SELF-HELP

Stay grounded—no matter

distress

distress tolerance made easy

what life throws your way

Let’s face it: Life can feel downright overwhelming at times, and
struggles can arise when you least expect them. Whether it’s a bad
breakup or divorce, illness, loss of a job, or even a natural disaster or
pandemic, sometimes you need a little extra help managing difficult
tolerance
emotions when times get tough. This go-to guide is packed with proven-
effective skills you can use anytime, anywhere to keep cool and thrive in
the face of life’s inevitable challenges.
made easy
Grounded in evidence-based dialectical behavior therapy (DBT),
Distress Tolerance Made Easy offers essential tools for staying
grounded, no matter what. You’ll learn to navigate difficult experiences
and setbacks—without resorting to unhealthy coping habits. And as you
practice and hone the skills outlined in this guide, you’ll discover you
can handle whatever life throws your
“A much-needed, valuable way—without avoidance, anger, or
guide to making sense of despair. Life happens, but you don’t Dialectical Behavior Therapy
VAN DIJK • MCKAY • WOOD • BRANTLEY
have to get pulled under. Grab this FANNING • POOL • ZURITA ONA
distress—and responding book and head for calmer waters. Skills for Dealing with
more effectively to it.”
—Joel Minden, PhD, author of Intense Emotions in Difficult Times
Show Your Anxiety Who’s Boss

SHERI VAN DIJK, MSW • MATTHEW MCKAY, PhD

newharbingerpublications
w w w. n e w h a r b i n g e r . c o m JEFFREY C. WOOD, PsyD • JEFFREY BRANTLEY, MD • PATRICK FANNING
ERICA POOL, PsyD • PATRICIA E. ZURITA ONA, PsyD
“As a fellow dialectical behavior therapy (DBT) therapist, author,
and trainer, I am always on the lookout for simple, practical, and
effective ways of making DBT skills accessible to the average
reader. In this book, you will find just that! Even after using,
teaching, and writing about DBT concepts for more than a
decade, I now have a richer understanding of distress tolerance
that I am excited to try on myself—and share with others!”
—Kirby Reutter, PhD, bilingual clinical psychologist
with the Department of Homeland Security, and
author of The Dialectical Behavior Therapy Skills
Workbook for PTSD

“For those looking for practical and accessible distress tolerance

skills, this book is for you. Distress Tolerance Made Easy compiles
a list of simple and must-have coping strategies to add to your
repertoire. With guidance and scripts, this book will lead you to
finding the skills that suit you best during moments of distress.
You’re guaranteed to walk away with several tools to help you face
strong emotions.”
—Dylan Zambrano, MSW, founder of DBT Virtual,
and author of The DBT Skills Daily Journal

“People who struggle with intense emotions and self-destructive

behavior will benefit from the information in this book. The
authors have done an excellent job of teaching skills that are
simple, clear, accessible, and true to DBT. Valuable for adults and
adolescents!”
—Cedar Koons, LCSW, author of The Mindfulness
Solution for Intense Emotions
“Distress Tolerance Made Easy is an excellent resource for anyone
wanting an in-depth look at some of the most valuable skills DBT
has to offer. This book offers readers a deeper understanding of
what our emotions do for us, and what it means to ride the wave
of your emotions without letting them overtake you. These vitally
important skills are offered in a way that is compassionate, and
easy to understand and practice.”
—Emma Lauer, LCSW, author of DBT Skills
for Highly Sensitive People

“A much-needed, valuable guide to making sense of distress—

and responding more effectively to it. This empowering resource
will help you decide when to act on emotions, work through them
to prioritize meaningful action, or practice self-compassionate
acceptance.”
—Joel Minden, PhD, clinical psychologist, and
author of Show Your Anxiety Who’s Boss
 distress
tolerance
made easy
Dialectical Behavior Therapy
Skills for Dealing with
Intense Emotions in Difficult Times

SHERI VAN DIJK, MSW • MATTHEW MCKAY, PhD

JEFFREY C. WOOD, PsyD • JEFFREY BRANTLEY, MD • PATRICK FANNING
ERICA POOL, PsyD • PATRICIA E. ZURITA ONA, PsyD

New Harbinger Publications, Inc.

 Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to
the subject matter covered. It is sold with the understanding that the publisher is not
engaged in rendering psychological, financial, legal, or other professional services. If expert
assistance or counseling is needed, the services of a competent professional should be
sought.

NEW HARBINGER PUBLICATIONS is a registered

trademark of New Harbinger Publications, Inc.

New Harbinger Publications is an employee-owned company.

Copyright © 2023 by S
 heri Van Dijk, Matthew McKay, Jeffrey C. Wood,
Jeffrey Brantley, Patrick Fanning, Erica Pool, and
Patricia E. Zurita Ona
New Harbinger Publications, Inc.
5720 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com

All Rights Reserved

Cover design by Amy Daniel; Interior Design by Michele Waters-Kermes;

Acquired by Georgia Kolias; Edited by Joyce Wu

Library of Congress Cataloging-in-Publication Data on file

 Contents

Introduction Why Distress Tolerance?1

Chapter 1 Learn Your Emotional Landscape 5

Chapter 2 Pause and Observe32

Chapter 3 Soothe and Calm Using Your Senses and Body53

Chapter 4 Be Kind to Yourself70

Chapter 5 Take Refuge from Your Pain79

Chapter 6 Accept and Move Beyond113

Conclusion133

References137
 Introduction

Why Distress
Tolerance?

We all get dysregulated sometimes—when our emotions get

intense and we feel overwhelmed as a result. Of course, this looks
different for everyone—for some, it might feel like shutting down,
stuffing emotions, or perhaps isolating ourselves from others,
physically or just emotionally. For others, it may mean feeling out
of control, ruminating, and venting frustration. And for still
others, it may come out in very unhealthy behaviors such as
lashing out at people, or lashing out at themselves in the form of
self-judgment and blaming, or even self-harm or suicidal thoughts
or behaviors.
Whatever intense emotion looks like for you right now, it’s
important to know that part of learning to manage emotions
more effectively is learning to tolerate distress. But what does
learning to tolerate distress mean, exactly? Distress tolerance
involves being able to tolerate emotional distress so you can get
through difficult experiences in ways that don’t result in negative
 consequences. Many people learn skills to manage their emotions
as they grow up, and as a result, regulating emotions becomes a
natural process. But there are times when things get especially
distressing and we have to consciously put more effort into this
process. And of course, some people never learned healthy ways of
managing emotions in the first place.
Regardless of which category you fall into—whether you have
skills that you would like to enhance to improve your life, you
never learned these skills at all, or you fall somewhere in
between—the goal of this book is to teach a variety of skills and
provide practical exercises that will help you improve your capa-
bilities and your confidence in your abilities to tolerate distress.
The skills you’ll find in this book will help you get through crisis
situations without making things worse by falling back on prob-
lematic behaviors you may have used in the past; and you’ll find
fast-acting, effective, and scientifically proven strategies that will
help you stop making problematic choices in the moments when
your emotions are overwhelming you.

What Is Dialectical Behavior Therapy?

The skills in this book are based on a psychological treatment
called dialectical behavior therapy (DBT), created by Dr. Marsha
Linehan. She developed DBT to treat people with borderline per-
sonality disorder (BPD), an illness of which one of the main

2 Distress Tolerance Made Easy

components is emotion dysregulation. Since its creation, however,
countless studies have shown how effective DBT is in helping
people regulate their emotions in healthier ways, even when they
don’t have a diagnosis of BPD. The fact is, DBT is a wonderfully
helpful therapy that teaches us skills to manage emotions more
effectively—including learning to tolerate distress. And since life
doesn’t always go as smoothly as we would like, we all need skills
like these at times.

Instructions for Using This Book

Keep in mind that simply reading a book like this typically isn’t
going to help you make meaningful changes in your life. What
will help you to really learn the skills is to read about each skill,
follow the instructions to practice them, and then practice the
skills regularly to build your proficiency with them. There are two
specific things that will be important for you to know.
First, it is very important to personalize the skills you’ll be
reading about—making them your own to increase the chances
you’ll use them as well as to enhance their efficacy. Since every-
one is different and experiences emotional distress differently, it’s
important that these skills make sense for you. To help remind
you of the skills you’ve learned and start integrating them into
your life, we recommend you keep a dedicated journal as you work
through the book. In the journal or notebook, you can keep a list
of skills you learn and respond to the prompts and exercises.

Why Distress Tolerance? 3

 Second, some of the skills you’ll be learning will involve
engaging in formal, scripted exercises, where you’ll be asked to set
aside a specific amount of time to sit quietly and turn inward in
some way. For these practices, you’ll have some options:

• You can read through the script a couple of times

until you have the feel of it, and then start the
practice.

• You might want to read through the script as you do

the practice; or you can also have someone else read
it to you as you practice, if that’s comfortable for you.

• You may choose to record yourself or someone else

reading the script (for example, on your smart-
phone), and then you can listen to the recording as
you do the practice.

You might want to experiment with each of these methods to

see what works best for you. Whatever you choose, be sure you set
aside some quiet time to do these practices, when you’ll likely be
undisturbed, so you can really turn your attention and energy to
the exercise. You might notice that the exercises themselves and
turning your attention inward can sometimes bring up distress, in
which case you can turn to some of the other skills you’ll be learn-
ing to help you tolerate that discomfort!
We’re confident that this compilation of skills will be helpful,
and we hope you enjoy them!

4 Distress Tolerance Made Easy

 Chapter 1

Learn Your
Emotional
Landscape

It’s actually quite common for people to not recognize the emo-
tions they’re experiencing. In the extreme, some people struggle
to feel and put words to any emotion; whereas others may only be
able to identify some of the emotions they experience. If this is
you, you might find yourself walking around in an emotional fog,
not aware of the feelings you’re having, or aware that you feel bad
or upset, but not being able to put an accurate label on the emotion.
This can lead to problems as emotions take over and cause some
people to act in ways that have negative consequences (like
lashing out at others). But even if that’s not the case for you,
naming emotions accurately is an important skill to have. In order
to tame emotions, we must be able to name them (Siegel 2014);
this is why you need to get to know your emotions better. To help
 with this, we’ll be taking a closer look at some of the basic human
emotions, their purpose, and information and strategies to help
you accurately identify and label them, including exercises to help
you unravel their different components.

What Is an Emotion?
Although we often refer to emotions as “feelings,” the feeling
aspect is just one part of the experience. Emotions are, in fact, full
system responses that involve thoughts, physical sensations, urges,
and behaviors (Linehan 1993). Because there’s so much going on
when we’re feeling an emotion, it can be difficult to tell the differ-
ence between how we feel, what we think (the thoughts), and what
we do (the behaviors). For example, if you’re experiencing the
emotion of curiosity, you’re going to feel curious, which would
include physical sensations in your body (like tilting your head to
the side, raised eyebrows, and body language that perks up). Your
thought might be, I’m curious about what this book has to offer about
managing my emotions in more effective ways! And the behavior
might be to continue reading. Urges, by the way, are a combina-
tion of emotions and thoughts. In the previous example, for
instance, the urge would be a combination of the emotion of curi-
osity and the thought of continuing to read, both of which precede
the action.

6 Distress Tolerance Made Easy

Naming Emotions
Researchers still disagree about which emotions are “basic”
human emotions—those that are universal experiences and are
hardwired into us. In DBT, ten basic emotions have been identi-
fied: anger, fear, sadness, guilt, shame, envy, jealousy, disgust,
love, and happiness (Linehan 2014). We won’t be offering an in-
depth analysis of all of these emotions, just the ones that most
commonly contribute to emotion dysregulation. So, keep in mind
that if you finish this chapter and still have questions about some
of the emotions that cause you difficulties, you may need to do
more work in this area outside of what’s offered here. For some
people, happiness, love, and other pleasurable emotions are prob-
lematic (for instance, some people might engage in impulsive
behaviors when they’re feeling happiness or love, whereas others
might have beliefs like they’re not deserving of these emotions).
Please keep in mind that you can use the skills in this book to
help you manage even the more pleasurable emotions.

What You Need to Know About Emotions

From a DBT perspective, every emotion serves a purpose or can
be justified at times, meaning that they make sense given the situ-
ation. In the following pages (adapted from Linehan 2014), you’ll
learn about the function of some of the more common painful
emotions; the urges, thoughts, and body sensations associated

Learn Your Emotional Landscape 7

 with each; and different words for each. You’ll also have an oppor-
tunity to consider your own experience of these emotions, since
everyone experiences emotions differently.
You’re not expected to remember all of the following informa-
tion. Rather, when you experience an emotion, you’ll want to
refer back to these pages so you gradually learn how to name your
emotions accurately (or confirm that you’re already labeling them
accurately). We suggest that you thoroughly read about these
emotions now, and come back to them periodically to help you
complete the self-inquiry exercises provided later in this chapter.
Keep your journal handy so you can respond to the self-inquiry
sections to dig a little deeper into your personal experience with
each emotion.

Anger
Anger’s purpose. Anger arises when someone or something is
getting in the way of you moving toward a goal, or when you or
someone you care about is being attacked, threatened, insulted, or
hurt by others.

What anger does. Anger typically causes people to become

aggressive, possibly causing them to physically or verbally attack
what they see as dangerous, to make the threat go away. When
the human race was evolving and there were constant threats in
the environment, anger helped us survive.

8 Distress Tolerance Made Easy

Example of when anger is justified. You get passed over for a
promotion even though you have seniority and your performance
appraisals have been good. Your boss has prevented you from
reaching a goal, so it makes sense and is justified that you feel
angry in this situation.

Examples of anger thoughts. This is ridiculous. They can’t get

away with this; that promotion should have been mine. They don’t
know what they’re doing. Usually anger thoughts involve judgments
(like This is ridiculous), thinking what’s happening shouldn’t be
happening or that people shouldn’t be the way they are.

Body sensations:

Tense or tight muscles, such as clenching fists or jaw (your

body preparing you to fight in a dangerous situation)

Trembling or shaking

Racing heart

Increased breathing rate

Change in body temperature, which might lead to feeling

hot or cold

Urges and behavior. Anger usually involves aggression, so you

might yell, scream, swear, or say hurtful things to someone, or you
might even physically lash out, throw things, or hit or punch

Learn Your Emotional Landscape 9

 things or people (including yourself). It’s important to note that
just because a feeling is justified, it doesn’t mean you should act on
the urges associated with it. For example, you can feel anger at
your boss for not giving you what you want and choose not to
respond to your urge to quit your job or verbally abuse your boss.

Other words for feeling anger:

Annoyed Frustrated Irritated

Exasperated Resentful Bitter

Mad Irate Furious

Aggravated Bothered Incensed

Cross Impatient Enraged

Outraged Hostile Peeved

Indignant

Self-Inquiry: Anger
Think of a recent time when you felt angry, and describe the
situation. What happened? What urges did you notice when
you were in the situation you described? What did you actually
do? Can you think of other words that fit better to describe
what you experienced?

10 Distress Tolerance Made Easy

Fear and Anxiety
Fear is different from but very related to anxiety. Fear and anxiety
essentially feel the same physically. The main difference between
them is that fear is present focused and related to a specific threat;
it motivates you to act by triggering the fight-or-flight response,
which helps you survive in dangerous situations. Anxiety,
however, comes up when there’s a more general threat you’re wor-
rying about—something that hasn’t happened yet and may never
happen. It also comes up when there’s something you might rea-
sonably expect to happen and you expect the results to be cata-
strophic, or out of proportion with reality. So, if you’re driving on
the highway and you’re thinking What if someone hits me? you’re
likely going to feel anxious.
While there are definitely times when fear is justified, there is
rarely a time when you should feel anxious, or when you can say
that your anxiety would be justified, because anxiety involves a
fear of something that isn’t a real or immediate threat—even if it
feels that way! Some anxiety is helpful, because without it you
wouldn’t be cautious while you’re driving, which might make you
less likely to leave enough space between you and the car ahead of
you. Without some anxiety, you might take more risks, like driving
too fast. So we’re not trying to get rid of anxiety (or any emotion,
for that matter, since all emotions serve a purpose), but if you have
anxiety regularly—or to the extreme, such as by having panic

Learn Your Emotional Landscape 11

 attacks—you want to be able to manage it better, instead of
letting it control you.

Fear’s purpose. Fear comes up when there’s a danger to your

health, your safety, or your well-being or to that of someone you
care about.

What fear does. Fear motivates you to act to protect yourself or

those you care about.

Example of when fear is justified. You’re driving down a busy

freeway at seventy miles per hour and you see traffic coming to a
dead stop not far in front of you. Fear is justified because your
safety is threatened.

Examples of anxiety thoughts. Anxious thoughts are future-

focused catastrophizing or worry thoughts often consisting of
what-ifs: What if I make a fool of myself? What if I can’t do it? What
if that car hits me?

Body sensations:

Tense or tight muscles (your body preparing you to flee a

dangerous situation)

Trembling or shaking muscles

Racing heart

12 Distress Tolerance Made Easy

 Increased breathing rate

Change in body temperature, which might lead to feeling

hot or cold

Urges and behaviors. With fear, urges and behaviors usually

involve running away from the threat to protect yourself or the
people you care about. With anxiety, urges and behaviors usually
involve avoiding a situation (like choosing not to go to work
because you’re worried that you’ll have a panic attack and make a
fool of yourself) or escaping the situation if you’re already in it
(like leaving work early, because you’re feeling anxious).

Other words for feeling fear:

Trepidation Panicky Terrified

Scared Apprehensive Nervous

Worried Dread Disturbed

Stressed Startled Alarmed

Edgy Jumpy Jittery

Troubled Anxious Concerned

Uneasy

Learn Your Emotional Landscape 13

 Self-Inquiry: Fear and Anxiety
Think of a recent time when you felt fearful or anxious, and
describe the situation. What happened? What urges did you
notice when you were in the situation you described? What did
you actually do? Can you think of other words that fit better to
describe what you experienced?

