Distress Tolerance Skills In Addiction Therapy

Distress tolerance skills are specific skills that can help people deal with stressful situations in a healthy way. These skills are a core part of dialectical behavior therapy (DBT), but other types of therapy also teach them.

Reasons for addiction can include genetics, family history, co-occurring disorders, and life circumstances. Often, these causes overlap, and a person may experience many of them at once.

No matter the cause of addiction, poor distress tolerance skills can make that addiction more difficult to deal with.

In general, distress tolerance is a person’s ability to handle difficult situations without becoming overwhelmed.

It involves specific skills that are often taught in individual therapy and group therapy.

Addiction therapy can help people strengthen their distress tolerance skills so they can use coping mechanisms other than drugs or alcohol.

Why Is Distress Tolerance Important For People With Addictions?

When a person does become overwhelmed by distress, they may react impulsively and make the situation worse.

A lack of proper coping skills can lead to impulse decisions, drug use, alcohol binges, and other negative consequences.

Fight Or Flight Response

For many people, this impulsivity comes from the body’s “fight or flight” response.

When humans are in danger, their sympathetic nervous system helps them make an instant decision, whether that decision is to stay and fight the danger or run away from it.

Unfortunately, the body cannot always tell the difference between true danger and a non-life-threatening situation, such as an argument with a family member.

In the fight or flight state, the body is primed to act quickly. For somebody who has an addiction, acting quickly might include using drugs or alcohol as an escape.

How Distress Tolerance Skills Can Help

Distress tolerance skills allow people to slow down and assess the situation properly.

When a person has strong distress tolerance skills, they can turn to those skills instead of using substances to cope with the situation.

Distress Tolerance Skills In Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a form of therapy that puts a strong emphasis on distress tolerance skills.

DBT teaches several skills that can help people deal with relapse triggers and other distressing situations. Many of these skills overlap with one another.

A person does not need to memorize or cycle through all of these skills to deal with distress.

Instead, they can work with their therapist and try different options to figure out which ones work best for them.


One DBT skill is the ACCEPTS skill. This skill can help people who need either a distraction or perspective about their situation.

ACCEPTS tasks include:

  • Activities: shifting attention to errands, games, movies, or other distractions
  • Contributions: doing something nice or helpful for another person
  • Comparisons: comparing the situation to the suffering of others
  • Emotions: engaging emotions other than the one the person is currently feeling. For example, a person may read an emotional book or watch a funny television show.
  • Pushing away: temporarily forcing the problem away from the mind
  • Thoughts: engaging the brain with puzzles, books, word games, or something similar
  • Sensations: engaging one or more of the body’s physical senses. Examples include holding an ice cube or listening to music.

TIP Skill

The goal of the TIP skill is to change body chemistry and reduce overwhelming emotions. By bringing attention back to the body, a person may feel more grounded and calm.

TIP tasks include:

  • tipping the temperature: holding ice cubes, splashing the face with ice water, or holding an ice pack to the face for 10 to 30 seconds
  • intense exercise: performing physical exercises such as running or lifting weights
  • paced breathing: taking slow, intentional breaths

Self-Soothing Skill

The self-soothing skill, like the “sensations” part of the ACCEPTS skill, focuses on the five senses: sight, sound, smell, taste, and touch.

A person can engage these senses to experience comfort and relief. For example, they might chew gum to engage the taste buds or reach for a blanket to engage the sense of touch.


The IMPROVE skill seeks to improve the current moment by focusing on something positive.

IMPROVE tasks include:

  • Imagery: imagining a beautiful scene
  • Meaning: finding meaning in the situation
  • Prayer: reaching out to a higher power
  • Relaxation: taking deep breaths or doing another relaxing activity
  • One: focusing on just one thing about the moment rather than several
  • Vacation: taking a break
  • Encouragement: using positive self-talk and affirmations

Pros And Cons Skill

The pros and cons skill can help people avoid destructive behaviors such as using substances.

With this skill, a person thinks about or writes down the positive and negative aspects of the behavior that they are attempting to avoid.

Then, they compare the two lists to see why the behavior may not help with the distressing situation.

Problem-Solving Skill

The problem-solving skill helps people recognize when they have the power to change a situation.

This skill is complex, but it can help people who may otherwise feel powerless in specific situations.

It involves recognizing that a situation is a problem, determining how the problem is standing in the way of the person’s goals, and choosing the best way to move forward.

Radical Acceptance Skill

Radical acceptance is accepting a situation as it is rather than denying the situation or demanding it to change.

Radical acceptance does not mean that a person “gives up” or never changes anything. Rather, it asks the person to acknowledge reality instead of fighting it.

For example, somebody with an addiction may deny having an addiction. However, when they accept that they do have a substance use disorder, they can seek treatment for it.

Benefits And Drawbacks Of Distress Tolerance Skills

Like many therapy techniques, distress tolerance skills have benefits and drawbacks.

Benefits Of Distress Tolerance Skills

These skills can benefit people with addictions because they provide practical, learnable activities that do not rely on willpower alone.

In DBT and other forms of therapy, distress tolerance skills are practiced when the person is not in distress.

As the person gains these skills, they may reduce the urge to use substances while strengthening healthier desires, such as the desire to go for a walk or talk to a friend.

Drawbacks Of Distress Tolerance Skills

Some distress tolerance skills may not work for everybody.

For example, the “comparisons” activity in the ACCEPTS skill may cause guilt for some people, or it may cause people to invalidate their own suffering by comparing it to others.

Furthermore, the DBT model teaches so many skills that a participant may become overwhelmed by all of them, which is itself a distressing situation.

However, participants may experiment with different skills to figure out which ones meet their needs, and they don’t have to use the options that don’t work.

Likewise, if the DBT model doesn’t work well for a person, they may choose another therapy approach, such as cognitive behavioral therapy, which also teaches practical coping skills.

Addiction Therapy At Spring Hill Recovery Center

Addiction therapy requires a personalized approach. Once a person finds the right approach, they can begin the path toward successful recovery.

Spring Hill Recovery Center is a drug and alcohol rehab center that provides several types of evidence-based care.

If you or a loved one are looking for addiction therapy, contact Spring Hill for more information today.

  1. American Psychological Association — The Independent Roles Of Mindfulness And Distress Tolerance In Treatment Outcomes In Dialectical Behavior Therapy Skills Training https://psycnet.apa.org/record/2019-63661-001
  2. DBT Tools — Distress Tolerance Skills https://dbt.tools/distress_tolerance/index.php
  3. National Library Of Medicine — Distress Tolerance And Psychopathological Symptoms And Disorders: A Review Of Tthe Empirical Literature Among Adults https://pubmed.ncbi.nlm.nih.gov/20565169/

Written by Spring Hill Recovery Editorial Team

© 2024 Spring Hill Recovery | All Rights Reserved

* This page does not provide medical advice.

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