Distress Tolerance Skills

Cheat Sheet
Notes: to be used in crisis moments; only works in the short term

STOP Skills
- Stop
Stop; Do not just react. Stop! Freeze! Do not move a muscle! Your
Take A Step Back; emotions may try to make you act without thinking. Stay in control!
Observe;
Proceed Mindfully - Take a step back
Take a step back from the situation. Take a break. Let go. Take a
deep breath. Do not let your feelings make you act impulsively.

- Observe
Notice what is going on inside you and outside you. What is the
situation? What are your thoughts and feelings?

- Proceed Mindfully
Act with awareness. In deciding what to do, consider your thoughts
and feelings, the situation, and other people’s thoughts and
feelings. Think about your goals. Ask Wise Mind: Which actions will
make it better or worse?
Pros and
cons Overview of pros and cons:
A grid with 4 boxes. Pros and cons of acting mindlessly (do the crisis
behaviour), and pros and cons of acting mindfully (resist the crisis
behaviour)

When to use pros and cons:

- To compare the advantages and disadvantages of different options
- When deciding between two choices
- In-depth examination of choices
- To resist destructive urges
- To ultimately make a choice using Wise Mind

How to use pros and cons:

- Describe the crisis behaviour
- Consider long term and short-term consequences
- Consider the advantages and disadvantages of the behaviour

IMPORTANT NOTES:
- Rehearse pros and cons multiple times
- Consider pros and cons for each different crisis urge
- Review earlier pros and cons when a crisis urge strikes
- Say no to crisis urges
TIPP Skills
- Tipping the temperature of your face with coldness:
Tip; Applying cold water (usually by submerging your face into a bowl of water
Intense exercise; for as long as you comfortably can), an ice pack, or cold fingers to
Paced breathing; the face, particularly the temple, eyes, and cheek bones, changes
Paired muscle your body chemistry to reduce high emotional arousal and feelings
relaxation of being overwhelmed

- Intense Aerobic Exercise

Work out pent up adrenaline that is caused by high arousal of emotions. Do
physical exercise, even if only for a short time. Go for a fast walk, a
run, lift weights, play basketball, etc

- Paced Breathing
Take a deep breath, breathing deeply.
Slow the pace of inhaling and exhaling (on average, 5 to 6 breaths per
minute).
Exhale longer than inhalation (for example, 4 seconds in, 6 - 8 seconds out)

- Paired Muscle Relaxation

While inhaling, tense your muscles
Notice the tension in your body
Say ‘relax’ in your mind
Let go of the tension as you breathe out
Notice the difference in your body
Distraction
(Wise Mind - Activities
Watch a movie; clean a room; go to an event; play a computer game; go
ACCEPTS) for a walk; eat a meal; go out with a friend; listen to music; read a
book
Activities;
Contributing;
Comparisons; - Contributing
Emotions; Do volunteer work; help a friend or family member; surprise someone
Pushing Away; with something nice; do something thoughtful
Thoughts;
Sensations - Comparisons
Compare the feeling you have now to a previous feeling; think about other
people coping the same as you or less than you; compare to those
who are less fortunate; watch reality shows about others’
troubles; read about disasters

- Emotions (different)
Read an emotional book; watch an emotional movie or tv show; listen to
music that creates a different emotion

- Pushing Away
Leave the situation mentally; build an imaginary wall between you and the
situation; deny the problem for the moment; put the situation in
an imaginary box and shelf it for a while

- Thoughts (others)
Count to 10; count colours in a painting or out the window, count
anything; repeat words to a song in your head; Watch a movie or
TV; read a book; day dream

- Sensations
Listen to very loud music; squeeze a stress ball; have a shower, go for a
walk when it’s cold outside; have a cold drink
Self-Soothing
(Five senses) - Vision
Look at the stars at night; look at pictures in a book; buy a beautiful
Vision; flower; make a beautiful space in a room; people-watch; window
Hearing; shop; go to a museum; look at nature; walk in a pretty part of
Smell; town; watch a sunrise or sunset; watch a dance performance; take
Taste; a walk in a park; browse through a store
Touch
- Hearing
Listen to soothing music; listen to the sounds of nature; listen to the
sounds of the city; sing to your favourite songs; hum a soothing
tune; listen to a specially made playlist

