As a psychologist, I’ve helped hundreds of my clients develop the skills to sufferwell. So much so that they text me #sufferwell in solidarity. The idea of suffering well teaches us that we have a choice in how we suffer. We can either sufferwell or suffer poorly.

Like most people, I never thought I had a choice in how I suffered. Basically I suffered until the pain or situation was over. I could never imagine peace, calm or clarity co-existing with suffering, or joy co-existing with suffering. Instead I would worry, become sad, get angry, feel bad, or grin and bear it until the suffering passed. Once this agonizing time of suffering ended, I was free to be happy or peaceful again.

Often when I was suffering, people would tell me, “there was light at the end of the tunnel.” I would passively nod my head in agreement but privately wonder, “What am I supposed to do in the tunnel?!!!” If I got up the courage to ask what I should do in the tunnel, the person would look at me with glazed eyes, shrug his or her shoulders and say, “I don’t know.”

Doing “tunnel time” is inevitable in our lives, but to sufferwell means we transform the experience in the tunnel. We might imagine transforming the tunnel by “decorating” it with comfortable, colorful, and cozy furniture, soft blankets and pillows, nice smelling candles, high powered lamps, and space heaters. We might bring in inspirational books and incredible food. Learning to peacefully accept our “tunnel time” no matter how bad it is, is the foundation of suffering well. We must also invite our friends and family into our tunnel to be with us.

We should never sit alone in the tunnel miserable, frightened, and shivering waiting for more light to enter each day. And what if there is no light at the end of the tunnel or you cannot see the light, what do we do then? Well, we make the tunnel into a palace!

The ability to sufferwell is a set of skills we can master. These skills can help us throughout our lives from the difficult teen years to the challenging senior years. I first came across the idea of suffering well in 2003, while teaching a series of workshops at a psychiatric hospital. As a postdoctoral fellow, one of the workshops I taught was called, “Distress Tolerance Skills Training.” This module blended spirituality with western science and was created by psychologist, Marsha Linehan. It was a beautiful training on how to sufferwell and provided a variety of tools to help us do so. Sadly, these transformational skills are hidden away in psychiatric hospitals and are not easily accessible to the rest of us.

However, I immediately saw the potential of distress tolerance skills to not only transform severe suffering, but also ordinary suffering. As a result, I have been teaching these skills since 2011 at my private practice to clients with ordinary life stressors. My clients have raved about the skills and how it has worked wonders in their lives.

When we sufferwell, we bring more stability, peace, joy, calm, and clarity into our lives. Let’s create a sufferwell moment together! Share these skills below with friends and family, and in solidarity lets encourage each other to #sufferwell.

Below you will find specific skills from distress tolerance created by psychologist, Marsha Linehan. Some of these skills have been adapted and some are in their original format. When I work with clients I create a customized distress tolerance plan for them based on their specific needs and issues. 

The skills below can be customized to meet your needs so pick and choose a combination that works for you. I encourage you to print these skills out or to copy and paste them into a new file. Choose a few skills to focus on when suffering arises. You do not have to wait for something big to happen to practice distress tolerance skills. You can start today and transform the smallest amount of suffering. 

Distress Tolerance Skills Training

There are three distinct sections in distress tolerance: (1) Basic Principles for Accepting Life on Life’s Terms; (2) Skills for Tolerating Stressful Situations and Strong Emotions; (3) Guidelines for Accepting Reality: Breathing Exercises, Half-Smiling Exercises, and Awareness Activities.

1. Basic Principles for Accepting Life On Life’s Terms


  • Everything is as it should be. Everything is as it is.
  • Freedom from suffering requires ACCEPTANCE from deep within of what is.
  • Let yourself go completely with what is. Let go of FIGHTING REALITY.
  • ACCEPTANCE is the only way out of hell.
  • Pain creates suffering only when you refuse to ACCEPT the pain.
  • Deciding to tolerate (endure) the moment is ACCEPTANCE.
  • ACCEPTANCE is acknowledging what is.
  • To ACCEPT something is not the same as judging that it is good, or approving of it.
  • ACCEPTANCE is turning my suffering into pain that I can endure.


