Distress tolerance is a practical set of skills that helps people ride out intense moments without making things worse. Understanding how we tolerate pain, fear, and discomfort can reduce impulsive reactions, protect safety, and support long-term well-being. When we know how to endure distress in healthy ways, we gain options for moving forward even when life feels overwhelming.
Distress tolerance isn’t about pretending the pain isn’t there or avoiding problems. It’s about choosing effective responses in the moment while gradually developing longer-term solutions. These strategies can be useful in therapy, but they’re also valuable in everyday life—during work stress, conflicts with others, or when difficult news comes in.
In this post you’ll find practical concepts, concrete strategies, and actionable steps you can start using today. We’ll also cover when professional guidance is helpful and how to build a personal distress-tolerance plan that fits your life.
What is distress tolerance?
Distress tolerance refers to the ability to endure strong emotional or physical distress and still act in ways that are safe and effective. In dialectical behavior therapy (DBT), distress tolerance is treated as a core skill set designed for crisis moments—skills that help you survive intense pain without worsening the situation. You can read more about distress tolerance and its role in therapy here: What is distress tolerance.
Core concepts to know about distress tolerance
- Radical acceptance: acknowledging reality as it is, even when it’s painful or unfair. Acceptance doesn’t mean approval; it means choosing to stop fighting what you can’t change so you can respond more effectively.
- Crisis survival skills: short-term strategies designed to endure distress without making things worse. These include distracting, self-soothing, improving the moment, and weighing the pros and cons before acting.
- Urge surfing: riding an urge like a wave—watching it rise, peak, and fall without immediately giving in to it.
- Distraction versus acceptance: sometimes distraction helps reduce immediate intensity, but longer-term problems still need attention. The goal is to use the right tool at the right time.
- Grounding and self-soothing: sensory and calming practices that bring you back to the present moment and reduce physiological arousal.
For a broader overview of distress tolerance skills and how they fit into DBT, see resources such as individual skill guides like Psychology Today’s distress tolerance basics.
Practical applications: where and how to use distress tolerance
Distress tolerance skills are useful in a wide range of situations. Here are some common applications and practical examples:
- Use a brief crisis-skill burst (ACCEPTS or TIPP) to get through the peak intensity while you plan a longer-term solution. For example, take a few minutes to box-breathe, splash cold water on your face, or hold ice to reset your nervous system.
- Integrate cheap, quick tools like grounding (naming five things you see, hear, feel) or a 2-minute body scan to reduce spiraling thoughts during a tough workday.
- When a conflict heats up, pause before responding, acknowledge your distress, and choose a skill that buys time (practice radical acceptance of what you can’t change right now while you identify a concrete next step).
- Apply “improve the moment” strategies—small acts that lift mood or provide a sense of control (a short walk, listening to a favorite song, or journaling a few lines).
Practical skills you can try now include ACCEPTS (Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, Sensations) and TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation). A brief guide to these can be found in various skill resources, such as Distress tolerance basics.
Benefits and considerations
- Reduces impulsive actions, lowers risk of self-harm during crises, preserves safety, supports emotional resilience, and creates space to choose more deliberate, effective responses.
- Distress tolerance is not a substitute for problem-solving or addressing root causes. It helps you endure and survive; you still benefit from addressing underlying issues with longer-term strategies or therapy.
- Some techniques may feel natural, others unfamiliar. It’s okay to adapt tools to fit your values and comfort level. Consistency and practice often improve ease over time.
Professional guidance when needed
Distress tolerance skills can be powerful, but they’re most effective when paired with a broader plan that includes problem-solving, coping strategies, and, when appropriate, professional support. If distress feels unmanageable, if you’re experiencing ongoing thoughts of self-harm, or if you have a mental health condition that complicates regulation, consider seeking help from a qualified professional. A therapist can tailor distress-tolerance strategies to your situation and help you build a safety and coping plan.
If you or someone you know is in immediate danger, call your local emergency number. In the United States, you can reach immediate mental health support via the 988 Lifeline.
Actionable steps you can take today
- Write down what you do in the moment of distress. Include a short pause (e.g., 30 seconds), a preferred skill to use (ACCEPTS or TIPP), and a plan for reaching support if needed. Keep this plan where you’ll see it during tough moments.
- Assemble 8–12 items or activities you can use quickly. Examples: a cold pack, a favorite playlist, a short grounding script, a scented item, a fidget or textured object, a short grounding exercise (5-4-3-2-1), a comforting photo, or a short journaling prompt. Store it in a small bag or on your phone for easy access. If you’d like some guidance, see a practical overview here: distress tolerance toolbox ideas.
- Dedicate 5 minutes at two different times each day to a single skill (breathing, grounding, or self-soothing). Regular practice makes skills more automatic when you need them most.
- Pick two or three items from A (Activities), C (Contributions), C (Comparisons), E (Emotion), P (Pushing away), T (Thoughts), S (Sensations). Use them to shift your attention and mood long enough to choose a constructive next step.
- Temperature (cold water on your face), intense exercise (a quick burst or walk), paced breathing (inhale for 4, exhale for 6), progressive muscle relaxation for 1–2 minutes. These can rapidly reduce arousal and give you space to decide what to do next.
- At the end of the day, note one situation where distress arose, which skill you used, and how it affected the outcome. Use this to refine your toolkit over time.
- If distress is persistent, if you’ve experienced trauma, or if you’re unsure how to integrate skills safely, consult a mental health professional who can help tailor a plan to your needs.
Distress tolerance is a practical, learnable set of skills that can make difficult moments more manageable. It’s about building a reliable toolkit, practicing regularly, and knowing when to get additional support. With patience and persistence, you can weather distress with greater calm and clarity—and continue moving toward the goals that matter to you.
