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From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may 
download a larger version of this worksheet from www.guilford.com/dbt-  
worksheets .distress tolerance WorksHeet 4b   (Distress Tolerance Handout 6c)
effective r ethinking and p aired r elaxation
Due Date:       Name:                   Week Starting:  
Step 1. Describe one typical prompting event  for distress in your life: What led up to what? What 
is it about this event that is a problem for you? Be very specific in your answers. Use describing 
skills. Check the facts.
Step 2. a sk: “What must I be telling myself (or what are my interpretations and thoughts ) 
about this event that contributes to my stress?” Write them down.
Step 3. r ethink the thoughts that lead to distress. Rethinking involves reevaluating the situation 
and its meaning in ways that counteract stress-  producing thoughts and thereby reduce stress 
responses. Write down as many effective thoughts as you can to replace the stressful thoughts.
Step 4. Did you practice in your imagination effective rethinking of a stressful situation this 
week? Yes    No   
If you engaged in rethinking, did it reduce fear of the situation happening again? (0–5,  
0 = not at all; 5 = very much):   
What effective thoughts did you use to replace stress-  causing thoughts?
Rate average level of relaxation (0–100): Before    After