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You are at:Home»Therapy»20 Effective Distress Tolerance Techniques for Therapeutic Sessions
Therapy

20 Effective Distress Tolerance Techniques for Therapeutic Sessions

July 18, 2025009 Mins Read
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20 Effective Distress Tolerance Techniques for Therapeutic Sessions
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Distress tolerance skills are primarily recognized for their significance in Dialectical Behavioral Therapy (DBT), a method initially designed to assist individuals dealing with borderline personality disorder. Research has been investigating the advantages of cultivating distress tolerance abilities for various mental health issues and other types of psychological distress. When we explore the term distress tolerance, we should consider several factors. This encompasses an individual’s perceived capacity and the actual behavior taken to handle negative emotions and challenging circumstances. Continue reading to discover 20 distress tolerance activities that you can implement with your clients during counseling sessions.

When a person doubts their capability to manage their distress, they may be less inclined to apply these skills and other coping methods. This can elevate their overall distress levels, resulting in obvious functional impairment. Additionally, mastering distress tolerance skills requires time and practice. For some, there will be a trial-and-error phase to identify which strategies are effective and which ones can be seamlessly incorporated into daily life. It’s crucial to remind clients that acquiring new skills is rarely an immediate solution to symptoms.

Distress tolerance skills are beneficial to those who deal with uncertainty, frustration, physical discomfort, and what they classify as negative feelings. These skills can be relevant to various mental health challenges, including borderline personality disorder, post-traumatic stress disorder, depression, substance use disorders, anxiety disorders, eating disorders, obsessive-compulsive disorder, adjustment disorders, and self-harm issues.

These skills serve as practical tools for everyday life, assisting those without formal mental health diagnoses who are experiencing stress, emotional regulation issues, and disappointment. This support can benefit individuals across all age groups, including children, teens, adults, and seniors.

The Advantages of Distress Tolerance Activities for Clients

Distress tolerance activities can be integrated into individual, group, and family therapy sessions. They may be applied in both inpatient and outpatient settings, allowing for tailored approaches for each client. These practical tools empower clients to manage their emotions in a healthy way, preventing them from escalating into higher distress levels. Clients can utilize these skills during emotional crises, aiding them in coping until they can apply problem-solving techniques.

Some advantages of using distress tolerance skills include a reduction in impulsive or harmful behaviors, such as resisting self-harm urges or substance abuse. Clients often notice improvements in their emotional regulation through the consistent practice of these skills. Over time, they become capable of tolerating discomfort without feeling the need to immediately “fix” or react to the situation.

Cultivating confidence in their distress management abilities can also reduce avoidance behaviors related to challenging or uncomfortable subjects, such as trauma, grief, or familial relationships. Clients may experience a greater sense of control and the ability to articulate their thoughts while enduring discomfort.

Overall, enhancing distress tolerance skills contributes to improved emotional well-being for clients. They may observe tangible progress in various aspects of their lives, including work, educational settings, social interactions, and personal relationships. With time, these skills can become instinctive, reflecting their resilience and personal growth.

Distress Tolerance Activities

As previously mentioned, distress tolerance is an essential life skill that can benefit individuals of all ages. Therefore, we will discuss distress tolerance activities suitable for both adults and children. Depending on your therapeutic environment and client preferences, you may opt for a more adaptive or structured approach to introducing these skills. For those who benefit from structured sessions, consider exploring relevant worksheets available at TherapyByPro, a reliable resource for mental health professionals that provides customizable and printable worksheets tailored to various mental health challenges. Suggested worksheets beneficial for both adults and children may include:

Distress Tolerance Activities for Kids

Here are some engaging distress tolerance activities designed for children:

1. Glitter Jar

Children can create a glitter jar using water, glue, and glitter. Shaking the jar symbolizes their emotions in turmoil, while watching the glitter settle demonstrates emotional calming and regulation.

2. Draw Your Safe Place

Encourage kids to illustrate a real or imagined space where they feel safe and tranquil. This visualization can serve as a mental sanctuary during emotionally challenging times.

3. Feelings Wheel Game

Utilize a spinner or emotions wheel to assist kids in identifying and discussing various feelings. This practice enriches their emotional vocabulary and enhances their ability to recognize and articulate their emotions.

4. Emotion Animal Game

Children can match emotions with animals (e.g., “Anger is like a lion”). This fun activity promotes emotional expression and helps them externalize challenging feelings.

5. Stuffed Animal Breathing Buddy

Ask the child to lie down with a stuffed animal on their tummy. As they breathe, the stuffed animal’s movement acts as a visual cue to foster deep belly breathing and relaxation.

6. Coloring Mandalas or Patterns

Coloring elaborate designs helps kids focus, reduces anxiety, and places them in a calm, meditative state. Encourage them to select colors that reflect their emotions and consider their feelings afterward.