  • Acceptance of reality as it is requires an act of CHOICE. It is like coming to a fork in the road. You have to turn your mind towards the acceptance road and away from the “rejecting reality” (“I don’t have to put up with this!”) road.
  • You have to make an inner COMMITMENT to accept.
  • The COMMITMENT to accept does not itself equal acceptance. It just turns you toward the path. But it is the first step.
  • You have to turn your mind and commit to acceptance OVER AND OVER AND OVER again. Sometimes, you have to make the commitment many times in the space of a few minutes.


  • Cultivate a WILLING response to each situation.
  • Willingness is DOING JUST WHAT IS NEEDED in each situation, in an unpretentious way. It is focusing on effectiveness.
  • Willingness is listening very carefully to your inner wisdom, acting from your inner self.
  • Willingness is ALLOWING into awareness your connection to the universe—to the earth, to the floor you are standing on, to the chair you are sitting on, to the person you are talking to.

2. Skills for Tolerating Stressful Situations and Strong Emotions

SKILL #1: DISTRACT (inner wisdom A.C.C.E.P.T.S) 

  • Activities (distract yourself by keeping busy doing activities)
  • Contributing (distract yourself by getting out of your mind and off yourself by helping someone else)
  • Comparisons (distract yourself by considering how things could be worse…)
  • Emotions (distract yourself by doing something that makes you feel differently)
  • Pushing away (distract yourself by blocking out thoughts and feelings)
  • Thoughts (distract yourself with other thoughts or ideas)
  • Senses (distract yourself by being aware of your 5 senses)


  • Vision: Notice what you see, find soothing things to look at.
  • Hearing: Pay attention to what you can hear around you.
  • Smell: Be aware of the memories that smell can bring. Notice the scents around you.
  • Taste: Carefully savor the flavors that the day brings.
  • Touch: Find comfort in touch.


  • Imagery: Imagine everything going well. Imagine coping well. Imagine worries draining out of you like water out of a pipe.
  • Meaning: Find or create some purpose, meaning, or value in the suffering. Focus on whatever positive aspects of a difficult situation you can find. Repeat them over and over in your mind. Make lemonade out of lemons.
  • Prayer: Open your heart to a supreme being, greater wisdom, God, your own wise mind. Ask for strength to bear the suffering in this moment.
  • Relaxation: Try muscle relaxation by tensing and relaxing each large muscle group, starting with your hands and arms, going to the top of your head, and then working down; listen to a relaxation tape; exercise hard; take a hot bath or sit in a hot tub.
  • One thing in the moment: Focus your entire attention on just what you are doing right now. Keep yourself in the very moment you are in; put your mind in the present.
  • Vacation: Give yourself a brief vacation. Get into bed and pull the covers up over your head for 20 minutes. Take an hour breather from hard work that must be done.
  • Encouragement: Cheerlead yourself. Repeat over and over; “I can get through this difficult situation.” “I can sufferwell!”

3. Guidelines for Accepting Reality: Observing-Your-Breath Exercises

  1. DEEP BREATHING: Lie on your back. Breathe evenly and gently, focusing your attention on the movement of your stomach. As you begin to breathe in, allow your stomach to rise in order to bring air into the lower half of your lungs. As the upper halves of your lungs begin to fill with air, your chest begins to rise and your stomach begins to lower. Don’t tire yourself. Continue for 10 breaths. The exhalation will be longer than the inhalation.
  2. COUNTING YOUR BREATH: (my personal favorite) Sit in a comfortable position on the floor or in a chair, lie down, or take a walk. As you inhale, we aware that “I am inhaling, ONE.” When you exhale, be aware that “I am exhaling, ONE.” Remember to breathe from the stomach. When beginning the second inhalation, be aware that “I am inhaling, TWO.” And, slowly exhaling, be aware that “I am exhaling, TWO.” Continue up through 10. After you have reached 10, return to ONE. Whenever you lose count, return to ONE.
  3. FOLLOWING YOUR BREATH WHILE LISTENING TO MUSIC: Listen to a piece of music. Breathe long, light, and even breaths. Follow your breath; be master of it while remaining aware of the movement and sentiments of the music. Do not get lost in the music, but continue to be master of your breath and yourself.