As you recalled your experience of fear or anxiety, did you

notice a similarity to what you experience when you feel angry?
The body sensations can be very much the same, which is one
reason why it can be easy to mix up feelings of fear or anxiety and
anger!

Sadness
Sadness’s purpose. Sadness is the emotion felt when things aren’t
the way you expected them to be or when you’ve experienced a
loss of some sort.

What sadness does. This is the emotion that encourages people

around you to try to be of help or to offer support. It might also
motivate you to try to regain what you’ve lost, or to seek comfort
from others.

14 Distress Tolerance Made Easy

Examples of when sadness is justified. You didn’t get a job you
really wanted, your partner is ending your relationship, or someone
close to you receives a diagnosis of a terminal illness. Sadness is
justified in these situations because you’ve experienced loss, and
because things aren’t as you had expected them to be.

Examples of sadness thoughts. When we’re feeling sad, our ten-

dency is to focus on the loss we’ve experienced and on the disap-
pointment we feel. Some examples of sadness thoughts include
Things are hopeless, I’m not worthwhile, I’m unloved, or I have no
one.

Body sensations:

Tightness in chest or throat

Heaviness in chest or heart

Tears in eyes

Slumped posture

Tired or heavy body

Urges and behaviors. Urges and behaviors associated with feeling

sad often involve withdrawing from others, isolating ourselves, or
crying.

Learn Your Emotional Landscape 15

 Other words for feeling sadness:

Disappointed Discouraged Distraught

Resigned Hopeless Miserable

Despair Grief Sorrow

Anguish Down Distressed

Depressed Heartbroken Glum

Downhearted Unhappy Despondent

Self-Inquiry: Sadness
Think of a recent time when you felt sad, and describe the
situation. What happened? What urges did you notice when
you were in the situation you described? What did you actually
do? Can you think of other words that fit better to describe
what you experienced?

Guilt
We often feel guilt and shame in the same situations, and many
aspects of these emotions are similar, which can cause us to confuse
them. These two emotions are very common for people who experi-
ence emotion dysregulation, and shame especially can be very pow-
erful in keeping people dysregulated. We’ll cover shame next.

16 Distress Tolerance Made Easy

Guilt’s purpose. Guilt is the feeling that comes up when you’ve
done something that goes against your values and you judge your
behavior.

What guilt does. Guilt motivates you to make amends and pre-
vents you from acting a certain way in the future.

Examples of when guilt is justified. You say something to pur-

posely hurt your partner during an argument, or your boss over-
pays you and you decide to keep the money and not tell them.
Your behavior in both situations doesn’t match your values, so you
feel guilty.

Examples of guilt thoughts. When feeling guilty, we tend to

think judgmental thoughts about our behavior: That was wrong, I
shouldn’t have done that. If only I had done things differently. It’s my
fault. We might also dwell on past behaviors when feeling guilty.

Body sensations:

Feeling jittery or agitated

Hot, flushed face

Bowed head

Urges and behaviors. When feeling guilty, you often want to

make amends (apologizing to your partner, for example) to try to
make up for what you did.

Learn Your Emotional Landscape 17

 Other words for feeling guilt:

Remorseful Apologetic

Regretful Self-reproach

Contrition Sorry

Self-Inquiry: Guilt
Think of a recent time when you felt guilt, and describe the
situation. What happened? What urges did you notice when
you were in the situation you described? What did you actually
do? Can you think of other words that fit better to describe
what you experienced?

Shame
Shame’s purpose. Shame protects you by keeping you connected
to others. Shame arises when you’ve done something, or when
there is something about you as a person, that you fear might
cause people to reject you if they knew about it. Part of this
involves self-judgment, where you judge yourself for this thing,
and you anticipate that others will also judge you.

What shame does. Shame causes you to hide—your behavior, or

that characteristic of yourself—so you can remain connected to

18 Distress Tolerance Made Easy

people who are important to you. Shame is also the emotion that
comes up to stop you from doing that same behavior again in
future. If people know about your behavior (or characteristic),
shame causes you to try to make amends in those relationships.

Examples of when shame is justified. You engage in a behavior

like drinking, using drugs, or gambling as a means of dealing with
your emotions, and you hide your behavior so others won’t reject
you for it. Whether shame is justified in this example depends on
whom you’re hiding from. Some people might reject you for what
you did, in which case shame is justified; it’s causing you to hide
the behavior, protecting you by keeping you connected. But
others (like your significant other, your best friend, or your thera-
pist) hopefully would not reject you, in which case shame would
not be justified. Shame is also justified if you cheat on your
partner, because quite possibly they will reject you if they find out,
and shame is there to stop you from doing the same behavior
again in future.

You may also experience shame if there’s something that makes

you different from others, or at least you believe it makes you dif-
ferent. This could be your sexual or gender identity, a mental
health or addiction problem, your religion, or a particular belief or
opinion you hold. Hiding that part of yourself protects you from
being rejected by others. It’s sometimes difficult to tell if shame is
justified or not, because this emotion involves an element of

Learn Your Emotional Landscape 19

 knowing the opinions and values of others, and what they might
think if they knew about this thing. For instance, many still
attach stigma to mental illness, and if your best friend has previ-
ously told you about their coworker who “uses their depression as
an excuse all the time,” or they insist that there’s “no such thing
as mental illness,” then you’re likely to keep quiet about your emo-
tional problems in order to avoid their judgment. On the other
hand, if your boss has confided in you about their own anxious
thoughts, or the fact that their child has been hospitalized for
mental health problems, you’ll be more certain that you can talk
to them without fear of rejection.
More often than not, shame is not actually justified. It often
comes up, though, because shame is the awful, soul-sucking
feeling that we feel when we judge ourselves. So instead of think-
ing, I shouldn’t have said that to my partner (causing guilt), you’re
thinking, What kind of person am I that I said that to my partner? or
I’m awful. Judging yourself for something you’ve done or for some-
thing you feel is defective about you will cause you to feel shame.
We often confuse guilt and shame. One reason for this is that
we often feel both at the same time, when we judge our behavior
(leading to feelings of guilt) and we judge ourselves for having
done that behavior (causing us to feel shame).

Examples of shame thoughts. When we feel ashamed, we’re

usually judging ourselves in some way: I’m defective. There’s some-
thing wrong with me. If others knew the real me they would leave. I’m

20 Distress Tolerance Made Easy

an awful person. I’m a failure. With shame there is also often an
element of fearing that others will reject us.

Body sensations:

Pain in the pit of the stomach

Slumped posture, bowed head

Hot, flushed face

Sense of dread

Urges and behaviors. Shame can make you want to crawl under
the nearest rock, hiding and isolating yourself from others. Taken
to the extreme, it can cause thoughts of suicide. It can also be dif-
ficult to make eye contact with others when you’re feeling shame.

Other words for feeling shame:

Mortified Self-loathing

Self-disgust

There aren’t really many other words for shame, although

sometimes we use “embarrassed” or “humiliated” to describe the
emotion, even though both are very different from shame. Think
of “embarrassed” as the feeling we have when we trip up the stairs
or walk out of the bathroom with TP stuck to our foot: when we’re
embarrassed, we can laugh at ourselves or the situation later.
“Humiliation” is a little closer to shame, but it also involves

Learn Your Emotional Landscape 21

 anger—the sense of someone having caused us to feel shame
when we didn’t deserve it. In this sense, humiliation can be seen
as more tolerable than shame because the anger drives us to talk
to others about the situation and seek validation for our feelings,
whereas shame keeps us disconnected and hiding.

Self-Inquiry: Shame
Think of a recent time when you felt shame, and describe the
situation. What happened? What urges did you notice when
you were in the situation you described? What did you actually
do? Can you think of other words that fit better to describe
what you experienced?

Envy
Envy and jealousy are two more emotions that are often confused
with each other, but they are very distinct.

Envy’s purpose. Envy is the emotion that usually comes up when

an individual or group of people has something that you want.

What envy does. Healthy envy motivates us to work hard to get

what we want. For example, if you envy a coworker who received
recognition at work, it drives you to work harder so that you might
also be recognized in some way. But envy can also play out in

22 Distress Tolerance Made Easy

unhealthy urges, such as acting in ways to try to make the other
person look bad to others, judging the person, trying to take away
or ruin what the other person has, and so on.

Example of when envy is justified. You have feelings for your

best friend’s partner—that is, you envy your best friend for that
relationship. If you were never part of the in-crowd at school, you
may have been envious of the popular people (and this may still
be happening!). Seeing someone who seems to have everything—
lots of money, a great career, a beautiful house, a happy mar-
riage—and wanting (understandably!) what that person has is
justified.

Examples of envy thoughts. It’s not fair; why can’t I have that?
Why do they get all the luck and I get nothing but suffering in life?
When envy is accompanied by feelings of happiness for the other
person, it can be quite healthy. As noted earlier, envy can moti-
vate us to work hard to get the things we want: I’m happy that my
coworker got that promotion, but damn I wish that had been me!
When envy isn’t accompanied by those feelings, but rather by
feelings of anger, it can be detrimental and cause us to get stuck
in feelings of self-pity and unhealthy behaviors.

Body sensations:

Tight or rigid muscles

Teeth clenching

Learn Your Emotional Landscape 23

 Mouth tightening

Face flushing

Pain in the pit of the stomach

Urges and behaviors. Healthy urges and behaviors related to

envy usually involve pushing yourself to do more and try harder to
improve yourself and your situation. Unhealthy urges and behav-
iors related to envy include attacking or criticizing the person you
envy; doing something to try to make that person fail, look bad to
others, or lose what they have; or avoiding seeing or interacting
with the person.

Other words for feeling envy:

Craving Covetous Hunger

Wanting Desirous Longing

Resentful

Self-Inquiry: Envy
Think of a recent time when you felt envy, and describe the
situation. What happened? What urges did you notice when
you were in the situation you described? What did you actually
do? Can you think of other words that fit better to describe
what you experienced?

24 Distress Tolerance Made Easy

Jealousy
Jealousy’s purpose. Like all of the emotions we’re looking at, jeal-
ousy is a basic emotion that has been identified in infants and can
therefore be described as hardwired in the human brain. This
emotion arises when an important relationship or sense of belong-
ing is in danger of being lost or taken away.

What jealousy does. Jealousy typically causes people to try to

control others in order to protect what’s “theirs” (whether accu-
rate or not!), and to not share the people or things they fear they’ll
lose.

Examples of when jealousy is justified. You find out that your

partner has been talking to their ex. Or, you reached out to your
three closest friends to see if they’d like to get together, but no one
responded; then weeks later your best friend lets slip that they and
those two other friends met last week without you—ouch.

Examples of jealousy thoughts. They’re going to leave me. No one

cares about me. I’m going to lose everything. Jealousy can also be
thought of as anxiety about losing someone or something that’s
important to you.

Learn Your Emotional Landscape 25

 Body sensations:

Racing heart

Breathlessness

Choking sensation

Lump in throat

Tense or tight muscles, such as clenching teeth

Urges and behaviors. Urges and behaviors associated with feeling

jealous might involve being violent or threatening violence toward
the person you feel threatened by; trying to control the person
you’re afraid of losing, including interrogating and spying on them
and snooping through their belongings; accusing the person
you’re afraid of losing of being unfaithful or disloyal; behaving in
a clinging, dependent way; or increasing demonstrations of love,
like trying to spend more time together.

Other words for feeling jealousy:

Protective Suspicious Possessive

Covetous Distrustful Rivalrous

Clingy Insecure

26 Distress Tolerance Made Easy

 Self-Inquiry: Jealousy
Think of a recent time when you felt jealous, and describe the
situation. What happened? What urges did you notice when
you were in the situation you described? What did you actually
do? Can you think of other words that fit better to describe
what you experienced?

Awareness of Emotions
Now that you have a better understanding of some of the painful
emotions you might be experiencing, let’s get you applying what
you’ve learned by thinking about situations you encounter in your
own life. The following questions will help you start to examine
your emotions more closely, which will help you name the emo-
tions accurately and understand them better.
Think about a situation that triggered an emotion for you. In
your journal, answer the following questions. (Hint: You can do
this for as many situations and emotions as you like!)

• Describe the situation (just the facts!).

• What thoughts did you have about this situation

(including judgments, interpretations, assumptions)?

• What physical sensations did you notice?

• What urges did you experience?

Learn Your Emotional Landscape 27

 • What did you actually do?

• What is the name of the emotion(s) you were

experiencing?

As you answer these questions and get to know your experi-

ence of emotions better, it will be helpful for you to refer to the
information about emotions we’ve just covered. For example, you
may think you’re feeling guilt but find, when you turn to the refer-
ence sheet on “guilt,” that it doesn’t quite match with your experi-
ence: you realize you’re not judging your behavior, but yourself, and
it’s actually shame you’re feeling. Over time, engaging in these
exercises and reviewing the information about emotions will help
improve your ability to identify what you’re feeling. This next
practice will further help you to label your emotions accurately.

Mindfulness of Emotions
This practice will help you recognize the different components of
your emotions, so that over time you’ll be able to accurately label
them. To prepare for this practice (as well as the others in this
book), you might want to read the script to yourself a couple of
times so it comes more naturally for you. You might also choose to
record yourself reading the scripts throughout the book so you
can play them back until you get the hang of them; or you might
have someone read them out loud to you.

28 Distress Tolerance Made Easy

Start by sitting in a comfortable position, taking a dignified
posture: your back fairly straight against the chair, your feet
flat on the floor. (If you have physical pain issues, just do your
best to adopt a posture that you’ll be able to stay in.) Take a
couple of deep breaths. Our breathing can become shallow
when we’re having a strong emotion, so try to feel your belly
expand as you inhale. When you’re ready, let your attention
slowly move through your body from your head to fingertips
and toes, scanning your body for places you’re holding tension.
It’s common to clench your jaw or to literally sit on the edge of
your seat if you’re feeling a difficult emotion, so just observe
whatever is happening in your body.

Allow yourself to become aware of any emotion that’s with you

right now. (If you don’t notice anything, continue to scan
through your body until you do notice something, however
small or neutral it might seem.) Where do you feel it most
strongly? There might be one or several places in your body
where you feel the emotion. Just be curious about the sensa-
tions, exploring them as best as you can with a sense of open-
ness. It’s natural to notice yourself wanting to avoid or resist
the feelings and sensations, especially if they’re uncomfort-
able, but see if you can be with them with acceptance and
curiosity instead, just for a moment. Remember to breathe.

Now, see if you can put nonjudgmental words to your experi-

ence: describe what you notice in your body. For example, you
might describe the quality of the feeling as “tight,”

Learn Your Emotional Landscape 29

 “butterflies,” “knot,” or “hard;” describe the size of the feeling
(small, medium, large); or notice a temperature to the emotion
that you can label as “hot” or “cold” or somewhere in between.
Go with whatever feels right; you’re just listening to your body
in this moment, observing the sensations that are present and
the emotions they might reveal. You’re not trying to make any-
thing happen, nor are you trying to stop anything from
happening.

You may be able to put a label on the emotion, like “grief,”

“shame,” “bored,” or “anxious.” Label it if you can; if you can’t
put a name on it, just notice that. If you notice a thought or a
story come up that’s related to this emotion (for example,
remembering something hurtful you did or said that has trig-
gered feelings of shame for you), just notice that as best as you
can without judging, and bring your attention back to whatever
physical sensations are most prominent in your body right now.

If an emotion feels uncomfortable or distressing, see if you can

just breathe into it, and continue to observe it, reminding your-
self that it isn’t permanent—emotions come and go.

If it gets to be too much, you can leave the practice and come
back to it another time. Ultimately, you can do this practice
(letting your thoughts and emotions go and staying connected
with your body) for as short or long a time as you’d like.

30 Distress Tolerance Made Easy

 In your journal, reflect on your experience doing this exercise
by answering the following questions:

• As you did this exercise, what did you notice in your

body?

• What did you notice about your thoughts?

• What did you notice about your emotions?

• Were you able to distinguish between the physical,

mental, and emotional parts of your experience?

• Did you notice the emotions change in any way?

• Did you notice any thoughts that brought up or

intensified an emotion or physical sensation?

Learn Your Emotional Landscape 31

 Chapter 2

Pause and Observe

While naming our emotions accurately is important in helping us

to tame them (Siegel 2014), pressing the pause button, so to speak,
will also help us to choose how we want to respond in any situa-
tion, rather than just reacting from those emotions. In this
chapter, you’ll first learn some skills that will help you to detach
from the emotion—you’ll still feel it, of course, but in putting a
little bit of distance between you and the emotion, it will no longer
have the ability to control you.
In the second part of this chapter, you’ll do some practices
and learn skills to help you to not be hijacked by emotions. As you
read through these skills and exercises, remember that the most
important part of work like this is finding the skills that resonate
for you, and putting them into practice on a regular basis in order
to benefit from them in the long run. Now is a good time to start
that list of skills in your journal. As you read through this book,
pay attention to the skills that resonate for you in some way and
that you’re willing to try. On your list, you can include skills you
already use to effectively help you tolerate distress as well as the
new ones you’re learning.

Skills to Quickly Regulate Emotions

Here are some strategies that activate certain systems in the
human body to help you to hit that pause button. These strategies
will allow you to quickly feel more emotionally balanced and able
to make choices from a place of responsiveness rather than reac-
tivity. When first learning these skills, it’s usually most helpful to
practice them before your emotions are really activated, so you
know how to do them and what to expect. Once you have a
handle on them, you can use them when emotions start to inten-
sify. (Here’s a tip, though: While these skills will still help when
you’re already in full-blown crisis mode, they’ll be even more
effective if you can catch yourself as emotions start to escalate,
before you get really dysregulated.) These skills can help reduce
many emotions, including anger, fear, anxiety, shame, and sadness.

