeating acceptance-based statements, like “I don’t have to like this, but I can work through it,” can help reinforce the mindset over time.

Distress Tolerance and Addiction Recovery

Addiction recovery comes with many challenges, including cravings, withdrawal symptoms, and overwhelming emotions. In these difficult moments, it’s natural to want to find relief, but turning back to prior substance abuse continues the cycle of self-destruction.

Distress tolerance skills provide an alternative—helping people cope with discomfort healthier and more sustainably.

These techniques don’t make cravings or negative emotions disappear, but they make it possible to sit with discomfort, knowing it will pass, and choose a healthier path forward.

Managing Cravings and Withdrawal Symptoms

Cravings and withdrawal symptoms can feel unbearable, especially in early recovery. The urge to use substances may come on suddenly, often triggered by stress, negative emotions, or even boredom.

Distress tolerance skills help manage these moments by providing a structured way to ride out cravings without giving in.

• Using Crisis Coping Strategies – A person experiencing intense cravings might use TIP skills, such as splashing cold water on their face or going for a brisk walk, to interrupt the cycle of distress and regain control.
• Self-Soothing as an Alternative to Substances – Many people use drugs or alcohol to numb emotional pain. Instead, engaging the senses—like listening to calming music, drinking herbal tea, or wrapping up in a soft blanket—can provide relief without harmful consequences.

Replacing Substances with Distress Tolerance Skills

For many in recovery, substances were the go-to way to handle stress, sadness, anger, or frustration. Learning distress tolerance means finding new ways to respond to discomfort without self-destruction.

• Radical Acceptance in Recovery – Recovery is a long process with ups and downs. Accepting that cravings, withdrawal, and emotional struggles are part of healing—rather than fighting or resenting them—can help reduce frustration and prevent relapse.
• Improving the Moment Instead of Using – If the urge to use feels overwhelming, small actions like stepping outside for fresh air, repeating positive affirmations, or visualizing a peaceful place can shift focus and provide relief.

Take Control of Your Recovery

Distress tolerance skills can make a powerful difference in addiction recovery, helping you manage cravings, navigate withdrawal, and handle emotional challenges without turning to substances. Building these skills takes time and practice, but you don’t have to do it alone.

• Seek professional support: A therapist or addiction counselor trained in DBT can help you develop and strengthen distress tolerance strategies tailored to your needs.
• Join a recovery community: Connecting with support groups like SMART Recovery, Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or online recovery forums can provide encouragement and shared strategies for handling cravings and emotional distress.
• Start practicing today: Small steps, like grounding techniques, self-soothing strategies, or radical acceptance of daily challenges, can help make these skills second nature when needed.

If you’re struggling to cope with addiction or overwhelming emotions, help is available. Call the SAMHSA National Helpline or visit SAMHSA’s online treatment locator to find support near you.

Written by

Jessica Miller

Editorial Director

Jessica Miller is the Editorial Director of Addiction Help. Jessica graduated from the University of South Florida (USF) with an English degree and combines her writing expertise and passion for helping others to deliver reliable information to those impacted by addiction. Informed by her personal journey to recovery and support of loved ones in sobriety, Jessica's empathetic and authentic approach resonates deeply with the Addiction Help community.

Reviewed by

• Fact-Checked
• Editor

Kent S. Hoffman, D.O.

Founder & Chief Medical Officer

Kent S. Hoffman, D.O. has been an expert in addiction medicine for more than 15 years. In addition to managing a successful family medical practice, Dr. Hoffman is board certified in addiction medicine by the American Osteopathic Academy of Addiction Medicine (AOAAM). Dr. Hoffman has successfully treated hundreds of patients battling addiction. Dr. Hoffman is the Co-Founder and Chief Medical Officer of AddictionHelp.com and ensures the website’s medical content and messaging quality.