Distress tolerance skills are a core set of tools of Dialectical Behaviour Therapy (DBT), used to treat a wide range of emotional dysregulation disorders, from Borderline Personality Disorder (BPD) to difficulties in controlling moods and strong emotions.

More specifically, distress tolerance skills help you to bear intense feelings without resorting to destructive or self-destructive strategies. Their goal isn’t necessarily to reduce the distress you are feeling, but to teach you to tolerate the pain and not do something that you would regret later, or which would make you feel even worse.

When and how will applying distress tolerance skills help?

These skills are at their most useful when you are in a painful situation which cannot be changed by anything you might do or say. Faced with intense frustration and overwhelming emotional pain, this is the time when you are at your most vulnerable and feel that you can’t handle those unbearable feelings.

In such a state, your instinctive reaction would probably be to turn to your usual coping technique to feel better, be it drug abuse, drinking, engaging in reckless activities, etc…  However, after a short, temporary feeling of release, the distress returns, compounded by feeling ashamed that you gave in to your impulsive behaviour and having to face whichever unhappy consequences it had.

Distress tolerance skills will help you to bear the pain while you are going through a crisis, and help you build self-confidence in your ability to navigate through rough weather without resorting to destructive strategies.

Radical Acceptance

Distress tolerance skills are based on the principle of “radical acceptance”. When a situation doesn’t suit us, it is a natural defence mechanism for the mind to “rewrite” it, and select only the facts that contribute to how we want to see it, leading us away from reality. Radical acceptance means accepting a situation as it is, rather than how we wish it to be, or how we think it ought to be.

As simple as it sounds, it is, however, a challenge to people who struggle to control their emotions as they become engulfed in a whirlpool of pain. This is why mindfulness-based strategies are particularly effective at helping them. Mindfulness and DBT teach them to focus on the present moment and sensations, and ignore any other stimulus, for example, and when it comes to applying those skills to a specific situation, to actively disregard undesirable thoughts and behaviours.

It is easier said than done though, as your mind will repeatedly try to lead you astray and towards tried-and tested coping mechanisms, presenting you with more pleasant but untrue interpretations of the circumstances causing you distress. Through mindfulness training, you will learn to gently bring your attention back to the current moment and observe the situation as it is and let it flow away.

It is important to stress that radical acceptance is certainly not about pretending that a bad situation is good, or accepting to stay in a painful situation forever. It is about replacing unhealthy coping strategies with healthier, sustainable ways of dealing with pain.

Distress Tolerance Skills use acronyms as memory aids to the techniques you can use to help yourself cope during a crisis:


I        Imagery: think about a place that makes you feel safe and try to visualise it with as much detail as possible.

M     Meaning: Make sense of the situation.

      Prayer: not necessarily of the religious kind, but more as meditation.

R       Relax.

O      One thing at a time: concentrate on the present moment.

V       Vacation: Remove yourself from the situation emotionally and give your mind a vacation.

E       Encouragement: Celebrate your achievements and use positive self-talk.



A       Activities: Distracting yourself from the situation that causes you distress is a very valid and successful strategy. It can be any activity you like, as long as it keeps you engrossed.

C       Contributes: Helping others will help you to turn away from unhelpful inner thoughts.

C       Comparison: Compare yourself with the better self that you are becoming.

E       Emotions: Replace your distressing feelings with upbeat ones from movies, TV, music, etc…

P       Pushing away: Actively refuse to turn your attention back to the situation which is causing you pain.

T       Thoughts: Focus your mind on other thoughts, trying to count backwards from 1,000 or saying the alphabet skipping a certain number of letters for example.

S       Sensations: Concentrate on feelings conveyed by your senses: the texture of a peach, the smell of a fragrance, the noises around you, etc… to stay in the present moment.


If you, or someone you know, is affected by emotional dysregulation and you are looking for a DBT therapist in Auckland or counselling in Auckland, contact the Robert Street Clinic or call us on 09 973 5950 to discuss how our experienced clinicians can help you learn to live a more fulfilling life.