The forward bend. Bend over as though you’re trying to touch

your toes, take some slow, deep breaths, and hang out there for
thirty to sixty seconds if you can. This activates the parasympa-
thetic nervous system (PNS), which acts as our body’s brake,
helping us to slow down and feel calmer. When you’re ready, stand
up again—slowly, so you don’t fall over! It doesn’t matter if you
can actually touch your toes, and you can also do this sitting

Pause and Observe 33

 down if you need to by sticking your head between your knees.
The key here is getting your head below your heart.

Focus on your exhale. It may sound cliché, but breathing is truly

one of the best ways to calm intense emotions, and making your
exhale longer than your inhale activates the PNS. As you inhale,
count in your head; as you exhale, count at the same pace, making
sure your exhale is at least a little bit longer than your inhale. For
example, if you get to four when you inhale, make sure you exhale
to at least five. By the way, pairing this exercise with the forward
bend is a double whammy to challenging emotions, so while doing
a forward bend, focus on making your exhale longer than your
inhale.

Suck on lemons! Okay, so you don’t actually have go that far, but
sucking on a tart candy or eating something tart like salt-and-
vinegar chips—or even imagining that you are (did your mouth
just start to water?!)—stimulates the salivary glands, which are
connected to our PNS. The long and short of it is that producing
more saliva moves our body into the rest and digest PNS mode,
helping us to feel calmer and come back down from that fight-or-
flight state.

Activate your dive reflex. Putting your face in cold water acti-
vates a system in our body known as the mammalian dive reflex—
another technique that can help you quickly break out of an

34 Distress Tolerance Made Easy

intense emotion and get your emotions re-regulated (Linehan
2014). All mammals have this reflex; since we can’t breathe under
water, our body conserves oxygen by slowing down the heart. The
good news for us humans is that this reflex can also help us to
regulate our emotions—fast!
It’s important to know that if you have a heart problem
(including low blood pressure), are taking medications called
“beta blockers,” or have disordered eating (restricting or purging),
you can’t use this skill, so stop reading here! If you’re not sure
whether you can use this skill safely, check with your doctor before
reading any further, because this skill can actually cause you to
pass out. If you’re 100 percent certain that these caveats do not
apply to you, go to the nearest sink, fill it with cold water, and put
your face in the water for thirty seconds (or as long as you can). If
you’re fearful of trying this technique, you can splash cold water
on your face or hold an ice pack over your eyes instead, but to
activate the dive reflex, it works best if you hold your breath and
tip yourself forward to trick your body into thinking you’re in
water.
If you’re not able to use this skill for whatever reason, you can
still use temperature to help you manage emotions: whenever the
body is required to adjust to cold temperatures, the SNS system
turns off and the PNS is activated. This means that holding a
cold compress or ice pack to your forehead, your wrists, or the
back of your neck, for instance, will still help.

Pause and Observe 35

 Intense exercise. Most people know that there’s an association
between aerobic exercise and emotional well-being, but the nature
of this link is still not well understood (Bernstein and McNally
2017). We do know that intense exercise boosts certain chemicals
in our brain, reducing emotional pain and improving our mood
and our ability to manage emotions. Here’s what this connection
boils down to: if you’re stressed out and emotions are beginning to
overwhelm you, do some jumping jacks or lunges in your bedroom,
go for a run around the block, or run up and down your stairs. As
with the other skills in this section, doing so will help interrupt a
cycle of feelings, thoughts, and behaviors that might otherwise
take over, opening space for you to respond to what you’re feeling
in a healthier, more adaptive way.

Acupressure points. This is another skill that doesn’t take a lot

of thought or practice; you just have to remember to do it when
emotions get intense. Many people are already familiar with using
acupressure points to treat physical pain, but acupressure points
can also help us feel a little calmer when emotions start to spike.
The LI4 acupressure point, between your thumb and your index
finger, activates endorphins in the body that help reduce stress.
Using the index finger and thumb of your right hand, gently pinch
the cushy part between the index finger and thumb of your left
hand; use a deep, firm pressure to massage and stimulate the area
for four to five seconds (you can also massage your right hand
with your left).

36 Distress Tolerance Made Easy

 Another acupressure point is located just under our collar-
bone. Massaging the little indent directly underneath the collar-
bone, between the breastbone and shoulder, can also help us to
feel a little calmer. You can massage either side alone, or do both
sides at once, adding in a bit of a self-hug, which can’t do anything
but help! And, incorporating paced breathing, which you already
learned, with this self-massage will further activate a calming
response in your body.

Skills to Prevent Dysregulation

Now you have some skills to use that will help you hit that pause
button and reduce the likelihood of you reacting in problematic
ways when emotions start to get intense. Next, let’s move to some
exercises that are more preventative, and will keep you from
getting to that dysregulated state in the first place.

The First Doorway to Spirit: Your Breath

For thousands of years, the breath has been used as a focus for
meditation. This is no accident, because breath is the source, the
center, of your physical life. The in and out of each breath, as it
holds your attention, can do three important things that
strengthen your spiritual awareness:

Pause and Observe 37

 1. Breath-focused meditation quiets emotions. A large
body of scientific research demonstrates the power of
meditation to soften intense feelings, so you become
less emotionally driven and overwhelmed. Even
meditating two to five minutes a day can make a dif-
ference, because you learn to watch your feelings
instead of being carried away by them.

2. Breath-focused meditation allows you to observe and

distance yourself from thoughts. Runaway thoughts,
in the form of rumination and worry, play a major
role in human distress, and they can occupy your
mind to the point that spiritual awareness gets lost.
Meditation teaches you to merely watch thoughts
rather than get lost in them; to quiet your mind so
you can listen to spirit.

3. Breath-focused meditation creates awareness of the

moment of choice and strengthens your ability to
choose wisely. The moment of choice occurs when
painful or distressing thoughts and emotions gang
up and start driving you to do something—any-
thing—to get rid of the pain. Pain-driven actions are
often damaging; over time they have a corrosive
effect. Meditation can strengthen your ability to see
the alternative, wise actions you could take instead.

38 Distress Tolerance Made Easy

 The way you breathe is very important. The way we’re going
to suggest that you breathe might feel unnatural at first. But do
your best to be patient, and don’t judge yourself or give up.

Most of us were never taught “how” to breathe. We just did it

from birth. However, many of us have picked up some unhelp-
ful habits that might be interfering with our ability to relax and
focus. So, right now, as you’re reading this, put one hand on
your chest and one hand on your belly. Notice which hand
moves more. Many people will notice the hand on the chest
moves more, and might even notice that the body tends to
rock or sway as they breathe in and out. This is not the most
efficient or effective way to breathe; instead, ideally, you
should be breathing with the support of your diaphragm, the
muscle at the bottom of your rib cage. When the diaphragm
moves down toward your belly button, it causes your lungs to
fill with air. However, in order for it to move easily and prop-
erly, you have to release your abdominal muscles and allow
them to expand, rather than hold them tight and rigid. (Look
at the way an infant breathes for a good example—all the
movement is in the belly, without any upper chest rocking.)
This is called diaphragmatic breathing, breathing that acti-
vates the diaphragm muscle at the bottom of your lung cavity.
As you continue to hold one hand on your chest and one hand
on your belly, do your best to mentally shift the movement you
feel to your abdominal area. As you slowly breathe in, allow
your belly to gently inflate like a balloon, and as you slowly

Pause and Observe 39

 exhale, allow your belly to gently and effortlessly deflate. The
key here is to take “slow” breaths, not “deep” breaths. You do
not have to fill up your entire lung capacity when you breathe.
Rather, allow yourself to find a slow steady rhythm that allows
a natural amount of air in and out of your body. (If you breathe
too deeply or too rapidly you might start to feel light-headed,
dizzy, or tingly in your lips or fingertips; this means you’re
hyperventilating. If so, stop the practice, relax, recover, and try
again later using a slower, steadier rhythm. Try imagining an
ocean wave slowly moving in to the shore and then slowly
retreating, and you’ll probably find a slow, steady rhythm.) It
might take some time to make this transition from upper chest
breathing to diaphragmatic breathing, but don’t give up—it’s
worth it.

Cue-Controlled Relaxation
Cue-controlled relaxation is a quick and easy technique that will
help you reduce your stress level and muscle tension. A cue is a
trigger or command that helps you relax. In this case, your cue
will be a word, like “relax” or “peace.” The goal of this technique
is to train your body to release muscle tension when you think
about your cue word. Initially, you’ll need the help of the guided
instructions to help you release muscle tension in different sec-
tions of your body. But once you’ve been practicing this technique
for some time, you’ll be able to relax your whole body at once,

40 Distress Tolerance Made Easy

simply by taking a few slow breaths and thinking about your cue
word. With practice, this can become a very quick and easy tech-
nique to help you relax. Before you begin, choose a cue word that
will help you relax. Write your word in your journal.
To begin this exercise, find a comfortable chair to sit in. Once
you’ve been practicing this exercise for some time, you’ll be able to
do it wherever you are, even if you’re standing. You’ll also be able
to do it more quickly. But to begin, choose a comfortable place to
sit in a place where you won’t be disturbed. Make sure you’ll be
free from distractions. Turn off your phone, television, computer,
and radio. Tell the people in your home, if there are any, that you
can’t be disturbed for the next twenty minutes. Allow yourself the
time and the freedom to relax. You deserve it.

To begin, sit in a comfortable chair with your feet flat on the

floor and your hands resting comfortably, either on the arms of
the chair or in your lap. Close your eyes. Take a slow, long
breath in through your nose. Feel your belly expand like a
balloon as you breathe in. Hold it for five seconds: 1, 2, 3, 4,
5. Then, release it slowly through your mouth. Feel your belly
collapse like a balloon losing its air. Again, take a slow, long
breath in through your nose and feel your stomach expand.
Hold it for five seconds: 1, 2, 3, 4, 5. Then, exhale slowly
through your mouth. One more time: take a slow, long breath
in through your nose and feel your stomach expand. Hold it for
five seconds: 1, 2, 3, 4, 5. Then, exhale slowly through your
mouth. Now, begin to take slow, long breaths without holding

Pause and Observe 41

 them, and continue to breathe smoothly for the rest of this
exercise.

Now, with your eyes still closed, imagine that a beam of light
(it can be any color that feels soothing to you) shines down
from the sky like a bright laser and lands on the very top of
your head. Notice how warm and soothing the light feels. This
could be a light from God, the universe, or whatever power
makes you feel comfortable. As you continue to breathe
smoothly, taking slow, long breaths, notice how the light
makes you feel more and more relaxed as it continues to shine
on the top of your head. Now, slowly, the warm light begins to
spread over the top of your head like soothing water. And as it
does, the light begins to loosen any muscle tension that you’re
feeling on the top of your head. Slowly, the light begins to slide
down your body, and as it moves across your forehead, all the
muscle tension there is released. Then the light continues
down past your ears, the back of your head, your eyes, nose,
mouth, and chin, and it continues to release any tension you’re
holding there. Notice how pleasantly warm your forehead
feels. Now, slowly, imagine that the light begins to move down
your neck and over your shoulders, releasing any muscle
tension. Then the light slowly proceeds down both of your
arms and the front and back of your torso. Feel the muscles in
your upper and lower back release. Notice the soothing sensa-
tion of the light as it moves across your chest and stomach.
Feel the muscles in your arms release as the light moves down
to your forearms and then across both sides of your hands to

42 Distress Tolerance Made Easy

your fingertips. Now, notice the light moving down through
your pelvis and buttocks and feel the tension being released.
Again, feel the light move like soothing water across your
upper and lower legs until it spreads across both the upper
and lower surfaces of your feet. Feel all of the tension leaving
the muscles of your body as the light makes your body feel
warm and relaxed.

Continue to notice how peaceful and calm you feel as you

continue to take slow, long, smooth breaths. Observe how
your stomach continues to expand as you inhale, and feel it
deflate as you exhale. Now, as you continue breathing, think to
yourself, Breathe in, as you inhale, and then think your cue
word as you exhale. (If your cue word is something other than
“relax,” use that word in the following instructions.) Slowly
inhale and think: Breathe in. Slowly exhale and think: Relax.
As you do this, notice your entire body feeling relaxed at the
same time. Feel all the muscle tension in your body being
released as you focus on your cue word. Again, inhale and
think: Breathe in. Exhale and think: Relax. Notice your entire
body releasing any muscle tension. Again, inhale…Breathe in.
Exhale…Relax. Feel all the tension in your body releasing.

Continue breathing and thinking these words at your own pace

for several minutes. With each breath, notice how relaxed your
entire body feels. When your mind begins to wander, return
your focus to the words “breathe in” and “relax.”

Pause and Observe 43

 Practice the cue-controlled relaxation technique twice a day,
and record how long it takes you to feel relaxed. With daily prac-
tice, this technique should help you relax more quickly each time.
Again, remember that the ultimate goal of this technique is to
train your entire body to relax simply when you think of your cue
word, such as “relax.” This will only come with regular practice.
Initially, you might also have to think of the light imagery and
engage in slow, deep breathing to help yourself relax. But with
practice, this technique can help you relax even in distressing
situations.

Acceptance Meditation
This Acceptance Meditation is inspired by Neff and Germer’s
(date unknown) “Soften, soothe, allow” meditation. Practicing
this meditation as soon as you notice distressing physical sensa-
tions or emotions will help you to manage the discomfort more
effectively and press pause to prevent yourself from reacting. But
it will also be important to take time to practice this meditation
(about fifteen minutes), at least once a day, so that you’ll be more
able to use it in times of distress.

Begin by getting into a comfortable sitting position. Close your

eyes and focus on your breath. Bring your attention to your
diaphragm, the center of your breath and life force. Notice each
in-breath and mark it by thinking to yourself, In. Notice each

44 Distress Tolerance Made Easy

out-breath and mark it by thinking to yourself, Out. Continue
watching your breath, thinking In and Out. (Pause here)

As you focus on your breath, thoughts will likely begin to arise—

memories, worries, plans for the future, judgments. Just notice
the thoughts and, as soon as you can, return to your breath.
(Pause here) Just watch the breath, letting it rise and fall gently
and effortlessly. A slow, natural rhythm. (Pause two minutes)

At this moment, let your attention expand beyond your breath.

Let yourself notice where the tension or difficult emotion mani-
fests in your body. You might notice tension, pain, an itch, or
just a strange sensation in your body. Do your best to just
notice it without judgment, and place your attention there for
a moment. (Pause here)

Next, soften toward that tension or difficult emotion in your

body. Allow the muscles to release around it. Just notice the
physical sensation or emotion without trying to control it,
without trying to push it away. Your body can be soft around
the edges of the feeling, making room for it. Letting go…letting
go…letting go of tension around the edges of the feeling.
(Pause here)

As you’re observing, if you experience too much discomfort

from an emotion, do your best to note your experience and
return to the rising and falling of your breath; use your breath
as your anchor. Do your best not to judge your emotion and
not to get distracted by it. (Pause here)

Pause and Observe 45

 Similarly, if a difficult thought arises, do your best to just
notice it and let it go. Again, return to the rising and falling of
your breath as your anchor. Do your best not to judge yourself
or the thought. (Pause here)

Now, hold the physical sensation or emotion kindly. Move your

hand to cover and hold the spot. Breathe into that feeling.
Breathe in a kind regard for that tension or difficult emotion.
Think of this place as yours to take care of, to hold as if it were
precious and needing your love. (Pause here)

Again, if a difficult thought arises, or your mind wanders,

notice and accept it. Then, let it go. (Pause here)

Let this physical sensation or emotion be. Let it be there

without resistance. Let it go or stay. Let it change or not
change. Let it be where it is or move. Let it be what it is,
making room for it, holding it, accepting its presence in your
body and your life. (Pause here)

Soften…hold…let be. Soften…hold…let be. Soften…hold…

let be. Repeat these words to yourself, holding any pain you
may have kindly. Allowing it to stay or leave or change. (Pause
here) As you continue, allow difficult thoughts to arise—just
noticing them and letting them go. (Pause here)

As you continue, you may find that the emotion moves in your
body, or even changes into another emotion. Try staying with

46 Distress Tolerance Made Easy

 your experience, continuing to use the mantra of soften-hold-
let be. (Pause here)

Finally, return your attention to your breath, simply noticing

the rising and falling of your breath: breathe in and breathe
out. Then, when you are ready, slowly open your eyes. (Close
the meditation)

Keep practicing the Acceptance Meditation daily. Its trans-

formative effect takes time, but you should notice over a period of
six to twelve weeks that emotions and feelings disturb you less.
They’re just part of the ever-changing present. You hold them and
merely wait. The pain, always and eventually, becomes something
else—some new experience—that you can welcome and hold
until the next new thing shows up.

Where Am I Now? Overcoming Thoughts of the

Future and the Past
The next time you’re in a distressing or difficult situation, ask
yourself the following questions:

• Where am I right now?

• Am I time traveling in the future, worrying about or

imagining something that might happen?

Pause and Observe 47

 • Am I time traveling in the past, reliving mistakes, rehash-
ing bad experiences, or thinking about how my life could
have been under different circumstances?

• Or am I in the present, really paying attention to what

I’m doing, thinking and feeling?

If you’re not in the present moment, refocus your attention on

what’s happening to you now by using the following steps:

• Notice what you’re thinking about and recognize if

you’re time traveling. Bring your focus back to the
present moment.

• Notice how you’re breathing. Take slow, long breaths

to help you refocus on the present.

