Here Are My 5 Favorite Distress Tolerance Techniques and How I Use Them

In my opinion, one of the most difficult parts of living with a mental health condition like borderline personality disorder (BPD) is dealing with intense emotions. When unregulated, emotions like sadness, anger, or heartache can cause physical and emotional distress, which can quickly spiral into a crisis situation.

However, dialectical behavior therapy (DBT) provides an abundance of distress tolerance skills that can help you deal with intense emotions and avoid spiraling into crisis. There are five of my favorites, along with some explanation as to how I use them.

1. Temperature

Dialectical behavior therapy uses many acronyms to help participants remember the skills they learn through each group session. One of those acronyms is TIPP, and the T stands for “temperature.” For this, you use ice or cold water to essentially trick your brain into engaging in the dive reflex, which naturally relaxes the body when it senses cold temperatures.

How I Use It: When my automatic thoughts get the better of me, I can quickly spiral into a state of dysregulation thanks to the fear and anxiety I feel. As soon as I catch myself doing this, I head to my freezer and grab an ice pack to stick on my forehead while holding my breath for 15 to 30 seconds.

If I’m out in a public place where ice packs aren’t available, then I usually either use a cold beverage from a fridge or go to the bathroom and use cold water from the sink.

2. Willing Hands

“Willing Hands” is another emotion regulation tool that plays on the connection between your body and your mind. It’s a pose that “tricks” your brain into thinking a situation isn’t as distressing as you may think because your hands are open and “willing” to accept the situation. To perform “Willing Hands,” you simply stretch your arms away from your body, turn your palms upward, and open your hands.

How I Use It: Willing Hands help me navigate difficult situations where my emotions tell me to shut down or disengage. I use Willing Hands when I need to be assertive and express my needs to people who normally intimidate me. I also use this skill to push through something uncomfortable, like facing fears related to my trauma history.

3. Paced Breathing

Paced breathing is one of the Ps in TIPP. It involves purposely slowing your breath while you focus on the amount of time you spend breathing in and out. It’s great for situations where you feel anxious or overwhelmed but can’t escape the moment. It’s also a great grounding technique people use when they dissociate.

How I Use It: I love paced breathing because it’s a skill I can use virtually anywhere for any reason. I often use it when I begin to feel angry or upset but know that an emotional response will make the situation even worse. I use it when people argue with me, when traffic makes me angry, or when I feel overwhelmed during the work day.

My favorite paced breathing exercise to use is square breathing (also called box breathing) because it’s a simple pattern my brain can jump into without much thought required. To do it, you simply imagine a square and use your breath to move through all four sides, breathing in, holding, breathing out, and holding.

4. Self-Soothing

As the name implies, self-soothing is a distress tolerance coping skill in which you comfort yourself to lower the intensity of your emotions. Self-soothing can involve any of the five senses and often mimics soothing techniques we found calming as children.

How I Use It: Because my primary love language is physical touch, I often use self-soothing techniques in situations where I feel overwhelmed by sadness or loneliness and need a bit of comfort. I sometimes run my fingers across the flame tattoo on my right wrist or hug a pillow. I also will suck on hard candy or play with a metal slinky and forms of self-soothing since those activities involve multiple senses.

5. Alternate Rebellion

Although most distress tolerance skills aim to replace impulsivity and emotion mind with something calming, alternate rebellion is a tool that can help you achieve that feeling of defiance or impulsivity without reinforcing destructive behaviors. In other words, you channel the feelings behind your distress into an activity that is “rebellious” but benign, like dyeing your hair or turning up your music to a point that could be considered disruptive.

How I Use It: In the early stages of my recovery, I frequently used alternate rebellion activities like driving with my windows down and playing loud music in place of unhealthy coping skills like self-harm or drinking in excess. I don’t use this one as much now, but I sometimes enjoy playing music and dancing in my bedroom Callie Torres-style when I really need to feel a rush of happy emotions.

Coping skills are an incredible way to deal with overwhelming emotions. And, the truly beautiful thing about them is there are many options out there that you can try out and use as you see fit. Personally, these five distress tolerance skills are my favorites to use, and many of them have become a habit after years of regular utilization.

How do you cope with overwhelming negative emotions? Let us know in the comments below.