7. Emotion Thermometer

Create an emotion thermometer that uses colors ranging from calm to overwhelmed. Assist children in identifying their emotional state and discussing strategies to return to a calm state.

8. Create a “Calm Down” Box

Collaborate with children to assemble a calm-down kit filled with sensory and soothing items like stress balls, fidget toys, calming scents, or positive affirmations. Having these tools readily available teaches self-regulation.

9. Movement Breaks or Freeze Dance

Short intervals of movement—like dancing, jumping, or practicing yoga—help kids release pent-up energy and stress. Games like Freeze Dance can add enjoyment while helping them shift from a heightened state to calmness.

10. Bubble Breathing

Provide kids with a bubble wand and encourage them to blow gently to create large bubbles. This reinforces controlled, slow breathing and offers a visual method for managing emotional levels.

Distress Tolerance Activities for Adults

Below are some distress tolerance activities tailored for adult clients:

11. TIPP Skill

The TIPP skill—Temperature, Intense Exercise, Paced Breathing, and Progressive…

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Relaxation techniques employ body-based methods to swiftly manage overwhelming emotions. Clients might splash cold water on their faces, do jumping jacks, or take deep breaths to reassure their nervous system. After introducing this method, give your clients a TIPP Worksheet for individual customization and reflection outside of therapy sessions.

12. 5-4-3-2-1 Grounding Technique

This exercise grounds clients in their immediate environment by prompting them to identify five things they can see, four they can feel, three they can hear, two they can smell, and one they can taste. It’s particularly beneficial for those dealing with anxiety, dissociation, or repetitive thoughts.

13. Journaling

Encourage clients to write freely or respond to specific prompts. Journaling can serve as an emotional outlet, aiding in the processing of overwhelming feelings. Discussing journal entries during sessions can illustrate personal growth, help recognize patterns, and enhance self-awareness.

14. ACCEPTS Distraction Skill

ACCEPTS is an acronym for Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, and Sensations. This DBT-inspired technique provides various distraction methods during emotionally intense times, allowing clients to select the most fitting approach based on their surroundings and level of distress.

15. Self-Soothe Box

Instruct clients to create a self-soothing box filled with sensory items, such as scented lotion, a calming music playlist, a small textured object, or cherished photographs. The purpose is to engage the five senses during emotional turmoil to encourage grounding and comfort.

16. Mindful Walking

Mindful walking merges physical activity with focused awareness. Suggest that clients walk slowly while paying attention to their steps, their breathing, and their surroundings. This practice is especially effective outdoors, combining movement with mindfulness.

17. Radical Acceptance Practice

Help clients learn to embrace radical acceptance of situations beyond their control. Employ worksheets or visual metaphors (like “dropping the rope in a tug-of-war”) to help them understand the advantages of letting go of resistance and acknowledging reality as it is.

18. Visualization Exercises

Lead clients through soothing mental imagery, such as envisioning a serene forest, beach, or safe haven. This is particularly effective for those who are imaginative and find it helpful to focus internally to alleviate outside pressures.

19. Emotion Regulation Cards

Develop or utilize emotion regulation cards that feature brief, calming messages or directives (e.g., “Pause and Breathe,” “This Will Pass,” “Observe Without Judgment”). Clients can carry these cards and refer to them during moments of distress.

20. Progressive Muscle Relaxation (PMR)

PMR instructs clients to tense and then relax various muscle groups to alleviate physical tension. Practicing PMR increases body awareness and teaches clients techniques to calm themselves during emotional surges.

Final Thoughts on Selecting Effective Distress Tolerance Activities for Your Clients

Teaching distress tolerance skills to individuals both with and without mental health challenges can aid in navigating emotional crises and intense feelings. These skills foster resilience, enhance coping strategies, and build emotional intelligence. Incorporating distress tolerance techniques can also complement the effects of other therapeutic methods.

To delve deeper into how distress tolerance skills can benefit your clients, we recommend exploring available continuing education and training opportunities relevant to your professional field.

TherapyByPro serves as a reliable resource for mental health professionals globally. Our therapy tools are crafted to save you time and allow you to concentrate on what really matters—your clients. Each worksheet, counseling script, and therapy poster available in our shop is designed to streamline your workflow, enhance your sessions, reduce stress, and most importantly, support your clients.

Looking to connect with more clients? We can assist! TherapyByPro also functions as a therapist directory, helping you reach potential clients, showcase your expertise, and make a meaningful difference in others’ lives.

Resources:

  • Zvolensky MJ, Vujanovic AA, Bernstein A, Leyro T. Distress Tolerance: Theory, Measurement, and Relations to Psychopathology. Curr Dir Psychol Sci. 2010 Dec 1;19(6):406-410. doi: 10.1177/0963721410388642. Epub 2010 Dec 14. PMID: 33746374; PMCID: PMC7978414.

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