• Notice how your body feels and observe any tension

or pain you might be feeling. Recognize how your
thoughts might be contributing to how you’re feeling.
Use cue-controlled relaxation to release any tension.

• Notice any painful emotions you might be feeling as

a result of time traveling, and use one of the distress
tolerance skills (such as an activity to distract or self-
soothe; more about these skills in later chapters!) to
help you relieve any immediate pain.

48 Distress Tolerance Made Easy

Mindfulness of the Present Moment in Daily Life
You may have heard the word mindfulness thrown about here and
there—it’s used often nowadays; but what does it really mean?
The definition of mindfulness is doing one thing at a time, in the
present moment, with your full attention, and with acceptance.
The more you stay in the present moment, the less you’ll worry
and ruminate. The less you judge, the less emotional suffering you
create for yourself.

To begin integrating mindfulness into your daily life, choose to

apply it to something you do briefly every day. It could be
taking a shower, doing the dishes, drinking coffee, walking to
the bus stop, eating breakfast, or helping your children get
dressed. The activity should be physical, not mental, so you
can focus on each detail of the experience. For example, if
you’ve chosen doing the dishes as an opportunity for daily
mindfulness, you’d focus on the feeling of hot water on your
hands. Notice the sensations of holding the sponge and feeling
the soap. Pay attention to the texture of the dish in your hands
and the sensation of the water as you rinse it.

It doesn’t matter what activity you choose. The point is to

listen to what all your senses tell you. What you see, hear, feel,
smell, and taste are the cornerstones of mindfulness. When
thoughts arise, notice and label them, then return your atten-
tion to the sensory details of the activity you’ve chosen.

Pause and Observe 49

 Practice doing your activity mindfully for a week. Sometimes it
helps to put up signs or reminders to cue you to do the exer-
cise. For example, a plan to do the dishes mindfully is more
likely to happen if you put a sign over the sink. A plan to eat
breakfast mindfully would be supported by a sign on the refrig-
erator, a carton of milk, or something else you typically
consume at breakfast. If you plan to take a mindful walk to the
bus stop, tie a piece of string on your briefcase or backpack as
a reminder.

After the first week, add a second mindful activity and use a
similar reminder system to help you follow through. Continue
to add new mindful activities to your routine every week until
you have a number of them peppered throughout your day.

While all mindfulness exercises will help you reduce negative

thinking, you will still have moments when painful thoughts
show up. Whenever that happens, slow down, make sure
you’re doing just one thing, and then pay attention to the phys-
ical activity you’re engaged in. Notice only that activity and
nothing else. Let yourself get immersed in what you’re doing
by paying attention to what your senses tell you.

Doing one thing at a time in the present moment, with your

full attention, and with acceptance, helps slow you down, quiet
your thoughts, and prevent extra emotional pain from arising; it
will help you shift from thoughts about the future and the past to
what’s happening right now.

50 Distress Tolerance Made Easy

Choosing Your Mind’s Focus
With more flexible thinking skills, you can choose what you think
about. When negative thoughts show up, your first choice is now
or later. If the thought feels compelling and you choose to think
about it now, so be it. Any time you get tired of the thought, you
can practice letting it go, disconnecting from it, and making room
for another focus (for instance, mindfully noticing the thought; or
reminding yourself, It’s just a thought, it’s not a fact). You can also
delay worry and rumination, setting a later time for those thoughts
(writing them down to make sure you don’t forget).
The next choice is what your alternative focus will be. Usually
the best alternative focus is the present moment. Paying attention
to your experience right now—everything your senses tell you
about this moment—leaves little room for worry and rumination.
Here are some other choices for an alternative mental focus:

• Planning

• Problem solving

• Pleasant reminiscing

• Daydreaming about positive future events

• Creative activities

• Pleasure activities

• Exercise

Pause and Observe 51

 • Reading and learning

• Communicating and connecting with others

Remember, you control where your attention goes—so choose

a focus that promotes your mental well-being!

52 Distress Tolerance Made Easy

 Chapter 3

Soothe and Calm

Using Your
Senses and Body

Self-soothing, finding ways to calm ourselves, is another impor-

tant skill that contributes to our ability to manage emotions effec-
tively. While finding ways of soothing and calming ourselves can
be helpful in the middle of a difficult situation and help us reduce
the intensity of painful emotions, activities that soothe and calm
us are generally also good self-care skills. And of course, the more
care we take of ourselves, the more we’ll be able to manage intense
emotions as they arise.
In this chapter, you’ll learn about how to self-soothe using
each of the five senses, as well as a variety of practices to help you
feel calmer; and you’ll see many examples of how you might do
this. Of course you won’t relate to all of the examples, so what’s
 most important is that you be thinking about what activities are
soothing for you, and add them to your list in your journal.

Self-Soothing Using Your Sense of Vision

Vision is very important to humans. In fact, a large portion of our
brain is devoted solely to our sense of sight. The things we look at
can have very powerful effects on us, for better or for worse,
making it important to find sights that are soothing to help you
manage emotions. As already mentioned, for each person, it
comes down to individual taste and preference. Here are some
ideas. Add any of these activities you’d be willing to do, and any
others that you can think of, to your list:

• Go through magazines and books to cut out pictures

that you like. Make a collage of them to hang on
your wall, or use a soothing picture for the wallpaper
on your phone.

• Go to a place that’s soothing for you to look at, like

a park or a museum, or find a picture of a place that’s
soothing for you to look at, like the ocean.

• Go to the bookstore and find a collection of photo-

graphs or paintings that you find relaxing, such as
nature photographs.

54 Distress Tolerance Made Easy

 • Draw or paint your own picture that’s pleasing to
you.

• Carry a picture or photograph of someone you love,

someone you find attractive, or someone you admire.

Self-Soothing Using Your Sense of Smell

Smell is a very powerful sense that can often trigger memories and
make you feel a certain way. Therefore, it’s very important that
you identify smells that are pleasurable for you. Here are some
ideas; add the ones you’re willing to do, and any others that you
can think of, to your list:

• Burn scented candles or incense in your room or

house. Find a scent that’s pleasing to you.

• Wear scented oils, lotion, perfume, or cologne that

makes you feel happy, confident, or sexy.

• Cut out perfumed cards from magazines and carry

them with you.

• Go someplace where the scent is pleasing to you, like

a bakery or restaurant.

• Bake your own food that has a pleasing smell, like

chocolate chip cookies.

Soothe and Calm Using Your Senses and Body 55

 • Go to a park or forest and inhale the smells of nature.

• Buy fresh-cut flowers or seek out flowers in your

neighborhood.

• Hug someone you know whose smell makes you feel

calm.

Self-Soothing Using Your Sense of Hearing

Certain sounds can soothe us. Listening to gentle music, for
example, may be relaxing. However, everyone has different
responses to music, so it’s important that find what works best for
you. Use the following examples to identify the sounds that will
help you with different emotions. Add the ones you’re willing to
do, and any others you can think of, to your list:

• Listen to music. Identify the emotion you’re experi-

encing, and consider what music might work best to
help you manage that emotion. If you’re feeling
anxious, you might find jazz music calms you; if
you’re feeling sad, you might want something more
energetic or upbeat. Listen to a wide variety of genres
to determine which ones might be most helpful for
you with different emotions. Then, download the
music on your phone so you can listen to it anywhere
you want.

56 Distress Tolerance Made Easy

• Listen to audiobooks. Many public libraries will let
you borrow books on CDs or temporarily download
audiobooks. Borrow a few to see if they help you
relax. You don’t even have to pay attention to the
storyline. Sometimes just listening to the sound of
someone talking can be very relaxing. Again, keep
some of these recordings on your phone so you can
access them when you need them.

• Turn on the television and just listen. Find a show

that’s boring or sedate, not something that might be
agitating like the news. Sit in a comfortable chair or
lie down, and then close your eyes and just listen.
Make sure you turn the volume down to a level that’s
not too loud. Many years ago, there was a show on
public television featuring a painter named Bob
Ross. His voice was so soothing and relaxing that
many people reported falling asleep while watching
him. Find a show like this that will help you relax.

• Listen to a soothing podcast or video online, or find

a soothing talk show on the radio. Remember—a
soothing podcast or talk show, not something that’s
going to make you stressed or angry. Again, stay
away from political talk shows and the news. Find
something neutral or perhaps interesting in discus-
sion, like the TED Talks series online or This

Soothe and Calm Using Your Senses and Body 57

 American Life on public radio. Again, sometimes just
listening to someone else talk can be relaxing.
Bookmark the links or download your favorite pod-
casts on your phone so you can listen to them when
you’re feeling a difficult emotion.

• Open your window and listen to the peaceful sounds

outside. Or, if you live in a place without calming
sounds outside, go visit a place with soothing sounds,
such as a park.

• Listen to a recording of nature sounds, such as birds

and other wildlife. You can often download these
online and then take them wherever you go.

• Listen to white noise. White noise is a sound that

blocks out other distracting sounds. You can buy a
machine that makes white noise with circulating air,
turn on a fan to block out distracting sounds, stream
a white noise video on your computer, or download a
white-noise app on your smartphone. Some white-
noise machines and apps even have other recorded
sounds on them, such as the sounds of birds, water
falls, and rainforests, which you might find soothing.

• Listen to the sound of a water fountain. Many people

find the sound of the trickling water from these
small electronic fountains to be very soothing.

58 Distress Tolerance Made Easy

 • Listen to a meditation or relaxation exercise.
Exercises such as these will help you imagine your-
self relaxing in many different ways. Other recorded
exercises can even teach you self-hypnosis tech-
niques to help you relax. Recordings like these can
be found online; you can take the programs with you
on your phone to listen to whenever you’re feeling
overwhelmed. (Just don’t listen to them while you’re
driving or operating equipment, when it might be
dangerous if you fell asleep.) Call someone you care
about and speak to them for a few minutes; just
hearing the voice of loved ones can be soothing. If
this is something you know is soothing for you, you
might even ask your loved one to record a message
that you can listen to when they’re not available.

Self-Soothing Using Your Sense of Taste

Taste is another very powerful sense. Our sensations of flavor can
trigger memories and emotions, so again, it’s important that you
find the tastes that are pleasing to you. If eating is a problem for
you, such as eating too much, bingeing, purging, or restricting
what you eat, talk to a professional counselor about getting help
for yourself. If the process of eating can be stressful for you, use
your other senses to calm yourself. But if taste soothes you, use

Soothe and Calm Using Your Senses and Body 59

 some of these suggestions. Add the ones you’re willing to do, and
any others you can think of, to your list:

• Enjoy your favorite meal, whatever it is. Eat it slowly

so you can enjoy the way it tastes.

• Carry lollipops, gum, or other candy with you to eat

when you’re feeling a difficult emotion.

• Eat a soothing food, like ice cream, chocolate,

pudding, or something else that gives you pleasure.

• Drink something soothing, such as tea, coffee, or

hot chocolate. Practice drinking it slowly so you can
enjoy the way it tastes.

• Suck on an ice cube or an ice pop, especially if you’re

feeling warm, and enjoy the taste as it melts in your
mouth.

• Buy a piece of juicy, fresh fruit and then eat it slowly.

Self-Soothing Using Your Sense of Touch

We often forget about our sense of touch, and yet we’re always
touching something, such as the clothes we’re wearing or the
chair we’re sitting in. Our skin is our largest organ, and it’s

60 Distress Tolerance Made Easy

completely covered with nerves that carry feelings to our brain.
Certain tactile sensations can be pleasing, like petting our dog or
cat, while other sensations shock or cause pain in order to com-
municate danger, like touching a hot stove. Again, each of us
prefers different sensations, so you’ll have to figure out which are
the ones that are most pleasing for you. Here are some sugges-
tions. Add the ones you’re willing to do, and any others you can
think of, to your list:

• Carry something in your pocket to touch when you

need to, like a piece of soft cloth or a smooth stone.

• Take a warm or cold shower and enjoy the feeling of

the water falling on your skin.

• Take a warm bubble bath or a bath with scented oils

and enjoy the soothing sensations on your skin.

• Get a massage. Many people who have survived

physical and sexual abuse do not want to be touched
by anyone. This is understandable. But not all types
of massage require you to take off your clothes,
which may feel safer. Some techniques, such as tradi-
tional Japanese shiatsu massage, simply require you
to wear loose-fitting clothes. A shoulder and neck
massage, received while seated in a massage chair,
can also be done without removing any clothes.

Soothe and Calm Using Your Senses and Body 61

 • Massage yourself, or rub some lotion into your skin.
Sometimes just rubbing your own sore muscles is
very pleasing.

• Play with your pet. Owning a pet can have many

health benefits. Pet owners often have lower blood
pressure, lower cholesterol levels, and reduced risk
for heart disease (Anderson, Reid, and Jennings
1992), and they also experience other general health
improvements (Serpell 1991). In addition, playing
with your pet and stroking the animal’s fur or skin
can provide you with a soothing tactile experience.
If you don’t have a pet, consider getting one. Or if
you can’t afford one or if you can’t have one where
you live, visit a friend who has a pet or volunteer at
your local animal shelter, where you can play with
the rescued animals.

• Wear your most comfortable clothes, like your favor-

ite worn-in T-shirt, baggy sweat suit, or old jeans.

Half-Smile
There is a saying that “sometimes your joy is the source of your
smile, but sometimes your smile is the source of your joy.” Research
has shown that changing our facial expression can influence our

62 Distress Tolerance Made Easy

mood (Ekman and Davidson 1993). The idea behind the half-
smile (Linehan 2014) is that by slightly turning the corners of our
mouth up—try for less than the Mona Lisa—we can improve our
sense of well-being. The half-smile is a very slight smile—so slight
that if you’re looking at yourself in a mirror you might not be able
to see it, but you feel it. Let me clarify that this isn’t a fake smile,
which creates tension in the muscles in our face that reduces our
sense of well-being. If you’re struggling to find the balance with
this expression, bite down on a pen; doing so will turn the corners
of your mouth up slightly. Give the half-smile a try the next time
you notice emotional pain arising. Try it with different emotions
at different times.

Taking an Open Posture

Our mind and body are irrevocably connected, so adopting a
willing posture increases our receptiveness to an experience by
influencing our mind to be more accepting and willing.

Sitting with your back fairly straight and your feet flat on the
floor (if that’s comfortable), tune in to your breath. Notice how
it feels to breathe, drawing the air in through your nose. If you
can, deepen your breathing. Feel the air expand your lungs as
you inhale, and notice your lungs deflate as you exhale through
your mouth or your nose, whichever is more comfortable.

Soothe and Calm Using Your Senses and Body 63

 Now, turn your attention to the rest of your body, noticing your
posture and slowly opening it up:

Roll your shoulders back.

Open up your heart by pointing your chest toward the

ceiling.

Open your hands wide, spreading your fingers as far apart

as you can.

If you’d like, sweep your arms over your head and reach
for the sky, keeping your fingers wide.

For additional willingness, add the half-smile skill you just

learned!

Notice when your attention wanders, and gently, without

judging, return your attention to the present—the feel of your
breath and your body opening up. Continue to breathe and
maintain this willing, open posture for as long or as short a
time as you’d like. Don’t forget to add this and the half-smile
to your list of distress tolerance skills if they’re ones you’re
willing to try!

You can practice this mindfulness exercise when you find

yourself feeling willful or struggling to accept something, or just
for the sake of practicing. The more you practice, the more willing
and accepting you’ll feel on a regular basis, and the more you’ll be

64 Distress Tolerance Made Easy

able to get to that willing attitude when you want or need to.
Don’t forget, if these skills resonate with you, add them to your
list!

Mindful Breathing Meditation

Another exercise that will help you stay focused in the present
moment is breathing. It sounds simple, but we often don’t breathe
as well as we should. Think about it: Who taught you how to
breathe? If you’re like the rest of us, probably no one. And yet, you
do it about fifteen times a minute or almost twenty-two thousand
times a day! Everyone knows that we breathe air to take in oxygen.
But how much of the air you breathe is actually oxygen—100
percent, 75 percent? The correct answer is that the air you breathe
is only about 21 percent oxygen, and when your body doesn’t get
enough oxygen it can knock your biological system off balance.
For this reason alone, taking full, slow breaths is important. But
another benefit of breathing correctly is that this simple tech-
nique can help you relax and focus. Many spiritual traditions
combine slow breathing techniques with guided meditations to
help people focus and relax.
Here’s another diaphragmatic breathing exercise that many
people find helpful. Engaging the diaphragm helps you take fuller,
deeper breaths, which helps you relax.

Soothe and Calm Using Your Senses and Body 65

 Set a timer for three to five minutes and practice breathing
until the alarm goes off. Then, as you get more accustomed to
using this technique to help you relax, you can set the alarm for
longer periods of time, like ten or fifteen minutes. But don’t expect
to be able to sit still that long when you first start. In the begin-
ning, three to five minutes is a long time to sit still and breathe.
When using this new form of breathing, many people often feel as
if they become “one” with their breathing, meaning that they feel
a deep connection to the experience. If that happens for you,
great. If not, that’s okay too. Just keep practicing. Also, some
people feel light-headed when they first begin practicing this tech-
nique. This may be caused by breathing too fast, too deeply, or too
slowly. Don’t be alarmed. If you begin to feel light-headed, stop if
you need to, or return your breathing to a normal rate and begin
counting your breaths.

