DBT Skill #3: Distress Tolerance
The third foundational skill taught in Dialectical Behavior Therapy (DBT) is distress tolerance. Distress tolerance increases a patient’s tolerance of negative emotions. The goal is to be able to calmly recognize negative situations and their impact, rather than becoming overwhelmed or hiding from them. This allows patients to make wise decisions about how to take action, rather than falling into intense and often destructive emotional reactions. There are two acronyms used to help patients use distress tolerance:
Distract with ACCEPTS
Patients use the acronym ACCEPTS to distract themselves temporarily from unpleasant emotions.
- Activities: Do an activity or hobby that you enjoy.
- Contribute: Serve the people around you or contribute to service in your community.
- Comparisons: Compare yourself either to people that are less fortunate or to how you used to be when you were in a worse state.
- Emotions: Cause yourself to feel something different by provoking your sense of humor or happiness with corresponding activities.
- Push away: Put your situation on the back-burner for a while. Put something else temporarily first in your mind.
- Thoughts: Force your mind to think about something else.
- Sensations: Do something that has an intense feeling other than what you are feeling, like taking a cold shower or eating spicy food.
IMPROVE the Moment
Patients use the acronym IMPROVE to help them relax in stressful situations.
- Imagery: Imagine relaxing scenes, things going well, or other things that please you.
- Meaning: Find some purpose or meaning in what you are feeling.
- Prayer: Either pray to whomever you worship or, if not religious, chant a personal mantra.
- Relaxation: Relax your muscles and breathe deeply.
- One thing in the moment: Focus your entire attention on what you are doing right now. Keep yourself in the present.
- Vacation: Take a break from it all for a short period of time.
- Encouragement: Cheer yourself on. Tell yourself that you can make it through this.
In our next blog post, we will discuss the fourth and final core DBT skill, which is interpersonal effectiveness.