What Is Distress Tolerance?

What Is Distress Tolerance?

Distress tolerance is a person's ability to manage actual or perceived emotional distress. It also involves being able to make it through an emotional incident without making it worse. People who have low distress tolerance tend to become overwhelmed by stressful situations and may sometimes turn to unhealthy or even destructive ways of coping with these difficult emotions.

Everyone experiences a wide variety of stress during life. These stresses can range from daily annoyances to major events such as a job loss, divorce, or the death of a loved one. Whether the stress is large or small, your ability to tolerate distress can play a role in how you manage the situation. Learning distress tolerance skills can make a very positive difference in your ability to handle difficult emotions.

Types of Distress Tolerance Techniques

Distress tolerance techniques that may be helpful include:

Distraction

Distraction can be a very effective way of taking action to increase your distress tolerance. It involves using a variety of methods to take your mind off of your feelings of distress.

Improving the Moment

This strategy involves using a variety of strategies to help make the stressful situation more tolerable. Visualizing a relaxing scene, looking for the silver lining, or taking a mental break to do something pleasant are all examples of ways that you can improve the moment.

Pros and Cons

This distress tolerance technique involves thinking about the potential pros and cons of either tolerating the distress or not tolerating it. It can be a good tool for thinking through the short-term and long-term consequences of an action.

Radical Acceptance

Rather than focusing on things that cannot be changed or that are out of your control, radical acceptance involves just accepting things as they are and letting go of feelings of regret, anger, or bitterness. 

Follow Now: Apple Podcasts / Spotify / Google Podcasts / Amazon Music

Self-Soothing

Finding ways to calm yourself and keep negative emotions in check is an important part of building distress tolerance. Different sensory experiences that involve sight, sound, smell, taste, or touch can all be used to self-soothe during difficult moments.

You can learn and practice these techniques on your own, but they can also be incorporated into different forms of psychotherapy that focus on teaching distress-tolerance skills. Some of these forms of therapy include:

Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy can provide you with skills that are directly focused on increasing distress tolerance. DBT is a technique that was originally developed to treat borderline personality disorder (BPD) but has also been used to treat a range of other conditions including:

• Anxiety disorders
• Mood disorders
• Post-traumatic stress disorder (PTSD)
• Substance use

It is a form of cognitive behavioral therapy (CBT) that incorporates mindfulness meditation, interpersonal effectiveness, emotional regulation, and distress tolerance skills. 

Interoceptive Exposure

Interoceptive exposure can help increase your ability to tolerate the effects of intense negative emotions on your body, such as increased heart rate and muscle tension. It is another form of CBT that involves gradual exposure to physical sensations that are associated with threats or stress.

Stress can cause physical sensations that can then influence how people think about and respond to stress. By eliciting these sensations, people can work to identify the unhelpful thoughts and actions associated with these feelings.

How to Practice Distress Tolerance Skills

Many practical and effective behaviors for distracting you from intense emotions are emphasized in DBT and other types of therapy, including:

• Getting active: Do something you enjoy, such as taking a walk in beautiful surroundings. Or do something you'd be doing now​ if you weren't feeling so upset.
• Contributing: Go outside of yourself by focusing your attention on helping others (for example, volunteering at a school or nursing home).
• Comparing: Think of a time when you were even more emotionally distressed than you are now. Give yourself praise and credit for getting through that crisis—and for doing all you can to get through this one.
• Triggering opposite emotions: Ask yourself, "What's the opposite feeling to the distress I'm feeling now?" Then do something to make you feel that opposite way. For example, if you're feeling very angry, watch a comedy show or movie that always makes you laugh.
• Thinking big: The idea is to fill your brain with other thoughts so there's no room for the distressing ones. You need a lot of detail for this one, so imagine something like decorating a beautiful new home room by room or, if you're in a crowd, guessing each person's profession.
• Self-soothing: You may already be familiar with this calming technique, in which you use sight, sound, smell, touch, and taste to "treat" yourself to comforting, pleasurable experiences. But this time, think of how you'd comfort a loved one who's in the situation you're in now. Then, comfort yourself in the same caring way.
• Putting your body in charge: Some mental health professionals consider this the best way to get unstuck from the grip of intensely distressing emotions. It's based on the idea that where your body leads, your emotions will follow. So get going! Run up and downstairs. If you're inside, go outside. If you're outside, go inside. Your body and your emotions will thank you.

