Intro to the Distress Tolerance Module


One of the central components of DBT is the Skills Training, which is divided into four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. This summary describes the Distress Tolerance module, highlighting its importance and interconnection with the Mindfulness module. This page is your main menu for the lessons and exercises in the module, a table of contents is below, please scroll down.

Understanding Mindfulness in DBT

Before delving into distress tolerance, it is crucial to understand the foundational role of mindfulness in DBT. Mindfulness, the practice of being fully aware and present in the moment without judgment, is the core skill that underpins all other DBT skills. It involves developing an awareness of one’s thoughts, emotions, and bodily sensations in a non-evaluative and non-reactive manner.

Mindfulness skills are essential for several reasons:

  • They provide a grounding technique to manage overwhelming emotions.
  • They enable individuals to observe and describe their thoughts and feelings without immediately reacting to them.
  • Mindfulness enhances self-awareness, which is crucial for recognizing the need to employ other DBT skills.

The Role of Distress Tolerance

Distress tolerance skills are designed to help individuals cope with painful emotions in difficult situations without resorting to destructive behaviors. These skills are particularly beneficial for those who experience intense emotional responses and have difficulty managing these responses effectively.

The Distress Tolerance module teaches skills that include:

  • Crisis Survival Strategies: These are immediate, short-term techniques to get through an intense emotional episode without making it worse. They include distraction, self-soothing, and improving the moment.
  • Reality Acceptance Skills: These skills help in accepting reality as it is, not as we wish it to be. This acceptance, while difficult, can lead to a decrease in suffering and an increase in emotional freedom.

The Interplay between Mindfulness and Distress Tolerance

The completion of the Mindfulness module prior to the Distress Tolerance module is strategically important for a few reasons:

  1. Improved Self-Awareness: Mindfulness practices enhance self-awareness, enabling individuals to recognize when they are becoming emotionally overwhelmed and need to apply distress tolerance skills.
  2. Non-Judgmental Stance: Mindfulness encourages a non-judgmental stance towards one’s experiences, which is essential in practicing distress tolerance. Accepting distress without judgment is key to effectively managing intense emotions.
  3. Grounding in the Present Moment: The ability to stay grounded in the present moment, a skill honed through mindfulness, is essential when faced with distressing situations. It allows for a more measured response, rather than an impulsive reaction.

Deciding Between Emotional Regulation and Distress Tolerance Skills

An important aspect of DBT is learning to differentiate between when to use emotion regulation skills and when to employ distress tolerance skills. This decision is significantly informed by mindfulness practices.

  • Emotion Regulation Skills are used when an individual has enough mental and emotional capacity to manage and change their emotional responses actively. These skills are about understanding and reducing vulnerability to negative emotions and increasing positive emotional experiences.
  • Distress Tolerance Skills, on the other hand, are necessary when the situation cannot be changed immediately, or the emotional response is so intense that managing or changing it is not possible at that moment.

Mindfulness skills assist in making this distinction by providing clarity on the intensity of the emotional experience and the immediacy of the situation. This awareness helps in choosing the most effective coping strategy.


The DBT Distress Tolerance module, informed by mindfulness practices, is a crucial aspect of managing emotional distress in a healthy and effective manner. By first completing the Mindfulness module, individuals gain the necessary awareness and grounding techniques that are essential for the successful application of distress tolerance skills. Understanding the interplay between mindfulness, distress tolerance, and emotion regulation is key to navigating complex emotional landscapes and making empowered choices towards wellness and stability.

In a health and wellness program, incorporating these DBT skills can significantly aid in developing resilience, emotional intelligence, and a more balanced approach to handling life’s challenges. By embracing these skills, individuals embark on a transformative journey towards improved mental health and overall well-being.