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Low Distress Tolerance in PTSD

Understanding its Causes, Consequences, and How to Improve Distress Tolerance

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Updated June 28, 2012

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Distress tolerance is defined as the actual or perceived ability to withstand emotional distress. Distress tolerance is an important ability to have. However, a number of studies have found that people with posttraumatic stress disorder (PTSD) struggle with low distress tolerance.

This isn't surprising given that people with PTSD often experience very intense negative emotions, such as shame, fear, anger, anxiety, guilt, and sadness. Intense emotions can be very difficult and frightening to experience and sit with. The stronger emotions are, the harder it is to manage them. In addition, when emotions are strong, it can be hard to identify what specific emotions you are experiencing. This can make emotions feel more frightening, unpredictable, and out of your control.

As a result, intense negative emotional experiences often lead people with PTSD to engage in unhealthy behaviors that help them get immediate relief from these emotions, such as deliberate self-harm, binge eating, substance use, or other impulsive behaviors. Although these behaviors may bring about some immediate relief, it is short-lived and the distress often comes back even stronger.

Fortunately, there are ways in which you can increase your tolerance of distress.

Increasing Distress Tolerance

There are a number of different ways to improve your distress tolerance. First, the more you are able to increase contact with, accept, and understand your emotions, the less frightening they may seem. There are a number of coping skills that can help with this, including journaling, mindfulness of emotions, and exposure. In addition, learning skills aimed at reducing negative reactions and evaluations of your emotions (also called secondary emotions) can make emotions feel less intense and upsetting. By using these skills, you may feel less like you need to get immediate relief from your emotions.

It can also be helpful to monitor your emotions so you have a better sense of what triggers certain emotions. This can make emotions feel more predictable. By knowing what types of things trigger your emotions, you can also plan ahead to cope with emotions in a healthy way. Distraction is another strategy that can help "take the edge off" of intense emotional experiences. Distraction is a particularly useful strategy when you are in a situation where you are unable to employ other healthy coping strategies, such as while at work or in school.

Finally, certain treatments have been found to increase distress tolerance. Dialectical Behavior Therapy (or DBT) provides you with a number of different skills that are directly focused on increasing distress tolerance. In addition, interoceptive exposure has been found to be helpful in increasing tolerance of internal sensations (for example, increased heart rate, muscle tension) that are often associated with intense emotional experiences.

Increasing your tolerance of emotions can be a long and difficult process. Initially, it may be very stressful to come into contact with your emotions. However, the more you are able to do so, the easier it will get. Distress tolerance is like a muscle. The more you work at it, the stronger your ability to tolerate distress will become. As you start working toward increasing your distress tolerance, it may be helpful to reach out to friends and family for support or work with a therapist. This can make the process feel safer and less distressing. There are a number of websites available that can help you find a therapist in your area.

Source:

Vujanovic, A.A., Bernstein, A., & Litz, B.T. (2011). Traumatic stress. In M.J.Zvolensky, A. Bernstein, & A.A. Vujanovic (Eds.), Distress Tolerance: Theory, Research, and Clinical Applications (pp. 126-148). New York: Guilford Press.

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