What it is
Distress tolerance skills are tools for tolerating strong emotions—like panic, anger, grief, or urges to act impulsively—when a problem can't be solved in the moment. The goal is to ride out the wave of feeling without doing something that creates new harm.
These skills are one of the core skill sets in DBT, alongside mindfulness, emotion regulation, and interpersonal effectiveness. They're often described as 'crisis survival' tools because they're meant for the most difficult, high-pressure moments.
Rather than changing how you think about a situation, distress tolerance focuses on helping you accept and move through a hard moment. Many people find them useful when emotions feel too big to reason with right away.
How it’s traditionally been approached
Historically, people were often simply told to 'calm down' or 'tough it out' during emotional crises, with little guidance on how. Intense distress was sometimes seen as something to suppress rather than to work with skillfully.
Distress tolerance as a named set of skills grew out of the development of DBT, which was created to help people who experience very intense emotions. The approach reframed difficult moments as opportunities to practice specific, learnable responses.
Today, these skills are taught in individual therapy, in DBT skills groups, and in related approaches. Many therapists see them as a practical complement to deeper work on the patterns behind recurring distress.
How a therapist may help
A therapist who uses cognitive and behavioral approaches may help you notice the early signs of mounting distress and explore responses that fit your life. Sessions often start with understanding your own patterns—what tends to set off intense emotion, and what you usually do next.
DBT therapists and DBT skills groups frequently teach distress tolerance alongside other skills, while ACT therapists may focus on making room for painful feelings rather than fighting them. Anger management, schema, and compassion-focused therapists may draw on related ideas in their own ways.
Work like this is usually collaborative and paced to you. A therapist generally helps you practice, reflect on what worked, and adjust—so that over time difficult moments may feel a little more manageable. This is a possibility, not a guarantee, and everyone's experience is different.
Where mind meets body
Intense distress isn't only in your thoughts—it shows up in the body as a racing heart, tight chest, shallow breathing, or a flood of restless energy. Thoughts, emotions, and the body's stress response constantly influence one another, which is part of why a crisis can feel so physically overwhelming.
Because of this loop, some people pair thinking-based skills with body-based (somatic) practices that work directly with physical sensations and the nervous system. If you're curious about that side, Somatic Experiences is a place to learn about body-based options. Neither approach is better than the other; many people find value in combining them.
Explore on Somatic Experiences: nervous system regulation →Explore on Somatic Experiences: polyvagal →Explore on Somatic Experiences: nervous system dysregulation →
Keep in mind
- This page is educational and is not medical advice, therapy, or a diagnosis.
- If distress is tied to trauma, self-harm, suicidal thoughts, or other serious concerns, a licensed professional should guide your care.
- In a crisis in the US, you can call or text 988 or call 911.
- Decisions about medication are made with a licensed prescriber, separate from skills practice.
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Frequently asked questions
What are distress tolerance skills?
Distress tolerance skills are tools for getting through painful, high-intensity moments without making things worse. They come mainly from DBT and focus on surviving a crisis rather than solving its cause right away. The aim is to tolerate strong emotion long enough for it to settle.
How are distress tolerance skills different from emotion regulation?
Distress tolerance is about coping in the moment when emotions are too big to change, while emotion regulation focuses on understanding and shifting emotional patterns over time. In DBT they're separate but related skill sets. Many people learn both, using each at different points.
Who teaches distress tolerance skills?
DBT therapists and DBT skills groups most often teach these skills, and ACT, anger management, schema, and compassion-focused therapists may use related ideas. A licensed therapist can help you practice skills suited to your situation. A directory like this one can help you find the right fit.
Can distress tolerance skills help with panic or anger?
Many people find distress tolerance skills useful for intense states like panic, anger, or overwhelming urges, because they're designed for exactly these high-pressure moments. They don't cure or treat any condition, but they may help you respond differently in the heat of the moment. A therapist can help you tailor them.
Do I need a therapist to use distress tolerance skills?
You can learn about these skills on your own, but a therapist can help you understand your patterns, practice safely, and adjust what isn't working. This is especially helpful when distress feels frequent or very intense. Working with a professional is not required, but it can make the process more effective.
How does the body relate to distress tolerance?
Distress shows up physically—through a pounding heart, tense muscles, or rapid breathing—because thoughts, emotions, and the body's stress response are deeply connected. That's why some people pair thinking-based skills with body-based (somatic) practices. You can explore the body-based side through resources like Somatic Experiences.
Educational resource. Therapists.plus shares general information and connects people with independent therapists, coaches and groups. It is not medical advice, diagnosis or treatment. Talk with a licensed professional about your health. In a crisis in the US, call or text 988 or call 911.