To begin, find a comfortable place to sit where you won’t be

disturbed. Turn off your phone and anything else that might be
distracting. Take a few slow, long breaths and relax. Place one
hand on your stomach and imagine your belly filling up with air
as you breathe instead of your lungs. Now, slowly breathe in
through your nose and slowly exhale through your mouth as if
you’re blowing out birthday candles. Feel your stomach rise
and fall as you breathe. Imagine your belly filling up with air
like a balloon as you breathe in, and then feel it effortlessly
deflate as you breathe out. Feel the breath moving in across

66 Distress Tolerance Made Easy

your nostrils, and then feel your breath blowing out across
your lips. As you breathe, notice the sensations in your body.
Feel your lungs fill up with air. Notice the weight of your body
resting on whatever you’re sitting on. With each breath, notice
how your body feels more and more relaxed.

Now, as you continue to breathe, begin counting your breaths

each time you exhale. You can count either silently to yourself
or aloud. Count each exhalation until you reach 4 and then
begin counting at 1 again. To begin, breathe in slowly through
your nose and then exhale slowly through your mouth. Count
1. Again, breathe in slowly through your nose and slowly out
through your mouth. Count 2. Repeat, breathing in slowly
through your nose, and then slowly exhale. Count 3. Last
time—breathe in through your nose and out through your
mouth. Count 4. Now, begin counting at 1 again.

When your mind begins to wander and you catch yourself

thinking of something else, return your focus to counting your
breaths. Try not to judge yourself for getting distracted. Just
keep taking slow breaths into your belly, in and out. Feel your
belly rising with each inhalation and falling with each exhala-
tion. Keep counting each breath, and with each exhale, feel
your body relaxing, deeper and deeper.

Keep breathing until your alarm goes off, and then slowly
return your focus to the room.

Soothe and Calm Using Your Senses and Body 67

 Relaxation Without Tension (Body
Awareness)
The relaxing effect of this exercise relies on the fact that you can’t
feel tense and nervous when all your muscles are in a state of
relaxation.

Find a quiet spot where you can lie down and not be dis-
turbed. Lie on your back with your legs uncrossed and your
hands at your sides. Close your eyes. Take a long, slow breath,
and bring your attention to your feet. Become aware of any
tension you’re feeling in your feet. Say to yourself, Calm, Relax,
Serene, Easy, or another cue word of your choice. As you say
the cue word, imagine any tension draining out of your feet.

Next, move your attention up to your calves and shins. Notice

any tension in your lower legs, and say your cue word to your-
self. As you say the word to yourself, imagine any tension
draining out of your calves and shins.

Now, do the same thing with your upper legs—the large

muscles in your thighs. Continue moving your relaxing atten-
tion up your body: to your buttocks, then your stomach, then
your chest, then your back, and then your shoulders. For each
area of the body, become aware of any tension, then say your
cue word and let the tension fade away.

Turn your attention now to your hands, then your forearms,

your upper arms, your neck, and finally your head, in each

68 Distress Tolerance Made Easy

 case noticing any tension and using your cue word to dissolve
the tension. When you’ve scanned your entire body in this
way, you should have significantly reduced your overall mus-
cular tension, profoundly relaxing your body.

Practicing this exercise once or twice a day for a week will

teach you a lot about where you carry tension in your body. It will
also make you much more adept at relaxation.

Soothe and Calm Using Your Senses and Body 69

 Chapter 4

Be Kind to
Yourself

While part of tolerating distress of course is managing the pain

we experience in life, another part of it is learning to increase the
pleasure. When things are stressful and chaotic, it can be easy to
overlook moments of calm, peace, contentment, and even enjoy-
ment—even more so when you’re experiencing a lot of emotional
pain or distress. Take a moment right now to consider the
moments in your life when you might experience some kind of
small pleasurable moment: your dog greets you at the door with
unconditional love; you take a few minutes to sit outside on a
sunny day; sharing a hug with your partner or child, or a smile
with a stranger. How often do you think you miss noticing these
moments? With practice, you’ll be more able to notice the plea-
sure in life, even when it’s only there for a short time or when the
pleasurable emotion isn’t an intense one like happiness or joy.
 In this chapter, we’ll look at some skills to help us do exactly
that: generate pleasure, and really experience the pleasure when
it’s present, rather than missing out on it. The first set of skills will
focus on changing our body chemistry to help us create those
pleasurable emotions; and then we’ll turn our focus to changing
thoughts and behaviors. Remember as you read through these
skills to continue to add to your list of distress tolerance skills.

Activities That Generate Pleasurable

Emotions
The following list of activities are proven to change our body
chemistry to help us feel good. Of course, not every skill will fit
every person, so you’re going to need to try them out to figure out
which ones work best for you.

Get out in nature. Just twenty minutes of exposure to a natural

forest setting has been shown to significantly reduce a digestive
enzyme called salivary alpha amylase, which is a marker of stress.
Compared to a group sitting in a city park with no trees, study
participants who sat in the woods experienced an eightfold
decrease in salivary alpha amylase and reported significantly less
stress (Beil and Hanes 2013).

Humming, chanting, and singing. Humming, chanting a

mantra, and energetic singing increase heart rate variability

Be Kind to Yourself 71
 (HRV), which is an indicator of the body’s stress level. A low
HRV means you’re more stressed, whereas a high HRV means
you’re less stressed. In addition, singing at the top of your lungs
works the muscles in the back of the throat to activate the vagus
nerve, one of the main components of the parasympathetic
nervous system (PNS). And singing with others offers a double
whammy, as it generates oxytocin, known as the “love hormone”
because it makes people feel more connected to one another!
Oxytocin also calms the amygdala, the part of our brain respon-
sible for emotional hijack, and temporarily prevents the release of
stress hormones.

Reach out for physical connection. Hugging and holding hands

releases oxytocin and reduces stress and feelings of loneliness.
Even a pat on the back or a friendly handshake will help!

Laughter. Laughter also stimulates the vagus nerve, activating

the PNS, and research has shown that when we laugh with a
group of people our HRV increases, indicating lower stress levels
(Dolgoff-Kaspar et al. 2012). So read the funny pages, turn on the
comedy channel, or look into laughing yoga or laughing medita-
tion—yep, both are a thing!

Listen to music. Research has found that areas of the brain

release dopamine—known as the “feel-good neurotransmitter”—
when we listen to our favorite music. So yes, there’s a biological
reason why music makes us feel good!

72 Distress Tolerance Made Easy

Having Compassion Helps
Compassion is defined as having an awareness and understanding
of the emotional distress of others, along with a desire to alleviate
it. As a result, compassion motivates us to help and support others,
and it turns out this is good for our mental health! Research has
shown that practices that increase compassion improve our rela-
tionships with others, which of course makes sense when we’re
bringing more compassion to those individuals; but even if we
don’t know the people for whom we’re feeling compassion, this
practice stimulates positive attitudes and feelings of kindness
(Frostadottir and Dorjee 2019). This happens because, when we
start practicing compassion, the brain activates circuits related to
positive feelings. This may indicate that the more compassionate
we are, the more often these types of feelings awaken in us. As a
result, our ability to experience self-compassion also increases,
reducing symptoms of depression, anxiety, self-criticism, and the
feeling of inferiority.
So how do we increase our ability to be compassionate? Here
is an exercise to help get you started.

Create a Compassion Awareness Journal

For the next week, pay attention to moments when you felt com-
passion—for yourself or someone else.

Be Kind to Yourself 73
 In your journal, answer the following questions:

• Describe the situation that triggered your

compassion.

• What allowed this feeling to bloom? Was there a way

you turned compassion into action? What exactly
happened? (For example, you listened to a friend
having a hard time or did a small kindness for a
stranger.) Note: When there isn’t a compassionate
action, that’s okay. Make no judgment about it. But
be aware that a compassionate action is often possi-
ble and grows from the intention that you and others
be free of suffering.

• Next, take a look at how compassion felt to you in

this situation.

If there was self-compassion:

• Did you pause to appreciate and validate your own

struggle?

• Did you ask for support? Did you tell someone what
you’re going through?

74 Distress Tolerance Made Easy

Loving-Kindness
Practicing loving-kindness, which is a form of mindfulness medi-
tation, has also been shown to increase compassion for self and
others. Following is a guided practice you can do.
Find a place to sit where you’ll be comfortable. Begin by
focusing on your breathing—not trying to change your breath but
just noticing how it feels to breathe. Slowly, deeply, and comfort-
ably, inhale and exhale.
As you focus on your breathing, allow yourself to connect
with pleasurable feelings—feelings of kindness, friendliness,
warmth, and compassion. These are the feelings you experience
when you see a person you really care about; when your pet comes
to greet you; when you do something nice for someone “just
because.” Recall that warmth and kindness you experience toward
others; imagine those feelings right now, as though they were hap-
pening in this moment, and let yourself feel the joy, love, and
other pleasurable feelings that come up for you. As you experience
these feelings of kindness and compassion, gently say the follow-
ing words:

May I be happy.

May I be healthy.

May I be peaceful.

May I be safe.

Be Kind to Yourself 75
 You can say these words in your head or out loud; either way,
put feeling and meaning into them, and make sure that you really
feel the words as you say them. If you have a hard time feeling
kindness toward yourself, remember that habits take time to
change—as best as you can, do not judge yourself or the exercise
but just know that this is something you’ll need to spend more
time on.
Make sure that you practice this exercise regularly, and you
will find yourself taking a more kind, loving, and compassionate
attitude toward yourself.

Increasing Self-Compassion Through

Self-Validation
It’s not uncommon for people to dislike certain emotions and
even judge themselves for feeling certain feelings; the problem
with this is that it increases our emotional suffering. So, how do
you change this habit of judging your emotions to be more self-
compassionate? The first step is to increase your awareness. If you
don’t know how you think and feel about your emotions, you
won’t be able to change your response. Mindfulness, such as the
mindfulness of emotions practice we did in chapter 1, will of
course help with this. The next step is to start changing your self-
talk. Here are three ways to validate your emotions (Van Dijk
2012).

76 Distress Tolerance Made Easy

1. Acknowledging. The most basic form of self-validating
is acknowledging the presence of your emotion: for
example, “I feel      .” By simply labeling the
emotion (accurately!), you’re validating it.

2. Allowing. Another form of self-validating is allowing

yourself, or giving yourself permission, to feel the
emotion, for example, “It’s okay that I feel
     .” You’re not saying “It’s okay” in the
sense that you like it or want it to hang around;
you’re just noting that you’re allowed to feel it.

3. Understanding. The third and most difficult form of

self-validating is saying, “It makes sense that I
feel      .” You might be able to understand
the emotion based on past experience (for example,
“It makes sense that I feel anxious when I’m meeting
new people, because I was bullied when I was a kid”),
or based on the present (for example, “It makes sense
that I feel anxious about public speaking, because it’s
not something I’m used to doing”). We can’t always
understand why we feel the way we do, but even if we
can’t understand our emotion, we can still validate it
by either acknowledging its presence or allowing it.

Be Kind to Yourself 77
 Create Self-Validating Statements
Hopefully you’ve been able to identify which emotions you need
to work on validating. If you’ve identified more than one emotion
you judge yourself for feeling, choose just one to start with. You
can always come back and work on the others later. In your
journal, write out some statements to validate your emotion.
Below are some examples to validate anger; feel free to use these
if they resonate for you, or to tweak them to make them fit your
emotion.

Emotion: Anger

• I feel angry.

• Anger is a normal human emotion that we all feel at

times, so it’s okay that I feel this way.

• I’m feeling angry; it’s uncomfortable, but it is what it

is.

• It makes sense that I’m feeling angry, because I just

had a fight with my partner.

• I’m feeling angry right now, but that doesn’t mean

anything about me as a person.

• It makes sense that I have anger problems because of

the environment I grew up in.

78 Distress Tolerance Made Easy

 Chapter 5

Take Refuge
from
Your Pain

In this chapter, we’re going to continue looking at skills that will

help you to tolerate distress by learning skills to help you change
your thinking. These skills usually take some practice when things
are calm so that you’ll be more able to draw on them when emo-
tions become more intense, but in the long run, they’ll provide
you with more flexibility in managing your emotions. We’ll start
with a couple of acronyms to help you remember the skills and to
put them all together; remember to add to your list of distress
tolerance skills as you continue to learn new ways (or are reminded
of ways you already knew!) of tolerating your distress.
 REST
The acronym REST is a nice one to help you remember what to
do when emotions start to intensify:

R—Relax.
Take a deep breath. You may need to go even further than that
and use some of your re-regulating skills such as paced breathing,
tipping the temperature of your face with cold water, or doing a
forward bend; and even then you may not feel relaxed, so don’t
worry! But the key here is to do something to help you calm your-
self a little so you can get closer to your wise self. This will set the
stage for the next step.

E—Evaluate.
From your Wise Mind (see chapter 6 for more on this), ask your-
self, What am I worrying about? Am I in danger right now? What’s
the threat? This helps us to put things in perspective a bit more;
often when we can see what it is we’re fearing will happen, we’re
able to see that it’s not all that realistic, which can help to calm us
further.

80 Distress Tolerance Made Easy

S—Set an intention.
Ask yourself what skills you can use right now, then make a plan
to use them. This is where that list you’ve been working on will
come in handy by taking some of the thinking out of the equation
for you—we all know how hard it can be to think straight when
we’re experiencing an intense emotion. Having your list means
you don’t have to think as hard, you just have to pull out your list
and set an intention to use one of the skills you’ve already come
up with.

T—Take action.
The last step, of course, is to put your plan into action. Mindfully
take the steps to use the skill.
Remember that these skills will be helpful no matter the
painful emotion and no matter the behaviors you’re dealing
with—from struggling with your own emotions and the pain they
cause to more problematic behaviors like substance use or avoid-
ance through food, sleep, or self-harm.

Take Refuge from Your Pain 81

 RESISTT
The second acronym we’ll use here is RESISTT (Van Dijk 2013),
with the idea that, when an emotion arises and results in an urge,
we want to resist acting on the urge! You’re going to see many dif-
ferent examples of skills here, so remember to have your list of
distress tolerance skills at hand to add to.

R: Reframe
We can learn to manage emotions more effectively by reframing,
or changing, our perspective about something. You might be
familiar with the sayings “making lemonade out of lemons” and
“finding the silver lining in a situation;” both are examples of
reframing—finding a positive in what seems to be negative,
making problematic stuff more bearable. Keep in mind that
reframing does not mean minimizing your pain or telling yourself
you should “suck it up;” it’s about trying to see another perspec-
tive. It’s important to acknowledge the pain you’re dealing with,
and then work on changing your perspective.
There are many ways to reframe; here are a few techniques
for you to try:

• You can compare yourself to someone else who isn’t

coping as well as you are. This isn’t about minimiz-
ing your problems, nor is it about putting the other
person down. Rather, it’s about helping you see that

82 Distress Tolerance Made Easy

 even though things are difficult for you right now,
they could also be worse (for example, Things are
hard right now, but my friend Kelly is in the hospital, so
I can also see that things could be worse).

• You can compare yourself now to a time in your life

when you weren’t coping as well (for example, I’m
really struggling right now, but this time last year I was
still smoking weed to cope).

• Or you could compare your own situation to a

broader situation in the world (for example, Things
are hard for me since I lost my job, but I’m grateful I
have my family to help me through these difficult times,
whereas others might not have this kind of support).

The way we talk to ourselves about what’s happening in our

lives can change the way we think and feel about things. And
unfortunately, it’s a fairly common human experience to focus on
the negative, or catastrophize, where we imagine the worst
outcome imaginable. Changing your negative thoughts about a
situation usually makes it more tolerable, and you’ll be more likely
to get through it without doing things that could make it worse. To
help change your negative self-talk, write out some coping state-
ments to use when you get into situations that trigger intense emo-
tions. That way you’ll be less likely to make the situation worse,
and more likely to cope in effective ways instead of turning to
target behaviors. Here are some examples of coping statements:

Take Refuge from Your Pain 83

 These feelings are painful, but I know I can bear them.
I can get through this.
This pain will not last forever.

If you can’t think of more encouraging or neutral ways of

talking to yourself, feel free to use the examples provided, if they
resonate for you. You can also ask yourself what you would say to
a loved one if they were in your shoes. How can you reframe to
help yourself when things get difficult? Add your ideas to your
distress tolerance skills list.

E: Engage in an Activity
Sometimes doing something that creates some kind of pleasurable
emotion (such as peace, calm, satisfaction, or even enjoyment) is
the best way to distract yourself from painful emotions. But
remember, you don’t have to wait until you feel overwhelmed by
painful emotions in order to do one of these activities. It’s also
helpful to engage in these types of activities on a regular basis. In
fact, you should try to do something pleasurable every day.
Exercise is especially important because not only is it good for
your overall physical health, but it’s also been shown to be an
effective treatment for depression in some cases (Babyak et al.
2000). Plus, exercise causes your body to release endorphins,
which are the body’s natural feel good chemicals that can trigger
positive feelings, naturally boosting your mood.

84 Distress Tolerance Made Easy

 Following is a list of over one hundred pleasurable activities
you can use to distract yourself.

• Talk to a friend on the telephone.

• Go out and visit a friend.

• Invite a friend to come to your home.

• Text or email your friends.

• Organize a party.

• Exercise.

• Lift weights.

• Do yoga, tai chi, or Pilates, or take classes to learn.

• Stretch your muscles.

• Go for a long walk in a park or someplace else that’s

peaceful.

• Go outside and watch the clouds.

• Go for a jog.

• Ride your bike.

• Go for a swim.

• Go hiking.

• Do something exciting, like surfing, rock climbing,

skiing, skydiving, motorcycle riding, or kayaking, or
go learn how to do one of these things.

Take Refuge from Your Pain 85

 • Go to your local playground and join a game being
played or watch a game.

• Go play something you can do by yourself if no one

else is around, like basketball, bowling, handball,
miniature golf, billiards, or hitting a tennis ball
against the wall.

• Get a massage; this can also help soothe your

emotions.

• Get out of your house, even if you just sit outside.

