Distract yourself from crisis urges with constructive activities.

# ACCEPTS Skill

---

## Definition

---

**ACCEPTS** is a Distress Tolerance skill in DBT used to distract yourself temporarily from overwhelming emotions. Each letter stands for a category of distraction techniques that can help you get through a crisis without making things worse.

---

## Purpose

---

Used to:

- Reduce emotional intensity to a tolerable level.
- Interrupt harmful impulses.
- Create space for wiser decision-making.
- Help you *cope ahead* with short-term distress when problems can’t be solved immediately.

---

## When to Use

---

Use ACCEPTS when:

- You feel emotionally flooded and unsafe.
- You are experiencing strong urges to act impulsively.
- You cannot change the crisis right away.
- You need to ride out an emotional wave without escalation.

---

## When *Not* to Use

---

Avoid using ACCEPTS if:

- The situation requires urgent problem-solving (e.g., medical emergency).
- You are using distraction to avoid important commitments long-term.
- You are denying the existence of real problems indefinitely.

---

## How-To

---

Here is what each letter stands for and how to apply it:

**A – Activities**

- Engage in healthy activities that require focus (e.g., cleaning, hobbies, exercise).

**C – Contributing**

- Do something kind for others (e.g., volunteer, send a caring text).

**C – Comparisons**

- Compare to a time you felt worse and survived, or to others coping effectively.

**E – Emotions**

- Generate different emotions by watching a funny video or listening to uplifting music.

**P – Pushing Away**

- Temporarily set the distressing situation aside mentally.

**T – Thoughts**

- Distract your mind by counting, doing puzzles, or reciting something memorized.

**S – Sensations**

- Use strong sensory input to shift focus (e.g., holding ice, taking a cold shower).

---

## Tips & Variations

---

- Try combining more than one letter for stronger distraction.
- Make an “ACCEPTS toolkit” with reminders for each category.
- Be mindful not to let distraction turn into chronic avoidance.

---

## Example

---

*Monica was triggered by an argument.*

1. **Activities:** Took her dog for a walk.
2. **Contributing:** Sent an encouraging message to her friend.
3. **Comparisons:** Reminded herself she survived worse arguments.
4. **Emotions:** Watched a lighthearted comedy show.
5. **Pushing Away:** Put her thoughts about the fight in an imaginary box.
6. **Thoughts:** Counted backward from 100 by sevens.
7. **Sensations:** Squeezed a stress ball.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, as part of DBT’s Distress Tolerance module. The acronym draws on cognitive-behavioral and mindfulness-based distraction methods.

---

## Related Skills

---

- IMPROVE the Moment
- Self-Soothing
- TIPP
- Radical Acceptance

---

## Limitations

---

May not be effective if:

- Used exclusively to avoid solving real problems.
- Emotions are left unprocessed over time.
- There is an immediate safety issue that requires action.

---

## Evidence Base

---

Research shows:

- Distraction reduces acute emotional arousal.
- Incorporating sensory strategies helps regulate nervous system responses.
- Regular practice increases emotional resilience.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [ACCEPTS Worksheet](https://www.therapistaid.com/worksheets/dbt-distress-tolerance-skills.pdf)
- *The Dialectical Behavior Therapy Skills Workbook* by McKay, Wood, and Brantley

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Neacsiu, A.D., Rizvi, S.L., & Linehan, M.M. (2010). "Dialectical Behavior Therapy Skills Use as a Mediator and Outcome of Treatment for Borderline Personality Disorder." *Behaviour Research and Therapy*, 48(9), 832–839.

ACCEPTS

Focus on physical sensations to stay grounded in the present.

# Awareness of Body Sensations Skill

---

## Definition

---

**Awareness of Body Sensations** is the skill of intentionally paying attention to what you feel in your body.  
It helps you tune in to physical signals that are linked to your emotions and urges.

---

## Purpose

---

Used to:

- Increase mind-body connection.
- Recognize early signs of distress or escalation.
- Prevent impulsive reactions by catching sensations early.
- Ground yourself in the present moment.
- Improve emotion regulation and distress tolerance.

---

## When to Use

---

Use this skill when:

- You feel overwhelmed, disconnected, or numb.
- You want to understand how emotions manifest physically.
- You’re practicing mindfulness.
- You are preparing to use other DBT skills like Check the Facts or Opposite Action.

---

## When *Not* to Use

---

Avoid using if:

- You feel unsafe to notice body sensations due to trauma (work with a therapist).
- You are in severe crisis and need immediate action (use TIPP skills first).
- Focusing on sensations increases panic without grounding.

