Distress Tolerance: Techniques Used in Managing Emotional Distress

Life is full of hardships and challenges that are often beyond our control and can result in feeling overwhelmed emotionally and even having a breakdown. This is why it's important that we are able to manage our emotions, especially in times when they can feel particularly overwhelming and painful.

In order to effectively manage those overwhelming emotions, we will need to enhance our distress tolerance skills. But first, let's understand what distress tolerance is.

Even though the word "stress" is usually used in a negative context, certain stress is actually good for us. Let's say you're taking an exam, eustress (the good stress), will help you get that kickstart to start studying. However, if you are so incredibly nervous for the exam that you study weeks beforehand without sleeping, socialising, eating, or exercising, it takes a toll on your mental and physical health and will then result in distress, which is "pain or suffering affecting the body or the mind" (Merriam-Webster, 2022). The term "tolerance" is defined as the "capacity to endure pain or hardship".

Therefore, Distress Tolerance is a person's ability to endure or manage actual or perceived emotional distress in order to help a person return to their emotional state of equilibrium. Compitus mentions that it also includes "people being able to make it through an emotional incident without making it worse" (Compitus, 2020).

Marcus Aurelius once said:

“If you are distressed about anything external, the pain is not due to the thing itself, but to your estimate of it; and this you have the power to revoke at any moment"

Distress tolerance helps us manage the extent of our emotions and gives us the power of control back, especially in situations beyond our control. It's important to know when to improve your distress tolerance and what distress tolerance skills you can use. A good rule of thumb to know when you should improve your distress tolerance is when you feel extremely emotionally distraught. For example, if you are generally feeling more or less okay, maybe sometimes slightly irritated or annoyed at something, then it's okay, everyone has their ups and downs in life. However, when your emotions are interfering with your daily functioning and rational decision-making, for example, you realize that you have started to get more upset, angry, frustrated, anxious, overwhelmed, or depressed even in times when those emotions cannot be justified, then you might need to start strengthening your distress tolerance.

You know what they say about reacting toward bullies? Sometimes, the best reaction is no reaction to avoid agitating the bullies and possibly making things worse for you. This is what distress tolerance focuses on. Managing those extreme emotions.

There are a few techniques and skills that you can do to strengthen your distress tolerance. It's important to note that distress tolerance does not mean you should ignore your emotions or avoid having them, it's more about trying to find ways to manage those emotions when they feel particularly overwhelming.

There are distress tolerance skills that involve active change and then there are skills and techniques that focus on awareness.

The techniques that involve change are what dialectical behavioural therapists call "Crisis Survival Skills" and these techniques are used when we feel that we are in a crisis situation. These skills are short-term coping mechanisms to prevent extreme emotional distress, destructive behaviour, and irrational decision-making like self-harm, running away or substance abuse, or even denying that the stressor is real.

Self-Soothing Techniques

Sometimes in crisis situations, we often feel incredibly overwhelmed, anxious, and feel completely out of control. Self-soothing techniques are then the best way to cope. This includes grounding yourself using your senses (sight, hearing, smell, taste, and touch). List 5 things you can see, 4 things you can hear, 3 things you can smell, 2 things you can taste, and one thing you can touch. This helps you get your mind off those emotions you are feeling at that moment and focus on something else. By the time you think about your crisis situation again, your emotions will have calmed and you will be able to think rationally about your situation.

The great Master Oogway once said (Am I quoting an animated turtle? Yes!)

“Your mind is like this water, my friend. When it gets agitated, it becomes difficult to see. But if you allow it to settle, the answer becomes clear.”

Another technique is simply listing the pros and cons in a crisis situation. This is because when we reach that overwhelming emotional state in a crisis, we often make irrational decisions that we regret later. So before making any decisions at this time. PAUSE. TAKE A DEEP BREATH. SAY THE SITUATION OUT LOUD. and try to think logically about possible actions to take and their consequences.

