Distress Tolerance

Distract with wise mind ACCEPTS

-Activities – Do your favourite hobbies, go for a walk, play a sport, cook, do some retail therapy
-Contribution – Help a neighbour, offer to babysit
-Comparisons – compare yourself to others who are coping the same or less well than you. Compare yourself to how you were 2/3 years ago and how your coping.
-Emotions – finding emotions which are opposite to the ones you are feeling now, so read an emotional non triggering book or watch an emotional film/scary film, listen to funny music, watch your favourite comedian, go on a youtube trip (watching random youtube videos)
-Pushing Away – by mentally leaving the distressing situation for a while, but not avoiding it as this becomes an issue in itself.
-Thoughts – taking your mind of the current thoughts, so counting objects first to ten then do multiples, write poetry, reading.
-Sensations – use your senses holding ice cubes in your hand and squeezing really hard, pinging an elastic band against your wrist, using strong physical stimuli can really help you disrupt the distress.

IMPROVE the moment

-Imagery – Creating a safe haven in your mind, can be a place of peace for example, a crisp green meadow with rabbits and butterflies, a stream with flowing water etc. When in distress you can focus on this safe haven. Imagine good things happening to you, think about the situations likely to arise and how to take care of them in a safe and calm manner.
-Meaning – Finding meaning in the bad things and turning them into good things. Bit like taking sour lemons and turning them into lemonade.
-Prayer – this is about prayer to a god, higher being or to your own wise mind if you’re not religious. Allowing yourself to find acceptance through the act of prayer.
-Relaxation – listening to relaxing music or a relaxation tape, going for a massage to help you to de-stress and loosen your muscles and un-tense your body.
-One thing at a time – using mindfulness to be aware of the current moment.
-Vacation – actually take yourself away from your current everyday life, book a weekend away, go and stay with friends.
-Encouragement – Think about what you would say to a friend or famly member who was experiencing the same distress as you. What would you say that is supportive to them? “I have faith in you” “you can do this” this is like cheerleading, now once you have thought about what you would say to someone else, now say it to yourself over and over.

Acceptance and Willingness

Half Smile

Half smiling is about accepting reality with your body. Your body talks to your mind so by relaxing your body you help to calm your mind, a half smile is a slightly up turned lips with a relaxed face. Try to adopt a calm and serene face.

Half Smile Activities

– First thing in the morning – When you awake in the morning
– Free moments – Anytime you have 5 minutes to yourself
– Listening to music – put on some relaxing music
– When irritated – take a few minutes to half smile and relax your body
– Laying down/Sitting – half smile can help you to relax and get ready for sleep
– There may be other times when you can half smile

Awareness Exercises

– Awareness of connection to the universe – being aware of your feet touching the floor, the floor touching the ground, the worms in the soil, etc
– When making a cup of tea/coffee
– Hand washing clothes
– Washing up
– Cleaning
– Having a bath
– With meditation

Radical Acceptance

– Freedom from suffering – this requires acceptance from within what it is, you have to let yourself go completely with what is and not fight the reality/truth
– Accepting is the way out of hell – Being able to accept means you are able to cope better with the situation rather than try to fight it all the time
– Pain creates suffering – but only when you refuse to accept the pain for what it is.
– Tolerating the moment is acceptance
– Acceptance is acknowledging what is
– To accept something is not the same as agreeing with what is

Turning the mind

Acceptance of reality for what it really is does require an act of choice. You have two paths, you can either choose the acceptance path which will help you recover or take the rejecting reality path which will prolong your suffering and pain.

Making a commitment to accept does not mean you completely accept what is but rather it is making the first steps towards the acceptance path but doing it over and over many times even in the space of a few minutes.


-Willingness is doing exactly what is needed to get through each situation, focusing on what works and effectiveness
– Listening to wise mind and acting from your inner self
– Allowing into your awareness your connection with the universe, from the floor to the chair to people you may be talking to.

Over Wilfulness

– Wilfulness is sitting on your hands when action is needed and refusing to make the changes needed. This may include refusing to use the DBT skills taught in a crisis.
– Wilfulness is giving up – Not wanting to try and use DBT skills, not wanting to get better.
– Wilfulness is acting opposite to what works best or doing what works.
– Wilfulness is trying to fix every situation – not accepting reality for what it is
– Wilfulness is refusing to tolerate the moment.


Linehan, M. Skills training manual for treating borderline personality disorder. 1st. New York, NY: The Guilford Press, 1994. Print.

McKay, M., J. C. Wood, and J. Brantley. The dialectical behavior therapy skills workbook, practical dbt exercises for learning mindfulness, interpersonal effectiveness, emotion regulation &. Oakland, CA: New Harbinger Pubns Inc, 2007. Print.

One Response to “Distress Tolerance”

  • Greg says:

    Another informative post of yours! Thank you for this. Doing daily activities, be optimistic, and just give a little smile for yourself, obviously helps a lot to lift up yourself. It just a matter of how you deal with yourself.

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