---

## How-To

---

1. **Find a Quiet Space:**

   - Sit or lie down comfortably.

2. **Scan Your Body:**

   - Start at your head, slowly move downward.
   - Notice tension, tingling, warmth, coolness, pain.

3. **Describe Sensations:**

   - Use neutral, factual language (e.g., “tight,” “fluttery,” “heavy”).

4. **Allow Sensations:**

   - Observe without trying to change them.

5. **Connect to Emotions:**

   - Consider what feeling the sensation may signal.

6. **Practice Acceptance:**

   - Remind yourself that sensations are temporary.

---

## Tips & Variations

---

- Pair this skill with **Mindfulness of Current Emotion**.
- Use body scan recordings or apps like Insight Timer.
- Journal about your sensations and associated emotions.
- If overwhelmed, open your eyes and focus on your environment.

---

## Example

---

*Maria noticed a pit in her stomach before a difficult conversation.*

- Sat quietly for 3 minutes.
- Noticed tightness in chest, shallow breathing.
- Recognized signs of anxiety.
- Validated: “My body is trying to protect me.”

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD** within DBT mindfulness skills.  
Inspired by:

- Mindfulness-Based Stress Reduction (Jon Kabat-Zinn).
- Somatic practices in psychology and meditation traditions.

---

## Related Skills

---

- Observe
- Describe
- Non-Judgmental Stance
- Mindfulness of Current Emotion

---

## Limitations

---

May not be effective if:

- You expect sensations to go away quickly.
- You judge sensations as “bad” or “wrong.”
- You are using the skill to avoid action or problem-solving indefinitely.

---

## Evidence Base

---

Research shows:

- Body scanning reduces stress and improves self-regulation.
- Awareness of sensations enhances emotional clarity.
- Mindfulness of the body can decrease avoidance and improve resilience.

---

## Further Reading

---

- *DBT Skills Training Manual* by Marsha Linehan
- *Wherever You Go, There You Are* by Jon Kabat-Zinn
- [Body Scan Meditation Script](https://www.mindful.org/body-scan-meditation/)

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Kabat-Zinn, J. (1990). *Full Catastrophe Living*. New York: Dell Publishing.
- Mehling, W.E. et al. (2011). Body awareness: a phenomenological inquiry into the common ground of mind-body therapies. *Philosophy, Ethics, and Humanities in Medicine*, 6(6).

Awareness of Body Sensations

Relax your face to signal openness and acceptance.

# Half-Smiling Skill

---

## Definition

---

**Half-Smiling** is a mindfulness practice in which you gently raise the corners of your mouth into a subtle, peaceful smile.  
It’s a way of signaling openness, acceptance, and willingness to your body and mind, even in distressing situations.

---

## Purpose

---

Used to:

- Help reduce tension and resistance.
- Foster calm and acceptance in the face of discomfort.
- Soften anger, anxiety, and shame.
- Engage the parasympathetic nervous system (the “rest and digest” response).

---

## When to Use

---

Use Half-Smiling when:

- You feel tightness in your face or jaw during strong emotions.
- You want to practice acceptance of reality.
- You are stuck in judgment or resentment.
- You need a simple, discreet mindfulness exercise anywhere.

---

## When *Not* to Use

---

Avoid using if:

- You feel coerced or pressured to pretend you’re okay.
- Smiling feels invalidating to your pain (e.g., you need to cry or express).
- You have not first acknowledged and named your emotions.

---

## How-To

---

1. **Relax Your Face:**

   - Let your forehead, jaw, and shoulders soften.

2. **Take a Few Deep Breaths:**

   - Gently exhale tension.

3. **Half-Smile:**

   - Slightly lift the corners of your mouth.
   - Keep the rest of your face relaxed.

4. **Focus Attention:**

   - Mindfully notice sensations in your face and body.
   - Allow any emotions to be present without pushing them away.

5. **Hold the Half-Smile:**

   - Maintain for at least a few breaths.
   - You can keep it longer if you like.

---

## Tips & Variations

---

- Pair Half-Smiling with **Mindful Breathing**.
- Practice in front of a mirror to see the expression.
- Use Half-Smiling while lying down or sitting comfortably.
- Try combining with **Willing Hands** (palms open, facing upward).

---

## Example

---

*Sam was feeling anxious before a presentation.*

- Paused, unclenched jaw, and took a breath.
- Softened mouth into a half-smile.
- Felt calmer and more accepting of the anxiety.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD** as part of DBT’s mindfulness skills.  
Inspired by:

- Zen Buddhist teachings on mindful presence.
- Thich Nhat Hanh’s practices of gentle smiling to cultivate peace.

