Distress Tolerance Skills Worksheets

Help your clients learn to sit with their distress and build up their tolerance to distressing emotions with our Distress Tolerance Skills Worksheet.

By Jamie Frew on Jul 15, 2024.


Fact Checked by Nate Lacson.

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What Is A Distress Tolerance Skills Worksheet?

Experiencing a range of emotions, both positive and negative, is part of being human. Everyone will experience emotions that are distressing at some point in their lives, such as fear, anxiety, anger, or guilt, but not everyone will be able to tolerate these emotions the same way. Those who are more intolerant to distressing emotions can feel as though these emotions are unbearable, wrong, or something to be avoided at all costs. As such, it is common for distress-intolerant people to engage in escape behaviors to avoid ever being in a distressing situation. However, these escape methods serve only to reinforce their distress-intolerant beliefs and keep them in an avoidance cycle so they never practice tolerating distress, but that’s where our Distress Tolerance Skills Worksheet can help.

This Distress Tolerance Skills Worksheet is designed to help your clients identify their distress triggers, warning signs, and escape methods, and implement new opposite actions and acceptance skills derived from dialectical behavioral therapy (DBT)2. This worksheet is therefore a useful resource for helping your clients engage in their own treatment, and build up their distress tolerance skills to help them move through their lives with more confidence.

Distress Tolerance Skills Worksheets Template

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Distress Tolerance Skills Worksheets Example

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How To Use This Distress Tolerance Skills Worksheet

We’ve kept it easy for you to start incorporating this Distress Tolerance Skills Worksheet into your practice. Just follow the simple steps below to start helping your clients of all backgrounds to build up their distress tolerance.

Step One. Download the worksheet

The first step is to download a copy of the Distress Tolerance Skills Worksheet, which you can do using the link on this page. This link will provide you with a PDF copy of the worksheet which you can then save to your local computer, or proceed to print out if you prefer.

Step Two. Provide a copy of the worksheet to your client

Next, provide a copy of the worksheet to your client. This can be provided digitally via a secure email attachment or file transfer, and your client can also fill the worksheet out entirely digitally using the interactive PDF text boxes provided.

Step Three. Client to complete the worksheet

Now for the important part, your client should complete the worksheet either in their own time or during a session with you if you feel they need extra support or guidance for any of the exercises.

Step Four. Discuss their responses and store securely (if applicable)

Finally, if your client is happy to share their responses with you, these can be a useful discussion tool for their next session with you, to help them in the implementation and maintenance phase of these distress tolerance skills. The last step is for you to store your copy of the Distress Tolerance Skills Worksheet securely with the rest of their clinical documentation.

Who Can Use these Printable Distress Tolerance Skills Worksheets (PDF)?

There is no one type of person who becomes intolerant to distressing emotions, and the continued intolerance of distress can contribute to the maintenance of a variety of health conditions such as generalized anxiety disorder, major depression, personality disorders, or substance use disorders1. As such, there is a similarly wide range of mental health practitioners who can benefit from offering this Distress Tolerance Skills Worksheet to their clients. These include:

  • Psychotherapists
  • Psychiatrists
  • Substance Abuse Counselors
  • Clinical Psychologists
  • Smoking Cessation Advisor
  • Counselors
  • Mental Health Nurses

Why Is This Form Useful For Therapists?

Practice Opposite Actions

This worksheet introduces several distress tolerance skills, one of which is taking opposite actions to your client’s usual distress escape behaviors. This is an invaluable skill for helping your clients counter their old behaviors and prove to themselves that they do not need these escape behaviors. The second activity of this worksheet is dedicated to helping your clients identify their escape behaviors, and create opposite actions to take in place of these behaviors.

Empower your clients to challenge their beliefs

The purpose of this worksheet is to illustrate to your client that their distress-intolerant beliefs, such as “I can’t cope with this” or “I can’t handle this”, are not unshakeable truths. This can be a powerful discovery that can help your client to challenge their beliefs in other areas of their mental health, such as their self-esteem or self-confidence.

Includes explanations and prompts

This worksheet is designed to be able to be completed by your clients with minimal extra instruction required from the practitioner. This has the benefit of both saving you time, but also reinforcing any explanations you do give on the DBT principles underlying this worksheet in writing for your client.

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Benefits of Distress Tolerance Skills Worksheets Template

Reduce the fear around distressing emotions

Counteracting a fear response to distressing emotions with an escape behavior only serves to reinforce your client’s belief that the distressing emotions are something to be feared. This worksheet helps your clients put in place tangible skills to sit with their distress and learn that it is something they can cope with.

Engage your clients in their treatment

Having a tool like a worksheet to offer your clients helps your clients to contribute and engage with their own treatment, rather than feeling like passive participants in sessions led by you. This is hugely valuable for both you and your clients, as if they feel empowered to engage in their own treatment, you are sure to see better treatment outcomes in the long run.

Maintain progress between sessions

This worksheet can be assigned as therapy “homework” to help your clients keep up the good work between sessions with you. Providing resources in this way can also be a great way to reinforce the concepts you introduce in therapy sessions, and help to illustrate these concepts in a personally relevant way for your client.

Keep your resources digital

This worksheet can be accessed, sent, completed, and stored entirely digitally thanks to the interactive PDF functionality. This means your client can access and complete this worksheet in their own time from their device of choice, and without either of you needing access to a printer.

Can be used in all different situations

Distress intolerance can arise from all kinds of situations for different people, whether it’s social, work, or family interactions, or something entirely different- we all have different things that can stress us out. Sometimes the situation itself can be controlled by taking action and solving the problem that is causing the distress, but other times, the situation cannot be problem-solved and must simply be accepted. This worksheet is designed to be useful in either situation, regardless of if problem-solving can be employed prior to addressing one’s distress.


  1. Leyro TM, Zvolensky MJ, Bernstein A. Distress tolerance and psychopathological symptoms and disorders: a review of the empirical literature among adults. Psychol Bull. 2010 Jul;136(4):576-600. doi: 10.1037/a0019712. PMID: 20565169; PMCID: PMC2891552.
  2. Linehan, Marsha M., (2015) DBT Skills Training Manual (2nd Ed) New York: The Guilford Press.
Who should use Distress Tolerance Skills Worksheets?
Who should use Distress Tolerance Skills Worksheets?

Commonly asked questions

Who should use Distress Tolerance Skills Worksheets?

This worksheet can be helpful for anyone struggling to engage with their negative emotions, or who finds it intolerable or unbearable when they are faced with distressing emotions. 

When should I complete Distress Tolerance Skills Worksheets?

While this worksheet includes prompts and explanations to help ensure your clients understand the purpose of each exercise, it can still take some time to work through and so it should either be completed by your client in their own time between sessions, or time should be set aside in their session specifically for working through the activities in this worksheet.

When should I tolerate distress and when should I take action?

If your client is in distress at the smell of smoke coming in from under a door, that’s not the time for them to try mindfully tolerating their distress! As you can see, there are times when your client can problem-solve to alleviate their distress, but there are also times they will be distressed when there is no action to be taken to alleviate the problem. The balance between tolerating and taking action is one of the toughest problems your client will need to manage as they learn to engage with their negative emotions rather than engaging in escape behaviors. The degree to which they should accept their distress or improve their situation is mainly dictated by the degree of control your client has over the situation. Sometimes a combination of problem-solving and tolerating can be beneficial in more complex situations.

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