Distress Tolerance STOP Skill

Understanding the STOP Distress Tolerance Skill


Dialectical Behavior Therapy (DBT), developed by Dr. Marsha Linehan in the late 1980s, is a cognitive-behavioral treatment approach primarily designed to help individuals with borderline personality disorder (BPD). However, its application has been effectively extended to a variety of mental health issues. One of the core components of DBT is the use of distress tolerance skills, among which the STOP skill stands out as a crucial technique. In this article, we will explore the STOP skill in the context of DBT Skills Training, focusing on its application, effectiveness, and relationship with mindfulness skills and the concept of ‘wise mind.’

What is the STOP Skill?

STOP is an acronym that stands for:

  • S: Stop
  • T: Take a step back
  • O: Observe
  • P: Proceed mindfully

This skill is used as an emergency measure to manage extreme emotional distress or to prevent impulsive behaviors in response to stressful situations.

When to Use the STOP Skill

The STOP skill is particularly useful in situations where emotions become overwhelming and there is a risk of acting impulsively in ways that could be harmful or counterproductive. This includes scenarios such as intense arguments, high stress environments, or when experiencing strong emotions like anger, frustration, or sadness.

Why Use the STOP Skill?

The primary purpose of the STOP skill is to create a pause between stimulus and response, allowing for a more mindful and considered action rather than an impulsive reaction. This pause helps in:

  1. Reducing emotional intensity.
  2. Preventing actions that might worsen the situation.
  3. Enhancing decision-making capabilities under stress.

How to Use the STOP Skill: Step-by-Step Instructions

  1. Stop: As soon as you notice emotional distress, physically stop what you are doing. If possible, stand still or sit down.
  2. Take a step back: Take a deep breath and create a mental distance from the situation. This can involve closing your eyes briefly or visualizing a step back.
  3. Observe: Pay attention to what is happening inside you and around you. Observe your thoughts, feelings, and bodily sensations, as well as the situation you are in. This step is about gathering information without judgment.
  4. Proceed mindfully: Consider your options and choose how to proceed based on what will be most effective and appropriate in the situation. Ask yourself what action aligns with your long-term goals and values.

The Science-Based Effectiveness of the STOP Skill

Research on DBT indicates that distress tolerance skills, including the STOP technique, are effective in reducing emotional dysregulation, impulsivity, and self-destructive behaviors. A study by Neacsiu, Rizvi, and Linehan (2010) found that distress tolerance skills significantly contributed to improvements in borderline personality disorder symptoms. These skills are effective because they directly target the ability to tolerate and accept distressing emotions without resorting to harmful behaviors.

Relationship with Mindfulness Skills in DBT

The STOP skill is closely related to the ‘what’ and ‘how’ skills of mindfulness in DBT. The ‘what’ skills (observe, describe, participate) focus on what to do to be mindful, while the ‘how’ skills (non-judgmentally, one-mindfully, effectively) focus on how to practice these skills. In the context of the STOP skill:

  • Observe aligns with the first ‘what’ skill, emphasizing the importance of noticing experiences without getting caught up in them.
  • Proceed mindfully incorporates the ‘how’ skills, particularly acting effectively and non-judgmentally.

Correlation Between Wise Mind and the Observe Part of the STOP Skill

The concept of ‘wise mind’ in DBT is the integration of logical (reasonable mind) and emotional (emotion mind) thinking. It represents a balanced and intuitive state of mind that acknowledges and respects both emotional responses and rational thoughts. The ‘observe’ step in the STOP skill is a direct path to accessing one’s wise mind. By observing without judgment, individuals can better understand their emotional and rational cues, leading to a more balanced and wise decision-making process.


The STOP skill in DBT is a powerful tool for managing distress and preventing impulsive reactions. Its effectiveness is supported by scientific research, and its integration with mindfulness skills enhances its utility. By practicing the STOP skill, individuals can cultivate a more mindful, balanced approach to handling emotional challenges, thereby fostering a healthier, more adaptive response to life’s difficulties.

This psychoeducational lesson provides a basic understanding of the STOP distress tolerance skill within the framework of Dialectical Behavior Therapy. It is intended to serve as a guide for individuals looking to incorporate DBT techniques into their mental health and wellness practices. As with any therapeutic technique, it is recommended to seek guidance from a qualified mental health professional for personalized instruction and support.