---

## Related Skills

---

- Willing Hands
- Mindful Breathing
- Radical Acceptance

---

## Limitations

---

May not be effective if:

- Used as avoidance to suppress valid emotions.
- You expect immediate relief or “happiness.”
- You feel forced to use it without readiness.

---

## Evidence Base

---

Research shows:

- Half-Smiling can activate parasympathetic response.
- Facial feedback can lower stress and improve mood.
- Mindfulness practices including Half-Smiling increase distress tolerance.

---

## Further Reading

---

- *The Miracle of Mindfulness* by Thich Nhat Hanh
- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [DBT Self Help - Half-Smiling](https://www.dbtselfhelp.com/html/half-smile.html)

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Ekman, P., & Friesen, W.V. (1978). *Facial Action Coding System*.
- Thich Nhat Hanh (1975). *The Miracle of Mindfulness*.

Half-Smiling

Use positive mental strategies to make distress more bearable.

# IMPROVE the Moment Skill

---

## Definition

---

**IMPROVE the Moment** is a Distress Tolerance skill in DBT that helps you cope with crisis situations by shifting your mindset or environment to temporarily make the present moment more bearable. Each letter stands for a specific strategy to “improve” your experience.

---

## Purpose

---

Used to:

- Survive intense emotional pain without making the situation worse.
- Prevent impulsive or self-destructive behaviors.
- Soothe yourself and foster a sense of hope and meaning.

---

## When to Use

---

Use IMPROVE when:

- You’re in an emotional crisis and can’t immediately change the situation.
- You feel urges to engage in problematic coping (e.g., self-harm, substance use).
- You need tools to get through the next few minutes or hours.

---

## When *Not* to Use

---

Avoid using this skill if:

- Immediate problem-solving or safety planning is required.
- You are avoiding urgent responsibilities indefinitely.
- You are using it to deny or minimize real problems.

---

## How-To

---

**I – Imagery**

- Visualize a peaceful, safe place or successful coping.

**M – Meaning**

- Find or create meaning in the crisis (e.g., personal growth, values).

**P – Prayer**

- Engage in prayer or spiritual connection (if relevant to you).

**R – Relaxation**

- Practice deep breathing, muscle relaxation, or stretching.

**O – One Thing in the Moment**

- Focus all attention on just one small task or sensation.

**V – Vacation**

- Take a short break from stress (e.g., step outside, unplug briefly).

**E – Encouragement**

- Use self-encouraging phrases (e.g., “I can handle this,” “This will pass”).

---

## Tips & Variations

---

- You don’t have to do every letter—pick what fits.
- Create a list of go-to strategies under each letter.
- Combine IMPROVE with Self-Soothing for extra support.

---

## Example

---

*Aaron felt panicked after a breakup.*

1. **Imagery:** Closed his eyes and pictured hiking in the mountains.
2. **Meaning:** Reminded himself this experience helps him grow stronger.
3. **Prayer:** Silently asked for strength from a higher power.
4. **Relaxation:** Focused on slow, steady breaths.
5. **One Thing:** Paid attention only to the feeling of his feet on the floor.
6. **Vacation:** Took a 30-minute walk alone.
7. **Encouragement:** Repeated, “I will get through this.”

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD** as part of DBT’s Distress Tolerance skills module, blending Eastern mindfulness practices with cognitive-behavioral strategies.

---

## Related Skills

---

- Self-Soothing
- Radical Acceptance
- TIPP Skill
- Pros and Cons

---

## Limitations

---

May not be effective if:

- You expect it to fix the underlying problem.
- You are in immediate danger and need urgent action.
- You use it exclusively as an avoidance strategy.

---

## Evidence Base

---

Research shows:

- Imagery and relaxation reduce physiological stress.
- Finding meaning and self-encouragement build resilience.
- Consistent use improves emotional regulation over time.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [IMPROVE the Moment Worksheet](https://www.therapistaid.com/worksheets/improve-the-moment.pdf)
- *The Dialectical Behavior Therapy Skills Workbook* by McKay, Wood, and Brantley

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Neacsiu, A.D., Rizvi, S.L., & Linehan, M.M. (2010). "Dialectical Behavior Therapy Skills Use as a Mediator and Outcome of Treatment for Borderline Personality Disorder." *Behaviour Research and Therapy*, 48(9), 832–839.

IMPROVE

Weigh the benefits and costs of acting on an urge or tolerating distress.

