Free DBT Distress Tolerance Skills Worksheets
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Dialectical behavior therapy (DBT) is a therapeutic intervention used to help clients enhance their coping mechanisms, manage stress, and regulate their emotions—aka build DBT distress tolerance skills.
Visual aids, like distress tolerance worksheets, are a great tool to provide psychoeducation about stress, illustrate DBT tools, and empower clients to implement the tools they learn in session in their own lives.
This article provides an overview of DBT distress tolerance skills for therapists, including free, printable DBT worksheets to use in your practice or save to your electronic health record (EHR) for future use.
What is dialectical behavioral therapy?
Dialectical behavioral therapy (DBT) is an evidence-based talk therapy used by mental health clinicians.
Like cognitive behavioral therapy (CBT), DBT is a structured intervention to support individuals psychotherapeutically. While based on CBT, DBT focuses specifically on the regulation of emotions and social relationships.
“Dialectic” means to integrate opposing views. DBT helps clients acknowledge the complexity of life by creating balance and self-inquiry around powerful emotions.
Dialectical behavioral therapy can be used to treat personality disorders, self-harm, anxiety, depression, eating disorders, post-traumatic stress disorder (PTSD), and substance use disorders.
DBT supports clients to manage their emotions and feelings through four core skills:
- Distress tolerance
- Mindfulness
- Emotion regulation skills
- Interpersonal effectiveness
What are DBT distress tolerance skills and how can they help clients?
DBT distress tolerance skills help individuals navigate challenging situations and emotions. This is done by building resilience to tolerate these situations or emotions, without the need to escape or turn to coping strategies that can cause harm.
For example, DBT distress tolerance skills can help clients avoid behaviors such as:
- Ruminating about past problems, painful experiences, and situations
- Isolating to avoid stressful situations
- Experiencing anxiety about future problems
- Engaging in high-risk behaviors, like reckless driving or using substances excessively
- Self-harm behaviors, like cutting, scratching, hitting, burning, or hair pulling
- Avoiding dealing with an abusive relationship
- Numbing out with substances, food, or restricting food
Types of DBT worksheets
There are many types of distress tolerance worksheets to help clients meet their therapeutic goals.
In this article, we’ve included a DBT REST skill worksheet and a self-soothing worksheet to download for free.
DBT REST skill
REST stands for Relax, Evaluate, Set an Intention, and Take Action.
The REST skill helps clients cope with overwhelming emotions by providing a structure to tolerate stressful situations or emotions. Practicing the REST skill over time will help clients build resilience and act more mindfully and less reactively.
Self-soothing worksheets
This DBT skill incorporates mindfulness, instructing clients to relax and self-soothe by focusing on each of their senses and noting their favorite things to smell, taste, hear, etc.
Other types of DBT worksheets and skills include:
- Cost analysis of self-destructive coping strategies
- Radical acceptance skill
- ACCEPTS skill
- Distraction plan, which may include:
- Pleasurable activities
- Paying attention to someone else
- Leaving
- Distract your thoughts
- Distract with tasks and chores
- Counting
- IMPROVE skill
- Safe place visualization
- Pros/cons skill
- Mindful breathing
- Self-affirming statements
How to use distress tolerance worksheets with clients
These distress tolerance worksheets are great tools for therapists to use with clients to build DBT distress tolerance skills.
You can use these worksheets with clients in session as part of their treatment plan, or to illustrate how to apply a coping strategy to a situation your client finds emotionally challenging.
You could also use them to reinforce what your client is already practicing, and provide the worksheets as a visual reminder to take home with them.
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