• Go for a drive in your car or go for a ride on public

transportation.

• Plan a trip to a place you’ve never been before.

• Sleep or take a nap.

• Eat chocolate (it’s good for you in moderation!) or

eat something else you really like.

• Eat your favorite ice cream.

• Cook your favorite dish or meal.

• Cook a recipe that you’ve never tried before.

• Take a cooking class.

• Go out for something to eat.

• Go outside and play with your pet.

86 Distress Tolerance Made Easy

• Borrow a friend’s dog and take it to the park.

• Give your pet a bath.

• Go outside and watch the birds and other animals.

• Watch a funny video on the internet.

• Watch a funny movie (start collecting funny movies

to watch when you’re feeling difficult emotions).

• Go to the movie theater and watch whatever’s

playing.

• Watch television.

• Listen to the radio.

• Go to a sporting event, like a baseball or football

game.

• Play a game with a friend.

• Play solitaire.

• Play video games.

• Go online to chat.

• Visit your favorite websites.

• Create your own website.

• Create your own online blog.

• Join an online dating app.

Take Refuge from Your Pain 87

 • Sell something you no longer want on the internet.

• Buy something (within your budget).

• Do a puzzle with a lot of pieces.

• Go shopping.

• Go get a haircut.

• Go to a spa.

• Go to the library.

• Go to your favorite café for coffee or tea.

• Visit a museum or art gallery.

• Go to the mall or the park and watch other people;

try to imagine what they’re thinking.

• Pray.

• Meditate.

• Go to your church, synagogue, temple, or other place

of worship.

• Join a group at your place of worship.

• Write a letter to God, the universe, or your higher

power.

• Call a family member you haven’t spoken to in a long

time.

• Learn a new language.

88 Distress Tolerance Made Easy

• Sing or learn how to sing.

• Play a musical instrument or learn how to play one.

• Write a song.

• Listen to some upbeat, happy music (start collecting

happy songs for times when you’re feeling painful
emotions).

• Turn on some loud music and dance.

• Memorize lines from your favorite movie, play, or

song.

• Make a movie or video with your smartphone.

• Take photographs.

• Join a public-speaking group and write a speech.

• Participate in a local theater group.

• Sing in a local choir.

• Join a club.

• Plant a garden.

• Work outside.

• Knit, crochet, or sew—or learn how to.

• Make a scrapbook with pictures.

• Paint your nails.

Take Refuge from Your Pain 89

 • Change your hair color.

• Take a bubble bath or shower.

• Work on your car, truck, motorcycle, or bicycle.

• Sign up for a class that interests you at a local college,

adult school, or online.

• Read your favorite book, magazine, paper, or poem.

• Read a celebrity magazine.

• Write a letter to a friend or family member.

• Finger paint.

• Write a poem, story, movie, or play about your life or

someone else’s life.

• Do a craft.

• Write a loving letter to yourself when you’re feeling

good and keep it with you to read when you’re feeling
distressed.

• Make a list of ten things you’re good at or that you

like about yourself when you’re feeling good, and
keep it with you to read when you’re feeling painful
emotions.

• Draw a picture.

90 Distress Tolerance Made Easy

• Paint a picture.

• Spend time with someone you care about, respect, or

admire.

• Make a list of the people you admire and want to be

like—it can be anyone real or fictional throughout
history. Describe what you admire about these
people.

• Write a story about the most outlandish, funniest, or

most meaningful thing that has ever happened to
you.

• Make a list of ten things you would like to do before

you die.

• Make a list of ten celebrities you would like to be

friends with and describe why.

• Make a list of ten celebrities you would like to date

and describe why.

• Write a letter to someone who has made your life

better and tell them why. (You don’t have to send the
letter if you don’t want to.)

• Create your own list of pleasurable activities.

Take Refuge from Your Pain 91

 Here’s an example of using pleasurable activities to distract
yourself:

Karen was feeling lonely and had nothing to do. As she sat
alone at home, she began to think about how lonely she’d
been her whole life and how she was hurt by her father when
she was growing up. Very quickly, Karen was overwhelmed
with very painful emotions. In fact, the memories also
triggered physical pain in her shoulder. Karen began to cry
and didn’t know what to do. Luckily, she remembered the
distraction plan she had created. Exercise had always been
a powerful tool for Karen, so she went for a long walk in
the park while she listened to some of her favorite music.
The activity didn’t erase her memories or remove her pain
completely, but the long walk did soothe her and prevent
her from being overwhelmed with sadness.

CHORES ARE ACTIVITIES!

Strangely, many people don’t schedule enough time to take
care of themselves or their living environments. As a result, tasks
and chores go uncompleted. Here, then, is the perfect opportu-
nity to do something to take care of yourself and your environ-
ment. The next time you’re in a situation in which your emotions
become too painful, temporarily distract yourself by engaging in

92 Distress Tolerance Made Easy

one of the following activities. Add the ones you’re willing to do,
and any others you can think of, to your list:

Wash the dishes or load the dishwasher.

Make phone calls to people you haven’t spoken to

recently (but not someone you’re angry with).

Clean your room or house, or go help a friend with their

cleaning or gardening project.

Clean out your closet and donate your old clothes.

Redecorate a room or at least the walls.

Organize your books, music playlists, computer desktop,

and so forth.

Make a plan for getting a job if you don’t already have

one, or make a plan for finding a better job.

Wash your car (or someone else’s!).

Mow the lawn.

Clean your garage.

Wash the laundry.

Do your homework.

Do work that you’ve brought home from your job.

Polish your shoes.

Take Refuge from Your Pain 93

 Polish your jewelry.

Clean the bathtub and then take a bath.

Water your plants.

Pay the bills.

Go to a support meeting, like Narcotics Anonymous,

Alcoholics Anonymous, or Overeaters Anonymous.

Here’s an example of using tasks and chores to distract

yourself:

Mike was stressed about his job; on his way home from work
he drove past the liquor store and on a whim he stopped and
bought himself a bottle. It was only after he had taken his
second drink that he realized he had just lost his three months
of sobriety; shame immediately arose and Mike didn’t know
what to do. Quickly, he began to feel light-headed and
confused, and his emotions became very intense. But this
time, instead of taking another drink and making more
choices that he would regret later, he opened his wallet and
pulled out the distraction plan he had made. He had written
down, “Take a REST and distract with chores.” So he took a
few breaths to relax and then evaluated the situation. He
recognized that he was feeling shame—but was not in danger.
Next, he set an intention to go see his parents. A visit would
take him at least two hours, and connecting with his parents

94 Distress Tolerance Made Easy

 would help him feel less shame since they understood what he
was going through. And finally, he took action by walking a
half mile to his parents’ home. Getting out of his house helped
soothe his intense emotions, and he was able to have his
father come home with him to ensure he poured out what
was left of the alcohol.

S: Someone Else
Another great way to distract yourself from pain is to divert your
attention to someone else. Here are some examples. Add the ones
you’re willing to do, and any others that you can think of, to your
list of skills:

• Do something for someone else. Call your friends

and ask if they need help doing something, such as a
chore or running an errand. Ask your parents,
grandparents, or siblings if you can help them with
something. Tell them you’re feeling bored and you’re
looking for something to do. Call up someone you
know and offer to take them out to lunch. Find a
charity to donate a sum of money that is reasonable
for you. If you can plan ahead for moments like these
when you’re overwhelmed with pain, call your local
soup kitchen, homeless shelter, or volunteer organi-
zation. Plan to participate in activities that help

Take Refuge from Your Pain 95

 other people. Join a local political activities group,
environmental group, or other organization, and get
involved in helping other people.

• Take your attention off yourself. Go to a local

store, shopping center, bookstore, or park. Just sit
and watch other people or walk around among them.
Watch what they do. Observe how they dress. Listen
to their conversations. Count the number of buttons
they’re wearing on their shirts. Observe as many
details about these other people as you can. Count
the number of people with blond hair versus the
number of people with brown, red, and gray hair.
When your thoughts return to your pain, refocus on
the details of the people you’re watching.

• Think of someone you care about. Keep a picture

of this person on your phone, or in your wallet or
purse. This could be your partner, your parent, chil-
dren, or friend, or it could be someone else you
admire, such as Mother Teresa, Gandhi, Jesus, the
Dalai Lama, and so on. It could even be a movie star,
an athlete, or someone you’ve never met. Then,
when you’re feeling distressed, take out the picture
and imagine a healing, peaceful conversation you

96 Distress Tolerance Made Easy

 would have with that person if you could talk to
them at that moment when you’re feeling distressed.
What would they say to you that would help make
you feel better? Imagine them saying those words to
you.

Here’s an example of distracting yourself by paying attention

to someone else:

Watching the evening news, Louis found himself feeling very

distressed by all of the pain he was seeing in the world
around him—the wars; the environmental disasters;
homelessness; people who were suffering with mental illness,
physical illness, and addictions. It felt like everywhere he
looked all he saw was suffering. Very quickly, Louis became
overwhelmed by sadness, anger and fear. Recognizing that
his emotions were intensifying and becoming more difficult to
bear, Louis went to his desk, where he kept a picture of his
mother. He sat down and started to talk to his mother as if
she were there with him. He asked for strength and guidance
to handle the pain he was feeling. Then he imagined what
she would say to him, and he started to feel better. Later,
when he was able to think more clearly, he returned to what
he needed to do that day.

Take Refuge from Your Pain 97

 I: Intense Sensations
Generating intense physical sensations can sometimes distract us
from painful emotions. What physical sensations might take your
.

mind off your emotions? For example, if you turn to self-harm to

deal with painful emotions, try holding an ice cube in your hand
(Linehan 2003); this causes an intense sensation but doesn’t come
with the negative consequences of self-harm. Here are some other
things you might try:

Take a hot or cold bath or shower (keep in mind that the

cold water, if you can go that route, will also help by acti-
vating your parasympathetic nervous system!), or go for a
walk in cold or hot weather.

Snap a rubber band on your wrist.

Chew on crushed ice or frozen fruit.

Do some stretches.

Have (healthy) sex.

Eat something sour (like a sour key or a lime).

S: Shut It Out
Quite often, physically leaving a situation and going somewhere
calm and quiet will make it more likely that you can use your

98 Distress Tolerance Made Easy

skills and manage emotions more effectively. Sometimes, of
course, this isn’t enough, and you may find yourself continuing to
dwell on the problem even after you’ve physically left the situa-
tion. This is when shutting it out—the DBT skill known as
pushing away (Linehan 2014)—can be helpful. With this skill, you
use your imagination to convince your mind that the problem
isn’t something that can be worked on now, and that it needs to
be put away for the time being.
The first step to shutting it out is to write out the problem (or
list of problems, if there’s more than one) contributing to your
emotional pain. Next, ask yourself if this is a problem you can
solve right now: Do you have the skills to solve the problem? Is
there a solution to the problem that you can start working on in
this very moment?
If you see that you can solve the problem, then stop right here
and solve it! Shutting it out is only effective if you can convince
your mind that you can’t do anything about the current problem
right now.
For a problem you can’t solve, close your eyes and get a sense
of something that represents it. For example, if you had an argu-
ment with your boss, you might conjure an image of your boss, or
visualize their name. (If you can’t visualize very well, see if you
can get a sense of the problem in some way, or feel it.) Next,
imagine yourself placing that representation of your problem in a
box, putting a lid on the box, and tying the lid on with string or
rope—or chains! The goal here is to convince your mind that the

Take Refuge from Your Pain 99

 problem can’t be worked on now and must be put away for the
time being, so do what you have to do to shut it out. For example,
you might need to imagine putting the box on a shelf in a closet,
shutting the closet door, and putting a padlock on the door.
You can also make this technique more concrete:

• Take the problem you’ve written down on a piece of

paper and literally put it away.

• Tell a worry doll about the problem before you go to

sleep. A worry doll is a doll that is put under the
pillow and will take over the worrying for the person,
allowing them to sleep better rather than lie awake
worrying.

• Put the problem in a “God box,” a container with an

opening on top. When using a God box, you write
your problem, worry, or difficult decision on a piece
of paper and put it in the box, turning the matter
over to God (or higher power, or whatever version of
this fits for you).

If you shut the problem out in some way already, fantastic;

add your method to your distress tolerance skills list. If this
concept is new to you, write out some ideas you’d be willing to try.
Keep in mind that this skill, and any other approach that involves
avoiding thinking certain thoughts or feelings, can be helpful for
some people, but pushing thoughts and emotions away often

100 Distress Tolerance Made Easy

makes them stronger, so this skill should be used sparingly. When
you’re in a more regulated state and feel like you have the skills,
you can also start to take things out of your container and work
on problem solving.

T: Think Neutral Thoughts

The human brain is a wonderful thought-producing machine. It
turns out millions of thoughts every day. Most of the time, this
makes our lives much easier. But unfortunately, we can’t fully
control what our brain thinks about. Here’s an example:
Imagine a picture of your favorite cartoon character, such as
Bugs Bunny, Snoopy, Superman, or whoever. Close your eyes and
see the character in vivid detail in your mind’s eye. Remember
exactly what it looks like. Think about the character for about
fifteen seconds. Got it? Now, for the next thirty seconds, do your
best not to think about that character. Try to block them from
your thoughts. But be honest with yourself and notice how often
they pop into your thoughts.
It’s impossible not to think about them; and in fact, the
harder you try not to think about that character, the more power
you give to the image and the more your brain keeps bringing it
into your thoughts. It’s almost as if the harder you try to forget
something, the harder your brain tries to remember it. This is why
forcing yourself to forget about something that happened to you is

Take Refuge from Your Pain 101

 impossible. It’s also why you can’t simply force yourself to get rid of
emotions that you don’t want.
So, instead of trying to force yourself to forget something—a
memory, thought, or something else that’s uncomfortable or
painful—try to distract your thoughts with other memories or
creative images. Here are some examples. Add the ones you’re
willing to do, and any others you can think of, to your list:

• Remember events from your past that were pleasant,

fun, or exciting. Try to remember as many details as
possible about these happy memories. What did you
do? Who were you with? What happened?

• Look outside at the natural world around you.

Observe the flowers, trees, sky, and landscape as
closely as you can. Observe any animals that are
around. Listen to the sounds that they make. Or if
you live in a city without much nature around you,
either do your best to observe what you can, or close
your eyes and imagine a scene you’ve observed in the
past.

• Imagine yourself as an avenger correcting some past

or future event in your life. How would you do it?
What would people say to you?

• Imagine yourself getting praise from someone whose

opinion matters to you. What did you do? What

102 Distress Tolerance Made Easy

 does this person say to you? Why does this person’s
opinion matter to you?

• Imagine your wildest fantasy coming true. What

would it be? Who else would be involved? What
would you do afterward?

• Keep a copy of a favorite prayer, poem, or saying

with you. Then, when you feel distressed, pull it out
and read it to yourself. Imagine the words calming
and soothing you. Use imagery (such as a light
coming down from Heaven or the universe) that
soothes you as you read the words.

• Count (for example, count your inhalations as you

do paced breathing, or count backward from one
hundred by threes).

• Say a prayer or repeat a mantra that you find com-

forting, such as “It is what it is” or “Peace and calm.”

• Sing your favorite song or recite a nursery rhyme or

poem.

Here’s an example of distracting with neutral thoughts:

Joel struggled to manage his anger. When he found himself

feeling angry, he noticed that he would often rehash the
situation that was triggering him, going over and over it in his
mind. He didn’t know what to do to get his mind unstuck; he

Take Refuge from Your Pain 103

 would often find himself screaming at his friends or whoever
else was around.
But after creating a distraction plan, Joel thought of
other ideas. The next time he noticed the feeling of anger
arising, he remembered to use his REST strategy. First, he
did his best to relax by taking a few slow breaths. Then, he
evaluated the situation and realized he wasn’t in any danger.
Next, he set an intention to distract his thoughts, so he took
action and went to his bedroom to lie down. Then, he
started to use neutral thoughts to distract himself. He began
counting his breaths as he did paced breathing; and he
repeated the mantra he had come up with: I can manage,
I can feel calmer. This gradually helped Joel to reduce the
intensity of his anger, and he was able to turn to his list of
distress tolerance skills to find something else to prevent the
anger from overwhelming him.

T: Take a Break
Sometimes the best thing that you can do is leave. If you’re in a
very painful situation with someone and you recognize that your
emotions are going to overwhelm you and possibly make the situ-
ation worse than it is already, then often it’s best to just leave.
Remember, if you’re already overwhelmed by your emotions, it
will be harder for you to think of a healthy resolution to your

104 Distress Tolerance Made Easy

problem. Maybe it’s best to put some distance between you and
the situation in order to give yourself time to calm your emotions
and consider what to do next. Just walk away if that’s the best you
can do. It will be better than adding fuel to the emotional fire.
Here’s an example of leaving to distract yourself:

Anna was in a large department store shopping for a blouse.

She wanted one of the clerks to help her find her size, but the
store clerk was busy with other customers. Anna waited as
long as she could and kept trying to get the clerk’s attention,
but nothing worked. Anna recognized that she was getting
angry very quickly. She was ready to tear the blouse in half.
She didn’t know what else to do. In the past, she would have
stayed in the store and gotten angrier, but this time she
remembered to leave. She walked out of the store, did some
shopping elsewhere, and returned to get the blouse later, when
the store was less crowded and when she was feeling more in
control of her behaviors.

Take a Vacation
We all need to relax in order to refresh our bodies, minds, and
spirits. Yet many people don’t take time out for themselves because
they feel like they’d be disappointing someone else, like their boss,
spouse, family, or friends. Or, they might feel guilty or ashamed

Take Refuge from Your Pain 105

 for doing anything for themselves. Others might struggle with the
constant need to please others, and as a result, they neglect to
take care of themselves. But people who don’t take care of them-
selves lead very unbalanced lives.
How long can you continue to take care of someone else
without taking care of yourself? Imagine a woman who stands on
a street corner on a hot summer day holding a jug of cold water.
She pours drinks for every pedestrian who walks by and, of course,
everyone is grateful. But what happens when she’s thirsty and
goes to get a drink? The woman spent a long day helping everyone
else and neglecting herself, and the jug is now empty. How often
do you feel like this woman? How often do you run out of time for
yourself because you’ve spent all of it taking care of other people?
Helping others is a good thing to do as long as it doesn’t come at
too much of an expense of your own physical or mental health.
You need to take care of yourself, and that doesn’t mean you’re
selfish; it’s self-care.
Here are some ideas you can use to take a vacation from
stress. Add the ones you’re willing to do, and any other ideas you
can think of, to your list:

• Treat yourself as kindly as you treat other people.

Do one nice thing for yourself that you’ve been
putting off.

106 Distress Tolerance Made Easy

 • Devote time to yourself, even if it’s just a few hours
during the week, by doing things like taking a walk
or preparing your favorite meal.

• Take a half day off from work. Go someplace beauti-

ful, like a park, the ocean, a lake, the mountains, a
museum, or even someplace like a shopping center.

• Take time to do things for your own life, like shop-

ping, errands, doctor’s appointments, and so on.

Peaceful Place Visualization

Peaceful place visualization is a powerful stress-reduction tech-
nique. Using it, you can soothe yourself by imagining a peaceful
place to help you feel more relaxed and to manage your emotions
more effectively. The truth is, your brain and body often can’t tell
the difference between what’s really happening to you and what
you’re just imagining. So if you can successfully create a peaceful,
relaxing scene in your thoughts, your body will often respond to
those soothing ideas.
Make sure you conduct this exercise in a quiet room where
you’ll be free from distractions. Allow yourself the time and the
freedom to relax. You deserve it.

Take Refuge from Your Pain 107

 Before beginning this exercise, think of a real or imaginary
place that makes you feel peacful, secure, calm, or relaxed. It can
be an indoor or an outdoor space. It can be a real place that you’ve
visited in the past, such as the beach, a park, a field, a place of
worship, a room in your home, and so on. Or it can be a place that
you’ve imagined, such as a white cloud floating in the sky, a medi-
eval castle, or the surface of the moon. It can be anywhere. It’s
also important that there are no other people in your peaceful
place, since we can’t control other people, even in our own imagi-
nation. Pets or other animals can be there if you wish, but no
people allowed! If you have trouble thinking of a place, think of a
color that makes you feel relaxed or calm, such as pink or baby
blue. Just do your best. In the exercise, you’ll be guided through
exploring this place in more detail. But before you begin, make
sure you already have a place in mind, and remember—thinking
of it should make you feel peaceful and relaxed.
Complete the following sentences about your peaceful place
in your journal before beginning the visualization:

• My peaceful place is      .

• My peaceful place makes me feel      .

108 Distress Tolerance Made Easy

To begin, sit in a comfortable chair with your feet and hands
resting comfortably. Close your eyes. Take a slow, long breath
in through your nose. Feel your belly expand like a balloon as
you breathe in. Hold it for five seconds: 1, 2, 3, 4, 5. Then,
release it slowly through your mouth. Feel your belly collapse
like a balloon losing its air. Again, take a slow, long breath in
through your nose and feel your stomach expand. Hold it for
five seconds: 1, 2, 3, 4, 5. Then, exhale slowly through your
mouth. One more time: Take a slow, long breath in through
your nose and feel your stomach expand. Hold it for five
seconds: 1, 2, 3, 4, 5. Then, exhale slowly through your
mouth. Now, begin to take slow, long breaths without holding
them, and continue to breathe smoothly for the rest of this
exercise.

Now, with your eyes closed, imagine that you enter your
peaceful place, using all of your senses to ground yourself in
the scene.

First, look around using your imaginary sense of sight. What

does this place look like? Is it daytime or nighttime? Is it sunny
or cloudy? Notice the details. Are you alone or are there other
animals there with you? What are they doing? If you’re outside,
look up and notice the sky. Look out at the horizon. If you’re
inside, notice what the walls and the furniture look like. Is the
room light or dark? Choose something soothing to look at.
Then, continue looking for a few moments using your imagi-
nary sense of sight.

Take Refuge from Your Pain 109

 Next, use your imaginary sense of hearing. What do you hear?
Do you hear music? Do you hear the wind or the ocean? Do
you hear the sound of animals or nature? Choose something
soothing to hear. Then, listen for a few moments using your
imaginary sense of hearing.

Now, use your imaginary sense of smell. If you’re inside, what

does it smell like? Does it smell fresh? Do you have a fire
burning that you can smell? Or, if you’re outside, can you smell
the air, the grass, the ocean, or the flowers? Choose to smell
something soothing in your scene. Then, take a few moments
to use your imaginary sense of smell.

Next, notice if you can feel anything with your imaginary sense
of touch. What are you sitting or standing on in your scene?
Can you feel the wind? Can you feel something you’re touching
in the scene? Choose to touch something soothing in your
scene. Then, take a few moments to use your imaginary sense
of touch.

Last, use your imaginary sense of taste. Are you eating or

drinking anything in this scene? Choose something soothing to
taste. Then, take a few moments to use your imaginary sense
of taste.

Now, take a few more moments to explore your safe place

using all of your imaginary senses. Do your best to let this
experience really sink in as much as possible, feeling its calm,
healing properties.

110 Distress Tolerance Made Easy

Now, let’s practice using this skill to regulate emotions.

Just for a moment, set aside this peaceful place you’ve envi-
sioned around yourself, think of a recent troubling situation—
something that caused you to feel irritated, annoyed, or
stressed, for example. On a scale from 0 (no emotion) to 10
(most intense emotion imaginable), the feeling should be
around a 3 or 4. Imagine that situation now as best as you can
so that you actually experience the emotion. Once you feel it,
go back to your peaceful place. Picture it in your mind, feel it
with all of your senses once again, really letting yourself be
there, allowing yourself to experience the calm, peace, and
security of that place. Stay with that peaceful experience as
long as you’d like, and see if you can get those emotions back
down to a 1 or even 0.

Remember that you can come back to this place in your imagi-
nation whenever you need to feel peaceful and relaxed. You
can also come back whenever you’re feeling sad, angry, rest-
less, or in pain. Look around one last time to remember what
it looks like. Now, keep your eyes closed and return your focus
to your breathing. Again, take some slow, long breaths in
through your nose and exhale through your mouth. Then,
when you feel ready, open your eyes and return your focus to
the room.

Take Refuge from Your Pain 111

 Hopefully you saw your emotions come back down. And
don’t forget that you can use other skills in conjunction with the
peaceful place, as well. For example, if your emotion is intense,
you might need to do some re-regulating with skills like the
forward bend or deep breathing before you can use your peaceful
place; or, if you’re using your peaceful place to re-regulate and you
find that the emotions don’t quite come down to a 0, you can also
use more skills you’ve been learning in this book to reduce the
emotion further. This peaceful place is one more tool to help you
tolerate your distress more effectively.

112 Distress Tolerance Made Easy

 Chapter 6

Accept and
Move Beyond

The distress tolerance skills we’ve been looking at so far in this

book have mostly been skills that will help you to tolerate distress-
ing or uncomfortable emotions in the short term. In this chapter,
we’ll be looking at some skills that will help you in the longer
term: first, through finding connection—with a higher power,
with yourself, and with others. We’ll do some practices to help you
discover that connection for yourself; or, if this is something you’re
already connected to, you’ll learn ways of deepening that connec-
tion, and drawing on it in a more conscious way when you need it.
The second skill we’ll look at in this chapter is radical accep-
tance: acknowledging reality as it actually is. You’ll learn how
each of these skills can be helpful when it comes to learning to
tolerate distress. You’ll also have the opportunity to consider how
you may have used these skills already in your life—as well as how
they can help you tolerate distress moving forward—and you’ll be
 encouraged to engage in some exercises to help you practice each
of them. Remember these skills take longer to develop and will
likely take work and energy, so do your best to keep an open mind
and be patient with yourself.

Connect to Higher Power

Whether you believe in one God, many gods, a divine universe, or
the goodness that exists within each human being, having faith in
something bigger and more powerful than yourself can often
make you feel empowered, safe, and calm. This is what people
mean when they talk about believing in a “higher power” or seeing
“the big picture” in life. Believing in something divine, holy, or
special can help you endure stressful situations as well as help you
soothe yourself.
At some point in life, we all feel hopeless or powerless. We’ve
all experienced unfortunate situations during which we felt alone
and needed strength. Sometimes unexpected circumstances hurt
us or the people we care about. These situations might include
being the victim of a crime, experiencing a natural disaster,
getting into an accident, having someone close to us die, or being
diagnosed with a serious illness. Having faith in something special
during times like these can often help you feel connected to a
bigger purpose in life. And remember, your faith doesn’t have to
involve God if that’s not what you believe in. Some people only

114 Distress Tolerance Made Easy

put their faith in the goodness of the people they love. Yet basic
beliefs like these are often powerful enough to help people find
the strength and comfort to lead happy, healthy lives.
While you’re exploring your spirituality, remember that your
beliefs can change over time. Sometimes a person is raised in a
religious or spiritual tradition that no longer makes sense or feels
helpful to them. Yet, despite these feelings, a person will some-
times continue to attend the services of that tradition out of a
sense of obligation. The truth is, if your spiritual tradition is no
longer giving you peace and strength, it’s okay (and even impor-
tant!) to reexamine that faith and to make changes.

Connect to Your Higher Power

Use the following questions to help you consider your beliefs
and some ways in which you can strengthen and use those
beliefs on a regular basis. Spend some time responding to
these questions in your journal.

What are some of your beliefs about a higher power or a

big picture that give you strength and comfort?

Why are these beliefs important to you?

How do these beliefs make you feel?

How do these beliefs make you think about others?

Accept and Move Beyond 115

 How do these beliefs make you think about life in general?

How do you acknowledge your beliefs throughout your

daily life? (For example, do you go to church, synagogue,
or temple? Do you pray? Do you meditate? Do you talk to
other people about your beliefs? Do you read books about
your beliefs? Do you help other people?)

What else would you be willing to do in order to strengthen

your beliefs?

What can you do to remind yourself of your beliefs on a

regular basis?

What can you say or do to remind yourself of your beliefs

the next time you’re feeling distressed?

Higher-Power Activities
Here are some additional activities to help you feel more con-
nected to your higher power, the universe, and the big picture.
Add the ones you’re willing to do to your list of distress tolerance
skills:

• If you do believe in the teachings of a particular

religion or faith, find related activities that make
you feel more empowered and calmer. Go to your
church, synagogue, or temple for services. Talk to

116 Distress Tolerance Made Easy

 the person who runs your services. Talk to other
members of your faith about how they’ve handled
difficult experiences. Join discussion groups formed
at your place of worship. Read the books that are
important to your faith. Find passages that give you
strength, and mark them or copy them to keep with
you in your wallet, your purse, or on your phone so
you can read them no matter where you are.

• Remember that your higher power can also be

something other than God. Your higher power can
be a person who makes you feel stronger and more
confident to deal with the challenges that you face.
Think of someone you admire who can be your
higher power. Describe that person. What makes
them special? Then, the next time you’re in a diffi-
cult or distressing situation, act as if you are that
person, and notice how you handle the situation
differently.

• Look up at the stars. The light you’re seeing is

thousands of years old, and it has traveled from stars
that are billions of miles away. In fact, each time you
look up at the stars, you’re looking through a time
machine and seeing the universe as it looked thou-
sands of years ago. Strangely, some of the stars you’re
looking may have already died, but their light is just

Accept and Move Beyond 117

 reaching your eyes on the Earth. Look up at the stars
and recognize that whatever created them also
created you, whether it was God or a cosmic force.

• You are connected to the stars. Imagine yourself

connecting with the universe. Sit in a comfortable
chair, close your eyes, and imagine a beam of light
shining down from the universe. Like a laser beam,
the light shines on the top of your head and fills you
with a feeling of peace. Now, imagine the light
spreading all over your body, relaxing every muscle.
Now, imagine your legs stretching down through the
floor like giant tree roots, going all the way down
into the center of the Earth. Imagine these roots
tapping into the energy that drives the planet. Feel
your body fill with confidence as your legs absorb the
golden energy flowing up from the Earth.

• Think about our planet Earth. Water is the most

important substance for sustaining life on our planet.
Yet if we were much closer to the sun, all the water
on our planet would evaporate because the tempera-
ture would be too hot, and if we were much farther
away, all the water would freeze because the tem-
perature would be too cold. Somehow, we were lucky
enough to be in just the right place for life to form.
Even if you don’t believe in a religious purpose, ask

118 Distress Tolerance Made Easy

 yourself what it means that you live on a planet with
just the right climate and elements for life to exist.
How did this happen, and what does it mean about
your life?

• Go to the beach. Try to count the grains in a

handful of sand. Now, try to imagine how many
handfuls of sand there are in the world, on all the
beaches and in all the deserts. Try to imagine how
many billions of years must have passed to create so
many grains of sand. And again, recognize that the
chemical elements that make up the sand also exist
in you. Stand with your feet in the sand and imagine
feeling connected to the planet.

• Go to a park or to a field and observe the trees,

the grass, and the animals. Again, recognize that
whatever created all of that also created you.
Remember that all living things are made of the
same chemical elements. On a subatomic scale,
there isn’t much difference between you and many
other life forms. Yet you are still different and special.
What is it that makes you unique?

• Think about the human body, especially your

own. Each human being is more wonderful than a
piece of artwork and more complex than any

Accept and Move Beyond 119

 computer ever invented. Everything about you is
largely determined by your DNA, the instructions
that are found in every cell of your body. Yet amaz-
ingly, each set of instructions that creates every part
of your body is composed of just four chemical ele-
ments that are repeated in different combinations.
These different combinations are called genes, and
these are the instructions you inherit from your
parents that make up the spectrum of your possible
physical and biological traits such as your eye color
and the structure of your heart. Incredibly, it only
takes an estimated twenty thousand genes to design
a human being (according to Carl Zimmer’s article
“Scientists Finish the Human Genome at Last” in
The New York Times, published July 23, 2021).
Imagine trying to write so few instructions in order
to create a body that thinks, breathes, eats, moves,
and does everything else you do. Plus, remember
that this same number of instructions is also respon-
sible for creating approximately eighty-six billion
neurons in your brain, sixty thousand miles(!) of
blood vessels throughout your body, six hundred
skeletal muscles, two hundred bones, thirty-two
teeth, and ten pints of blood.

120 Distress Tolerance Made Easy

 Some people might prefer to simply believe in their own
internal wisdom. We all have internal wisdom, although some-
times it can be more difficult to access than at others, and for
some people, tapping into it takes more practice. If you would
prefer to connect to your own internal higher power, or if you’d
like to strengthen this connection in addition to that with your
higher power, practicing getting to your Wise Mind can be very
helpful.

Getting to Your Wise Mind

Acting from our Wise Mind means finding a balance between our
emotions and our reasoning and following our intuition, or gut
instinct, about what’s in our best interest in the long run (Linehan
2014). Wise Mind has us considering how we feel (as well as our
logical thoughts about a situation), weighing the possible conse-
quences of different actions we might choose, and considering our
values. With our Wise Mind, we base our decisions or behavior on
all of these things. In other words, when we’re acting from our
Wise Mind, we’re choosing how we want to act rather than simply
reacting.
Like any new skill, it can be difficult to access that internal
wisdom, especially when you’re facing overwhelming emotions.
The human tendency is to fall back into old habits and patterns.
Here are some ideas to help improve your ability to access your

Accept and Move Beyond 121

 Wise Mind; give each a try (or come up with your own), find one
that resonates with you, and practice it as often as you can so that
getting to your Wise Mind starts to come more naturally, provid-
ing emotional relief when things are getting tense.

Mindfulness. The “mindfulness of emotions” practice from

chapter 1 is a good place to start for learning to notice your emo-
tions, thoughts, physical sensations, and urges. Over time you’ll
learn to just observe these internal experiences rather than react
to them. Of course, you don’t have to do just this particular prac-
tice; any mindfulness practice will help you with this noticing, so
be sure to incorporate mindfulness into your daily routine.

Self-talk. How you talk to yourself can influence how you think
and feel about things. Bring to mind a recent situation that was
painful for you. As you notice the emotion arising within you,
focus on saying things to yourself that you would say to your best
friend (or partner, or even a pet) if they were feeling this way: “It’s
okay that you feel like this. You’ve felt like this before, and you
know it doesn’t last forever. You’ll get through this.” Talking to
yourself as you would a friend can reduce the pain you’re feeling
and help you get to your Wise Mind.

Ask your Wise Mind. Ask yourself, What does my Wise Mind say
right now? Then, listen quietly and see if you get an answer. You
might want to close your eyes to do this.

122 Distress Tolerance Made Easy

Breathe. Do a breathing practice you like to get to your Wise
Mind. You might also pair this with a mantra or saying, such as
“Get to” (on the inhale) “Wise Mind” (on the exhale). Make it fit
for you.

