Distress Tolerance Box

A Distress Tolerance (DT) Box is a box filled with objects, items and ideas that your child can use to help calm and distract them when they have negative thoughts and feelings during times of strong emotion and distress.

When people are escalated or triggered, they often do not make good decisions and lose sight of effective strategies for calming. DT Boxes provide people with healthy coping options during times of distress and when they are upset and more likely to resort to unhealthy or unsafe behaviors.

When your child experiences stressful triggers and notices their early warning signs, they can use the contents in the DT Box. It can distract your child from negative thoughts and feelings while they calm down enough to choose healthy, safe coping skills.

1. Pick something to use as a DT Box. This could be a shoebox, a drawer, a toy chest, backpack, or any other item that will hold a range of objects.
2. Pick a place to store the box. This should be an easy-to-find, consistent location, such as your child’s bedroom, so that they will know exactly where to find it during a distressing event.
3. Stock the DT Box with items that your child enjoys and will keep your child’s interest. See below for some things other children and teens have found useful to have in their DT Boxes.

Keep the DT box stocked with new items and consider having at least one item to use for each of the five senses: sight, touch, taste, hearing, and smell. Below are suggestions for items to include in your child’s DT box. Think about which of these items your child might find helpful and be open to their suggestions.

• A journal and a pen
• Art pad or coloring book with pencils, markers, or oil crayons
• Paint, brushes, and paper
• Favorite CDs or mp3 player
• A photo album containing pictures of fun and pleasant memories
• Word search or crossword puzzle book
• Bubble bath soap
• Plastic bottle of nail polish
• Clay or playdough
• Silly putty
• Mad libs
• Favorite magazine
• Origami design book and origami paper
• Card making supplies: paper, glitter, glue, and scissors (if self-harm is not a concern for child)
• Jigsaw puzzle
• Scented lotion or plastic aromatherapy vials

Your child should only use the DT Box when they are beginning to feel overwhelmed. If your child uses the items in the DT Box frequently or when they are bored, they will lose interest in the contents. The purpose of the DT Box is to help your child develop healthy, acceptable coping skills to use during stressful times.

Similar to Trigger Cards and Crisis Prevention Plans, DT Boxes are a work in progress. If the items in the box are not helpful after some time, replace them with new items that are distracting or soothing.