Part 2: Distress Tolerance – Riding Out the Storm

When emotions become overwhelming, it can feel like you’re trapped in a tidal wave of distress. In these moments, it’s easy to fall into impulsive reactions that might bring short-term relief but create bigger problems in the long run. Distress tolerance is about getting through the moment safely—without making things worse.

These techniques won’t solve the underlying issue, but they will help you stay grounded, regain control, and make it to the other side with clarity. Let’s explore practical DBT strategies that can help you endure emotional intensity while keeping your well-being intact.

Distress tolerance focuses on managing emotional pain without resorting to harmful or impulsive behaviors. These skills are not about solving problems, but rather about enduring intense moments in a way that allows you to regain control. Below are grounding practices drawn from this module to help you survive difficult situations.

1. TIPP Skills: Physically Resetting Your Emotional State

The TIPP skills are designed to help regulate your body’s physical and emotional response to distress. By addressing your physiological state, you can interrupt the cycle of emotional overwhelmedness.

How to Practice TIPP:

1. Temperature: This shocks your system and stimulates the dive reflex, which can lower your heart rate and help you feel calmer.
   • Use cold sensations to quickly reduce emotional intensity.
   • Example: Hold an ice cube in your hand, splash cold water on your face, or place a cold pack on the back of your neck.
2. Intense Exercise: This releases endorphins, which naturally improve mood and reduce stress.
   • Engage in a brief burst of physical activity to channel nervous energy.
   • Example: Try jumping jacks, push-ups, running in place, or a brisk walk.
3. Paced Breathing:
   • Focus on slowing your breath to calm your nervous system.
   • Example: Inhale deeply for 4 counts, hold for 4 counts, and exhale slowly for 6-8 counts. Imagine each exhale as a release of tension, activating your parasympathetic “rest and digest” system.
4. Progressive Muscle Relaxation: This technique reduces physical tension and signals safety to your brain.
   • Tense and relax muscle groups systematically, starting from your feet and moving upward to your head.
   • Example: Tense your feet for 5 seconds, release, and notice the relaxation. Then move to your calves, thighs, etc.

2. Self-Soothing Using the Five Senses

Self-soothing involves nurturing yourself by engaging your senses in comforting ways. This practice can help you feel grounded and cared for during moments of distress.

How to Practice:

1. Touch:
   • Wrap yourself in a soft blanket, hold a stuffed animal, or apply lotion with a calming scent.
   • Feel the comforting texture and focus on the sensations.
2. Taste:
   • Sip a warm cup of tea, savor a piece of chocolate, or chew mint gum.
   • Focus on the flavors and how they change with each bite or sip.
3. Smell:
   • Light a scented candle, use essential oils, or smell something familiar and comforting, like freshly baked cookies or a favorite lotion.
4. Sound:
   • Listen to calming music, nature sounds, or a playlist of songs that uplift you.
   • Pay attention to the rhythm, melody, or lyrics.
5. Sight:
   • Look at soothing images, like photos of loved ones or nature scenes you like.
   • Focus on the colors, patterns, and details.

3. Distract with ACCEPTS: Redirecting Your Focus

ACCEPTS is an acronym for distraction techniques that help you shift your attention away from distressing emotions to regain control.

How to Practice ACCEPTS:

1. Activities:
   • Engage in something productive or fun, like cleaning, painting, gardening, or watching a movie.
   • Keep your hands and mind busy.
2. Contributing:
   • Shifting focus to others can provide a sense of purpose.
   • Example: Help someone else by volunteering, sending a kind message, or running an errand for a friend.
3. Comparisons:
   • This helps reframe your mindset and build resilience.
   • Example: Compare your current situation to a past challenge you have overcome or think of someone who inspires you.
4. Emotions:
   • By sparking new emotions, you can shift out of distress.
   • Example: Seek something that elicits a positive emotion or one that is different from what you are currently feeling, like watching a funny video or listening to upbeat music.
5. Pushing Away:
   • Mentally set aside the problem for now. Visualize putting it in a box and “shelving” it.
   • Remind yourself you can return to it later when you feel more capable.
6. Thoughts:
   • Intellectual focus can disrupt ruminative thoughts.
   • Example: Distract your mind by counting backward from 100 by sevens, solving a puzzle, or reading something engaging.
7. Sensations:
   • Introduce a physical sensation to interrupt emotional overwhelm, like holding a stress ball, taking a hot shower, or chewing something crunchy.

Combining Practices

In moments of intense distress, you can layer these techniques for maximum effect:

1. Begin with a TIPP skill to quickly reset your body’s emotional state.
2. Transition into Self-Soothing to create a sense of comfort and safety.
3. Use ACCEPTS to redirect your focus and engage with activities that help you feel in control.

These skills empower you to endure emotional pain, giving you time and space to process it without reacting impulsively.