3. Guidelines for Accepting Reality: HALF-SMILING EXERCISES

Accept reality with your body. Relax (by letting go or by just tensing and then letting go) your face, neck and shoulder muscles and half-smile with your lips. A tense smile is a grin (and might tell the brain you are hiding or masking). A half-smile is slightly up-turned lips with a relaxed face. Try to adopt a serene facial expression. Remember, your body communicates to your mind.

  1. HALF-SMILE WHEN YOU FIRST AWAKE IN THE MORNING: Put something in plain view on the ceiling or a wall so that you see it right away when you open your eyes. This sign will serve as your reminder. Use these seconds before you get out of bed to take hold of your breath. Inhale and exhale three breaths gently while maintaining a half-smile. Follow your breaths.
  2. HALF-SMILE WHILE LISTENING TO MUSIC: Listen to a piece of music for 2 or 3 minutes. Pay attention to the words, music, rhythm, and sentiments of the music you are listening to (not your daydreams of other times). Half-smile while watching your inhalations and exhalations.
  3. HALF-SMILE WHILE IRRITATED: When you realize, “I’m irritated,” half-smile at once. Inhale and exhale quietly, maintaining a half-smile for three breaths.

3. Guidelines for Accepting Reality: Awareness Exercises

  1. AWARENESS OF POSITIONS OF THE BODY: This can be practiced in any time and place. Begin to focus your attention on your breath. Breathe quietly and more deeply than usual. Be mindful of the position of your body, whether you are walking, standing, lying, or sitting down. Know where you walk, stand, lie, or sit. Be aware of the purpose of your position.
  2. AWARENESS OF CONNECTION TO THE UNIVERSE: This can be practiced any time, any place. Focus your attention on where your body touches an object (floor or ground, a chair or arm rest, your bed sheets and covers, your clothes, etc.). Try to see all the ways you are connected to and accepted by that object. Consider the function of that object for you. That is, consider what the object does for you. Consider it’s kindness in doing that. Experience the sensation of touching the object and focus your entire attention on that kindness until a sense of being connected or loved or cared for arises in your heart.
  3. AWARENESS WHILE DOING A SLOW-MOTION ACTIVITY: Prepare a cup of coffee, tea, or a warm snack with total awareness of each minute movement. Take a warm bath, do laundry, breath the fresh air, or do chores very slowly and deliberately with your focus absorbed completely on each tiny movement and sensation of the task.


As a psychologist, I am well aware of the fact that our society does not teach us how to suffer. The majority of us have no idea how to #sufferwell or that suffering well is even an option. For the most part, people minimize our suffering by encouraging us to focus on “the light at the end of the tunnel.” That’s because no one seems to know what to do in the tunnel. As a result many of us are drawn to substances like alcohol, marijuana or prescription drugs that only serve to worsen our suffering. But what if we had a choice in how we suffered and we could transform our experience in the tunnel as we waited for more and more light to enter. Share this article with friends and family so that we can create a movement to #sufferwell.

About the Author

Dr. Christine E. Dickson is a cognitive psychologist in private practice who specializes in mindfulness-based cognitive behavioral therapy. She is the owner of Tri-Valley Psychotherapy where she offers consultations and therapy both virtually and face-to face. Follow Christine’s blog #sufferwell to learn more tools to help transform the way we suffer. Christine’s work is also featured in Wikipedia, the world’s largest online encyclopedia. To learn more about her workshops, coaching, and counseling services, please see her website.

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