When Anxiety Says “Fix It Now”: Using DBT Distress Tolerance Skills to Pause Before Solving
Brianna Hawk, MHC-LP
Oftentimes when we are feeling distressed, we equate that intense feeling of stress with urgency. Have you ever had a conflict happen with a friend that made you feel incredibly anxious and you felt a need to hash it out right then and there, only to realize that doing so made it worse? Or how about getting an unexpected bill in the mail, and completely spiraling out of control, wondering how you can come up with the money today to pay it, even if it’s not due for another month? Or have you ever felt an uncomfortable sensation in your body, and immediately jump to the worst case scenario and start googling all the things that can be wrong, which only then heightens the uncomfortable sensation? When a distressing problem or conflict arises, some thoughts that we might experience are, “I need to figure this out right now”, “I need to send this text immediately”, “We need to resolve this argument tonight”, “I can’t relax until I know what to do”. All of these reactions are examples of when we equate distress with urgency. But feeling distressed does not always mean something needs to be fixed right now. Sometimes the most effective response is to help your nervous system come back online before deciding what, if anything, needs to be done.
Why Solving Problems While Dysregulated Often Doesn’t Work
When a problem leaves us feeling dysregulated or highly activated, we may become more rigid in our thinking, interpret situations more negatively, experience difficulty in seeing alternative perspectives, communicate more reactively, or make decisions primarily to get immediate relief. When anxiety and stress becomes heightened and totally takes over, our pre-frontal cortex, which manages problem-solving, emotional control, social behavior, and impulse control, often goes offline, meaning strategies we use to intentionally and thoughtfully manage a situation no longer feel accessible. In order to get our pre-frontal cortex back online, we have to return to our bodies, slow down, and take a beat.
It’s important here to highlight the difference between having a problem and feeling distressed about a problem. Sometimes there is a concrete problem that genuinely needs to be addressed. Your partner said something hurtful. You received upsetting news. You have a difficult decision to make. There is a conflict that needs to be discussed. But alongside the problem, there may also be anxiety, anger, fear, shame, uncertainty, or a sense of urgency about the problem. And those feelings can create the impression that the problem itself needs to be solved immediately. When anxiety creates a sense of urgency, it’s important to take some time to pause and actually ask ourselves if any immediate action is even required.
The key point here is that urgency is a feeling—not always an instruction. A problem may be real, but that doesn’t necessarily mean it needs to be solved right away. When we’re distressed, we can become so focused on making the discomfort go away that we lose sight of whether our actions are actually helping address the underlying problem. Sometimes, they can even make things worse. You might send an angry text because you desperately want relief from uncertainty, only to escalate the conflict. You might repeatedly seek reassurance, feel better for a few minutes, and then find yourself anxious again. Or you might make an impulsive decision simply because sitting with the unknown feels unbearable. This is where distress tolerance becomes particularly important. Distress tolerance isn’t about avoiding problems or pretending they don’t exist; it’s about creating enough space between what we’re feeling and how we respond so that we can approach problems from a more grounded and effective place.
So Let’s Get to The Skills…
The Distress Tolerance module of DBT consists of a set of skills designed to help us get through intense emotional states without making the situation worse. The skills allow us to take some time to move away from the problem and towards something that will help bring us back into a window of tolerance where we feel more grounded and can think more clearly. Sometimes the goal isn’t to feel better immediately. Sometimes the goal is simply to not make things worse while you’re feeling bad. Distress Tolerance skills are especially useful for people who believe that they have to think their way out of every uncomfortable emotion.
Skill #1 TIPP- Change your state before changing the situation
TIPP is an acronym that consists of four components:
Temperature - using cold water/ice to help shift physiological arousal
Example: Putting an ice pack or a bag of frozen vegetables over your eyes and upper cheeks while leaning forward.
Example: taking a cold shower or splashing cold water on your face for 15-30 seconds.
Intense Exercise- briefly moving the body to discharge activation
Example: Do 20-30 jumping jacks or fast burpees
Example: Running up a flight of stairs or sprinting down the block for 10 minutes.
Paced Breathing - slowing and lengthening the exhale
Example: Inhale deeply through your nose for 4 seconds, then exhale slowly through your mouth for 6 to 8 seconds. Repeat for 2 minutes.
Paired Muscle Relaxation - intentionally tension and releasing muscles
Example: Clench your fists and tense your arms tightly as you inhale for 5 seconds, then let go completely and notice the relaxation as you exhale.
Example: Shrug your shoulders up toward your ears, hold tightly, and drop them down with a deep sigh.
TIPP is particularly useful when we are too activated to think clearly. Sometimes the body needs to settle before the mind is ready to problem-solve.
