Distress tolerance skills help you get through intense emotions without making things worse. Build your personal toolkit, prepare a survival plan, and know exactly what to do before the next wave hits.
The SUDS scale (0–10) gives you a shared language for how intense your distress is — and helps you choose the right strategy for the moment.
Distancing, communication, self-soothing, distraction, physical skills, and more — find what works for you at each distress level.
Having names ready means you don't need to think clearly in the moment — you just reach out. Even a brief connection can significantly reduce distress.
If distress ever reaches crisis point, a written safety plan means you already know what to do — without having to figure it out under pressure.
"Whatever gets you through the night…"
John Lennon
How It Works
Pain and distress are part of life — they cannot be entirely avoided or removed. Always trying to escape pain leads to more problems than it solves. Distress tolerance isn't about feeling better instantly; it's about getting through the moment without making things worse.
Attempts to shut out emotional pain — through avoidance, alcohol, or self-harm — come back to haunt us. People with PTSD or pathological grief are primarily trying to avoid cues that cause discomfort. The goal is to feel without being destroyed by it. The more you tolerate distress, the stronger you get.
The Subjective Units of Distress Scale (SUDS) runs from 1 (completely calm) to 10 (highest possible distress). Rating yourself gives you a snapshot of where you are right now — and helps you choose the strategy that matches your level.
Warning signs are the thoughts, feelings, and body sensations that tell you distress is building. Getting to know them early means you can use coping strategies sooner — before things become overwhelming.
Different skills work best at different intensities. When distress is very high (8–10), body-based strategies like TIPP work best — your thinking brain is less available. At lower levels, distancing, communication, and skills like Radical Acceptance become more accessible.
If distress ever becomes unsafe, a pre-written safety plan tells you what to do step by step. You don't have to think clearly under pressure — you just follow the plan. Review it with your therapist so you both know what it says.
Your Worksheet
Work through each section below and save your completed plan.
Distress tolerance skills are for crisis moments — when emotions are so intense they threaten to overwhelm you. The goal isn't to solve the problem or feel better immediately: it's to get through the moment without making things worse. Once the intensity has passed, problem-solving becomes possible again.
Fill this plan in when you're calm, so it's ready when you're not.
Briefly describe what is causing your distress, then rate how you are feeling right now.
The thoughts, feelings, and body sensations that tell me distress is building.
Think about what happens in your mind (racing thoughts, catastrophising), your emotions (sudden dread, irritability, tearfulness), and your body (tight chest, fast heartbeat, tension, nausea). The sooner you spot these, the sooner you can use your coping strategies.
Choose the strategies that feel right for you in each category. The chips are ideas — personalise them to what actually works for you.
People I can contact if I need extra help — written down in advance so I don't have to think in the moment.
Your step-by-step plan for when distress peaks — and what to do if it becomes unsafe.
Write exactly what you will do, step by step, when things become overwhelming. Having it written down means you just follow the plan — no decisions required in the moment.
If emotions reach a point where you feel at risk, what steps will you take? Write them in order so you don't need to think clearly under pressure.
What longer-term thought will you hold on to? Focus on the future helps you endure the moment.
You don't have to eliminate distress — you just have to survive it without making things worse. The more you tolerate it, the stronger you get. These skills improve with practice.
If you are in immediate danger, please call emergency services (999 in the UK / 911 in the US) or go to your nearest A&E.