DBT Skills: Distress Tolerance and Emotion Regulation

This is a Practitioner course in the DBT skills pathway. It assumes that you already hold the Foundation knowledge of this approach, whether from the Foundation course or from your training and practice, which is what DBT Foundations: Theory and Mindfulness teaches. What it adds is formulation and treatment decisions with real caseloads: the disorder-specific or situation-specific methods, sequencing, and what to do when the standard approach does not work; it revisits the foundations only as far as it needs to before building on them, so it does not repeat the course below.

If you have not met this approach before, DBT Foundations: Theory and Mindfulness is the place to start; if you already hold its foundations from your training or practice, this is the right level to begin at.

The DBT skills pathway. The skills themselves, module by module, for those who will teach or deliver them: theory and core mindfulness, then distress tolerance and emotion regulation, then interpersonal effectiveness and the delivery of skills groups. A different pathway from DBT-informed practice: take this one to deliver the skills, the other to practise in their light.

• Crisis survival skills When crisis survival skills apply
• Reality acceptance skills Radical acceptance
• IMPROVE the Moment: Integrating Crisis Survival and Reality Acceptance in Distress Tolerance IMPROVE the Moment integrates crisis‑survival immediacy with reality‑acceptance openness, providing a structured hierarchy of seven techniques.
• Generalising Distress Tolerance Skills: From Session to Daily Life Generalisation of distress tolerance skills requires explicit, personalised crisis survival plans that link identified high‑risk situations to specific skills.

• Distress Tolerance for Trauma‑Related Crises: Applying TIP and ACCEPTS with Post‑Traumatic Stress Safety assessment precedes any distress‑tolerance skill use with trauma survivors.
• Wise Mind and Dialectical Strategies for Distress Tolerance Wise Mind integrates the emotional and rational parts of the brain, allowing acceptance and change to coexist.
• Understanding and naming emotions What emotions do for us
• Changing unwanted emotions Checking the facts

• Checking the Facts Emotions are reactions to thoughts, not facts.
• Reducing Emotional Vulnerability with the PLEASE Skills PLEASE stands for Treating physical illness, Balanced eating, Sleep hygiene, Exercise, and Avoiding mood‑altering substances.
• Building Mastery: The Foundation of Emotional Resilience Building Mastery counters the feeling of helplessness by engaging in activities that foster a sense of capability and achievement.
• Opposite Action: A Behavioural Strategy for Changing Emotions When They No Longer Serve Us Opposite Action is a behavioural strategy in DBT that involves acting opposite to an emotion’s action urge when the emotion is unjustified or ineffective in the current context.
• Mindful Observation and Description of Emotions in DBT Observation involves non‑judgmental noticing of bodily sensations, thoughts, urges, and behaviours associated with an emotion.