Mastering Distress Tolerance: Essential Skills for Emotional Resilience and Recovery

Stressors are challenges that people experience in their daily lives. Some can be especially difficult to deal with, like emotionally distressing events or traumatic events. Distress tolerance then becomes an important skill to have, as it helps deal with emotionally distressing events without getting too overwhelmed.

Distress tolerance is one of the essential skills for emotional resilience and even for recovery from physical and mental challenges.

At the NuView Treatment Center, we emphasize distress tolerance as one of the essential skills in building emotional resilience and during recovery. Our programs equip clients how to manage stressors, build resilience, and recover from physical and behavioral health challenges.

What Is Distress Tolerance?

Distress tolerance is defined as the ability to manage real or perceived emotionally distressing events. Distress tolerance indicates how well a person can tolerate a crisis in their life, whether big or small.

Stressors in daily life range from regular disturbances to major events, like a job loss, divorce, the death of a loved one, and so on. With these events, negative emotions like anger, guilt, shame, fear, and uncertainty creep in, and these can be quite overwhelming. Strong distress tolerance levels allow for managing these emotions without going into crisis mode. Whereas, weak distress tolerance levels can make a person feel they are not in control and resort to unhealthy behaviors like substance use, binge eating, and other self-destructive behaviors.

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The Importance of Distress Tolerance in Recovery

Distress tolerance is a very important factor in recovery from Substance Use Disorders (SUDs). There are different ways in which distress tolerance helps in recovery, as it helps manage difficult emotions.

Distress tolerance decreases the tendency to self-medicate. To elaborate a bit, substances are used to self-medicate in many cases, to numb the distressing feelings or suffering. With greater distress tolerance, the tendency to self-medicate reduces, keeping a person away from making the conditions worse, preventing relapse, and so on.

Distress tolerance also helps in dealing with emotional challenges in a healthy, productive manner instead of resorting to drinking or drugs.

Distress tolerance helps in overcoming trauma and dealing with any unexpected challenges. When it comes to substance use, living with unresolved trauma or unpredictable challenges can lead to feelings of hopelessness, shame, guilt, isolation, and so on. Instead, distress tolerance, it can help cope with these emotions and deal with them effectively.

Distress tolerance also helps manage cravings. In recovery, certain triggers can lead to substance use and relapse. For instance, being with friends who still use or being in certain places associated with substance use. Distress tolerance allows to cope with the distress that comes with these triggers and reduces the urge to reach out for the substance again. In doing so, it minimizes the chances of a relapse as well.

Distress Tolerance as a DBT Module

Dialectical Behavior Therapy (DBT) is a type of psychotherapy that seeks to enable clients to accept the reality of their lives, and at the same time, reshape unhealthy behavioral patterns into healthier and productive ones.

Distress tolerance is one of the modules of DBT. It is part of one-on-one sessions and can also be delivered in group sessions, especially with a skills learning group. In this module, clients learn that there are times in life when pain and suffering cannot be avoided. Therefore, the skills that are covered in the distress tolerance module are:

• Identifying Crisis – Recognizing the signs of the crisis, especially during its initial stages itself.
• Distraction – Distract oneself from emotionally disturbing circumstances and direct thoughts toward other activities.
• Self-Soothing – Self-soothing activities involve the 5 senses to reduce emotions that spiral out of control.
• Grounding – Connecting with the present moment, especially when past and future thoughts become unhealthy and unproductive.
• RESISTT – It refers to a technique that helps in reducing unhealthy urges during times of crisis.
• TIPP – A relaxation technique, wherein temperature, intense exercise, paced breathing, and progressive muscle relaxation techniques are used to get the mind and body to relax.
• Pros and Cons – It is a cost-benefit analysis, where the client gets to analyze the cons of problematic behaviors and the benefits of changing them by reshaping them or coping with them in a healthy manner.
• Willingness vs. Willfulness – Rather than veering toward the willfulness side, it refers to being more willing to accept that reality and not controlling everything around.
• Radical Acceptance – This refers to accepting things that are what they are and things beyond control. It can let go of many negative emotions, like anger, shame, and so on.
• Actions Based on Values – It involves aligning actions with values or principles so as to deal with distressing circumstances.

