DBT SKills – Distress Tolerance…

“At some point in our lives, we all have to cope with distress and pain…While we can’t always control the amount of pain in our lives, we can control the amount of suffering we have in response to…pain…” (McKay, et al, 2007)

Lately, my life has been quite stressful.  I find my level of self-care and overall wellness falling into the crapper.  For this reason, I’ve decided to see my old therapist once a month.  I appreciate having somebody to “bounce things off of”.  Currently, my educational goals are up in the air.  I worry about finding a new internship placement.  I worry about getting a job when it’s all over.  Will all things fall into place?  Against this backdrop of stress, I’m faced with many responsibilities, and an infuriating realization that so little is in my control…

In this post I’m reviewing distress tolerance skills, I learned in a dialectical behavioral therapy skills group.

Mental Distraction Skills

“The first distress tolerance skills you’ll learn in this chapter will help you distract yourself from the situations that are causing you emotional pain (McKay p, et al, (2007).”

About three years ago, I was diagnosed with PTSD.  In reality, I’ve had it quite a while as an undiagnosed disorder.  The consequences of this are difficult to describe.  The reality is, some hurts from our past leave their marks upon us.  Like the death of a loved one – you can’t just forget it and move on.   These things stay with you, and leave you forever changed….

….After a crapload of therapy and lots of hard work, I’m quite proud of where I’m at.   The self-soothing skills below, were taught to me early in therapy and were a life-saver…


DBT Skills Groups are intended to provide clients a essential coping skills.  What I liked were the acronyms that made the advice so easy to remember…  Here “ACCEPTS” stands for the following list of distracting activities,

“A” = Activities

I have a bad habit of ruminating endlessly over things that worry me. When I catch myself doing this I distract my mind from what worries me.  For example  I will clean, exercise, blog 🙂 , or snuggle with my piglet.

“C” = Contributing

Contributing to the well-being of others is also a useful in coping with distress.  Lately, this internship had provided a constant reminder that I have lots to learn and success isn’t guaranteed.   For this reason, my job has actually been a respite from the stress. I am competent and everyone thinks highly of me.  Contributing to the wellbeing of others as a healthcare worker takes focus off my own mundane concerns.

“C” = Comparisons

I get constant reminders at work of how lucky I am. I’ve enjoyed over 40 years of perfect health.  At my internship are more reminders of my good fortune.  I was raised in an upper-middle home.  I make about 50k as a CNA.  I’ve been happily married 17 years and have two amazing boys.  I can’t complain really…

“E” = Emotions

Doing things that provide the experience of opposite emotions is essential.  I like to listen to great music on my iPhone and exercise in the park.  I love to draw and write.  Netflix binge sessions on a day off are another favorite.  Last but not least, hanging with my family doing just about anything brings me joy.

“P” = Pushing Away

When I notice myself ruminating over something that I can’t change/alter/remedy, I’m torturing myself needlessly.   For example, worrying about finding a job when I graduate is useless. I can’t address the issue right now, so just shove those thoughts aside.  Focus on right now, and worry about later – later 🙂

“T” = Thoughts

Thoughts that bring pleasure, hope, and excitement can eliminate or reduce distress significantly.  Imagining myself as a successful therapist is much more useful.  I will eventually land on my feet, and find myself where I’m meant to be.

“S”= Sensations

Pleasurable sensations are also useful in alleviating distress and tension.  I like the way I feel after exercise & hot whirlpool baths…

Self-Soothing Skills

“The second group of distress tolerance skills you’ll learn….are self-soothing skills…necessary…before you face the cause of your distress. (McKay, et al, 2007)”

There are also distressing situations you’re thrown in that you can’t run away from.  For example, I can’t run away from the therapy groups entirely.  I must find ways to cope with the stress.  What follows is another acronym of self-soothing skills….


“I” = Imagine

As a bullied child, I constantly found myself in inescapable situations that caused great distress and pain.  My imagination was a salvation & respite from the distressing situation.  I woud get lost in my own world, and mentally check out at school.  I was there in body but not person,  Today, I imagine relaxing situations at home & realize when the day is over, that’s where I’m going.

“M” = Meaning

Discovering the meaning & underlying purpose in today’s distressing events is also useful as a coping tool. My husband and I have talked at length about this.  We work hard for our family, to provide them something better.   Adding to this meaning, is the clear underlying purpose in my chosen line of work.  I am a Kiersey Healer/INFP type.  I derive greate meaning in my work as a caregiver /counselor. I enjoy opportunities to make an impact on people’s lives.

“P” = Prayer

I am agnostic, but still find great benefit in prayer.  Having faith in something greater than yourself is comforting.  Admittedly, I struggle to fully accept organized religion.  However, a relationship with “my creator is essential…

“R” = Relaxation

When my husband is stressed, he responds by slowing down and relaxing at the end of a long day.  In contrast, when I’m stressed, I go into high gear.  I push through to overcome, hell or high water.  This ego-driven adaptive response causes more problems than anything,  I make mistakes when I rush through.  Slowing down & relaxing can help my mind focus more on the task at hand.

“O” = One Thing

When I get stressed, I’m like a chicken with her head cut off.  Stopping a minute to ask myself what needs to get done right now is critical.  Focusing on one thing at a time – One-Mindfully is how I enter the moment fully present in it.

“V” = Vacation

Finding ways to take mini-breaks is useful.  Last week a new intern started.  Sensing my stress, she invited me to lunch.  I enjoyed toe time we took to chat.  It allowed me to regain some emotional equilibrium so I could focus on the task at hand.

“E” = Encourage yourself

I am unnecessarily hard on myself.  My inner critic likes yelling at me whenever my performance is “less-than-stellar”.  I need to be gentle and nurturing with myself.   Encouragement needs to start within.

check out this online resource for more information…


Mckay, M., Wood, J., & Brantley, J. (2007). The dialectical behavior therapy skills workbook: Practical DBT exercises for learning mindfulness, interpersonal effectiveness, emotion regulation & distress tolerance. New Harbinger: Oakland, CA.

Share This: