ALPIMS • DBT Skills
Distress Tolerance
Get through this moment.
One small step is enough.
You do not have to solve everything right now.
Start with one small thing
Choose the easiest option. You can stop here.
Pause
Wait before replying or acting on an urge.
Reduce input
Lower noise, light or demands if possible.
Get support
“I am overwhelmed. Can you stay nearby?”
What do you need right now?
Open one box. Skip anything that adds strain.
I need to pause — STOP
S — Stop: pause before acting.
T — Take a step back: give yourself a little space. You can stay seated.
O — Observe: notice what is happening inside and around you.
P — Proceed mindfully: choose the next step that protects what matters.
“I can wait before sending this message.”
I need something comforting — Self-soothe
Choose one familiar, comfortable sensation.
A soft blanket. A quiet room. A reassuring voice. A gentle image.
You do not need to use every sense. Avoid fragrances, touch or sounds that make things harder.
If noticing your body increases distress, focus on something neutral outside you.
I need a short break — Distraction
Give your attention a brief, manageable task.
Try a familiar programme, a simple puzzle or looking at a photograph.
Resting with familiar audio can be enough. You do not have to be productive.
About the DBT skill ACCEPTS
ACCEPTS offers several distraction options: Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts and Sensations.
Choose an option that fits your capacity. Skip comparisons if they feel invalidating, and avoid intense sensations that cause pain or overload.
Distraction is a temporary break. Return to problems or care needs when you have enough support.
I need the moment to feel more manageable — IMPROVE
Try one supportive phrase:
“This is hard. I only need to choose the next step.”
Or make one small change: sit somewhere comfortable, reduce a demand or ask for company.
What does IMPROVE mean?
Imagery, Meaning, Prayer, Relaxation, One thing in the moment, Vacation and Encouragement.
“Vacation” means a brief break. Prayer is optional. If imagery is difficult, use a real picture or simple words.
You do not have to find a positive meaning in suffering.
I am fighting what has happened — Radical acceptance
Name the current fact, without judging yourself.
“This is happening. I do not like it. What would help next?”
Acceptance does not mean approval, forgiveness or giving up on change.
You can accept that something happened and still set boundaries, seek care or leave an unsafe situation.
I have a strong urge — Pros and cons
Ask: “What might happen if I act on this urge? What might happen if I pause?”
Consider the next few minutes and tomorrow.
If thinking is too hard, use a prepared plan or contact someone safe.
You do not need to analyse an emergency before getting help.
What about TIPP body-based skills?
TIPP stands for Temperature, Intense exercise, Paced breathing and Paired muscle relaxation.
These are standard DBT skills, but they need individual adaptation.
With ME/CFS, post-exertional worsening, POTS, heart or breathing conditions, pain or temperature sensitivity, ask your clinician which parts are suitable.
Avoid using intense exercise or sudden cold exposure as a default. Do not force deep breaths, breath-holding or muscle tension.
A comfortable position, lower stimulation or supported rest may fit better. These are ALPIMS adaptations, not the standard TIPP protocol.
I cannot manage a skill right now
Make the next step smaller.
Put the phone down. Stop the task. Ask someone to help reduce demands.
“I cannot explain right now. I need quiet and help.”
Needing support is not a failure to use skills.
ALPIMS Notes
Make it fit your experience
Open the area that feels relevant.
A Anxiety & Autonomic
One small step
Use a supported, comfortable position.
Make it work for you
Do not assume dizziness, racing heart or breathlessness is only anxiety. Follow your usual symptom plan and seek care for new or concerning symptoms.
L Laxity & Connective Tissue
One small step
Support your joints and reduce physical strain.
Make it work for you
Skip strong muscle tensing or uncomfortable positions. Ask for practical help with a task.
P Pain & Bodily Sensitivity
One small step
Lower light, noise or other triggers where possible.
Make it work for you
Use your pain or migraine care plan. Distress skills can support coping; they do not replace assessment or treatment.
I Immune & Inflammatory
One small step
Choose low-effort support and reduce relevant exposures.
Make it work for you
During illness or post-exertional worsening, prioritise rest and your care plan. Avoid exercise-based coping that exceeds your capacity.
M Mood & Mental Health
One small step
Use a kind phrase or contact someone safe.
Make it work for you
If inward attention worsens trauma distress, try a neutral external focus. A DBT-trained clinician can help adapt skills.
S Sensory & Neurodevelopmental
One small step
Reduce input before adding a coping activity.
Make it work for you
Allow quiet, safe stimming, written communication or a support person. Do not use skills to force masking or endure overload.
Sources & further reading
Original plain-language summaries, not reproduced worksheets.
- Linehan, M. M. (2015). DBT Skills Training Manual, second edition. Guilford Press.
- VA — DBT programme and skills modules
- VA — DBT skills flash cards (PDF)
Educational information only. This is an introduction to skills, not a full DBT programme or personalised care.