Tolerating Distress - Colorado Mental Wellness Network

I have always experienced emotions on a massive scale: this is due in part to my behavioral health condition. I live and thrive with bipolar disorder, and often find myself in situations where my emotions, anxiety, and stress become unbearable. I call these situations “episodes,” but the reality is that they are normal human experiences – distress is a normal human experience.

It’s hard to talk about distress; I’m not proud of the ways in which I’ve handled difficult emotions. Before my experiences in therapy, distress would wholly untether me – I often felt completely out of control, at the mercy of my meltdowns. I never learned how to tolerate situations of high distress, so I would often turn to self-destructive behaviors to alleviate the pain. I couldn’t sit with difficult emotions – I would either avoid them or succumb to them entirely.

It wasn’t until I discovered Dialectical Behavior Therapy (DBT) that I began to unlearn my distress intolerance. One of the first lessons that I learned has stuck with me for years: there are no “good” or “bad” emotions. Some emotions are easier than others, and some are overwhelming, but that doesn’t make them right or wrong. Distress is a normal and inevitable part of life, and we can learn how to tolerate it – we can learn how to sit with discomfort, and we can learn how to support ourselves through difficult and upsetting situations.

What is Distress?

Distress typically means the experience of highly difficult emotions that often overwhelm, overpower, and incapacitate people. Scientific definitions of distress refer to the phenomenon as “an aversive, negative state in which coping and adaptive processes fail to return an organism to physiological and/or psychological homeostasis.” Distress can also be defined as “emotional, social, spiritual, or physical pain or suffering that may cause a person to feel sad, afraid, depressed, anxious, or lonely.” The key component of distress is the inability to return to a healthy, happy equilibrium.

For those that have behavioral health conditions, distress is often more difficult and experienced more often than for those that live without these conditions. One of the biggest hurdles in recovery is learning how to tolerate distress and sit with uncomfortable and difficult emotions. Most of us avoid distress at all costs. Avoidance often develops as a defense mechanism; in response to difficult and distressing events, our brains develop a strategy to avoid similar situations in the future. However, avoidance tactics often fail when distress becomes overwhelming.

What is Distress Tolerance?

Distress tolerance and crisis survival skills are hallmarks of Dialectical Behavior Therapy (DBT), developed by Dr. Marsha M. Linehan in the late 1970s. Distress tolerance is defined as a person’s ability to manage an emotional incident without feeling overwhelmed. When we are able to withstand difficult emotions, we are able to more quickly return to a healthy state of equilibrium when stressors arise. These skills can help you manage emotional pain and avoid destructive behaviors.

Distress Tolerance Skills

Self-soothing techniques:

Self-soothing skills reset our bodily systems and allow us to return to equilibrium. These skills operate as an intervention for those that experience emotional dysregulation, but they can also be helpful for everyone!

Some self-soothing techniques are helpful in the moment, but are ultimately bad for us: binge-watching TV, social withdrawal, turning to substance use, and emotional eating are all examples of common self-soothing techniques that we may use to regulate our emotional state. Distress tolerance skills are all about finding healthy, productive self-soothing techniques that can help us regulate more effectively and ultimately help us withstand distress.

We can use the five senses to self-soothe:

Soothing imagery: Find comforting, soothing imagery that makes you feel safe, loved, and calm. This can be anything that you want – nature scenes, a comforting TV show, beautiful art, etc.
Soothing music: Listen to music that makes you feel calm; it can be especially helpful to listen to music that reminds you of a safe, happy place.
Take a shower or a bath: Let the water wash over you and pay attention to how it feels. Use your sense of touch to reset your body’s system! Taking a long shower or bath can help us return to equilibrium.
Mindful eating: Using our sense of taste can be a powerful way to self-soothe. As you’re eating, try to pay attention to every taste – this can help us focus on the moment and stay present.
Aromatherapy: Our sense of smell is one of our most powerful senses – using incense, candles, and other scents can reset our brain and help us regulate difficult emotions.

TIPP skills:

TIPP skills are extremely helpful for all kinds of distress, including everything from anxiety to insomnia. Originally developed for use in Dialectical Behavior Therapy (DBT), these skills have become standard practice for those that experience distress on a large scale.

TIPP stands for Temperature – Intense Exercise – Paced Breathing – Paired Muscle Relaxation. TIPP skills tend to work very quickly, and can be practiced almost anywhere. These skills help to calm the brain and reset bodily systems. Think of these skills as bodily overrides – we can use our body to reset our brains! TIPP skills can be used as an adaptive coping technique, and can benefit anyone.

