Distress Tolerance Skills: Getting Through a Crisis Without Making It Worse

It’s 11 p.m. Something just happened, a text, a memory, a fight, and the feeling arrives like a wave: your chest is tight, your thoughts are racing, and every part of you wants to do something right now to make it stop, whether that’s sending the message, having a drink, quitting, screaming, or hurting yourself. If you know that moment, you know how fast it can turn a bad night into a worse week.

That surge has a shape. Most people notice that intense emotions rise, peak, and eventually ease, and that the urge to act is strongest near the top. Distress tolerance skills work in that window, giving you specific actions that match the moment with precision so the wave can crest without you acting on it.

The established path for handling emotional pain is to understand it and change it, by solving the problem, rethinking the situation, or working through what happened in therapy. That approach sits at the core of cognitive behavioral therapy, and for many problems it works well.

But some moments are too intense to solve or rethink, and at Siggy we’d rather you have a plan for those moments than be told to calm down.

Distress tolerance is the set of skills from dialectical behavior therapy (DBT) designed for exactly that window, when the goal is getting through the next ten minutes or the next hour without making things worse. Rather than fixing the problem, it keeps you safe and steady enough to face the problem later, and that difference comes down to timing rather than willpower.

What This Page Covers

• What Is Distress Tolerance?
• Why Does Low Distress Tolerance Matter?
• What Are the Crisis Survival Skills?
• What Are Reality Acceptance Skills?
• When Should You Use Distress Tolerance Skills?
• Do Distress Tolerance Skills Actually Work?
• How Do You Build Distress Tolerance Before a Crisis?
• How Siggy Fits In
• The Bottom Line on Distress Tolerance
• Start Your Anonymous Intake

What Is Distress Tolerance?

Distress tolerance is your capacity to experience painful emotions without being driven to escape them in ways that cause more harm. Everyone has some, and it varies from person to person and day to day.

Researchers often measure it with the Distress Tolerance Scale, developed by Simons and Gaher. A 2011 factor analysis of the scale found four related facets:

• Tolerance: how bearable distress feels
• Appraisal: whether you see being upset as acceptable or shameful
• Absorption: how much distress takes over your attention
• Regulation: how strongly you feel driven to make the feeling stop immediately

That last facet is the one distress tolerance skills target most directly. The urge to make a feeling stop right now is what turns an emotion into an action you regret.

Why Does Low Distress Tolerance Matter?

Low distress tolerance shows up across many mental health struggles. A review in Psychological Bulletin described distress tolerance as an emerging risk factor candidate for various forms of psychopathology, with documented links to symptoms and disorders, while noting that researchers define and measure it in different ways.

You can see why. If intense feelings seem unbearable, behaviors that bring fast relief, like drinking, bingeing, lashing out, or self-harm, start to look like solutions. They often work for a few minutes and make things worse for days. Building distress tolerance gives you other options for those minutes.

What Are the Crisis Survival Skills?

Crisis survival skills, developed by psychologist Marsha Linehan as part of DBT, are for moments when emotions are high and you can’t fix the problem right now. The table below summarizes each one.

Skill	What It Involves	Best For
STOP	Stop, Take a step back, Observe, Proceed mindfully	The first seconds of an urge
TIPP	Temperature, Intense exercise, Paced breathing, Paired muscle relaxation	Peak intensity, body in overdrive
ACCEPTS	Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, Sensations	Riding out hours of distress
IMPROVE	Imagery, Meaning, Prayer, Relaxation, One thing, Vacation, Encouragement	Making a hard moment more bearable
Self-soothe	Comfort through sight, sound, smell, taste, and touch	Feeling raw or alone
Pros and cons	Weighing acting on the urge versus tolerating it	Before a decision you can’t undo

STOP and TIPP are the fastest. TIPP works through your body, and our guide to TIPP skills explains the research behind each step, including slow, paced breathing.

ACCEPTS leans on distraction, which has real support. A 2012 emotion regulation meta-analysis covering 306 experimental comparisons found distraction was an effective way to regulate emotions in the moment, while concentrating on the feeling made it worse and trying to suppress the inner experience didn’t help. That’s the logic of crisis survival: shift your attention for now, and come back to the problem later.

What Are Reality Acceptance Skills?

Some pain can’t be fixed at all, like a loss, a diagnosis, or something that already happened. Reality acceptance skills help you stop fighting what you can’t change, which is often where the most suffering comes from.

The core reality acceptance skills include:

• Radical acceptance: fully acknowledging reality as it is, without approving of it
• Turning the mind: choosing acceptance again each time you notice yourself fighting reality
• Willingness: doing what the situation needs instead of refusing or digging in
• Half-smiling and willing hands: relaxed facial and hand postures that signal openness to your body

Acceptance frees up energy for what you can still influence, which makes it very different from giving up. Our guide to radical acceptance goes deeper on this skill.

