DBT: Distress Tolerance, and Final Installment

Primary source for this post: DBT Skills Training Handbook and Worksheets, Second Edition, by Linehan, Marsha.  Copyright 2015





Hey everybody!



Well, a few days ago we completed our Spice of My Shelves series – and today, comes the end of our DBT saga.  It’s been fun, and good for me to review all the skills I have at my disposal.  Hopefully this has also helped to demystify the inner world of group therapy, particularly Dialectical Behavioral Therapy, and the point of trying it out.

I have a huge black binder I brought home when I completed group therapy that organizes all the four main sets of skills that we went over. The first three are 1 Mindfulness, 2 Emotion Regulation and 3 Interpersonal Effectiveness.  Guess what?!!! Today, we’ll discuss number 4 – Distress Tolerance!  And you will have completed this broad survey of the DBT principles and skills.  If you would like to go back to the very beginning where I explain the motivation behind this series, click here.


Distress Tolerance: What is it?

Have you ever had an emotional crisis?  There are times when our emotions just crush us, suffocate us, and keep us from thinking clearly or making choices.  Everyone’s worst moment looks different, but often, these crises are characterized by desperation, a foggy or racing mind, and maybe temptation to turn to harmful measures or addictions – things we know aren’t good for us, or that could hurt us.  Usually, we don’t WANT to do these things, but we feel WE HAVE NO OTHER CHOICE.  Otherwise, how can we make it through these overwhelming urges and emotions?  And even though in the past we may have made it through similar crises, and we felt better the next day, in the moment, WE FEEL TRAPPED.

Distress Tolerance, to me, is exactly what it says – learning to tolerate deep distress, even when it hurts more than we ever imagined it could.  It’s getting through the worst moments when we feel like we can’t go on, redirects our mind from making plans we’d regret, and provides an alternative to what we’d ordinarily turn to – such as drugs or self-harm or destructive outbursts.  It’s basically learning to breathe when all the doors and windows in our lives appear closed.


Distress Tolerance skills, my binder specifies, are for the moments when you know you are about to choose something you will regret, and you are in a bad crisis.

There are many things you can do in such a crisis.  Sometimes the wisest thing I can do, even though it is the exact opposite of what I typically want, is to go to another person.  Stay with them.  You can let them know you’re struggling, and ask to hang out with them so you’re not alone. Don’t worry about inconveniencing someone.  Any real friend would rather lose a little sleep to talk to you than find out you hurt yourself.  In your worst moments you will easily believe that you are worth nothing, and just a problem.  Maybe you don’t even believe you are worthwhile  – but choose to act to protect yourself, before you make a decision based on that conclusion.  Hopefully, later in time, you’ll realize that is not the case.

For addictions, it can be helpful to have a plan of what you are going to do when an urge or low point hits you.  Or create a pros and cons list.  This is something I did a long time ago and recently I discovered it tucked away in a journal.  Looking back, I wish I remembered to keep it out when I struggled during a crisis – I think it would have made a huge difference.  I’ll walk you through how to create one, and then remember to set it somewhere you can be reminded of it.  You never know when a panic moment will hit.  It won’t hurt to be prepared:

First, write down the pros of following through with the addiction.  Maybe you temporarily feel better.  It makes you feel momentarily powerful, or able to escape.  Maybe you just can’t bear who you are, and this coping mechanism allows you to forget your life for a while.  But do these ‘benefits’ really solve your problem?

Next, write down the cons of the addiction.  Does it negatively affect your health?  Will you feel horrible the next day for resorting to this course of action?  Does it strain your relationships, make you feel isolated, or extremely guilty?

What are the pros of NOT acting on your urge?  Maybe you’ll feel better and more powerful in the long run if you refuse to let this desire control you.  Maybe it will keep your relationships more honest, and intimate, if you don’t allow yourself to give into something you will have to hide from them.  Maybe it will improve your health – and your self esteem.

What are the cons of NOT acting on your urge?  Will it be difficult to resist the urge?  Will it strain other relationships or deny you escape from your mind?

Now look over the entire list.  What’s most important to you?  Are the pros of the addiction more important to you than the pros of not acting on the addiction?  What are the past consequences of acting on this urge?  What if, just as an experiment, the next time your urge hits, you try something else, something less detrimental, instead.

I wish I could keep other people from suffering.  All I can tell you is, I truly believe you will be glad if you push through to the other side, and I think that’s true for everybody, no exceptions – if you’ve been given life, it’s because your life, your existence, was deemed worthwhile and purposeful and good.  Next time you are struggling with your demons, look over your list.  Then find a different way to cope.  Pray, play music till you fall asleep, watch a movie you never get tired of, or go running.  Find an alternative.  I will if you will.


Just a note:  in the news recently, I saw that the number of middle schoolers committing suicide has doubled.  Mental health needs to be discussed.  Suicide needs to be discussed.  Emotional crises need to be discussed.  And more than that, we need to be a community more than ever.  If you are struggling and can’t talk to anyone you know, call a suicide prevention hotline.  Or email me, and I will reply as soon as possible.  But if you are in a crisis, like the one we talked about above, try to stay calm.  It will be ok.  I’ve felt so trapped and cornered and had my own moments, but I’ve made it out on the other side.  You can find freedom from your guilt and terrifying fears. And I am a baby when it comes to pain, so if I can, you can too!  I love you guys, and I hope this was a helpful series.  Stay safe 🙂


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