Distress Tolerance is split into two parts: Crisis Survival Skills (designed to get you through the next five minutes without destructive behavior) and Reality Acceptance Skills (designed to help you cope with long-term, unchangeable pain).
Use these skills when you are highly emotional, experiencing intense urges to self-harm or lash out, and when your thinking is clouded.
S.T.O.P.
To pause before acting on impulse
Stop
Freeze. Do not react on impulse. Your emotions might try to make you act without thinking. Take control of your behavior.
Take a step back
Step away from the situation physically or mentally. Take a deep, slow breath to create space between your urge and your action.
Observe
Collect the facts. What is happening around you? What are you feeling inside? What are the urges you are experiencing? Avoid judging.
Proceed mindfully
Ask your Wise Mind: 'What is the most effective thing to do right now?' Choose a response that will make things better, not worse.
T.I.P.P.
To shift your body chemistry fast
Temperature change
Change your body chemistry fast by splashing ice-cold water on your face, holding an ice cube, or stepping into a cold shower. This activates the mammalian dive reflex to slow your heart rate.
Intense exercise
Discharge raw emotional energy. Do jumping jacks, run, pushups, or climb stairs for 10-15 minutes to burn off high-intensity adrenaline.
Paced breathing
Slow your breathing. Inhale deeply into your stomach for 4 seconds, hold, and exhale slowly for 6 seconds. Keep your exhales longer than inhales to activate the parasympathetic nervous system.
Paired muscle relaxation
Tense a muscle group (like your jaw or shoulders) tightly for 5 seconds, then let go completely. Focus on the contrast between tension and relaxation as you let the stress drain.
A.C.C.E.P.T.S.
To distract your mind from pain
Activities
Engage in an absorbing activity: hobbies, cleaning, reading, or watching a favorite movie. Occupy your mind with constructive work.
Contributing
Focus your attention outward by helping someone else. Send a supportive text, help a neighbor, or complete a kind gesture.
Comparisons
Put your situation in perspective. Compare your current feelings to times you survived worse distress, or reflect on the struggles of others.
Emotions (opposite)
Trigger an emotional state opposite to your current distress. Watch a comedy if you are sad, or listen to upbeat music if you feel down.
Pushing away
Put the situation on a shelf in your mind. Box it up mentally and set it aside temporarily. You are not ignoring it; you are scheduling to solve it later.
Thoughts
Fill your working memory. Count backward from 100 by 7, do a puzzle, memorize a poem, or list countries alphabetically.
Sensations
Use intense physical sensations to shock your focus away from emotional pain. Hold ice, take a hot shower, or squeeze a stress ball.
I.M.P.R.O.V.E.
To make the present moment bearable
Imagery
Close your eyes and visualize a calm, safe place. Or picture yourself successfully coping with the crisis and looking back at it with relief.
Meaning
Find a sliver of purpose or learning in the pain. Remind yourself how overcoming this obstacle can build strength and resilience.
Prayer / Meditation
Connect to a higher power, the universe, nature, or your inner wise self. Open your heart to the present moment for strength.
Relaxation
Soften your body. Stretch your neck, do deep breathing, or take a warm bath. Tell your muscles to let go.
One thing in the moment
Focus completely on the single task you are doing right now. Keep your mind in the immediate present, ignoring the past and future.
Vacation
Take a brief, intentional mental break. Lie in bed for 20 minutes, turn off your phone, or step outside. Set a clear timer to return.
Encouragement
Speak to yourself like a loving friend. Repeat comforting phrases: 'I can survive this,' 'This feeling will pass,' or 'I am doing my best.'
Self-Soothe
with the Six Senses
Tap a sense to explore examples
Radical Acceptance
Pain is inevitable; suffering is optional.
Radical Acceptance is completely accepting reality as it is, without fighting it, denying it, or attempting to escape it. It is not approval, forgiveness, or agreement. It is letting go of the fight against the past or present, which frees up your energy to build a better future.
“Acceptance of reality is the only way to convert suffering into pain. Pain is still pain, but suffering is gone.”
If your mind is fighting acceptance, change your body posture. Relax your face and turn the corners of your mouth slightly up (a Half-Smile). Sit or stand with your palms open, facing up (Willing Hands). By adopting an accepting physical posture, you invite your mind to follow.