What is Distress Tolerance?
What is Distress Tolerance in Dialectical Behavior Therapy?
Distress Tolerance skills are there to help us cope and survive during a crisis. These skills are meant to be used as short-term solutions to get through emotional (and sometimes physical) intensity. Tolerance is the most important word here. These are skills to help you tolerate emotional intensity in the moment – distress tolerance skills are not meant as long term solutions. This is a very important distinction as you start to read about and practice these skills.
Distress Tolerance skills are to help you get through situations in life when you cannot make changes for the better, and for any number of reasons, you cannot sort out your feelings well enough to make changes in how you feel.
In DBT, Distress Tolerance skills are used when we are unable, unwilling, or it would be inappropriate to change a situation. It is important to use the right skills at the right time. In order to change a situation or your emotions, we would use the EMOTION REGULATION skills in DBT.
In the DBT module Distress Tolerance, the focus is on learning to counter your intolerance to distress (such as increasing capacity to feel uncomfortable feelings). When working with a DBT therapist or in a DBT skills training group, the connection between your inability to tolerate distress and impulsive behavior is a main focus of this module.
You may struggle with distress tolerance if you...
Have problems with alcohol, drugs, eating, spending, sex, and other types of self-destructive behavior. This is also identified as para-suicidal behavior such as threats, plan, and action.
React impulsively to avoid feeling uncomfortable (abrupt cancelling of plans, making overly hurtful and accusatory statements in arguments, self-injure immediately after a difficult event)
Avoid stress inducing activities or engagements
Check out this short video on how to practice distraction as a Distress Tolerance DBT Skill
What is the module of Distress Tolerance?
The ability to perceive one’s environment without putting demands on it to be different.
To experience your current emotional state without attempting to change it.
To observe your own thoughts and action patterns without attempting to stop or control them.
We all experience emotions. Our emotional experiences are an important part of being human, and are essential to our survival. We are designed to feel a whole range of emotions, some of which may be comfortable to us, and others may can be extremely uncomfortable and challenging.
It is natural to avoid pain – especially emotional pain. The type of discomfort that is addressed in the module of DISTRESS TOLERANCE is emotional discomfort, or what is often called distress.
You may believe that you “can’t face”, “can’t bear”, “can’t stand”, or “can’t tolerate” emotional distress. Being intolerant of experiencing emotional discomfort can actually create more problems, as it interferes with living a fulfilling life, and can compound any emotional discomfort you might be experiencing.
Distress Intolerance is a perceived inability to fully experience unpleasant, aversive or uncomfortable emotions, and is accompanied by a desperate need to escape the uncomfortable emotions. Difficulties tolerating distress are often linked to a fear of experiencing a negative emotion.
Often distress intolerance centers on high intensity emotional experiences, that is, when the emotion is ‘hot’, strong and powerful. However, it could also occur for lower intensity emotions such as less intense anxiety or sadness.
It is not the intensity of the emotion itself, but how much you fear it, how unpleasant it feels to you, how unbearable it seems, and how much you want to get away from it that determines if you are intolerant of the distress.
Healthy Distress Tolerance
An important thing to consider when assessing your own level of distress tolerance, is that like many things in life, doing anything at the extreme can be unhelpful. Think of distress tolerance as a continuum where at one end people can be extremely intolerant of distress, and at the other end people can be extremely tolerant of distress. Sitting at either end of the spectrum isn’t good for you.
If you were always overly tolerant of experiencing all unpleasant emotions, then problems might result such as tolerating bad situations or bad people in your life. If you were tolerant in the extreme, you would never take action to change unhappy circumstances in your life that need to be changed.
The Paradox
The strategy of avoidance seems to work for other things that make us uncomfortable (e.g., heat, cold, pain, hunger, etc). However, when we apply the same strategy to our emotions, it seems to backfire.
This is the paradoxical nature of distress intolerance. That is, the more we fear, struggle with, and try to avoid any form of distress, generally the worse that distress gets. Fear and avoidance of the distress actually magnifies the experience of difficult situations or emotions.
Again, it is often our relationship to our emotions, such as fear that produces even more disastrous situations for us. Fear that convinces us to avoid and not confront and heal from our difficulties may create a sense of peace in the short-term, but in the long-term, avoidance can make a difficult, but manageable experience, into something that is unbearable. Similarly, our negative and critical narratives around how we should feel in any certain situation, can create a non-engagement internally with difficult emotions – essentially distress intolerance in action.
Distress Tolerance skills help us tolerate difficult emotional experiences in the moment so that we can increase our capacity for emotional intensity, build a sense of confidence and competency in our ability to take care of our self, and sometimes, distress tolerance skills can be utilized to just not make a situation worse.
Acceptance and change – not acceptance or change. This is putting into practice the belief that you need to embody acceptance towards yourself and your situation as you are right now in order to start making meaningful changes in your life. It’s a big concept and the cornerstone of dialectical behavior therapy. More on that in a later post :)
Just like learning anything new, it takes practice to feel comfortable with using new skills. So, Practice! Practice! Practice! Not all of these skills work for all people, so if you find one not useful, go on to the next.
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