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Last updated: August 5, 2026

Quick answer

What is this?
DBT crisis-survival skills are distress-tolerance practices intended to help a person pause and avoid making a high-distress situation worse. This reference covers TIPP, STOP, ACCEPTS, and IMPROVE.
Who is it for?
Adults learning DBT skills who want a structured reference during non-emergency distress. For immediate danger, call emergency services.
Bottom line
A skill may help create a pause, but it cannot make a crisis safe. This page is not DBT treatment, medical advice, or emergency care.

Published by MindCheck Tools

Published: Last reviewed:

In crisis right now?

  • 988 Suicide & Crisis Lifeline: Call or text 988 (24/7)
  • Crisis Text Line: Text HOME to 741741
  • SAMHSA Helpline: 1-800-662-4357 (24/7, free)

DBT Crisis Survival Skills Cards

Educational distress-tolerance skills adapted from Dialectical Behavior Therapy. Tap a card for instructions and cautions. These cards are not a complete DBT program or emergency care.

TIPP: Body-Based Distress Tolerance

Tap a card to flip it and see instructions

About DBT Distress Tolerance Skills

Dialectical Behavior Therapy (DBT) is a structured, multicomponent treatment developed by Dr. Marsha Linehan. It was originally evaluated for people with borderline personality disorder and chronic suicidal behavior. Research reviews have since examined DBT in additional clinical settings, but evidence and treatment format vary by population. The cards on this page cover selected skills only and are not a complete DBT program.

Distress tolerance skills are one of DBT's four core skill modules (alongside mindfulness, emotion regulation, and interpersonal effectiveness). These skills are specifically designed for crisis moments, times when emotions are so intense that rational problem-solving is not yet possible. The goal is not to solve the problem or make the pain go away, but to survive the crisis without making it worse.

The four acronyms on this page organize different crisis-survival skills. TIPP uses body-based techniques and requires medical caution. STOP creates a pause before action. ACCEPTS offers temporary distraction. IMPROVE focuses on making the moment more manageable. These cards are a brief reference, not a complete DBT program or individualized treatment plan.

These skills are educational resources and are not a substitute for DBT therapy with a trained clinician. If you are experiencing a mental health crisis, please reach out to a professional or contact one of the crisis resources listed on this page.

Authoritative Sources

Frequently Asked Questions

What are DBT distress tolerance skills?

Distress tolerance skills are one of four core skill modules in Dialectical Behavior Therapy (DBT), developed by Dr. Marsha Linehan. They are designed for crisis moments when emotions are so intense that you cannot think clearly or solve problems effectively. The goal is not to fix the problem or eliminate the emotion, it is to survive the crisis without making things worse. The skills on this page (TIPP, STOP, ACCEPTS, IMPROVE) give you concrete actions to take when you are overwhelmed, helping you ride out the emotional wave until it naturally subsides.

Which skill should I use first in a crisis?

There is no single correct first skill for every person or crisis. STOP can create a pause before an impulsive action. TIPP includes physical techniques that may not be safe for everyone: very cold water can lower heart rate and intense exercise can raise it. If you have a medical condition, physical limitation, take medication that affects heart rate, or are unsure, ask a health professional before using those techniques. Call emergency services if there is immediate danger.

Do I need to be in DBT therapy to use these skills?

This page is an educational reference, not DBT treatment. Comprehensive DBT includes more than skills cards and is delivered within a structured clinical program. A trained professional can help choose, adapt, and practice skills safely. Seek professional help for persistent distress, self-harm urges, suicidal thoughts, or substance-use concerns.

What is the difference between distress tolerance and emotion regulation?

Distress tolerance skills are for crisis moments, they help you survive intense emotions in the short term without making things worse. Emotion regulation skills are for the longer term, they help you understand your emotions, reduce vulnerability to negative emotions, and change unwanted emotional responses over time. Think of distress tolerance as the fire extinguisher (put out the immediate fire) and emotion regulation as the fire prevention system (reduce the chance of fires starting). Both are essential parts of DBT.

What if a skill does not work for me?

Not every skill works for every person or every situation. If one skill is not helping, try a different one, that is why there are 22 skills across four categories. Some people respond better to physical skills (TIPP) while others do better with cognitive skills (IMPROVE). Also, skills take practice. The first time you try paced breathing during a crisis, it may feel pointless. But with repeated practice (ideally when you are NOT in crisis), the skills become more effective over time. If you consistently find that no skills help, that is important information to share with a therapist.

Can these skills help with substance use urges?

Some people include distress-tolerance skills in a clinician-guided substance-use treatment or relapse-prevention plan. This page cannot predict how long an urge will last or guarantee that a skill will reduce it. If an urge remains strong, move to a safer environment and contact a support person, treatment provider, or crisis resource.

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Important Disclaimer

These DBT distress-tolerance skills are presented for educational purposes only. DBT is a studied multicomponent treatment, but these cards have not been evaluated as a standalone intervention. This tool is not a substitute for DBT with a trained clinician. If you are experiencing a mental health crisis, contact a professional or use the crisis resources on this page.

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Crisis Resources

  • 988 Suicide & Crisis Lifeline: Call or text 988 (24/7)
  • SAMHSA National Helpline: 1-800-662-4357 (24/7, free, confidential)
  • Crisis Text Line: Text HOME to 741741
  • Veterans Crisis Line: Call 988, press 1

View all crisis resources and international helplines

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Reviewed by Jason Ramirez, CADC-II with 11 years of clinical experience in substance use counseling.

Review covers source alignment, scoring, limitations, and safety language within the reviewer's stated credential scope; it is not diagnosis or individual care.

Last reviewed: March 2026