Dialectical Behavior Therapy
Dialectical Behavioral Therapy (DBT)
Dialectical Behavioral Therapy (DBT) is a structured, evidence-based treatment approach designed to help individuals regulate emotions, tolerate distress, improve relationships, and build a life aligned with their values.
Originally developed by psychologist Marsha Linehan, DBT integrates principles of cognitive-behavioral therapy (CBT) with mindfulness and acceptance-based strategies. The term “dialectical” refers to balancing two seemingly opposite ideas at once:
Acceptance of yourself and your current reality
Change in behaviors, thoughts, and emotional patterns that are not serving you
DBT is especially effective for individuals experiencing:
Emotional dysregulation
Anxiety and panic
Trauma-related responses
Self-harming behaviors
Intense relationship conflicts
Chronic stress
As a therapist trained in DBT-informed practices, I help clients build practical skills that can be applied in real time — especially when emotions feel overwhelming.
Distress Tolerance Skills in Dialectical Behavior Therapy
Distress tolerance skills help you navigate emotional crises without making the situation worse. These tools are not about avoiding feelings — they are about surviving intense emotional moments safely and effectively.
When your nervous system is activated (fight, flight, freeze), clear thinking becomes difficult. DBT skills help regulate your nervous system and restore emotional balance.
Below are some of the core DBT distress tolerance strategies I teach and practice with clients.
1. ACCEPTS: Healthy Distraction Strategies
The ACCEPTS skill helps shift attention away from distressing emotions temporarily, giving your body and brain time to calm down.
A – Activities
Engage in something absorbing: walking, cleaning, organizing, puzzles, calling a friend, creative projects.
C – Contributing
Help someone else. Volunteer, check in on a friend, offer support. Contributing increases meaning and connection.
C – Comparisons
Remind yourself of past challenges you’ve survived. Recognize your resilience.
E – Emotions (Opposite Emotions)
Watch a funny video when sad. Listen to calming music when anxious. Intentionally shift your emotional state.
P – Pushing Away
Temporarily set the distressing thought aside. Visualize placing it in a box to return to later.
T – Thoughts
Distract your mind with counting, word games, mental lists, or learning something new.
S – Sensations
Use safe sensory input: hold ice, take a hot shower, light a candle, chew mint gum, step outside for fresh air.
How I Help Clients Use ACCEPTS
Together, we create personalized distraction plans tailored to your triggers and daily environment. Instead of scrambling in a crisis, you’ll have a written, structured plan ready to use.
2. STOP Skill: Pause Before Reacting
The STOP skill is designed to prevent impulsive reactions during emotional spikes.
S – Stop
Pause immediately. Do not react. Freeze the moment.
T – Take a Step Back
Physically or mentally remove yourself from the situation. Take a breath.
O – Observe
Notice your thoughts, emotions, and body sensations without judgment. What is happening internally?
P – Proceed Mindfully
Choose your next action intentionally — aligned with your values and long-term goals.
Why STOP Works
The STOP skill interrupts automatic survival responses. It strengthens the prefrontal cortex (the rational part of the brain) and reduces reactive behavior.
In sessions, we practice this skill through real-life examples so you can apply it confidently outside therapy.
3. TIP Skills: Regulating Body Chemistry
When emotions surge, your body chemistry shifts. The TIP skills work by directly influencing your physiological response.
T – Temperature Change
Cold water on the face, holding ice, or stepping outside into cool air can rapidly decrease emotional intensity by activating the dive reflex.
I – Intense Exercise
Short bursts of physical movement (jumping jacks, brisk walking, wall sits) burn off stress hormones.
P – Paced Breathing
Slow, controlled breathing (longer exhales than inhales) calms the nervous system.
These techniques are especially helpful during:
Panic attacks
Anger spikes
Emotional flooding
Urges to self-harm
Nervous System Regulation
TIP skills help shift you from sympathetic activation (fight/flight) into parasympathetic calm. We practice these in session so you feel confident using them independently.
Additional Distress Tolerance Skills
Self-Soothing Through the Five Senses
We identify comforting sensory experiences:
Sight (nature, calming images)
Sound (music, white noise)
Smell (essential oils, candles)
Taste (warm tea, mints)
Touch (soft blankets, warm baths)
Improving the Moment
This skill helps you make a difficult situation more tolerable through:
Imagery
Meaning
Prayer or meditation
Relaxation
One thing in the moment
Encouragement
Mindfulness Practice
Mindfulness is foundational in DBT. It increases awareness without judgment and reduces emotional reactivity. I guide clients in grounding techniques and present-moment awareness exercises tailored to their needs.
What Working With Me Looks Like
In our work together, we:
Identify emotional triggers
Map out patterns of reactivity
Develop personalized distress tolerance plans
Practice skills in session
Build long-term emotional regulation strategies
Dialectical Behavior Therapy is practical and skills-focused. You leave sessions with tools you can use immediately.
Is Dialectical Behavioral Therapy Right for You?
Dialectical Behavior Therapy may be helpful if you:
Feel overwhelmed by emotions
Struggle with impulsive reactions
Experience anxiety or panic
Have difficulty tolerating distress
Want concrete coping strategies
If you are looking for structured, evidence-based therapy focused on emotional regulation and nervous system stability, Dialectical Behavioral Therapy can provide a powerful framework for change. Contact Lotus Rayne for more information or to book today.