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Distress tolerance is a person’s ability to manage actual or perceived emotional distress. It also involves making it through an emotional incident without making it worse. People who have low distress tolerance tend to become overwhelmed by stressful situations and may sometimes turn to unhealthy or even destructive ways of coping with these difficult emotions.

Everyone experiences a wide variety of stress in life. These stresses can range from daily annoyances to significant events such as a job loss, divorce, or the death of a loved one.

Whether the stress is large or small, your ability to tolerate distress can affect how you manage the situation. Strong negative emotions such as shame, fear, anger, anxiety, guilt, and sadness can be difficult to manage. The stronger these emotions are, the more difficult they can be to control.

Poor Distress Tolerance

It can be challenging to identify the specific emotions you’re experiencing. This can make them feel even more frightening, unpredictable, and out of your control.

Unfortunately, the relief these self-destructive measures provide is short-lived, and to make matters worse, the distressing emotions often return even stronger, with additional feelings of shame and guilt, which is more upsetting.

Healthy Distress Tolerance

The good news is that learning distress tolerance techniques can help you:

• Prepare in advance to cope with intense emotions
• Enjoy a more positive long-term outlook for dealing with them

Research has found that distress tolerance can be effective in helping people better regulate anger and impulsivity. Reducing impulsivity may also have other helpful benefits, such as making people less likely to engage in unhealthy or even risky behaviors as a way of coping with distress.

Factors Impacting an Individual’s Distress Tolerance

While research has shown that distress tolerance can be beneficial in the treatment of a variety of psychological disorders, there are a number of factors that can make building these skills challenging.

Biological Influences

Distress tolerance may have biological influences. Research suggests that biology can play an essential role in influencing how well a person tolerates feelings of emotional distress.

Neural networks, brain chemistry, and specific brain structures may be associated with behaviors such as pursuing rewards or escaping distress.

Research also indicates that babies are born with a particular temperament which is hard-wired and with them at birth. Temperament is a strong predictor of personality traits that develop down the road. There are three main temperaments including:

• Easygoing babies are calm, adaptable, and have a higher stress tolerance.
• Slow-to-warm babies are more cautious and shy and may express mild stress until they are more familiar with people and situations.
• Challenging babies are more emotionally reactive, have difficulty adjusting, and take longer to soothe when stressed.

These brain differences and varying temperaments indicate that some people might struggle with a heightened reaction to stressors, and building their distress tolerance skills is more challenging. This doesn’t mean those skills cannot be developed—but it might take longer or require more effort.

Distorted Beliefs

There are thinking patterns that can make it more challenging to cope with emotionally upsetting events. These automatic thoughts are cognitive distortions, which everyone has to some degree.

Examples of distress-intolerant beliefs can include:

• “I can’t cope with this.”
• “I will never feel better.”
• “This is terrible.”
• “I hate this feeling.”
• “Life never goes my way.”
• “I am always upset about something.”
• “I have to get away from this feeling.”

Note when you use words on the extreme end of the spectrum like “always,” “never,” “love” and “hate.” Such distress-laden beliefs can lead to escape behaviors such as withdrawal, avoidance, and sometimes self-harm.

• Withdrawal can include isolating yourself and even turning to drugs or alcohol to help cope and alleviate feelings of distress.
• Avoidance often involves staying away from situations that lead to discomfort, sometimes making it difficult for a person to function normally in their daily life.
• Self-harm can involve turning uncomfortable emotions inwards and engaging in behaviors that are harmful to the self, such as picking, hair pulling, binge eating, or cutting.

Types of Distress Tolerance Techniques

Learning distress tolerance skills can make a very positive difference in your ability to handle difficult emotions. Distress tolerance techniques that may be helpful include distraction, self-soothing, radical acceptance, and more.

Distraction

Distraction can be a very effective way of taking action to increase your distress tolerance. It involves using various methods to take your mind off your feelings of distress. Switching activities might include occupying your mind with a good book or TV show, walking your dog, or finding productive ways to release your energy, like vacuuming the house or washing the dishes.

Improving the Moment

This strategy involves using a variety of strategies to help make the stressful situation more tolerable. Visualizing a relaxing scene, looking for the silver lining, or taking a mental break to do something pleasant are all examples of ways that you can improve the moment.

Weighing the Pros and Cons

This distress tolerance technique involves considering the potential pros and cons of tolerating or not tolerating distress. It can be a good tool for weighing the short-term and long-term consequences of an action.

