DBT Skills: How does a Distress Tolerance Box work?

I recently wrote a post about my new and improved Distress Tolerance Box. I shared a picture and a list of what I had inside. It occurred to me, after I received a comment from a fellow blogger, that explaining how the box works and why it works is and an important component of this skill (dur!).


My Distress Tolerance Box

A Distress Tolerance Box (DTB) is a box filled with objects that help you distract and calm yourself when you are in distress. These boxes may also be known as a Self-Soothe Box/Kit, Safety Box/Kit, Distraction Box/Kit and Recovery Box/Kit. The objects but into a DTB compliment many of the Distress Tolerance skills taught in DBT but also make sense when not in a DBT context. Every object in a DTB is unique to the box owner. This is because everyone finds different things distracting and calming. A DTB is kept in a place that is easily accessible by you. This means that it is in a memorable and visible location to act as a reminder that it is there for you in your moments of distress. The only rule with DTB is that the objects you put in it must support positive coping. Including items that could promote self-harm, substance use or negative thoughts should not be included as this is counter productive. DTB’s are not only supposed to distract and calm you but also act as a replacement to negative coping behaviours.

The theory behind a DTB and distress tolerance, in general, is that distracting your mind from physical or emotional pain makes the pain more bearable. The pain DOES NOT go away but it becomes less intense. When your body and mind are calm you are able to think more clearly which allows you to engage in problem-solving and you are more receptive to hearing about concerns and possible solutions.

A DTB is great to use when you notice the early signs of distress (ie: racing thoughts, chest tightening, heavy breathing etc.), when you are moderately distressed (upset but are still moderately in control) or even as a preventative measure (ie: if you know that taking exams gives you anxiety so you use something from the box before you write an exam). A DTB probably will not be effective if you are in deep in crisis. This is most likely when your prefrontal cortext (which controls emotion regulation, reality testing etc.) has shut off and a different approach needs to be taken. There is still no harm in trying! This might be a good time, if you are not alone at that moment, for someone to bring you your DTB and help you engage with the materials.

When I put together my box I thought a lot about the significance of each item, including the box.

The Box: I chose a pink box because it is a colour that makes me feel happy and hopeful.

ACCEPTS Skill Items:  Activities I put in my box include, string for making bracelets, a colouring book and Wreck This Journal, nail polish. Objects that support other Thoughts include a word search, The Happy Book, affirmations from a friend, personal love notes and snowflake building blocks. Objects that include Sensations are War Head candy, shea butter lip balm and anti-stress hand lotion.

Soothing with the 5 Senses: Vision objects include, the colouring book, nail polish, bracelet making, personal love notes, glitter silly putty candle (the flame). War Heads candy support Taste and silly putty is great for Touch. Smell objects include the candle (my favourite scent, Apple Cinnamon), shea lip balm and anti-stress eucalyptus spearmint scent. My Hearing object which is not in the picture and is my cell phone which has music on it.

A DTB can constantly evolve. When you find a new item that helps you, add it! If an object stops working then remove it! I really do find the personalization part of this box to be it’s best feature. For example, I recognise that have use of all 5 of my sense and that not everyone does. If you have low or no vision then skip those objects and add more of another! Only include tactile items that feel good to your skin!

Have fun with your DTB! If you have one, what has been your experience with it? If you make one, share what you put in it! If you need more inspiration go to YouTube and type in distress tolerance box, self-soothe kit etc., you will find a lot of examples!



18 thoughts on “DBT Skills: How does a Distress Tolerance Box work?

  1. I keep comments I’ve received from others saying how I’ve helped them. It always makes me feel good reading them. I have comments from my blog, Facebook, and other links.

  2. i have a box and i have bath bubbles nice soaps ,choc,colouring in books magazines i sometimes just go in there as rummage around on a not bad day but feel like having a be kind day.

  3. I am just stopping by to say I love your blog!!! I found you through bipolar first’s blog, so I’ve just been reading your posts non stop, and I love everything you are writing on here. This box idea is amazing, I could really do with something like this and come to think of it so could my Mum at the moment who is going through chemotherapy and has some rough days, something like this could really help her.

    Thank you for sharing, I will continue blog stalking you now and read your other posts LOL.


    • Thank you so much! You are so sweet! I love the idea of the distress tolerance box being used for anything. Many of us go through tough moments and need something to help us out. I hope your mom is doing well 🙂 I look forward to following you also 🙂

      • Thank you for your reply and kind words, been talking about the box with my mum and what she would put in hers, she has some nice ideas, velvet fabric for touch and a soft smooth stone. So I think we’ll be working on a couple boxes soon, such a great idea.

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