Taking On an Attitude of Gratitude

Let’s look at how you can use a gratitude practice to strengthen
your connection to yourself, your higher power, or to others when
you’re feeling distressing or painful emotions. It can be challeng-
ing to feel thankful while in a crisis, but gratitude can help us
manage our emotions effectively to get through difficult, emotion-
ally charged times.
Before employing this skill, you might first need to turn to
one of the fast-acting skills (like the forward bend, a breathing
practice, and so on) we covered in chapter 2 to get your emotions
somewhat regulated. Over time you’ll likely need these skills less
often as you turn to other skills that help you prevent emotions
from getting really intense in the first place; but until that’s the
case, be sure to use whatever skills you need to prevent yourself
from making a situation even more difficult.
Once you’ve reduced the intensity of the emotion (or if you
were able to catch it before it became intense), focus on something
you feel grateful for. It might be someone in your life now or from
your past, your job, the roof over your head, the country you live

Accept and Move Beyond 123

 in, and so forth. (When I’m feeling angry at the most recent problem
life has sent my way, I hear myself thinking, First-world problems. I
don’t mean this in a self-judgmental way, but rather as a reminder that
I have so many things to be grateful for—things I might not have, had
I been born in another part of the world.)
The key with this practice, of course, is finding what works
for you. It’s important to make sure you’re not invalidating your
experience—rather, you’re reminding yourself of what you can be
grateful for, turning your attention to those people or things,
instead of staying focused on the problem. You might find it
helpful to combine this skill with other skills, such as taking an
open posture, putting on a half-smile, distracting yourself from
the problem, or doing a breathing practice. In fact, it’s always
important to not forget to breathe!
So far in this chapter we’ve been looking at how to foster
­connection: with our higher power, with others, and within our-
selves. Now we’ll move to a different but related skill: radical
acceptance.

Radical Acceptance
In DBT, the word “dialectic” means to balance and compare two
things that appear very different or even contradictory. One of
the primary dialectics we work with is between change and accep-
tance (Linehan 1993). You need to change the behaviors in your

124 Distress Tolerance Made Easy

life that are creating more suffering for yourself and others while
simultaneously also accepting yourself the way you are. This
might sound contradictory, but it’s a key part of this treatment.
DBT focuses on acceptance and change, not acceptance or
change.
Radical acceptance is one of the hardest skills to practice
because it will require you to look at yourself and the world in a
different way. However, it’s also one of the most important
(Linehan 1993). Radical acceptance means that you accept some-
thing completely, without judging it. For example, radically
accepting the present moment means that you don’t fight it, get
angry at it, or try to change it into something that it’s not. To radi-
cally accept the present moment means that you must acknowl-
edge that the present moment is what it is due to a long chain of
events and decisions made by you and other people in the past.
The present moment never spontaneously leaps into existence
without having been caused by events that already took place.
Imagine that each moment of your life is connected like a line of
dominoes that knock each other down.
But remember, radically accepting something doesn’t mean
that you give up and simply accept every painful situation that
happens to you. Some situations in life are unjust, such as when
someone abuses or assaults you. But for other situations in life, you
share at least some responsibility. There’s a balance between what
you created and what others have created. However, many people
struggling with overwhelming emotions often feel like life just

Accept and Move Beyond 125

 “happens” to them, not recognizing their own role in creating a
situation. As a result, their first reaction is to get angry. In fact, a
client once said that anger was her “default emotion,” meaning
that when she was just being herself, she was angry. Her excessive
hostility caused her to hurt herself—by drinking heavily, cutting
herself, and constantly berating herself—and it also led to her
hurting the people she cared about by constantly arguing with
them.
In contrast, radically accepting the present moment opens up
the opportunity for you to recognize the role that you have played
in creating your current situation. And, as a result, it also creates
an opportunity to respond to that situation in a new way that’s
less painful for yourself and others. In many ways, radical accep-
tance is like the Serenity Prayer, which says, “Grant me the seren-
ity to accept the things I cannot change, the courage to change
the things I can, and the wisdom to know the difference.” In the
exercise below, you will find some questions to ask yourself when
you want to use radical acceptance. But first, let’s look at an
example of how radical acceptance can help a person in a distress-
ing situation.

Using Radical Acceptance

Christine and her boyfriend, John, had a difficult
relationship. John spent a lot of his free time at the bar

126 Distress Tolerance Made Easy

 drinking with his friends, and, in response, Christine would
get mad, threaten to leave him, and then do something
destructive to “piss him off.” This occurred regularly for five
years. One night, Christine came home from work angry,
and when John wasn’t around to talk to, she suddenly felt
hopeless about their relationship. So she called John to tell
him that she was going to kill herself because she couldn’t put
up with his behavior any longer. John raced home to find
Christine swallowing a handful of pills, and he made her spit
them out. Then, he made her promise that she wouldn’t do it
again. She promised, and John went back to the bar, taking
the keys to Christine’s car so that she couldn’t go anywhere.
Now Christine got even angrier and called the police to
report that her keys had been stolen. She walked up to the
bar, found John’s car, and smashed his windshield with a
brick. She would have broken the other windows too, but the
police stopped her and arrested her. Needless to say, neither
Christine nor John gave any consideration to using radical
acceptance in this situation. Both of them were angry at each
other, and by acting on their anger, they both ended up
hurting themselves and one another.

So how could this situation have occurred differently if

Christine and John had practiced radical acceptance?
Let’s consider the situation from Christine’s point of view.
Instead of threatening to kill herself, maybe she could have used

Accept and Move Beyond 127

 the REST strategy and one of her distress tolerance skills.
Remembering that the strategy for dealing with distressing situa-
tions is to relax, evaluate, set an intention, and take action,
Christine could have (1) stopped what she was doing and taken a
few breaths to relax (or at least to reduce the intensity of her emo-
tions), (2) evaluated the situation and recognized that she was
very emotional, (3) set an intention to use a distress tolerance skill
to help her reduce the intensity of the emotions, and then (4)
taken action by screaming into a pillow and going outside for a
long walk. Or she could have called one of her friends to talk for
a while (distracting herself, though, rather than venting about the
situation and continuing to keep the emotions going!). After she’d
cooled off a bit, Christine could have asked herself some questions
and used radical acceptance to reexamine her situation. Let’s look
at this situation and see how it could have been handled a bit
differently.

• What events led up to Christine’s situation? She and

John had been behaving and fighting like this for
years. This night was nothing new. But she had come
home angry about work, and she became even
angrier with John because he wasn’t around.

• What role did Christine play in creating this situation?

Instead of trying to cope with her anger and frustra-
tion in a healthy way, she took her emotions out on
herself and John. Also, Christine had had many

128 Distress Tolerance Made Easy

 reasons and opportunities in the past to try to
change, or even end this problematic relationship if
she wanted to, but she had chosen to stay.

• What role did John play in creating this situation? John

had an alcohol problem that had been interfering
with their relationship for five years. This night, he
also didn’t take the time to discuss Christine’s sui-
cidal behaviors with her. Instead, he chose to return
to the bar, which made her even angrier.

• What does Christine have control of in this situation?

She can end the relationship if she wants to; she can
talk to John about seeking help to make healthy
changes in their relationship; or she can choose a
different way to cope with this distressing situation.

• What doesn’t Christine have control of in this situation?

Ultimately, it is John who has to seek help to stop his
alcohol addiction. Christine can’t make him stop
drinking. She also doesn’t have control of how John
chooses to behave toward her in this situation.

• What was Christine’s response to this situation? She

tried to kill herself, and then she smashed John’s
windshield.

• How did her response affect her own thoughts and feel-
ings? Her actions made her feel worse about herself

Accept and Move Beyond 129

 and her relationship, and she kept thinking about
why she was still in this destructive relationship.

• How did her response affect the thoughts and feelings of

other people? Christine was arrested, which made
both of them feel worse than they already did about
themselves and their relationship.

• How could Christine have changed her response to this

situation so that it led to less suffering for her and John?
She could have used the REST strategy and other
distress tolerance skills to cope with her pain and
anger. She could also have used radical acceptance
to reevaluate the situation so that she could choose
to act in a different way. And perhaps she could even
have chosen to give herself some space—for instance,
going to stay with a friend.

• How could the situation have occurred differently if

Christine had decided to radically accept the situation?
If Christine had been able to accept the reality as it
was—including the causes that had led up to the
situation—she likely would have experienced less
emotional suffering. Radical acceptance would have
allowed her to access her Wise Mind. Perhaps she
could have made healthier choices, such as using
distress tolerance skills or delaying talking to John to

130 Distress Tolerance Made Easy

 the next morning because neither of them was in the
state of mind to have a helpful conversation. Or
perhaps if Christine had ended the relationship, she
could have made space in her life for a healthier rela-
tionship or simply spared herself the reoccurring
pain of a destructive relationship.

Radical Acceptance
Think of a distressing situation that you experienced recently.
Then, in your journal, answer these questions that will help
you radically accept the situation:

• What happened in this distressing situation?

• What past events led up to this situation?

• What role did you play in creating this situation?

• What roles did other people play in creating this

situation?

• What do you have control of in this situation?

• What don’t you have control of in this situation?

• What was your response to this situation?

• How did your response affect your own thoughts, feel-

ings, and behaviors?

Accept and Move Beyond 131

 • How did your response affect the thoughts, feelings and
behaviors of other people?

• How could you have changed your response to this situa-

tion so that it led to less suffering for yourself and others?

• How could the situation have occurred differently if you

had decided to radically accept the situation?

It’s important to remember that radical acceptance also

applies to accepting yourself. In this case, radical acceptance
means embracing who you are without judging or criticizing your-
self. Or, to put it another way, radically accepting yourself means
loving yourself just the way you are, with all of your goodness and
all of your faults. Finding the goodness inside of yourself might be
a difficult challenge, especially if you’re struggling with over-
whelming emotions. Many people with this problem often think
of themselves as being defective, bad, or unlovable. As a result,
they overlook their positive qualities and add more pain to their
lives. Accepting yourself as you are instead (remember, this
doesn’t mean that you stop trying to make changes!) will reduce
the amount of suffering you experience.

132 Distress Tolerance Made Easy

 Conclusion

One of the certainties of life is that it will involve pain—there’s

something we need to radically accept! Being able to tolerate dis-
tress—managing emotional pain and getting through crisis situa-
tions without making them worse by engaging in problematic or
self-destructive behaviors—is one of the first steps to managing
emotions more effectively, and to building a life worth living
(Linehan 1993).
The aim of this book has been to bring distress tolerance
skills into one place for you and help you expand your toolbox of
skills to turn to when emotions start to become problematic.
Remember that reading this book is just the start; hopefully you’ve
been trying out the exercises we’ve included, finding the ones that
resonate most for you, and adding them to your list of distress
tolerance skills. As with any new skill, these will take practice,
but over time you’ll find that they will start to come more natu-
rally to you.
 Write a Letter to Yourself
In this last chapter, we’re going to suggest one more skill that
will help you put what you’ve learned together, by writing a
letter to your future self. It’s called a “Letter to Your Unwell
Self,” but please use the language that works best for you.
Consider the timing of writing this letter—you may need to
wait a bit until you get to that “better” place in order to do this.
When you’re ready, you can use the following questions to
help you consider what you might want to include in your letter
to yourself.

• Now that you’re in this “better” place, how would you

describe the Self that is going to need to read this letter
later? In other words, who is the Self that you are writing
this letter to? For example, is this a letter to Your Unwell
Self, Your Depressed Self, Your Avoiding Self, Your Self-
Harming Self?

• What does that future You need to know? For example,

some people struggle to remember when they are in a
depressive episode that they haven’t always felt that way.
Are there words of reassurance or encouragement that
you want your future Self to hear?

• Are there specific skills that you know are helpful for you
when you get into that painful state? What do you want
that future You to know, or to remember? For example,
some people like to remind themselves to practice a
certain mindfulness exercise; others find writing out

134 Distress Tolerance Made Easy

 self-validating statements when they start to experience
familiar painful emotions such as shame quite helpful.
But this can also include reminders like “get fresh air
every day” or “exercise really helps our mood!”

• Is there anything else you’d like to share with your future

Self?

When you’re ready, you can put this information into a letter
to yourself. Some people find it helpful to think of this as an
instruction manual for themselves! The key is, once you’ve created
this letter or instruction manual, to make sure you keep it some-
where you’ll remember to look at it when you start to struggle with
tolerating distressing emotions. You might make it part of your
routine to read your letter once a week, or put a reminder in your
phone so you remember to look at it. Or you might keep it on your
dresser or night table so you see it every day. You’ll also probably
want to add new things that you find helpful over time.
Your next step is to continue to practice what you’ve learned.
Using these skills when things get difficult will of course be
helpful, and you’ll likely find it even more helpful to practice when
you’re not in a full-blown crisis; over time you’ll likely see that you
experience fewer crises as your ability to tolerate distress increases.
Remember that learning to tolerate distress and manage emotions
is a process, so do your best to have patience and be gentle with
yourself. Radically accept when you struggle—none of us is
perfect—and keep working to change.

Accept and Move Beyond 135

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Sheri Van Dijk, MSW, is a psychotherapist, and renowned dia-
lectical behavior therapy (DBT) expert. She is author of several
books, including Calming the Emotional Storm, Don’t Let Your
Emotions Run Your Life for Teens, and The DBT Skills Workbook for
Teen Self-Harm. Her books focus on using DBT skills to help
people manage their emotions and cultivate lasting well-being.
She is also the recipient of the R.O. Jones Award from the
Canadian Psychiatric Association.

Matthew McKay, PhD, is a professor at the Wright Institute in

Berkeley, CA. He has authored and coauthored numerous books,
including Self-Esteem, Thoughts and Feelings, When Anger Hurts,
and ACT on Life Not on Anger. McKay received his PhD in clini-
cal psychology from the California School of Professional
Psychology, and specializes in the cognitive behavioral treatment
of anxiety and depression. He lives and works in the Greater San
Francisco Bay Area.

Jeffrey C. Wood, PsyD, lives and works in Las Vegas, NV. He

specializes in brief therapy treatments for depression, anxiety, and
trauma. He also provides coaching for spiritual development,
communication skills development, and life skills. Wood is coau-
thor of The New Happiness, The Dialectical Behavior Therapy Skills
Workbook, and The Dialectical Behavior Therapy Diary.
Jeffrey Brantley, MD, is professor emeritus in the department of
psychiatry and human behavior at Duke University Medical
Center. He is founder and former director of the Mindfulness
Based Stress Reduction (MBSR) Program at Duke Integrative
Medicine. He has represented the Duke MBSR program in
numerous radio, television, and print interviews. He is author of
Calming Your Anxious Mind, and coauthor of the Five Good
Minutes series.

Patrick Fanning is a professional writer in the mental health

field, and founder of a men’s support group in Northern California.
He has authored and coauthored twelve self‑help books, including
Self‑Esteem, Thoughts and Feelings, Couple Skills, and Mind and
Emotions.

Erica Pool, PsyD, earned her doctorate at the Wright Institute in

Berkeley, CA; and has clinical and research experience at the
University of California, Berkeley; and the VA Northern
California Health Care System; and has consulted with mental
health start-ups. The goal of her work is to understand processes
at the core of human suffering to help craft individualized and
culturally responsive treatments.
Patricia E. Zurita Ona, PsyD, “Dr. Z,” is a psychologist special-
izing in working with and creating compassionate, research-based,
and actionable resources for overachievers and overthinkers to get
them unstuck from worries, fears, anxieties, perfectionism, pro-
crastination, obsessions, and ineffective “playing it safe” actions.
She is founder of the East Bay Behavior Therapy Center—a bou-
tique practice where she offers therapy and coaching services
based on acceptance and commitment therapy (ACT) and con-
textual behavioral science (CBS). She has been nominated as a
fellow of the Association of Contextual Behavioral Science for
her contributions to the applications of ACT to specific fear-
based struggles.
 Real change is possible
For more than forty-five years, New Harbinger has
published proven-effective self-help books and pioneering
workbooks to help readers of all ages and backgrounds
improve mental health and well-being, and achieve lasting
personal growth. In addition, our spirituality books
offer profound guidance for deepening awareness and
cultivating healing, self-discovery, and fulfillment.

Founded by psychologist Matthew McKay and Patrick

Fanning, New Harbinger is proud to be an independent,
employee-owned company. Our books reflect our
core values of integrity, innovation, commitment,
sustainability, compassion, and trust. Written by leaders
in the field and recommended by therapists worldwide,
New Harbinger books are practical, accessible, and
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 SELF-HELP

Stay grounded—no matter

distress

distress tolerance made easy

what life throws your way

Let’s face it: Life can feel downright overwhelming at times, and
struggles can arise when you least expect them. Whether it’s a bad
breakup or divorce, illness, loss of a job, or even a natural disaster or
pandemic, sometimes you need a little extra help managing difficult
tolerance
emotions when times get tough. This go-to guide is packed with proven-
effective skills you can use anytime, anywhere to keep cool and thrive in
the face of life’s inevitable challenges.
made easy
Grounded in evidence-based dialectical behavior therapy (DBT),
Distress Tolerance Made Easy offers essential tools for staying
grounded, no matter what. You’ll learn to navigate difficult experiences
and setbacks—without resorting to unhealthy coping habits. And as you
practice and hone the skills outlined in this guide, you’ll discover you
can handle whatever life throws your
“A much-needed, valuable way—without avoidance, anger, or
guide to making sense of despair. Life happens, but you don’t Dialectical Behavior Therapy
VAN DIJK • MCKAY • WOOD • BRANTLEY
have to get pulled under. Grab this FANNING • POOL • ZURITA ONA
distress—and responding book and head for calmer waters. Skills for Dealing with
more effectively to it.”
—Joel Minden, PhD, author of Intense Emotions in Difficult Times
Show Your Anxiety Who’s Boss

SHERI VAN DIJK, MSW • MATTHEW MCKAY, PhD

newharbingerpublications
w w w. n e w h a r b i n g e r . c o m JEFFREY C. WOOD, PsyD • JEFFREY BRANTLEY, MD • PATRICK FANNING
ERICA POOL, PsyD • PATRICIA E. ZURITA ONA, PsyD