DBT Distress Tolerance Skills include many and varied exercises and techniques for distracting people from pain.

The intention is not to avoid facing the pain,
but to give the person time for strong emotions to subside,
so that they can think more clearly about how to cope with negative events in the future.

One of the most specific design features of DBT is to help clients stop engaging in self-destructive behaviours such as cutting, burning, scratching and other types of self-mutilation, which some clients say temporarily relieve their emotional pain. A technique here is to provide the client with a list of alternative actions that they can take when the urge to self-harm arises. These options include inflicting real but harmless pain (e.g. holding an ice-cube in one hand and squeezing, or digging their finger nails into their arm), or actions that represent pain symbolically (e.g. writing or painting on themselves with a red marker or red paint exactly where they would put cuts, or sticking pins into a voodoo doll that represents themself) (p12-13).

Other types or categories of distraction techniques include: domestic tasks and chores; pleasurable activities; paying attention to someone else, and generating elaborate alternative thoughts or fantasies using their imagination.

Clients are encouraged to explore these options systematically and choose one or more of each type of distraction that they would be willing to use in particular types of situations that tend to cause them distress. The practitioner encourages the client to write up a distraction plan including precise statements of the actions that they will take (p22).

Writing the distractions on small cards that can be carried in a wallet and looked at regularly is encouraged.

These notes are based on McKay, Wood and Brantley (2007) unless otherwise stated.