Temperature: Change the temperature of your body! Splashing cold water on your face, taking a cold shower, or holding ice cubes can shock your bodily systems and override emotional distress.
Intense exercise: Exercise can change your body’s chemistry! When our heart rate rises, our bodies release adrenaline. Quick bursts of exercise can help us jumpstart our systems and fight distress with our bodies.
Paced breathing: Paced breathing includes breathing in deeply for 3 seconds, holding the breath for 4 seconds, and then breathing out for 5 seconds. Regulating your breathing can be helpful for regaining a sense of control! It also lowers blood pressure and stress levels.
Paired muscle relaxation: Also called PMR, paired muscle relaxation involves tensing and releasing a pair of muscles while breathing deeply. As you breathe in, tense the muscles you’re targeting. As you breathe out, release the tension.

The STOP skill:

The STOP skill stands for Stop – Take a step back – Observe – Proceed mindfully. Occasionally called the “sacred pause” in Buddhist philosophy, using the STOP skill can help someone in crisis find space and capacity in a moment of high distress. This skill is also useful for those who tend to engage in destructive behaviors when in crisis.

STOP: When you feel your emotions getting out of control, it’s important to stop right where you are. Create that pause for yourself to respond, rather than react.
Take a step back: Remove yourself from the moment or situation – take a step back and allow yourself to think it over.
Observe: Use your logical mind and your five senses to objectively assess the situation. Let yourself simply observe for a moment before the next step.
Proceed mindfully: Combine all the steps and proceed with your goals in mind. How do you want to respond to this moment?

IMPROVE skills:

The IMPROVE skills stand for Imagery – Meaning – Prayer – Relaxation – One thing in the moment – Vacation – Encouragement. These distress tolerance skills are all about improving the moment and withstanding difficult emotions until the intensity passes. IMPROVE skills provide us with the tools to change our perspective.

Imagery: This skill works in a few different ways. The first option is to imagine yourself in a safe, calm place. Visualize a space that has everything that you need. The second option is to imagine yourself coping successfully with the difficult or distressing situation that you’re facing – visualize yourself managing your emotions and emerging from the situation with confidence. You can also visualize the negative emotions flowing out; use your creativity to imagine a better, more stable environment.
Meaning: Search for the meaning of the situation: what is this moment teaching you? How can you use your values to gain a better understanding of this moment? When we are able to find the higher meaning behind our crises and distress, we are able to focus on the things that are important to us.
Prayer: This skill involves connecting to the higher existence to which we all belong. Prayer doesn’t have to be religious; sometimes this skill simply means acknowledging that some things are bigger than us. We don’t use this skill to pray for our situation to change; rather, we use this skill to let go of control, acknowledge our influence, and connect with a universal strength.
Relaxation: Find ways to bring relaxation into the moment. Use self-soothing skills to bring the intensity of the situation down – take a warm shower or bath, lay down in a quiet space, or listen to soothing music. You know yourself best! Choose an activity that relaxes you and makes you feel safe.
One thing in the moment: We often obsess over the future and the past in moments of crisis. This skill teaches us that we only need to handle one thing at a time, one thing in every moment. If we are able to remain present and stay mindful, we are less likely to be overwhelmed in moments of crisis or distress.
Vacation: Give yourself the vacation that you deserve. Take a break from work or life by letting yourself rest – this vacation should only be a few hours long, but should provide a space for you to decompress from stress. This skill can take any form – it’s up to you!
Encouragement: Speak to yourself like you would speak to a loved one. Be your own biggest supporter by encouraging yourself throughout the day. Bring a level of compassion and care to your relationship with yourself – don’t be afraid to cheer yourself on. We all need encouragement, but the person we really need it from is ourselves.

Radical acceptance:

Radical acceptance is the practice of letting go of control. One of the main reasons that we experience distress in such a visceral way is that we desire to change the outcome of the situation we’re facing. We want to be in control of what happens to us. Radical acceptance allows us to let go of that control and radically accept the situation for what it is.

With this skill, we are able to take a step back from our situation and simply observe. This skill teaches us to remove ourselves from the notion that we can control the outcome – radical acceptance allows us to accept things just as they are, without the desire to change them.

Making Friends with Distress

Before I learned these skills, I had a really hard time withstanding distress and crisis. My mind would race with negative consequences – I felt like I was not living in the same reality as others. Distress was a well-known and much-hated acquaintance of mine. When in an episode, I would wonder if I could survive such intense feelings of distress. Before DBT, I would find myself incapacitated by my feelings, totally unable to work through what I was experiencing. The skills I have outlined above helped me reach a safe, calm place within myself.

Distress is a normal and inevitable part of life – no matter who you are, you will experience crisis. And these emotions that often overwhelm are not inherently bad. In fact, we can learn how to tolerate difficult feelings. We can learn how to make friends with our distress, and we can learn how to withstand emotions that would otherwise destabilize us.

I recommend these skills to absolutely anyone, regardless of their diagnosis or experience with crisis. We deserve to feel loved and supported through distress, and we can be that resource for ourselves. All it takes is some practice and some self-love.