DBT tools- mindfulness and distress tolerance

4 minutes Written by Nicole Livingston

Dialectical Behavior Therapy (DBT) Tools to Utilize

DBT skills work best with repetition and practice (the more you use them the easier they will come to you in a moment of distress). The modules include mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills. This page will focus on the first two modules to start as it can be a lot of information.

Originally developed by Marsha Linehan to treat personality disorders and interpersonal conflict, DBT is an evidenced-based model whose tools can be utilized by many people with different presenting problems.

DBT tools can be utilized to replace the maladaptive skills that are no longer working for you. Along with helping to understand/identify these patterns and learning to use alternatives, the therapist also validates and accepts you where you are. A person’s protective factors (social support, strengths, skills, resources) and resiliency play a part in combating maladaptive coping.

This is meant as a guide to help you remember the tools to utilize:


Practicing bringing your mind into the present moment. (This is a basic DBT mindfulness tool and is not all inclusive of what DBT mindfulness offers).

Mindfulness is at the core of DBT tools as it reduces emotional sensitivity and helps regulate emotions.

Three states of mind: Wise mind (balanced mind between the logical cool side and emotional hot side). Wise mind aims to help someone look at things rationally while factoring in feelings to make the best choice.

Notice things as they are (thoughts, feelings) and create room between you and distress. Mindfulness can help change your moods and improve emotion regulation. Many resources can help with mindfulness (think insight timer, etc.).

Try mindfulness without judgment and while letting in acceptance to bring in a present focused awareness without invalidating your inner self which can perpetuate emotional dysregulation.

An example: during a work shift, you notice yourself becoming upset, so you focus on the texture of a fabric in your hands. Through focusing your senses on something else, your mind has less room to become emotionally dysregulated.

Learning to tolerate strong emotions as they come without trying to bury, judge, or push them away, can help bring your power back and help with emotional regulation.

If you notice getting distracted, you have the power to change your thoughts back into the present and be more mindful. Mindfulness is hard and takes practice to be effective as we are wired biologically to make judgments for survival. Mindfulness gets easier as you learn to shift focus!

Distress Tolerance Skills: 

Learning to bear the pain skillfully through replacing maladaptive coping with healthy coping strategies. This technique uses distraction and self-soothing skills for coping with difficult feelings and situations to help you tolerate things that cannot be changed in the moment.

Distract: Wise Mind- ACCEPTS (activities, contribute, comparison, opposite emotion, pushing away thoughts and sensations). Utilizing this strategy can help create distance from the trigger.

Self-soothe using the 5 senses: (engage in a soothing activity that calms you and utilizes one of your senses (visual: painting, hearing: music, smell: flowers, taste, touch, etc.)

Improve the moment: (imagery, meaning, prayer, relaxation, one mindfully, vacation, encouragement).

Do the opposite: Choosing to do the opposite of how you are feeling, like half of a smile when feeling distressed.

Radical acceptance: Accepting things as they are, what is in your control? Knowing the situation “is what it is”. Making a CHOICE to accept a situation as it is without judgment.

Turning the Mind: Notice when you are not accepting something in the moment and making a commitment within yourself to accept reality as it is. Choosing acceptance.

Observe your breathing.

Crisis Survival TIPP: Change body temperature, intense exercise (jumping jacks), breath work (in through the nose for 5 beats and out through mouth for 7), paired with muscle relaxation (tense muscles breathing in and relaxing on the out). This can help you stop spiraling through a change in body chemistry.

Alternate Rebellion can help with feeling rebellious without destructiveness. Getting the sensation without the destruction, like a tattoo, being outspoken, dressing differently, turning music up, being creative, chose mediocrity instead of drama, explore…

Explore the pros and cons of an action beforehand.

Avatar Nicole Livingston

Written by Nicole Livingston

Nicole Livingston is a therapist in Connecticut who specializes in couples, family and individual therapy.