Key Skills and Techniques for Building Distress Tolerance

Distress tolerance is highly necessary to deal with life’s challenges. Some of the key skills and techniques that can be used for building distress tolerance can be understood by their acronyms ACCEPTS and IMPROVE.

ACCEPTS Skills:

• Activities – These refer to activities that distract a person from negative emotions.
• Contributing – This is more on the altruistic side, where a person helps others in shifting focus and reducing distress.
• Comparisons – By comparing personal challenges to others’ challenges, it puts things into perspective.
• Emotions – Trying to evoke emotions opposite to the ones of distress.
• Push Away – Setting aside distressing things for a while and focusing on relaxing the mind and body.
• Thoughts – This is like a cognitive activity that distracts the mind. For instance, by engaging in things like puzzles or other games.
• Sensation – Using sensory experience to engage in self-soothing.

IMPROVE Skills:

• Imagery – Using imagery to visualize oneself handling problems in a healthy and productive manner.
• Meaning – It is meaning-making, finding meaning in difficulties. This makes them tolerable.
• Prayer – Believing in a higher power and seeking strength from the same gives a sense of peace.
• Relaxation – Using relaxation techniques like deep breathing or yoga. This relieves tension.
• One Thing in the Moment – Singular focus on one task or thing at a time. Prevents getting overwhelmed.
• Vacation – A form of escapism, where one can escape to better places for calm and peace.
• Encouragement – It is motivation, and refers to motivating oneself with positive affirmations.

Apart from ACCEPT and IMPROVE skills, other skills that also help build distress tolerance and resilience are distraction skills, self-soothing skills, grounding, physical activity, TIPP, RESISTT, cost-benefit analysis, willingness over willfulness, radical acceptance, and actions based on values skills.

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The Role of Mindfulness in Distress Tolerance

Mindfulness plays a very important role in distress tolerance, as it helps in increasing the level of distress tolerance. It connects the person with the present moment, and in doing so, it keeps the focus away from unfruitful and distressing past and future thoughts over which one has little control. It builds self-awareness and increases acceptance of the emotionally distressing challenges in life in a non-judgmental manner. This mitigates the negative emotions associated with them, like anger, fear, guilt, shame, and so on. Letting go of these feelings helps in handling moving past these challenges and forward in life.

In fact, experiments involving brief mindfulness training and distress tolerance showed that mindfulness had the ability to increase distress tolerance and help handle negative emotions and other aversive events in life more effectively.  

How Does Your Stress Tolerance Reflect Your Overall Distress Tolerance?

Stress and distress are related terms and the difference between them is severity. Stress turns into distress when it is more severe and prolonged. Therefore, the ability to tolerate stress translates to the ability to tolerate distress as well.

Healthy stress tolerance leads to productive ways of stress management, where a person aptly estimates their ability to deal with stress, engages in effective problem-solving, distances from stressful events whenever possible, knows when to rest and recover, understands other situations of stress, and knows when to ask for help, even if it means professional help.

These factors are important in distress tolerance as well. The ability to solve problems, distract, self-soothe, and reach out also form the crux of distress tolerance.

Moreover, apart from learned skills, biological factors that indicate stress tolerance also translate to distress tolerance. For instance, the temperament of babies shows how they adapt to stress and how they recover from it. This also indicates their ability to tolerate distress as well. Easygoing babies adapt better to distress than slow-to-warm and challenging babies, who may take little to more time to adapt to and recover from distress.

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How Does Distress Tolerance Relate To Emotional Regulation?

Emotional regulation refers to the ability to control one’s emotions in a healthy and flexible manner. Distress tolerance is related to emotional regulation in that better emotional regulation skills can reduce the intensity of negative emotions, thereby leading to higher distress tolerance levels. Weaker emotional regulation skills can further intensify these negative emotions, leading to poor distress tolerance levels. However, it is possible that regardless of the intensity of emotions, distress tolerance can be greater among people who can cope better with distress. It depends on temperament, thinking patterns, neural networks pertaining to pursuing rewards and escapism, and so on.

On the other hand, distress tolerance also has an effect on emotional regulation. Meaning, greater distress tolerance levels can effectively deal with negative emotions, like anger. This benefits people in other ways as well, wherein they tend to have a lower likelihood of engaging in unhealthy behaviors.