Mastering Distress Tolerance: Essential Skills for Emotional Resilience and Recovery

The great Lana Turner had once said, “My life has been a series of emergencies.” This quote kind of hits home, as stressors are everywhere - pain and struggles become part and parcel of life and cannot be entirely avoided altogether. Therefore, distress tolerance is a skill you can learn, which becomes the superpower you rely on when things become difficult and overwhelming.

Distress tolerance is an integral aspect of dialectical behavior therapy, which is based on the understanding that with complete acceptance comes positive change. Within this context, tolerance is specifically defined as the ability to perceive the environment as it is without wishing or demanding it were anything different. The idea is that when you accept pain, you reduce its power by transforming it from suffering into something ordinary and manageable.

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.

Dialectical Behavior Therapy (DBT) is a type of psychotherapy that enables you to accept the reality of your life and reshape unhealthy patterns into productive ones. As such, distress tolerance becomes one of the main modules of DBT, and the skills you will learn in this module are as follows:

• Identifying Crisis: You learn to recognize the signs of crisis during the initial stages itself.
• Distraction: You will learn to distract yourself from emotionally disturbing circumstances and focus your energy on other activities.
• Self-Soothing: You learn to use your five senses to self-soothe before your emotions spiral out of control.
• Grounding: It allows you to connect with your present, especially as past and future thoughts can become unhealthy and unproductive.
• RESISTT: Under RESISTT, you learn to reduce unhealthy urges during times of crisis.
• TIPP: TIPP is a relaxation technique where temperature, intense exercise, paced breathing, and progressive muscle relaxation techniques allow your mind and body to relax.
• Pros and Cons: You learn to do a cost-benefit analysis to understand the cons of negative behaviors and the benefits you stand to gain by reshaping or coping with them.
• Willingness vs. Willfulness: You become more willing to accept reality rather than veering toward the willfulness side and control everything around you.
• Radical Acceptance: You accept things as they are, especially those beyond your control. With radical acceptance, you can let go of negative emotions like anger, shame, and so on.
• Actions Based on Values: You take actionable steps that align with your principles so as to deal with distressing circumstances.

ACCEPTS, IMPROVE, and RESISTT are the crux of distress tolerance as well as the acronyms for the skills and techniques you can engage in to manage the distressing circumstances in life.

ACCEPTS Skills:

• Activities: Activities that distract you from emotionally distressing circumstances. It can be something like cleaning your room or attending an event.
• Contributing: You find something altruistic to do, like helping someone in need or volunteering.
• Comparisons: When you compare your struggles to those who are not doing as well as you, it puts things in perspective.
• Emotions: You seek to evoke emotions opposite to negative ones by engaging in some activities like watching a comedy or a scary movie.
• Push Away: You relax your mind and body and set aside the things that are distressing you.
• Thoughts: You distract your mind by engaging in cognitively engaging activities like solving puzzles or finding something interesting to read.
• Sensation: You use your five senses to soothe yourself. For instance, walking in the rain can engage your senses while being intensely soothing.

IMPROVE Skills:

• Imagery: You use imagery to improve the moment by imagining a beautiful scene or even a safe environment.
• Meaning: You try to find meaning in your difficulties, which makes them tolerable.
• Prayer: You draw a sense of peace from a higher power, which allows you to relax and develop a positive outlook.
• Relaxation: You use relaxation techniques like deep breathing or yoga to relieve tension.
• One Thing in the Moment: You focus on one thing at a time, which prevents you from becoming overwhelmed.
• Vacation: It is a kind of escapism where you escape to beautiful getaways to experience a sense of peace.
• Encouragement: You motivate yourself with positive self-affirmations that boost your confidence.

RESISTT Skills:

• Reframing the Situation: You reframe the situations in your life by changing your perspective. For instance, instead of looking at a certain difficult event as black and white, you look for a silver lining.
• Engaging in a Distracting Activity: You engage in distracting but pleasurable activities to divert your focus away from the distressing events in life.
• Someone Else: You focus your attention on someone else, which will take away your focus from your struggles. For instance, you can help someone in need or simply surprise a loved one by doing something special for them.
• Intense Sensations: You focus on intense sensations that are distracting but safe. For instance, taking a cold shower or going out for a walk in the rain or snow.
• Shut It Out: You remove yourself from environments that are distressing you and go somewhere that is more relaxed, peaceful, and safe.
• Neutral Thoughts: These are thoughts that do not add to the distressing events. For instance, you can count to ten or engage in mindfulness by focusing your attention on the environment around you.
• Take a Break: You simply take a break and engage in something that is good for you. This can be different for different persons. Maybe you can take a day off and engage in self-care or go for a walk in the woods.

Every person’s ability to tolerate distress differs from that of others. This ability mainly depends on two factors:

1. Biological Factors:

Your temperament plays a major role in your ability to tolerate distress, and your temperament is visible from the very early years of your life:

• Easygoing: Babies with this temperament are mostly flexible and relaxed, which means they have high levels of distress tolerance.
• Slow-to-Warm: Babies with this temperament take a little time to adapt to changing circumstances. So, they show moderate levels of distress tolerance.
• Challenging: Babies with this temperament are highly emotionally reactive and have low levels of distress tolerance.

2. Distorted Belief System:

Cognitive distortions can lead to skewed negative thinking patterns. It decreases distress tolerance because such cognitive distortions can lead to generalization and catastrophization. Avoidance, withdrawal, and self-destructive behaviors are commonly observed among those with a distorted belief system.

Stress and distress are related terms and are often used interchangeably. However, they differ in severity, which is to say that stress turns into distress when it is more severe and prolonged. Therefore, the ability to tolerate stress does translate to the ability to tolerate distress as well.

Healthy stress tolerance leads to productive ways of stress management, wherein you aptly estimate your ability to deal with stress, engage in effective problem-solving, distance yourself from stressful events whenever possible, know when to rest and recover, and know when to reach out to others. These factors are important in distress tolerance as well. The ability to solve problems, distract, self-soothe, and reach out are at the core of the same.

Moreover, apart from learned skills, biological factors that indicate stress tolerance also translate to distress tolerance. For instance, babies’ temperaments show how they adapt to stress and how they recover from it. This also indicates their ability to tolerate distress as well. As we learned before, easygoing babies adapt better to distress than slow-to-warm and challenging babies.

Q1. What is the role of mindfulness in distress tolerance?

A: Mindfulness increases the levels of distress tolerance by connecting you with the present and keeping your focus away from the negativities of the past or the future.

Q2. How does distress tolerance relate to emotional regulation?

A: Emotional regulation is the ability to manage your emotions. Emotional regulation directly impacts your distress tolerance levels as it can reduce the intensity of negative emotions.

Q3. What is the importance of distress tolerance in recovery?

A: Distress tolerance allows you to deal with your distressing thoughts and emotions in a healthy manner, thereby reducing the tendency to self-medicate. Distress tolerance also allows you to manage triggers and cravings, thereby reducing the urge to reach out and engage in substance use.