- Smell
Use your favourite shampoo, lotion, or perfume; put lemon on your
furniture, put eucalyptus oil in a bowl in your room; smell flowers;
open the window and smell the air; use a diffuser to burn oils

- Taste
Eat some of your favourite foods; drink your favourite drink; treat yourself
to a dessert; chew your favourite gum; mindfully eat – taste every
bite

- Touch
Have a long bath or shower; pet your dog or cat; have a massage; put
lotion on; go for a drive with the windows down; run your hand
along smooth wood or leather; hug someone; put clean sheets on
the bed; notice touch that is soothing
Improving the - Imagery
Imagine a relaxing scene; imagine a secret room; imagine everything going
moment
well; create a fantasy world
Imagery;
Meaning; - Meaning
Prayer; Find purpose or meaning in a painful situation; focus on whatever positive
Relaxing actions; aspects of a painful situation you can find; repeat these positive
One thing in the aspects in your mind; remember, listen to, or read about spiritual
moment; values
Vacation (brief);
Encouragement and
- Prayer
re-thinking the
Open your heart to a supreme being, God, or your own wise mind; ask for
situation
strength to bear the pain; turn things over to God or a higher
being

- Relaxing actions
Drink hot milk; massage your neck and scalp; practise yoga or other
stretching; breathe deeply; change your facial expression

- One thing in the moment

Focus your entire attention on what you are doing; keep yourself in the
moment; put your mind in the present; focus your attention on
the physical

- Vacation (brief)
Give yourself a brief vacation; get in bed and put the covers over your
head; go to the beach or the woods for the day; get a magazine
and read it with chocolates; take a blanket to the park and sit on it
for the whole afternoon; take a 1-hour breather from work; take a
brief vacation from responsibility

- Self-Encouragement and rethinking the situation

Cheerlead yourself; ‘you got this’; ‘you go, girl’; ‘I’m doing the best I can’, ‘I
can stand it’ (repeatedly); ‘this too, shall pass’; Or create own
mantra
 ‘I am the champion, no time for others’ – sung to Queen’s ‘We are the
champions’

Reality
acceptance - Radical Acceptance
Acknowledge or recognise the facts that are true; let go of fighting your
skills reality; accept with your mind, body, and soul; open yourself to
experiencing reality as it is, in this very moment; acknowledge
what exists without anger or holding a grudge; accept that there
Radical acceptance;
are limitations in the future;
Turning the mind;
Willingness;
Half smiling; The full experience of the moment will bring about peace and contentment
Willing hands;
Allowing the mind: Life can be worth living, even if it contains pain
mindfulness of
current thoughts Accepting reality brings freedom

- Turning the mind

Observe that you are no longer accepting reality; make an inner
commitment to accept reality as it is; do it again and again, as
many times as needed; develop a plan for catching yourself when
you drift out of acceptance; check in with yourself

- Willingness
Do only what is needed; do it wholeheartedly; listen and act from Wise
Mind; respond in an appropriate and effective manner; focus on
both individual and common needs; throw yourself into life
without reservation; say yes to the mystery of being alive in each
moment

- Half Smile, Willing Hands

Relax your face, put a small and discreet smile on and hold out your hands
with palms facing upwards.
Control your emotions; accept what is; be more accepting of the situation
and/or others; be more understanding; accept reality with your
body; it is opposite action to anger

- Mindfulness of current thoughts

Notice and radically accept thoughts that come and go; change our
relationship to thoughts; accept the thoughts and let them be; do
not fight the thoughts; do not allow the thoughts to fester and
grow

A thought is just a thought, it does not need to be acted on