# Pros and Cons Skill

---

## Definition

---

**Pros and Cons** is a Distress Tolerance skill used to carefully weigh the **advantages and disadvantages** of acting on an urge or choosing alternative behaviors. It helps you make thoughtful decisions when emotions are high.

---

## Purpose

---

Used to:

- Delay impulsive reactions.
- Clarify potential outcomes.
- Reinforce commitment to long-term goals.
- Increase motivation to use skills instead of problem behaviors.

---

## When to Use

---

Use Pros and Cons when:

- You feel an urge to engage in a harmful behavior (e.g., self-harm, substance use, lashing out).
- You are deciding whether to tolerate distress or give in to urges.
- You need clarity on the impact of choices.

---

## When *Not* to Use

---

Avoid using this skill if:

- You are in immediate danger and must act quickly.
- You are in a situation where delaying action would create harm.
- You are too dysregulated to think clearly (use STOP first).

---

## How-To

---

1. **Identify the Behavior.**  
   What are you considering doing? Example: Self-harm, using substances, quitting a job impulsively.

2. **List Pros and Cons of Acting on the Urge.**  
   - Short-term benefits and drawbacks.

3. **List Pros and Cons of NOT Acting on the Urge.**  
   - Long-term benefits and drawbacks.

4. **Review Your Lists.**  
   Read them slowly and carefully. Focus on long-term goals and values.

5. **Visualize Outcomes.**  
   Imagine the likely consequences of each option.

6. **Decide Mindfully.**  
   Choose the path that aligns with your Wise Mind.

---

## Tips & Variations

---

- Write lists down to make them concrete.
- Use a worksheet (DBT handouts often include templates).
- Keep your list somewhere visible to remind you during crises.
- Read your lists out loud to reinforce commitment.
- Revisit your lists regularly, even when calm, to strengthen motivation.

---

## Example

---

*Casey wants to binge eat after a stressful day.*

- **Pros of Binge Eating:**
  - Immediate comfort
  - Numbs feelings

- **Cons of Binge Eating:**
  - Guilt and shame later
  - Stomach pain
  - Undermines health goals

- **Pros of NOT Binge Eating:**
  - Feels empowered
  - Stays on track with self-care

- **Cons of NOT Binge Eating:**
  - Has to tolerate uncomfortable emotions

**Decision:** Tolerate distress and use self-soothing skills.

---

## Inventor / Origin

---

Pros and Cons is a core **Distress Tolerance skill in DBT**, developed by **Marsha Linehan, PhD**. It is adapted from cognitive-behavioral techniques that emphasize decisional balance.

---

## Related Skills

---

- STOP Skill
- Crisis Survival Strategies
- Radical Acceptance
- TIPP Skills

---

## Limitations

---

May not be effective if:

- You avoid reviewing the cons of harmful behavior.
- You rush through the lists without reflection.
- You are too dysregulated to think logically.

---

## Evidence Base

---

Research shows:

- Pros and Cons increases motivation to use skills over maladaptive coping.
- Strengthens commitment to behavioral change.
- Reduces impulsivity.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [DBT Self-Help: Pros and Cons](https://www.dbtselfhelp.com/html/pros_and_cons.html)
- *The Dialectical Behavior Therapy Skills Workbook* by McKay, Wood, and Brantley
- [Decisional Balance in CBT](https://www.psychologytools.com/resource/decisional-balance/)

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. New York: Guilford Press.
- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.

Pros and Cons

Fully accept reality as it is instead of fighting against it.

# Radical Acceptance Skill

---

## Definition

---

**Radical Acceptance** is a core DBT Distress Tolerance skill that involves fully and completely accepting reality as it is, without judgment, resistance, or avoidance—even if you dislike it or it feels unfair.

---

## Purpose

---

Used to:

- Reduce suffering caused by fighting reality.
- Free up mental and emotional energy to respond effectively.
- Help end cycles of bitterness, resentment, or denial.
- Promote peace and psychological flexibility.

---

## When to Use

---

Use Radical Acceptance when:

- You are stuck in rumination about why something “shouldn’t be happening.”
- You feel paralyzed by anger, bitterness, or denial.
- You cannot change the past or aspects of the present.
- You notice that fighting reality is making pain worse.

---

## When *Not* to Use

---

Avoid using Radical Acceptance if:

- You have the ability and responsibility to change the situation (e.g., unsafe conditions, abuse).
- You are using “acceptance” as an excuse for inaction or enabling harm.
- You are in acute danger requiring immediate intervention.

