DBT Distress Tolerance Crisis Survival & STOP Skills

Last Saturday my DBT Skills Group started up again, so I am back posting regular updates about what we are covering on the program! It was the first week of the Distress Tolerance module – the 3rd module out of the 4 we have covered so far.

There were 8 people in the group, a big difference to the mere 2-3 of us who regularly attended the Emotional Regulation module back in August. My anxiety was high due to the new(ish) situation and people, however it was surprisingly more manageable than I had expected it to be – considering that on my first ever week I had a near panic-attack in the bathroom before we had even started. I guess that’s progress right there, and proof that exposure and Opposite Action really can lead to lasting change. (Damn, maybe the therapists really were right all along about that one 😜.)

Because there were many new members to the group, we started with a brief introduction to the Core Mindfulness skill of Wise Mind, as well as a briefing of the WHAT and HOW skills; because it is the Mindfulness aspect of DBT which underpins so much of what we learn over the whole.

We were then introduced to Distress Tolerance which I will outline here:

What are the goals of Distress Tolerance?

  • Crisis Survival – ensuring not to make an already challenging situation worse.
  • Reality Acceptance – how pain does not have to lead to suffering, and how to move forward from a place of “stuckness”.
  • Becoming Free – escaping from the confines and control of urges, desires and intense emotions.

We started off by looking at the Crisis Survival aspect. A crisis is a situation that is highly stressful, short-term and where there is pressure to resolve the crisis now – to avoid otherwise worsening the situation.

When do you need to use Crisis Survival skills?

  • If you have intense pain that cannot be helped quickly.
  • If you want to act on your emotions, but it will only make the situation worse.
  • If you are experiencing high urges for harmful or destructive behaviours – either to yourself or others.
  • If you are struggling within a highly stressful or emotionally overwhelming situation, but where demands must be met.
  • If Emotion Mind threatens to take over, and being able to access skills is essential.
  • If you are highly aroused or dysregulated, but the problem cannot be solved effectively, straight away.

What are the Crisis Survival skills?

  • STOP skill
  • Pros and Cons 
  • TIPP (tip body chemistry)
  • Distract with ACCEPTS
  • Self-soothe with the senses
  • IMPROVE the moment

We then read through the STOP skill handout and discussed situations in which it would be helpful to implement it:

Examples could be anything from receiving an email from a colleague evoking anger and the desire to respond aggressively and disrespectfully, to experiencing feelings of intense shame of fear after a triggering interaction to the point of emotional overload.

It is important to remember that the STOP skill, alongside the other Distress Tolerance skills, always need to be followed up with other skills too. This is because they are only short-term and targeted at not worsening the problem, however they will not solve things long-term; this is where the other skills will come in.


7 thoughts on “DBT Distress Tolerance Crisis Survival & STOP Skills

  1. I find it fascinating that DBT is done with such different skills depending on who is teaching it. I was surprised when I joined a group and the skills were different from what my individual therapist gave me, and now the ones you’re sharing are different again.


      • When you say “official manual” do you mean Marsha Linehan’s Skills Training Manual for Treating Borderline Personality Disorder? That’s what we’re using for group, but it’s the 1993 edition so maybe there’s a newer edition that has some updates? My individual therapist uses the material from Moonshine Consulting.

        Among those two and what you’ve posted, a few of the Distress Tolerance skills are the same: Pros & Cons, ACCEPTS, Self-Soothe, and IMPROVE. In the material we use in group there is also Observe Breathing, Half Smile, Radical Acceptance, Turning the Mind, and Willingness.

        The stuff from Moonshine has all of that, plus Crisis Survival Network, Keeping It In Perspective, OBJECTIVES, SPECIFIC PATHS, and Self-Soothe First Aid Kit.

        I had never heard of STOP and TIPP until reading your post.


      • Ooh, well TIPP is usually called TIP (we just changed it in my Boston residential to fit what made more sense as there is Paced Breathing AND Progressive Muscle Relaxation) and that is 100% in the manual under Distress Tolerance. However I’m not sure about Crisis Survival Network and Keeping It In Perspective – although perhaps Crisis Survival Network comes under the Crisis Survival skills I mentioned. Self-Soothe is a common theme although I’ve never heard it be called the Self Soothe First Aid Kit. I know a lot of DBT practitioners advise clients to create a “Self Soothe Kit”. I guess it’s about finding what works for you and using those skills to the best of your ability. The more the merrier. Ultimately, whatever is effective, we should keep on doing right? If you have any questions or any ideas that haven’t come up in your groups or individual therapy, I’m sure they will appreciate hearing them, as they can be beneficial to many. Especially TIPP, I can’t emphasise enough how grateful I am to Temperature skills and Paced Breathing πŸ™‚
        The material you said from group re Breathing, Half Smile, Radical Acceptance, Turning the Mind and Willingness are all Distress Tolerance skills which fall under the “Reality Acceptance” aspect which I haven’t yet covered on my blog.
        And yes I do mean the Marsha Linehan Skills Training Manual, although I know that there are updates from 1993 as I have attended a recent workshop taken my Marsha herself. I know that there is an updated version of her manual because she referred to it, which comprises all the official DBT skills. πŸ™‚


    • I would suggest getting the manual (you can ask your therapist or skills coach for the access link or online pages so that you don’t have to pay) so that you can go through everything and work out what skills can help you the most and what are perhaps less vital for your recovery process πŸ™‚ good luck!


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