When Should You Use Distress Tolerance Skills?

Distress tolerance skills are for the crisis window, not for every hard feeling. A useful rule: if you can solve the problem right now, solve it. If you can’t, and the emotion is high enough that you might do something you’ll regret, that’s a distress tolerance moment.

Signs it’s time:

• The emotion feels overwhelming and hard to think through
• You notice strong urges to act impulsively
• The problem can’t be fixed tonight
• Acting on the urge would make tomorrow harder

These skills are meant to be short-term. Using distraction to avoid every difficult feeling or conversation can backfire, which is why DBT pairs distress tolerance with emotion regulation, mindfulness, and interpersonal effectiveness. Our overview of DBT skills explains how the four modules fit together.

If you’re in danger of hurting yourself, distress tolerance skills aren’t enough on their own. Call or text 988, or call 911 in an emergency.

Do Distress Tolerance Skills Actually Work?

The evidence is strongest for DBT skills training as a package, and it’s encouraging.

A randomized 2015 JAMA Psychiatry trial tested which parts of DBT matter in 99 women with borderline personality disorder at high suicide risk. All versions of treatment reduced suicide attempts similarly, but the versions that included skills training reduced self-harm, depression, and anxiety more than DBT individual therapy without skills training.

Skills use seems to be part of how DBT works. A 2010 skills-use study of 108 women in DBT trials found that people in DBT used three times more skills by the end of treatment than people in comparison treatments, and that skills use fully explained the decrease in suicide attempts and depression over time.

Skills training also helps people without borderline personality disorder. In a 2014 pilot trial of DBT skills training with 44 adults with anxiety or depression and high emotion dysregulation, 16 weeks of skills training reduced emotion dysregulation and anxiety more than a support group. Depression improved too, though the difference between groups wasn’t significant. A 2015 systematic review of stand-alone skills training found preliminary support across a range of settings and problems.

For full DBT, a 2020 Cochrane review of therapies for borderline personality disorder found DBT reduced symptom severity and self-harm compared with usual treatment, based on low-quality evidence. The honest gap is that individual distress tolerance skills have rarely been tested on their own, so the research supports the skills package more than any single technique.

How Do You Build Distress Tolerance Before a Crisis?

Skills are hardest to use when you need them most, so practice them when you’re calm. Think of it like a fire drill.

Ways to build the habit:

• Pick two or three skills to start, such as STOP, paced breathing, and one self-soothe kit
• Practice them daily for a few minutes when your stress is low
• Write a crisis plan with your skills, your reasons to stay safe, and people to contact
• Notice your early warning signs, like a tight jaw or racing thoughts, so you can act sooner
• Review what worked after each hard moment and adjust

A DBT therapist or skills group can coach you through this, and many people find that structure helps skills stick.

How Siggy Fits In

People who live with intense emotions often say the same thing: “I don’t feel truly heard or understood.” Crises can be hard to describe in a rushed appointment, especially if anxiety or depression sits underneath them.

Siggy starts with a free, anonymous intake, with no name or email required, where you can describe what your hardest moments are like in your own words. A licensed prescriber reviews your intake before anything is prescribed, and you get a summary you can download and share with any clinician, including a DBT therapist.

Siggy combines human clinicians with AI therapy and daily check-ins, so you have support between visits when hard moments hit. Siggy’s licensed prescribers diagnose and treat the full range of mental health conditions, and a DBT skills group can be part of the plan alongside any medication.

Siggy isn’t an emergency service. If you’re in crisis, call 911 or call or text 988. This article is for education and isn’t a substitute for care from a licensed clinician. It reflects sources available as of October 2026.

The Bottom Line on Distress Tolerance

Distress tolerance is a learnable skill set for the moments when emotion outruns your ability to think or fix anything. Crisis survival skills help you get through the peak, reality acceptance skills help with pain you can’t change, and both work best when practiced before you need them. The research supports DBT skills training as a whole, especially for self-harm, anxiety, and emotional intensity, while individual skills still need more study. If you want to understand why some moments push you past your limit, our guide to the window of tolerance is a good next step.

Start Your Anonymous Intake

If you’re in crisis or thinking about harming yourself, call 911 or call or text 988 first. If intense emotions keep pushing you into crisis mode and you want a prescriber to look at the whole picture, start your anonymous intake. It’s free, there’s no name or email required, and a licensed prescriber reviews your intake before anything is prescribed. A real doctor reviews everything, and your summary is yours to keep.