---

## How-To

---

1. **Notice you are resisting reality.**

   - What thoughts are you having? (“It shouldn’t be this way.”)

2. **Name what you are fighting.**

   - Be specific: “I am rejecting that this relationship ended.”

3. **Remind yourself that reality is as it is, whether you approve or not.**

4. **Use your body:**

   - Breathe deeply.
   - Relax your face and shoulders.
   - Unclench your jaw.

5. **Use self-talk:**

   - “This is happening right now.”
   - “I don’t have to like it to accept it.”

6. **Practice acceptance over and over.**

   - Radical Acceptance is a process, not a one-time event.

---

## Tips & Variations

---

- Pair Radical Acceptance with self-compassion.
- Use visualization (imagine yourself opening your hands to reality).
- Distinguish acceptance from approval: accepting doesn’t mean you condone.
- Practice with small annoyances to build skill.

---

## Example

---

*Jorge lost his job unexpectedly.*

1. **Resisting:** “This is unfair. It shouldn’t have happened.”

2. **Radical Acceptance:** “It did happen. I lost my job. This is reality.”

3. **Action:** After accepting, he started making plans to look for new work.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, Radical Acceptance integrates concepts from:

- Zen mindfulness practices
- Behavioral psychology
- Stoicism

---

## Related Skills

---

- Willingness
- Turning the Mind
- Mindfulness
- Self-Compassion

---

## Limitations

---

May not be effective if:

- Used to avoid appropriate problem-solving.
- You expect it to immediately remove all pain.
- You are in denial about the consequences of acceptance.

---

## Evidence Base

---

Research shows:

- Acceptance-based strategies reduce emotional suffering.
- Practicing Radical Acceptance improves coping and reduces avoidance.
- Mindfulness and acceptance together increase psychological resilience.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [Radical Acceptance Article](https://www.psychologytoday.com/us/blog/pieces-mind/201206/radical-acceptance)
- *Radical Acceptance* by Tara Brach

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (2011). *Acceptance and Commitment Therapy: The Process and Practice of Mindful Change*.

Radical Acceptance

Pause and ground yourself before reacting to strong emotions.

# STOP Skill

---

## Definition

---

STOP is a Distress Tolerance skill used to **pause before reacting impulsively**, especially when you are emotionally triggered. The acronym stands for:

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

---

## Purpose

---

Used to:

- Prevent impulsive actions that worsen a situation.
- Ground yourself in the present moment.
- Respond effectively rather than reacting emotionally.
- Maintain self-respect and align actions with your goals.

---

## When to Use

---

Use the STOP skill when:

- You feel strong urges to act impulsively.
- You are about to say or do something you might regret.
- You are overwhelmed by intense emotions.
- You need to buy time to think clearly.

---

## When *Not* to Use

---

Avoid using STOP if:

- You are in immediate physical danger that requires rapid action.
- Pausing could lead to greater harm.
- You are avoiding necessary assertive action.

---

## How-To

---

1. **S — Stop.**  
   Freeze. Do not move a muscle. Don’t react. Just stop.

2. **T — Take a step back.**  
   Take a deep breath. Remove yourself mentally or physically from the situation if needed.

3. **O — Observe.**  
   Notice what’s happening inside and around you.

   - What thoughts are showing up?
   - What urges do you feel?
   - What sensations are in your body?

4. **P — Proceed mindfully.**  
   Decide how you want to act. Consider your Wise Mind, your goals, and what will be effective.

---

## Tips & Variations

---

- Practice STOP in less intense situations to build the skill.
- Pair STOP with paced breathing or grounding exercises.
- Use a visual reminder (e.g., a STOP sign image on your phone).
- If you can’t remember all steps, simply pausing and breathing can help.

---

## Example

---

*Alex received a text that made them angry and wanted to immediately reply with insults. Instead, they:*

- **S:** Stopped and didn’t type.
- **T:** Took a deep breath and set their phone down.
- **O:** Observed their racing heart and clenched jaw.
- **P:** Chose to wait 10 minutes before deciding how to respond.

---

## Inventor / Origin

---

STOP is part of the **Distress Tolerance skills module in DBT**, created by **Marsha M. Linehan, PhD**. It integrates principles from mindfulness and crisis survival strategies.

---

## Related Skills

---

- Wise Mind
- TIPP Skills
- Pros and Cons
- Mindfulness of Current Emotion

---

## Limitations

---

May not be effective if:

- You repeatedly use STOP to avoid addressing problems.
- You are in a situation requiring immediate safety action.
- You don’t practice the skill in lower-stakes moments first.

