What is Coping in Crisis: The REST Strategy?
REST is a distress tolerance skill from DBT, or Dialectical Behavior Therapy, developed in the 1970s by Marsha Linehan, an American psychologist. Linehan drew from cognitive behavioral therapy, dialectical philosophy, and Buddhist psychology to create the approach. DBT was originally developed from early efforts to apply standard behavior therapy to treat individuals who were highly suicidal. While originally developed for BPD, DBT has also been adapted and shown to be effective in treating a range of other mental health conditions, including substance abuse, eating disorders, depression, and post-traumatic stress disorder (PTSD).
The REST strategy contains four steps. Relax your body using deep breathing or progressive muscle relaxation. Evaluate the facts by looking at the situation objectively. Set an intention by deciding how you want to respond. Take action by using healthy coping skills and following through. The worksheet guides clients to develop two personalized lists of coping strategies—one for interpersonal crises and one for managing distress when alone.
How therapists use it
Introduce REST when a client faces an upcoming crisis or after they've experienced one, to build their toolkit before the next emotional emergency. Distress Tolerance Skills are meant to help us survive crisis, but they need to be practiced before a crisis occurs. Have the client complete the two lists of coping strategies during a session or as homework. Review the lists together, refining strategies to fit their strengths and circumstances. Encourage them to keep the lists accessible—on their phone, in their wallet, or posted at home—so they can reference them when emotions feel overwhelming.
Who it's for
Distress tolerance has been identified as a risk factor in the development and maintenance of various mental health problems, including anxiety, traumatic stress, depression, substance use disorders, psychosis, borderline personality disorder, and eating disorders. REST suits clients who struggle with emotional intensity in relationships or when alone, and who tend to act impulsively when distressed. Research has shown DBT reduces anxiety severity and, in women with trauma-related PTSD, significantly reduces PTSD symptoms and trauma-related emotions. REST is less suited to clients who are in acute crisis requiring immediate safety intervention, or those who need primarily emotion regulation skills rather than crisis survival strategies.
What clients see
The client reads the REST framework and the activity description, then writes two lists of coping strategies—one for interpersonal crises and one for solitary distress. They reflect on their own needs, strengths, and circumstances as they personalize each strategy.
Modality fit
DBT Distress Tolerance skills are divided into three sub-skills: Crisis Survival Strategies, Reality Acceptance Skills, and Tolerance Building. REST is a crisis survival strategy that teaches clients to manage immediate emotional pain without making the situation worse. DBT emphasizes learning to bear pain skillfully because pain and distress are part of life and cannot be entirely avoided.
Common questions
When should I assign REST to a client?
Distress Tolerance Skills are meant to help us survive crisis, but they need to be practiced before a crisis occurs. Assign REST early in treatment, or when a client identifies a pattern of crisis situations they struggle to navigate. It works best when practiced in advance, not only during acute distress.
Is REST the same as emotion regulation?
No. REST is a crisis survival skill—it helps clients get through an immediate emotional emergency without making things worse. Emotion regulation, another DBT module, focuses on changing emotions over time. REST is for the moment when change isn't immediately possible.
What if a client's coping strategies don't work during a crisis?
The goal of REST is survival, not resolution. If a strategy doesn't work, the client moves to the next one on their list. The point is to stay engaged and avoid harmful behaviors until the acute distress passes. Review and refine the lists in session based on what they learn.
Can REST be used for clients with PTSD?
In women with trauma-related PTSD, DBT-PTSD significantly reduced PTSD symptoms and trauma-related emotions. REST can be part of a broader DBT approach for PTSD, though trauma-focused exposure work may also be needed depending on the client's presentation.
How is REST different from other DBT distress tolerance skills?
DBT Distress Tolerance skills are divided into Crisis Survival Strategies, Reality Acceptance Skills, and Tolerance Building. Crisis survival strategies are intended to help you get through immediate and intense emotional pain without making the situation worse, and are not designed to solve the crisis, but to survive it. REST is one crisis survival approach among several.