Skill #2 ACCEPTS - Give your mind somewhere else to go.
ACCEPTS is another acronym that consists of skills for temporarily shifting attention away from the distress.
A - Activities
C- Contributing
C- Comparisons
E- Emotions
P- Pushing away
T- Thoughts
S- Sensations
Some examples are:
Watching a familiar/funny TV Show.
Going for a walk.
Cleaning your Kitchen.
Help a Friend, Neighbor, or Family Member.
Call Someone to Check In.
Do a crossword puzzle or sudoku.
Exercise.
Volunteer.
Do a Puzzle.
Listen to music.
Do something creative.
It’s important to highlight that using these skills does not mean you are avoiding the problem. Sometimes stepping away from a problem for 30-minutes - or even until the next day - is exactly what allows you to return to it with more clarity.
Skill #3: Self Soothe- Sometimes the answer is comfort, not analysis.
Self soothe skills use the 5 senses to help you ground and come back to yourself.
The Five Senses Are:
Sight: dim lighting, nature, something visually calming.
Sound: music, rain sounds, a comforting podcast.
Smell: candle, essential oils, favorite lotion, baked cookies.
Taste: tea, favorite meal, mints, cold smoothie.
Touch: weighted or soft blanket, warm shower, soft clothing, petting an animal, playing with fidget toy.
Sometimes self-soothing can come across as too simple, especially for people who are accustomed to intense emotional processing. But you don’t always need a complicated coping strategy! Sometimes putting on a ridiculous sitcom, getting under a blanket, and giving yourself 20-minutes to decompress is a legitimate distress-tolerance skill.
Let’s Talk About Distraction Versus Avoiding the Problem
When I teach these skills to clients, I often hear that there is a general worry that by engaging with these skills, one is directly avoiding the problem entirely, which often goes against one’s nature. But avoidance and distress tolerance are two different things. Avoidance sounds like, “I never want to deal with this, so I’m going to pretend it doesn’t exist”. While Distress Tolerance sounds like, “I know this needs my attention, but I’m too activated to handle it effectively right now. I’m going to regulate first and come back to it”.
Delayed problem solving can be useful when we know that our initial impulse towards problem solving when we are angry or too overwhelmed, might not actually be in alignment with what we are wanting to get out of the situation. Not now does not have to mean never. It’s also important to emphasize that these skills are meant to be used for short-periods (20 minutes- a few days max). Now if you are bingeing your favorite reality show and ignoring your friend for 2 weeks, then yes, that would be considered avoidance. But sometimes the most skillful thing you can do is intentionally postpone a conversation or decision until you’re in a state where you can fully participate in it.
The “Do I need to solve this - or regulate first?” pause
As mentioned earlier, sometimes problems do need to be solved immediately! Like if your car breaks down (which is obviously distressing) you would need to call someone to come help you. Or if you are experiencing a major tooth pain that is derailing your day, you will most likely need to schedule that dentist appointment. But there are a lot of times where the urgency isn’t actually there requiring you to tackle a problem head-on.
Before responding to this question, ask yourself:
Am I actually in danger, or am I experiencing emotional urgency?
Is there something that genuinely needs to happen right now?
Am I regulated enough to have this conversation?
Will solving this right now actually help?
Is this actually about genuine and intentional repair or about my own need to feel more comfortable?
Would 20 minutes of distraction or self-soothing help me respond differently?
A simple phrase to remember is Pause - Regulate - Reassess - Respond.
The Biggest Lesson: You don’t have to earn rest by solving everything.
Some people have learned to treat discomfort as a problem that must immediately be eliminated. This could have been through family or origin messages, repeated exposure to trauma, a fast paced or pressured work environment, etc.
Some may believe:
If I’m anxious, something must be wrong.
If I’m upset, I need to figure out why.
If someone is upset with me, I need to fix it.
If there’s conflict, we need to resolve it immediately.
If I don’t understand what I’m feeling, I need to analyze it.
But emotional discomfort is not always a problem to solve. Sometimes it is simply an experience to move through. Oftentimes, when we take the pause, we can actually start to listen more internally for what we are needing, wanting, and hoping for in resolution.
Distress tolerance is not about becoming someone who never gets overwhelmed. It’s about learning that you can experience discomfort without immediately reacting to it. Sometimes the most effective thing you can do isn’t ruminate for another deep insight, spend another hour analyzing the situation, or finding the perfect solution. Sometimes it’s as simple as taking a walk, putting on your favorite comedy, taking a hot shower, putting on a breathwork video, and giving yourself permission to come back to the problem later. When we are hurt, our nervous system wants us to pay attention to that and nurture it but you don’t have to solve everything while you’re hurting.