---

## Evidence Base

---

Research shows the STOP skill:

- Reduces impulsive behavior.
- Supports emotional regulation.
- Improves crisis management.
- Increases sense of control during distress.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [DBT Self-Help: STOP Skill](https://www.dbtselfhelp.com/html/stop.html)
- *The Dialectical Behavior Therapy Skills Workbook* by McKay, Wood, and Brantley
- [Mindfulness in DBT](https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/)

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. New York: Guilford Press.
- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.

STOP

Calm yourself by engaging your five senses in comforting activities.

# Self-Soothing Skill

---

## Definition

---

**Self-Soothing** is a Distress Tolerance skill in DBT that involves comforting yourself through the deliberate use of your five senses: sight, sound, smell, taste, and touch. It is designed to reduce distress by engaging pleasant sensory experiences that promote calm and grounding.

---

## Purpose

---

Used to:

- Decrease emotional pain without acting impulsively.
- Nurture and care for yourself in healthy ways.
- Cultivate feelings of safety and comfort during difficult moments.

---

## When to Use

---

Use Self-Soothing when:

- You feel intense sadness, fear, or anger.
- You are experiencing urges to self-harm or use substances.
- You want to gently regulate emotion without problem-solving right away.

---

## When *Not* to Use

---

Avoid using this skill if:

- You are in immediate danger and need to take action.
- You are trying to suppress emotions long-term instead of processing them.
- Self-soothing activities could become compulsive or avoidant.

---

## How-To

---

1. **Sight:** Look at calming or beautiful things (e.g., nature, art, candles).
2. **Hearing:** Listen to soothing music, sounds of nature, or calming voices.
3. **Smell:** Use pleasant scents (e.g., essential oils, fresh flowers, your favorite lotion).
4. **Taste:** Mindfully savor comforting food or drink (e.g., herbal tea, chocolate).
5. **Touch:** Wrap yourself in a soft blanket, take a warm bath, hold something comforting.

---

## Tips & Variations

---

- Create a *Self-Soothing Kit* with items for each sense.
- Rotate activities so they stay effective.
- Combine multiple senses at once for greater impact.
- Practice when you’re calm so it’s easier to use when distressed.

---

## Example

---

*Lena feels lonely and overwhelmed after work.*

1. Lights a scented candle (smell).
2. Wraps up in a cozy blanket (touch).
3. Listens to gentle piano music (hearing).
4. Sips chamomile tea slowly (taste).
5. Looks at photos of a peaceful beach (sight).

---

## Inventor / Origin

---

Self-Soothing was integrated into DBT by **Marsha Linehan, PhD**, as part of the Distress Tolerance skills module, drawing on practices from mindfulness, behavioral therapy, and sensory-based interventions.

---

## Related Skills

---

- IMPROVE the Moment
- Pros and Cons
- TIPP Skill
- Radical Acceptance

---

## Limitations

---

May not be effective if:

- You expect it to solve the root of the problem.
- You engage in self-soothing only as avoidance.
- You are unable to access comforting sensory tools in the moment.

---

## Evidence Base

---

Research shows:

- Self-Soothing lowers physiological arousal and distress.
- Regular practice improves resilience to emotional crises.
- Mindful sensory engagement can increase emotional regulation capacity.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [Self-Soothing Techniques](https://www.therapistaid.com/worksheets/self-soothing.pdf)
- *The Dialectical Behavior Therapy Skills Workbook* by McKay, Wood, and Brantley
- [DBT Self-Help: Self-Soothing](https://www.dbtselfhelp.com/html/self-soothe.html)

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Neacsiu, A.D., Rizvi, S.L., & Linehan, M.M. (2010). "Dialectical Behavior Therapy Skills Use as a Mediator and Outcome of Treatment for Borderline Personality Disorder." *Behaviour Research and Therapy*, 48(9), 832–839.

Self-Soothing

Use body-based techniques to quickly lower emotional arousal.

# TIPP Skill

---

## Definition

---

**TIPP** stands for **Temperature, Intense Exercise, Paced Breathing, and Progressive Muscle Relaxation**. It is a Distress Tolerance skill used to rapidly reduce extreme emotional arousal by directly regulating the body’s physiological state.

---

## Purpose

---

Used to:

- Bring the nervous system out of “fight, flight, or freeze.”
- Reduce overwhelming emotions quickly.
- Regain control during crises.
- Stabilize the body before using other coping skills.

