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Distress Tolerance Skill Development in DBT

One of the benefits of being a therapist at Turnbridge is that our treatment team is always striving to learn and improve our counseling practices. At the end of August, we started to formally introduce Dialectical Behavior Therapy (DBT) practices to our individual and group therapy sessions.

DBT is an evidence-based treatment modality that has been shown to be effective in the treatment of both mental health and substance use disorders. Treatment is designed to assist clients in building a life worth living by developing a clearer sense of self. Clients learn how to manage emotions in healthier ways and learn to accept the highs and lows of life. They are taught how to create, improve, or maintain healthy, stable relationships. Clients learn that there are healthier, more effective methods to help cope with distress than turning to alcohol and/or drugs to numb emotional pain.

A key ingredient of DBT treatment is distress tolerance, which refers to experiencing the situation and accepting the reality of it as something the person cannot change.  By practicing acceptance without being judgmental or trying to fight reality, the client will be less vulnerable to intense negative feelings.  There are four primary categories of distress tolerance skills:


Distraction helps a person to stop thinking about the source of distress by engaging in pleasurable activities, focusing on someone other than oneself, and leaving a situation until emotions subside.


Self-soothing assists the client to create peace and relief within himself so that he can rationally figure out how to respond to the source of distress in a productive way.  This is done by visualization and relaxing, identifying values (bringing worth to self), identifying a higher power (believing that the person is not alone can make him feel empowered, safe and calm).

Living in the moment

Living in the moment is about being mindful of oneself and his surroundings. It keeps the client from thinking about the past, the future, multitasking or worrying about everything that needs to be done that day.  When a person is not living in the moment, he cannot truly experience life as it is happens.  This can be overwhelming.  Since what a person says to himself determines much of how he feels, it is important to avoid negative self-talk.  Positive thoughts that are encouraging, soothing and self-affirming work to remind a person of his good qualities and strengths.

Focusing on pros and cons

The client is asked to list the pros and cons of tolerating the distress and not tolerating the distress.  It is a helpful reminder of the past consequences of not tolerating distress, and to imagine how it will feel to successfully tolerate the current distress and avoid negative behaviors.  Through evaluating the short-term and long-term pros and cons, clients can understand the benefits of tolerating pain and distress.

Through different exercises and homework assignments, clients learn how to apply these distress tolerance strategies during their stay at Turnbridge. The road to recovery is filled with many challenges and bumps along the way.  One of my clients said felt he had more strategies to add to his “toolbox” for relapse prevention. He said he felt better equipped to tolerate the ups and downs of life.