Developing Distress Tolerance
Allison Osmer, Masters Level Clinician
Have you ever become so overwhelmed with emotions that you felt out of control? Painful emotions can be challenging to work through, and sometimes we cope with emotions in ways that only worsen our problems. We might become overly reactive, use substances, ruminate, or avoid the situation all together. Developing distress tolerance skills might be helpful if you notice yourself unsuccessfully coping with your emotions. Distress tolerance skills help us regulate in order to be able to address the root cause of distressing situations. Rather than using unhelpful/unhealthy ways of regulating, try using distraction, self-soothing, and/or radical acceptance to ground yourself before then addressing the necessary shifts, boundaries, or processing.
What is Distress Tolerance?
The founder of Dialectical Behavioral Therapy, Dr. Marsha Linehan, first developed the concept of distress tolerance. Distress tolerance is a person's ability to manage an emotional activation without feeling overwhelmed or resorting to unhealthy or maladaptive behaviors. Distress tolerance skills typically involve distraction techniques, self-soothing techniques, and Radical Acceptance. These skills may help you accept your distress without becoming overwhelmed, allowing you to make more rational and healthy choices in response to challenging situations.
What are Distress Tolerance Skills?
Distraction techniques are helpful as they can help you pause from thinking about distress and give us time to find an appropriate solution. However, distraction techniques are different from avoidance. When we use distraction techniques, we plan on giving ourselves time before dealing with our problems and not using distractions to avoid our problems.
Self-soothing techniques allow you to soothe yourself before facing the cause of distress. Sometimes we need strategies that help us calm down and regain our strength before confronting our problems. Self-soothing skills also allow us to treat ourselves with compassion and kindness, especially in the face of overwhelming emotions.
Radical Acceptance is to acknowledge the present situation for what it is without judging or criticizing it. It means that we recognize events in the past that led us to where we are now and accept that we can't change what's already happened. Attempting to fight reality for what it is only leads to more pain and distress. However, accepting the situation doesn't mean liking or condoning it; it's about acknowledging its existence.
How to Apply Distress Tolerance Skills
Distraction techniques are skills that give you space between a distressing situation and your reaction. The following are examples of practical distraction techniques that can be applied when you are feeling overwhelming emotions:
Taking a break: When emotions become overwhelming, it's sometimes best to take a break from what you are doing. Putting distance between ourselves and the situation causing distress gives us time to calm our emotions before taking action we may regret later. If you're in a disagreement with someone, communicate that you're feeling overwhelmed and need a break. It can also be helpful to take space for a certain amount of time to practice communication skills and to ensure we don’t fall into avoidance following the distraction/break.
Crying: Having a good cry not only distracts us from our distress but can also release tension and stress.
Engaging in pleasurable activities: Engaging in activities that you find comforting can distract you from distress, and it can help boost your mood. Activities could involve reading a book, watching a movie, going for a walk, or spending time with people you care about.
Redirecting attention: Focusing on someone or something else than what is causing distress is another way to distract and regulate. You can redirect our attention by focusing on other tasks or other people, or you can focus on mental exercises, such as counting, doing mental math, or engaging in mindfulness activities.
Self-soothing techniques are skills that calm and comfort you in times of distress. These techniques help regulate emotions and create a sense of safety and relaxation. Here are some self-soothing techniques you can use:
Engaging the senses: Use your senses of taste, touch, smell, vision, and hearing as an effective way to soothe yourself from distressing emotions. Some examples of things you can try are smelling a scented candle that's pleasing to you (scent), touching something soothing, such as a soft blanket (touch), looking at a photo of someone you love (vision), listening to your favorite music (hearing), or drinking something soothing, like tea (taste).
Deep breathing: Practice deep, slow breaths to activate your body's relaxation response. Breathe deeply through your nose, hold for a few seconds, and then exhale slowly through your mouth. Focus on the sensation of the breath entering and leaving your body. A specific breathing technique that may be helpful are Box Breathing (inhale for a count of 4, hold for a count of 4, exhale for a count of 4, hold for a count of 4).
Grounding techniques: Grounding techniques help you connect with the present moment and your surroundings. Somatic practices are helpful here as a way to ground your mind and body in the present moment. Examples include gentle stretching, focusing on the sensation of your feet on the ground or even walking barefoot in the grass, or naming things you can see, hear, touch, smell, or taste in your immediate environment.
Practicing self-compassion: Offer yourself kindness, understanding, and self-compassion to help soothe your distress. Practice positive self-talk and remind yourself that it's okay to feel what you're feeling. Treat yourself with the same compassion and care you would offer a distressed friend.
Radical Acceptance can be a tool for cultivating emotional resilience and finding peace in challenging situations. Here are some steps to help you practice radical acceptance:
Recognize resistance: Without judgment or criticism, notice where and how you are having difficulty accepting a situation or emotion. Acknowledgment is the first step to Acceptance.
Validate your emotions: Name and validate your feelings in the moment. We cannot control how we feel about something, so trying to fight or stop our emotions only leads to more distress.
Let go of control: Acknowledge and accept the things you cannot control and divert your attention toward what you can control, such as your reaction and attitude.
Use coping statements: Remind yourself to accept the situation for what it is by developing coping statements. Examples of coping statements include:
I am present and grounded.
I accept what is happening and trust I will be okay.
I accept my reality without needing to justify or condone it.
It is what it is.
This feeling is temporary, and I will be okay.
I can't change the past; I can only change the present.
Developing distress tolerance skills may help us cope with overwhelming emotions in more effective and healthy ways. When we avoid dealing with our emotions and problems or use unhealthy coping methods to manage our distress, we tend to cause more pain for ourselves and others. We may also get stuck in a cycle of encountering things, people, or situations that upset us, avoiding them or reacting to them, and then never fully processing the root issues, setting boundaries, or speaking our needs.
If you feel it’d be helpful to learn more about distress tolerance skills, reach out as our therapists and coaches can help you develop skills to more effectively manage your emotions in the face of distressing situations. We offer therapy in Chicago and therapy in Illinois; mental health coaching nationally and internationally; and DBT Skills coaching nationally as well.
