Dialectical Behavioral Therapy/Distress Tolerance Skills

Most approaches to mental health treatment focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. This task has generally been tackled by religious and spiritual communities and leaders. Dialectical behavior therapy emphasizes learning to bear pain skillfully.

Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although the stance advocated here is a nonjudgmental one, this does not mean that it is one of approval: acceptance of reality is not approval of reality.

Distress tolerance behaviors are concerned with tolerating and surviving crises and with accepting life as it is in the moment.

Four sets of crisis survival strategies are taught:

• Distracting
• Self-soothing
• Improving the moment
• Thinking of pros and cons.

Acceptance skills include:

• Radical Acceptance
• Turning the mind toward acceptance
• Willingness versus Willfulness.