Radical Acceptance

Another popular, although very tricky technique to strengthen your distress tolerance is Radical Acceptance. It's exactly what it says. It simply means accepting the way things are at that stage without pressuring yourself to fix things. As I said earlier, there are some things beyond our control. However, when we try to control things, we may feel an increase in distress if we fail. If we stop trying to control and just accept that things are as they are, then we can move forward without getting emotionally stuck.

Let's use an example of when a bee is nearby. Many of us are allergic to bees, or would just not like to be stung (how does something burn and itch at the same time?!). So, we would like to swat at them or even run away as an attempt to not get stung. However, these sudden and extreme reactions will more likely result in exactly that. Rather just observe, let them be, and when they are ready to leave, let them. Your chances of getting stung are much less. This is in essence what distress tolerance is.

The TIPP Skills: A Quick Fix

TIPP is an acronym for Temperature, Intense Exercise, Paced Breathing, and Paired Muscle Relaxation.

TIPP is very effective in calming the limbic system (this is the part of the brain, located on both sides of the thalamus, that is responsible for behavioural and emotional responses) and lowering the state of emotional agitation in a matter of minutes. Use temperature to splash cold water on your face, or hold ice in your hands. This gives a shock to your system and decreases your elevated emotional state. You can also do intense exercise which secretes adrenaline and elevates your heart rate, which results in it being difficult to feel distressed and elated simultaneously. The first P stands for paced breathing. You can do a technique where you inhale, hold your breath for one second, exhale, inhale, pause for two seconds, exhale, up to five. Do this while using your fingers as you count those seconds. This helps you to not only feel grounded, but in a situation where everything seems out of control, do the one thing you can control, the most basic autonomous biological function: your breath. According to Chapman et al (2011), paced breathing techniques can help address the effects of anxiety, insomnia, and fatigue, among other problems.

Lastly, paired muscle relaxation (PMR) is when a pair of muscles, such as the toes on both feet, are tensed while breathing in and then relaxed while breathing out. Work on the muscles in a particular order, from the top of the head to the feet or vice versa.

When the body is physically relaxed, it is difficult to be emotionally agitated.

The mind–body connection is very strong, so to calm the mind, calm the body. PMR also teaches mindfulness of the body and self-awareness. Some people believe guided PMR, such as with a practitioner or an audio recording, is helpful when starting PMR until you are familiar with the practice (McKay et al, 2019; Linehan, 2014; Koons, 2016; van Dijik, 2013).

In conclusion

Life loves to throw us curve balls that is often completely out of our control and sometimes our emotions towards these curve balls are so painful and overwhelming that we decide to do anything to try and avoid having these painful emotions and resulting in making rash decisions to avoid this pain which we will probably end up regretting. That is why it is so important to build our distress tolerance so that we can manage these overwhelming emotions more effectively. Luckily, there are a few techniques we can do to help build our distress tolerance.

References:

• Compitus, K. (2020). What Are Distress Tolerance Skills? Your Ultimate DBT Toolkit, Stress and Burnout Prevention. https://positivepsychology.com/distress-tolerance-skills/#skills

• Chapman, A., Gratz, K., & Tull, M. (2011). The dialectical behavior therapy skills workbook for anxiety: Breaking free from worry, panic, PTSD, and other anxiety symptoms. New Harbinger Publications.

• “Distress.” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/distress.

• Linehan, M. M. (2014). DBT skills training handouts and worksheets. Guilford Publications.

• Koons, C. R. (2016). The mindfulness solution for intense emotions: Take control of borderline personality disorder with DBT. New Harbinger Publications.

• McKay, M., Wood, J. C., & Brantley, J. (2019). The dialectical behavior therapy skills workbook: Practical DBT exercises for learning mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. New Harbinger Publications.

• “Tolerance.” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/tolerance.

• Van Dijk, S. (2013). DBT made simple: A step-by-step guide to dialectical behavior therapy. New Harbinger Publications

If you don't feel like reading a bunch of articles, you can listen to episode 42 and 43 of The Skillful Podcast which gives you a very detailed overview of Distress Tolerance.