Paced breathing
Distress tolerance · TIP paced breathing
If you become dizzy, short of breath, or uncomfortable, stop pacing and let breathing return to its usual rhythm. Choose a non-breath practice if attention to breathing is unhelpful.
- Notice. Notice your current posture, breathing, and urge to act.
- Name. Name the present situation as simply as you can.
- Choose. Choose this invitation if it suits the moment. You can leave it at any point.
- Try. Allow breathing to move into the belly without straining. Gradually slow to a comfortable pace, letting the out-breath last a little longer than the in-breath. No breath holding or target count is required.
- Observe. Notice what followed, including little or no change. Decide what the situation needs next.
Release through muscles
Distress tolerance · TIP paired muscle relaxation
Use only mild tension. Skip painful or injured areas and stop if you feel pain, cramping, or dizziness. Relaxation is not a required result.
- Notice. Notice your current posture, breathing, and urge to act.
- Name. Name the present situation as simply as you can.
- Choose. Choose this invitation if it suits the moment. You can leave it at any point.
- Try. Choose an uninjured muscle group, such as your hands. Gently engage it as you breathe in. As you breathe out, release it and silently use the word “relax.” Notice the contrast. Try another comfortable muscle group if useful.
- Observe. Notice what followed, including little or no change. Decide what the situation needs next.
Strong movement
Distress tolerance · TIP intense exercise
Check with a health professional before temperature skills or vigorous activity if you have a heart or other medical condition, a low heart rate, take heart-rate-lowering medication, or are unsure they are safe. Avoid cold with cold sensitivity. Choose Observe the body instead. Stop for pain, faintness, breathing difficulty, or concerning symptoms; seek appropriate medical help.
- Notice. Notice your current posture, breathing, and urge to act.
- Name. Name the present situation as simply as you can.
- Choose. If you are unsure about exercise safety, choose Observe the body instead.
- Try. If vigorous activity is safe for you, try a brief period of brisk walking or another familiar activity suited to your ability and surroundings. Ease off and reassess. This is never punishment or a test of endurance.
- Observe. Notice what followed, including little or no change. Decide what the situation needs next.
Temperature shift
Distress tolerance · TIP temperature
Check with a health professional before temperature skills or vigorous activity if you have a heart or other medical condition, a low heart rate, take heart-rate-lowering medication, or are unsure they are safe. Avoid cold with cold sensitivity. Choose Observe the body instead. Stop for pain, faintness, breathing difficulty, or concerning symptoms; seek appropriate medical help.
- Notice. Notice your current posture, breathing, and urge to act.
- Name. Name the present situation as simply as you can.
- Choose. Choose this only if you have learned a safe DBT temperature method appropriate to your health.
- Try. If you already have a clinician-approved DBT temperature plan, follow that plan. Otherwise, choose paced breathing or Observe the body now and ask a qualified DBT professional to teach you the cold-face skill safely. Do not improvise face immersion, ice exposure, or breath holding.
- Observe. Notice what followed, including little or no change. Decide what the situation needs next.
