Distress Tolerance Skills
Distress tolerance skills help a client get through a crisis without making it worse — surviving an intense urge (self-harm, substance use, quitting) without acting on it — and accepting a reality they can't change. On a diary card these map directly to the urge rows: the skill is what a client reached for when the urge spiked.
The distress tolerance skills
Stop, Take a step back, Observe, Proceed mindfully. The first move when an urge surges.
Temperature, Intense exercise, Paced breathing, Paired muscle relaxation — fast physiology change for very high arousal.
Weigh acting on the urge against riding it out, ideally before the crisis hits.
Distract with Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, and Sensations.
Soothe through the five senses to bring distress down a notch.
Imagery, Meaning, Prayer, Relaxation, One thing at a time, Vacation, Encouragement.
Accept reality fully, as it is, to stop the suffering that fighting it adds.
Choose acceptance — again and again, each time the mind turns back to fighting reality.
Do what the situation needs, the opposite of willful refusal.
Accept reality through the body when words aren't enough.
Track skill use on a diary card
Skills only help when they generalize. A DBT diary card captures which skills a client actually used between sessions — and Theracharts charts that use over time so you can see it in session.
Build a free diary cardAbout diary cardsFrequently asked questions
What are the DBT distress tolerance skills?
They split into crisis-survival skills (STOP, TIPP, Pros and Cons, ACCEPTS, Self-Soothe, IMPROVE) and reality-acceptance skills (Radical Acceptance, Turning the Mind, Willingness, Half-Smiling and Willing Hands).
How do distress tolerance skills show up on a diary card?
They line up with the urge rows. When a client logs a high urge but no target behavior, the skill they used to get through is the distress-tolerance skill worth reviewing in session.
In crisis? Call or text 988 (Suicide & Crisis Lifeline, US) — free, confidential, 24/7. This page is educational and is not therapy, diagnosis, or a substitute for professional care.