Mastering the Art of Teaching Distress Tolerance in Dialectical Behavior Therapy: 10 Exercises to Foster Expertise in Youth

Distress tolerance, a key module in Dialectical Behavior Therapy (DBT), equips individuals with skills to effectively manage and withstand negative emotions without resorting to maladaptive behaviors. Teaching these skills to youth can significantly enhance their resilience and emotional regulation. This article provides ten distress tolerance exercises designed to foster expertise in youth.

1. Deep Breathing: Teach youth to use deep, controlled breathing exercises as a way to soothe their nervous system during moments of distress.

2. Progressive Muscle Relaxation: Guide youth through the process of tensing and then relaxing each muscle group in their body. This can help them release physical tension associated with distress.

3. Self-Soothing with the Five Senses: Encourage youth to use their five senses to soothe themselves during times of distress. This could involve listening to calming music, smelling a favorite scent, or tasting a comforting food.

4. Mindfulness of Current Emotion: Teach youth to observe and describe their current emotion without judgment. This can help them create a bit of distance from their distress and reduce its intensity.

5. Distraction Techniques: Teach youth various distraction techniques, such as counting, reading, or drawing, which can help them shift their focus away from distressing thoughts or feelings.

6. STOP Skill: Teach the STOP skill: Stop, Take a step back, Observe, and Proceed mindfully. This can help youth pause and consider their actions when they’re feeling distressed.

7. TIPP Skills: Teach the TIPP skills: Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation. These physiological techniques can help youth quickly reduce extreme emotional arousal.

8. Pros and Cons List: Guide youth in creating a pros and cons list for tolerating distress versus not tolerating distress. This can help them make more effective decisions during times of distress.

9. Radical Acceptance: Teach youth the concept of radical acceptance, which involves fully accepting reality as it is in order to reduce suffering.

10. Safe Place Visualization: Guide youth in visualizing a safe, peaceful place where they can mentally retreat during moments of distress.

Teaching distress tolerance skills to youth in DBT requires patience, creativity, and a deep understanding of their unique needs and experiences. By implementing these exercises, you can foster their expertise in distress tolerance, empowering them to manage their emotions more effectively and navigate life’s challenges with greater resilience. Remember, the goal of teaching distress tolerance is not to eliminate distress but to provide youth with tools to manage it more effectively.