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November 30, 2023

Distress Tolerance Skills with Marley Alexis, MSW, LCSW

by Marley Alexis, MSW, LCSW

Distress tolerance skills are known as our “crisis skills” in Dialectical Behavioral Therapy (DBT), but they can also be used for day-to-day stressors that occur. Here are 3 distress tolerance skills and different examples you can utilize and start to practice.

Radical Acceptance

This is a skill that should be used when you have tried to control a situation or you realize the situation is out of your control. Tell yourself, “it is what it is” or “I accept that this is what is happening at this time.” In therapy, acceptance DOES NOT mean you have to like it, you can still dislike what is happening, but you must accept the current reality. This skill helps us to start letting go.

Self-Soothe with the 5 Senses

Use your already established coping skills and preferred activities to engage your 5 senses to start calming down your mind and physical distress.

  1. Vision: take a walk and pay attention to what you see
  2. Hearing: listen to calming or fun music, videos, etc.
  3. Touch: take a bath or shower, cuddle your pets, wrap yourself in your favorite blanket
  4. Taste: have a snack or a treat, make sure you have eaten enough today
  5. Smell: take time to smell your favorite scents; this could be in your home, outside or a fragrance.

Distraction, AKA the ACCEPTS Skills


Engage in activities that require concentration and something you already enjoy doing


Focus on someone or something other than yourself. You can volunteer, check on a friend or family member, contribute to a cause or charity you support


Look at your situation in comparison to something worse. Consider a time when you were feeling worse or when someone else was going through a difficult time.


Do something that will create a competing emotion. Watch something funny when feeling sad or angry. Listen to calming music when feeling anxious.

Pushing Away

It’s not always a good time to deal with a strong emotion. Push away an emotion that is causing you trouble. Imagine it floating away or write it on paper and throw it away. Then later, come back to the emotion or situation so you can process at a better time.


When your emotions take over, focus your thoughts on something else. Count backwards from 100, read a book or article, sing a song in your head and focus on the lyrics.


Find a safe sensation to distract you from intense emotions. Eat something sour or spicy, hold and ice cube or ice pack in your hand or exercise.

If you need professional support for your mental, emotional, and behavioral health, reach out to Avance Care Behavioral Health at 919.874.5443.

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