Radical Acceptance

Rather than focusing on things that cannot be changed or that are out of your control, radical acceptance involves just accepting things as they are and letting go of feelings of regret, anger, or bitterness. 

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Self-Soothing

Finding ways to calm yourself and keep negative emotions in check is an important part of building distress tolerance. Different sensory experiences, such as sight, sound, smell, taste, or touch, can all be used to self-soothe during difficult moments.

How to Practice Distress Tolerance Skills

Many practical and effective behaviors for distracting you from intense emotions are emphasized in DBT and other types of therapy, including:

• Getting active: Do something involving movement that you know you enjoy, such as walking in beautiful surroundings. Or do something you’d be doing now​ if you weren’t feeling so upset.
• Contributing: Go outside yourself by focusing on helping others (for example, volunteering at a school or nursing home).
• Comparing: Think of a time when you were even more emotionally distressed than you are now. Give yourself praise and credit for getting through that crisis and doing all you can to get through this one.
• Triggering opposite emotions: Ask yourself, “What’s the opposite feeling to the distress I’m feeling now?” Then, do something to make you feel the opposite way. For example, if you’re angry, watch a comedy show or movie that always makes you laugh.
• Thinking big: The idea is to fill your brain with other thoughts so there’s no room for the distressing ones. You need a lot of detail for this one, so imagine something like decorating a beautiful new home room by room or, if you’re in a crowd, guessing each person’s profession.
• Self-soothing: You may already be familiar with this calming technique, in which you use sight, sound, smell, touch, and taste to “treat” yourself to comforting, pleasurable experiences. But this time, think of how you’d comfort a loved one who’s in the situation you’re in now. Then, comfort yourself in the same caring and compassionate way.
• Putting your body in charge: Some mental health professionals consider this the best way to get unstuck from the grip of intensely distressing emotions. It’s based on the idea that where your body leads, your emotions will follow. So get going! Run up and downstairs. If you’re inside, go outside. If you’re outside, go inside. Your body and your emotions will thank you.

The goal of distress tolerance is to become more aware of how your emotions influence your response to distressing situations. Other stress management techniques that may help you build greater self-awareness and manage emotional stress more effectively include meditation, progressive muscle relaxation, deep breathing, and stretching exercises. 

You can learn and practice any of these techniques on your own, but they can also be incorporated into different forms of psychotherapy that focus on teaching distress-tolerance skills. Some of these forms of therapy are discussed in the next section.

Psychotherapy to Improve Distress Tolerance

Although research on distress tolerance is still emerging, it has already shown that poor distress tolerance plays an important role in both the development and maintenance of a number of mental health conditions, including:

For example, one key theory suggests that the inability or unwillingness to tolerate emotional distress is the key mechanism underlying the development of borderline personality disorder (BPD).

Because of this, a number of different types of therapy have emerged that incorporate aspects of distress tolerance skills-building. Some of these include:

More About Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) can provide you with skills directly focused on increasing your distress tolerance. DBT is a technique that was initially developed to treat borderline personality disorder (BPD) but has also been used to treat a range of other conditions, including anxiety and mood disorders, PTSD, substance use, and other personality disorders.

It is a form of cognitive behavioral therapy (CBT) that incorporates four skills:

1. Mindfulness
2. Interpersonal effectiveness
3. Emotional regulation
4. Distress tolerance

More About Interoceptive Exposure

Interoceptive exposure can help increase your ability to tolerate the effects of intense negative emotions on your body, such as increased heart rate and muscle tension. It is another form of CBT that involves gradual exposure to physical sensations associated with threats or stress.

Stress can cause physical sensations that influence how people think about and respond to stressors. By eliciting these sensations, people can work to identify the unhelpful thoughts and actions associated with these feelings.

Breakups can take a serious toll on your well-being. Not only can the end of a relationship lead to major life changes in finances and living situations, but breakups also create a great deal of emotional turmoil. Some splits are easier than others. You might be able to let go and move on fairly quickly. In other cases, you might feel angry, sad, bitter, anxious, and heartbroken. 

All of these emotions can be perfectly normal after a romantic breakup—but if they lead to prolonged feelings of sadness or apathy and significant impairment in areas of life functioning, this might be a sign that something more serious is going on. Stressful life events such as a breakup or divorce can sometimes trigger prolonged and severe emotional distress. 