---

## When to Use

---

Use TIPP when:

- You are feeling intense distress or panic.
- You are experiencing overwhelming anger, anxiety, or urges.
- You need to calm down quickly to prevent acting impulsively.

---

## When *Not* to Use

---

Avoid using this skill if:

- You have medical conditions that contraindicate cold exposure or intense exercise.
- You are already calm or only mildly upset.
- You need a long-term solution rather than immediate relief.

---

## How-To

---

**T - Temperature**

1. Hold your breath and submerge your face in a bowl of cold water for 30 seconds, or apply ice packs to the eyes and cheeks.
2. This activates the “mammalian dive reflex,” slowing your heart rate.

**I - Intense Exercise**

1. Engage in vigorous exercise (e.g., running in place, jumping jacks) for 10–20 minutes.
2. This burns off adrenaline and calms the body.

**P - Paced Breathing**

1. Slow your breathing to about 5–6 breaths per minute.
2. Inhale for 4 counts, exhale for 6–8 counts.

**P - Progressive Muscle Relaxation**

1. Tense and relax muscle groups in sequence.
2. Focus on the contrast between tension and release.

---

## Tips & Variations

---

- Keep a bowl of ice water ready if you struggle with panic attacks.
- Combine steps (e.g., cold water followed by paced breathing).
- Adjust duration of exercises based on your fitness level.
- Use TIPP discreetly—carrying an ice pack in your bag or doing breathing exercises anywhere.

---

## Example

---

*Jordan feels the urge to self-harm after an argument.*

1. Runs in place for 5 minutes.
2. Submerges face in cold water.
3. Practices slow breathing for 5 minutes.
4. Feels calmer and more able to call a friend.

---

## Inventor / Origin

---

TIPP is part of **DBT Distress Tolerance Skills**, created by **Marsha Linehan, PhD**. The skill integrates principles from behavioral therapy, biology, and mindfulness practice.

---

## Related Skills

---

- STOP Skill
- Self-Soothing
- Radical Acceptance
- Pros and Cons

---

## Limitations

---

May not be effective if:

- Practiced inconsistently or without preparation.
- You have severe medical restrictions.
- You expect it to solve underlying problems permanently.

---

## Evidence Base

---

Research shows:

- TIPP effectively decreases heart rate and emotional arousal.
- Immediate physiological calming improves ability to use other DBT skills.
- Cold water immersion reduces panic symptoms.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [Mayo Clinic: Relaxation Techniques](https://www.mayoclinic.org/tests-procedures/relaxation-techniques/about/pac-20385099)
- *The Dialectical Behavior Therapy Skills Workbook* by McKay, Wood, and Brantley
- [DBT Self-Help: TIPP](https://www.dbtselfhelp.com/html/tipp.html)

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Gratz, K.L., & Gunderson, J.G. (2006). "Preliminary Data on an Acceptance-Based Emotion Regulation Group Intervention for Deliberate Self-Harm Among Women with Borderline Personality Disorder." *Behavior Therapy*, 37(1), 25–35.

TIPP

Commit again and again to accepting reality whenever resistance returns.

# Turning the Mind Skill

---

## Definition

---

**Turning the Mind** is a DBT Distress Tolerance skill that involves making a conscious, internal commitment to accept reality as it is, over and over again. It is the moment when you *turn your mind* toward willingness and away from resistance.

---

## Purpose

---

Used to:

- Bridge the gap between recognizing reality and fully accepting it.
- Counteract avoidance, denial, or bitterness.
- Choose to engage with reality rather than fighting it.
- Move into more effective action.

---

## When to Use

---

Use Turning the Mind when:

- You notice you are rejecting reality (“I refuse to accept this”).
- You feel stuck in anger or resentment.
- You’ve acknowledged something painful but keep slipping into non-acceptance.
- You need to recommit to acceptance moment by moment.

---

## When *Not* to Use

---

Avoid using if:

- You are in active danger that requires immediate problem-solving.
- Acceptance would reinforce passivity in harmful situations.
- You need to take action first to ensure safety.

---

## How-To

---

1. **Observe that you are not accepting reality.**

   - “I can feel myself clenching, fighting this.”

2. **Notice the urge to reject reality.**

   - Label it: “Resistance.”

3. **Turn your mind toward acceptance.**

   - It is an *internal shift*—you are choosing willingness.

4. **Do it again, and again.**

   - Every time you drift back to rejection, recommit.

5. **Use supportive self-statements:**

   - “I am choosing to accept this reality as it is.”
   - “Acceptance is the only way through.”

