DBT Distress Tolerance Self-Soothe and IMPROVE Skills

In my DBT Skills Group this week we focused on two more of the Crisis Survival skills within the Distress Tolerance module of DBT. The first was Self-Soothing and the second an acronym known as IMPROVE, or ‘Improve the Moment’.

Regarding the Self-Soothe skill, I have already written a post about it which can be found here. To add to this, below is a list of examples that I have found helpful to get me started when self-soothing is the last thing I feel like doing! 

The IMPROVE skill which we also talked about is broken down as follows, with examples included on the handout below:

  • Imagery – create a temporary alternate reality for yourself through visualisations and positive reappraisals; allow for some respite from the current situation that is causing you distress. Close your eyes, make yourself comfortable, and let your imagination flood your brain with more pleasant emotions and sensations than the ones you have been struggling to manage.
  • Meaning – ‘When life throws you lemons, make lemonade’ – Ask yourself if there is a way to make something good out of a not-so-good situation.
    As in the words of the WW2 survivor and psychiatrist Viktor Frankl,
    “In some ways suffering ceases to be suffering at the moment it finds a meaning…”

    (N.B. This will not take the pain away, however it may make it slightly more bearable.)
  • Prayer – this can be directed towards a supreme being if you believe in one, or alternatively to your own wise mind. Praying for guidance during times of distress may help you tolerate it more effectively, or help you in feeling less alone in it.
  • Relaxation – taking some time out of a stressful situation to relax and reduce the stress response is effective in reducing levels of distress. Especially with exercises focused on relaxing the body, it can have a direct impact on the mind as well. Often it is in accepting reality within the body, instead of trying to fight it or push it away, which enables us to work through it most effectively.
  • One thing in the momentSTOP! When overwhelmed with stressors, thoughts or emotions, intentionally focusing on a single thing for a set period of time can help calm the storm.
    This skill is linked with the One-Mindful aspect within the HOW skills of Mindfulness.
  • (mini) Vacation – take yourself away from the distressing situation for a temporary break from reality, until you are calm enough to attend to the situation effectively later. There is no point in trying to confront a problem when your emotional arousal is too high to be able to think straight. Take some time out for you, then reassess when your arousal has come down.
    (This is not permission to avoid coming back to the situation; it is simply taking some time out to attend to yourself, for the moment.)
  • Encouragement – during times of distress it is likely that judgements and negative intrusive thoughts will accompany you on your way. Reframing the way you talk to yourself can help change the messages your brain takes in about your ability to cope, even on a biological level. Try swapping “I can’t do anything right, I hate myself and deserve to die” to some kinder and more gentle words of encouragement such as “It’s okay, I’ve got this, one step at a time”.

Take a look at these examples below (as well as the Self-Soothe ones above) and try implementing them into your day to see what works best for you:


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