The goal of distress tolerance is to become more aware of how your emotions influence how to respond to distressing situations. Other stress management techniques that may help you build greater self-awareness and manage emotional stress more effectively include meditation, progressive muscle relaxation, deep breathing, and yoga. 

Impact

Strong negative emotions such as shame, fear, anger, anxiety, guilt, and sadness can be difficult to manage. The stronger these emotions are, the more difficult they can be to control.

Poor Distress Tolerance

It can also be difficult to identify the specific emotions you're experiencing. This can make them feel even more frightening, unpredictable, and out of your control.

Unfortunately, the relief these measures provide is short-lived, and to make matters worse, the distressing emotions often return even stronger and more upsetting.

Healthy Distress Tolerance

The good news is that learning distress tolerance techniques can help you:

• Prepare in advance to cope with intense emotions
• Enjoy a more positive long-term outlook for coping with them

Research has found that distress tolerance can be effective in helping people better regulate anger and impulsivity. Reducing impulsivity may have other helpful benefits as well by making people less likely to engage in unhealthy or even risky behaviors as a way of coping with distress.

Challenges

While research has shown that distress tolerance can be beneficial in the treatment of a variety of psychological disorders, there are a number of factors that can make building these skills challenging.

Biological Influences

Distress tolerance may have biological influences. Research suggests that biology can play an important role in influencing how well a person tolerates feelings of emotional distress.

Neural networks, brain chemistry, and certain brain structures may be associated with behaviors such as pursuing rewards or escaping distress. This may mean that some people might have a more difficult time building their distress tolerance skills. This doesn't mean that those skills cannot be developed—just that it might take longer or require more effort.

Distress Intolerant Beliefs

Holding distress intolerant beliefs can make it more difficult to cope with emotionally upsetting events. Examples of such beliefs can include:

• "I can't cope with this."
• "This feeling will never go away."
• "This is bad."
• "I hate this feeling."
• "I have to get away from this feeling."

Such beliefs can lead to distress escape behaviors. Such behaviors include withdrawal, avoidance, and sometimes self-harm.

• Withdrawal behaviors can include turning to drugs or alcohol to help cope and alleviate feelings of distress.
• Avoidance often involves staying away from situations that lead to discomfort, which can sometimes make it difficult for a person to function normally in their daily life.
• Self-harm can involve turning uncomfortable emotions inwards and engaging in behaviors that are harmful to the self such as picking, hair pulling, or cutting.

The goal of treatments such as dialectical behavior therapy is to identify these distress intolerant beliefs and replace them with more helpful, realistic thoughts. DBT and other treatment methods also address the resulting behaviors and attempt to replace them with more effective coping skills.

History of Distress Tolerance in Therapy

Research on distress tolerance is still emerging. Research has shown that it plays an important role in both the development and maintenance of a number of mental health conditions including anxiety disorder, mood disorders, substance use disorders, and personality disorders. For example, one key theory suggests that the inability or unwillingness to tolerate emotional distress is the key mechanism underlying the development of borderline personality disorder (BPD).

Because of this, a number of different types of therapy have emerged that incorporate aspects of distress tolerance skills-building. Some of these include:

• Acceptance-based emotion regulation group interventions
• Acceptance and commitment therapy
• Functional analytic psychotherapy
• Integrative behavioral couples therapy
• Mindfulness-based cognitive therapy

Researchers continue to learn more about how distress tolerance develops and contributes to the etiology of different mental disorders. As a result, new treatments designed to help people build their abilities to tolerate distress will continue to emerge.