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From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission 
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details).Distress tolerance Han Do ut 6c   (Distress Tolerance Worksheet 4b)
Effective Rethinking and Paired Relaxation,  
Step by Step
Step 1. Write down the prompting event that is often related to distressing emotions and that you 
want to work on reducing your emotional reactions to.
Step 2. Ask:  “What must I be telling myself (that is, what are my interpretations and thoughts ) 
about the event that causes such distress and arousal?” Write these down. Examples:
“He hates me,” “I can’t stand this!” “I can’t do this,” “I’ll never make it,” “I’m out of control!”
Step 3. Rethink  the situation and its meaning in a way that counteracts the thoughts and interpreta -
tions producing stress and distressing emotions. As you rethink the situation, write down as many 
effective thoughts  as you can to replace the stressful thoughts.
Step 4. When you are not  in the stressful prompting event, practice imagining  the stressful event:
a. A
t the same time, while breathing in,  say to yourself an effective self-  s
tatement.
b. 
When breathing out, say  “Relax” while intentionally relaxing all your muscles.
Step 5. Keep practicing every chance you get until you have mastered the strategy.
Step 6. When a stressful situation occurs, practice effective rethinking and paired relaxation.