5 'Weird' Distress Tolerance Therapy Skills From DBT That Help Emotional Regulation

When you’re really struggling with your mental health, sometimes you’ll try just about anything that might help you feel better. And let’s face it, sometimes the therapy skills your therapist may ask you to try seem, well, unusual at first, especially when you’re doing dialectical behavior therapy (DBT).

DBT is designed specifically for people who struggle with emotional regulation, including people with borderline personality disorder and those who self-harm. At the core of DBT are four foundational sets of skills: mindfulness, distress tolerance, interpersonal effectiveness and emotion regulation.

Within each of these modules, you’ll learn a whole pile of skills often presented in a mind-boggling array of acronyms like PLEASE, DEAR MAN and ACCEPTS. You’ll get the hang of it in no time, don’t worry, so you feel better and, in the DBT vernacular, have a more “effective” life.

“The goal of DBT is to help individuals regulate emotions, typically negative emotions, that they consider ineffective and inconsistent with their own personal values and goals to their lives,” Pam Christy, Psy.D., HSPP, an Indiana-based DBT-trained psychologist, told The Mighty. “DBT is about ‘building a life worth living.’”

While all of DBT’s skills are designed to be helpful, after asking The Mighty community, there are five DBT skills that might seem so strange at first it’s hard to imagine they would even work. So we spoke with two expert DBT therapists to find out why these (distress tolerance) DBT skills seem “weird” at first and why they’re really very effective.

Here’s what we learned:

1. Half Smile

Half smile, willing hands #dbt pic.twitter.com/SCXbJ1bINh

— Kara Christensen (@KChristensenPhD) September 6, 2019

When you’re looking for distress tolerance skills, “half smile” may not be what you had in mind. What is a half smile, anyway? And how is this going to help when you feel flooded with emotions?

The goal of half smile is to release tension from the top of your head down to the jaw. Then, lightly turn up the corners of your mouth, which sends a message to your brain and the rest of your body to emotionally cool off a bit.

“The problem that people will have with it is they over-extend the smile, and it actually creates tension,” Christy said. “Half smile’s a subtle way of changing brain chemistry, from that kind of irritation, annoyance or even worse, a lot of pain, to more of an acceptance.”

Half smile isn’t going to solve all your problems, but it can give you a little relief temporarily.

“It’s not about going from being sad to being happy,” Nikki Kraslin, Psy.D., a DBT-trained psychologist in Colorado, told The Mighty. “It might be about going from being sad, to being a little more at peace with being sad.”

2. Willing Hands

Willing hands is a close cousin to the half smile in the distress tolerance skills portion of DBT. The idea is you stand, sit or lie with the palms of your hands out and open with your fingers relaxed.

As Marsha Linehan, the founder of DBT explains it, willing hands can help you accept and diffuse an intense emotion like anger. It may sound counterintuitive to “accept” an emotion that’s overwhelming or the result of something that’s deeply unfair, but it’s a cornerstone of emotion regulation.

“In emotion mind, we might do things like, nonstop calling and send 5,000 texts,” Christy explained. “It is that refusal to accept reality as it is and so, we think about turning our mind toward a willingness to accept reality. Doesn’t mean that we have to like it because the things we’re talking about, we don’t like, and we still need to accept them.”

3. TIP the Temperature

When you’re experiencing a really strong emotion, you probably know it’s a very physical experience — you’ll feel it in your body too. That’s why the DBT TIPP skills are designed to literally change your body chemistry to reduce extreme emotions fast. How? First is “tipping” your temperature by holding your breath while dunking your face in a bowl of cold water for 30 seconds.

“When I teach it, I’ll preface it by saying, ‘Look, I know this skill sounds super wacky.’ And then I’ll get into some of the benefits of the skill,” Kraslin said. “I have some people in groups who swear by that skill as far as the ability to change affect really, really quickly.”

Sounds strange, but the science behind it doesn’t lie. Submerging your face in cold water quickly drops your blood pressure and down-regulates your emotional intensity along with it. The effect was first observed in scuba divers.

If you want to try this tip the temperature skill, please check with a medical professional first if you have blood pressure issues or migraine. As an alternative to a bowl of cold water, you can also try holding a cold pack on your eyes and cheeks.

4. Comparisons

One of the more invalidating things to hear when you’re struggling is a comparison of how what you’re going through isn’t as bad as some other dire world problem. You might feel even worse or guilty. Conventional wisdom would say, therefore, comparing (or minimizing) what you’re going through isn’t helpful. Unless of course you’re trying out the ACCEPTS skills.

ACCEPTS stands for “Activities, Contributing, Comparisons, Emotions, Push away, Thoughts, and Sensation.” It’s a DBT distress tolerance and distraction skill designed to shift your perspective on your current experience.

“Think of another part of the country or the world where people are really suffering in a different sort of way… or even think of a time that you struggled more than you’re struggling right now and compare yourself to that older version of yourself,” Kraslin said.

While some people find comparisons helpful, Kraslin also said this is one skill people can have a lot of trouble with. It serves as a good reminder that not every skill will be helpful to you, and there’s nothing wrong with that.

“I would say that skill, very simply put, it’s just not for everyone,” Kraslin added. “And I always tell people, that’s perfectly OK.”

5. Push Away

In #DBT they LOVE acronyms. I find it helps me remember stuff when I’m wound up. “Wise mind ACCEPTS” is used in distress tolerance. pic.twitter.com/h1HXQY6NtA

— @NHS (@NHS) March 7, 2017

ACCEPTS also includes the skill “push away,” or block a distressing situation from your mind, temporarily walk away or “put the pain on a shelf, box it up and put it away for a while,” according to the official DBT skills manual. We all need a break sometimes when we’re overwhelmed, so at first glance push away doesn’t seem so weird. But Kraslin said it can cause confusion because it seems like a direct contradiction to many other DBT skills.

“I’m very careful when I’m explaining the skill of push away to let people know that this is not one of your skills of daily living,” Kraslin said, adding:

If you overuse the skill of push away, and all you’re ever doing is pushing away your problems, that’s going to come back and make things even worse. But every once in a while, there’s a time and a place for pushing something away. And that would be let’s say, if you’re at a business meeting, and you’re really, really upset by something… and yet you’re about to do a presentation. Can you put that on the shelf for awhile and then go and do your presentation?

Even if some of the new therapy skills you’re learning sound “weird,” like these five from DBT, remember they usually serve a purpose. If you’re unsure about something, don’t be afraid to ask your therapist for clarification. Therapy like DBT can be really effective, so keep practicing. And remember that not every skill will work for you every time you try it, but it’s worth it to keep at it.

“It’s probably the hardest therapy you’ll ever do because it requires a lot of energy and openness and willingness to try new things and to do them over and over again,” Christy said of DBT. “I tell everybody who walks in my office the same thing, which is, it’s the most beneficial treatment I’ve ever found to help people with emotion dysregulation disorders. And it is more than just learning skills — it really teaches a way of living life.”

What are the “weirdest” DBT skills?