313DiSTreSS Tolerance 
Skill S
Introduction to Handouts and Worksheets
Distress tolerance is the ability to tolerate and survive crises without making things 
worse. The ability to tolerate and accept distress is essential for two reasons. First, 
pain and distress are part of life; they cannot be entirely avoided or removed. The 
inability to accept this immutable fact increases pain and suffering. Second, distress tolerance, at least over the short run, is part of any attempt to change yourself. Oth -
erwise, efforts to escape pain and distress will interfere with your efforts to establish 
desired changes. There are two main sets of handouts and worksheets for distress 
tolerance skills: Crisis Survival Skills and Reality Acceptance Skills. There is an additional, specialized set of handouts and worksheets for Skills When the Crisis Is Addiction.  One introductory handout precedes the handouts and worksheets on 
these skill sets:
••Distress Tolerance Handout 1: Goals of Distress Tolerance. The goals of dis -
tress tolerance are (1) to survive crisis situations without making them worse, (2) to accept reality as it is in the moment, and (3) to become free.
Crisis Survival Skills
••Distress Tolerance Handout 2: Overview: Crisis Survival Skills. The goal of 
crisis survival skills is to get through crises without making things worse. Crisis situ -
ations are, by definition, short-term. Thus these skills are not to be used all the time.
••Distress Tolerance Worksheets 1, 1a, 1b: Crisis Survival Skills. These are three 
different versions of worksheets that can be used with Handout 2 and throughout this portion of the module. Each worksheet covers all of the crisis survival skills.