---

## Tips & Variations

---

- Use visual imagery: picture yourself turning a wheel or opening a door.
- Pair with deep breathing and mindful observation.
- Expect to turn the mind many times—it’s not a one-time event.
- Practice with small frustrations before tackling big challenges.

---

## Example

---

*Marisol’s partner ended their relationship.*

- **Initial Reaction:** “I can’t accept this. It’s too unfair.”

- **Turning the Mind:** “I am choosing to accept that this relationship is over.”

- **Follow-Up:** She repeated this phrase whenever the urge to reject reality came back.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, Turning the Mind is grounded in:

- Zen mindfulness principles
- Behavioral commitment strategies
- Acceptance-based approaches to distress tolerance

---

## Related Skills

---

- Radical Acceptance
- Willingness
- Mindfulness of Current Emotion

---

## Limitations

---

May not be effective if:

- You expect it to remove emotional pain instantly.
- You confuse acceptance with approval or resignation.
- You have not first clearly identified what you are resisting.

---

## Evidence Base

---

Research shows:

- Repeated practice of acceptance reduces suffering.
- Mindful commitment enhances psychological flexibility.
- Turning the Mind supports better coping during crises.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [Turning the Mind Resource](https://www.dbtselfhelp.com/html/turning_the_mind.html)
- *Radical Acceptance* by Tara Brach

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (2011). *Acceptance and Commitment Therapy: The Process and Practice of Mindful Change*.

Turning the Mind

Be open and flexible rather than stubborn or resistant to reality.

# Willingness vs. Willfulness Skill

---

## Definition

---

**Willingness** means choosing to do what works in each situation, with openness and flexibility.  
**Willfulness** is the opposite—stubbornly refusing to tolerate reality, clinging to control, or giving up entirely.

---

## Purpose

---

Used to:

- Help you let go of rigid, self-defeating behaviors.
- Foster an open, accepting attitude that promotes effective action.
- Support problem-solving and acceptance in distressing situations.
- Increase psychological flexibility and resilience.

---

## When to Use

---

Use Willingness when:

- You catch yourself resisting reality or digging in your heels.
- You are stuck in unhelpful patterns (e.g., procrastination, passive-aggression).
- You want to act skillfully, rather than react impulsively.
- You need to accept what you cannot change and do what is needed.

---

## When *Not* to Use

---

Avoid using if:

- Immediate action is required for safety, not acceptance.
- You are in situations of abuse where compliance may be dangerous.
- You have not identified whether your willfulness serves a protective purpose that needs exploring first.

---

## How-To

---

1. **Observe Willfulness:**

   - Notice signs of resistance (“I won’t,” “I shouldn’t have to,” “No.”).
   - Label it: “Willfulness.”

2. **Radically Accept the Moment:**

   - Acknowledge reality: “This is what is happening.”

3. **Turn the Mind Toward Willingness:**

   - Decide to open yourself to doing what works.
   - Recommit each time willfulness returns.

4. **Ask:**

   - “What is the effective action here?”
   - “What would willingness look like right now?”

5. **Act Willingly:**

   - Take the next right step, however small.

---

## Tips & Variations

---

- Use body posture: unclench fists, relax shoulders, soften your face.
- Imagine physically laying down your resistance.
- Willingness does *not* mean liking the situation—it means accepting it.
- Keep practicing; willingness is a choice you make over and over.

---

## Example

---

*Devon was told they needed to redo a project at work.*

- **Willfulness:** “I refuse. It’s not fair.”
- **Shift:** Recognize resistance and name it.
- **Willingness:** “I don’t like this, but I will do what is needed to move forward.”

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, this skill draws on:

- Zen concepts of radical acceptance
- Behavioral principles of effectiveness
- Mindfulness of internal resistance

---

## Related Skills

---

- Radical Acceptance
- Turning the Mind
- Mindfulness of Current Emotion

---

## Limitations

---

May not be effective if:

- You use it as avoidance (e.g., to avoid expressing boundaries).
- You expect willingness to remove discomfort.
- You haven’t acknowledged and validated your emotions first.

---

## Evidence Base

---

Research shows:

- Practicing willingness reduces experiential avoidance.
- Willingness increases adaptive coping and psychological well-being.
- Mindfulness-based acceptance improves emotional regulation.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [Willingness vs. Willfulness Overview](https://www.dbtselfhelp.com/html/willingness_vs__willfulness.html)
- *Radical Acceptance* by Tara Brach

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (2011). *Acceptance and Commitment Therapy: The Process and Practice of Mindful Change*.

Distress Tolerance DBT Tools