Experiencing depressive and other symptoms following the end of a relationship is sometimes diagnosed as an adjustment disorder with depressed mood, also sometimes referred to as situational depression. Because these feelings with adjustment disorders can last six months to two years, it is important to understand the signs and symptoms so that you can find help and support if you need it.

Symptoms of Breakup Depression

Feelings of sadness can vary from mild to severe after a breakup. Sometimes these feelings can be strong for a relatively brief period of time. In other cases, people might feel a range of mild to strong feelings of sadness that fluctuate and linger for a longer period of time.

Because emotional responses to a breakup can vary so greatly, it can be difficult to discern when to reach out for additional support. More serious symptoms that may indicate depression include:

• Feelings of hopelessness or helplessness
• Losing or gaining weight; appetite changes
• Sleeping too much or too little
• Loss of pleasure and interest
• Feelings of worthlessness
• Feeling sad or empty
• Fatigue and lack of energy
• Listlessness
• Thoughts of death or suicide

Grief and sadness are human responses to stressful and painful life events. Research has found that breakups can influence people in a number of profound ways.Following the end of a relationship, people report experiences such as distress, loneliness, and a loss of self-esteem.

Allow yourself time to grieve the loss of the relationship. Responses may include a period of mourning, sadness, frustration, bargaining, anger, denial, and regret. It is a period of adjustment, so you grant yourself as much time as needed to feel what you feel, process, and heal. While upsetting, these feelings usually start to shift with time as you heal and recover mentally, emotionally, and relationally from the breakup.

Causes of Depression After Breakup

As a form of situational depression, the end of a relationship is what triggers these feelings. A breakup can be a point of major change in a person’s life. Not only does it mean no longer being involved with someone you once loved, but it can also lead to an entire cascade of life changes.

Shared friends may choose sides, which can lead to the end of other relationships. You might have to adjust your finances, your living situation, or even cope with the challenges of co-parenting children with your ex.

Breakups can also influence how you view yourself.

Another study found that breakups not only altered self-concept but that people who have a greater disruption in their self-image are also more likely to experience more post-breakup emotional distress.

All of these adjustments can be challenging. They can make you feel confused, insecure, anxious, and sad. And in some cases, it may trigger more severe and longer-lasting symptoms of depression.

Diagnosis of Depression After Breakup

Breakup depression is not an actual medical term or diagnosis, but this does not mean that what you are feeling after a breakup does not represent a real condition.

If you decide to talk to your doctor or mental health professional about it, they may ask you a number of questions about your symptoms including their duration, frequency, and intensity.

To be diagnosed with this condition according to DSM-5, you must:

• Begin experiencing symptoms within three months of the identifiable stress (in this case, a breakup)
• Have symptoms that are out of proportion to the severity of the trauma that also take into account other things in your life that might influence your symptoms
• Have symptoms that are not the result of another mental disorder

Treatment

The good news is that even if you do experience depressive symptoms triggered by a breakup, they usually begin to get better on their own by six months after the event. As time passes, your situation improves, and you begin to recover from the breakup, in most cases, you will find yourself gradually feeling much better.

If your symptoms are mild to moderate, you may be able to handle them on your own by practicing good self-care and surrounding yourself with a strong support system.

If your symptoms are more severe or if you just feel that you need a little extra help coping, talk to your doctor or therapist. Counseling can be helpful to help you gain perspective, address negative thought patterns, and establish coping skills that may help you both now and in the future.

If your symptoms are severe or do not seem to be improving, your doctor may also prescribe medications such as antidepressants that can help.

Coping With Depression After Breakup

Whether you’re are having normal post-breakup sadness or something more serious, there are things that you can do to make it easier to cope once a relationship ends. While there is no way to predict who will experience breakup depression, there are things that you can do to help make yourself more resilient to stressful events.

Some things you can do include:

• Forming a strong social support network, including online networks
• Caring for yourself and your health
• Learn problem-solving skills
• Work on improving your self-esteem
• Create goals to work toward
• Take steps toward solving your problems
• Find a sense of purpose in your life
• Allow yourself time and space to process feelings in ways that feel true, honoring, and supportive for you (i.e. through art, music, movement, journaling, etc.)

Finding ways to stay occupied can also be helpful. While you might be tempted to brood, doing things that keep your mind and body busy keep you from ruminating over negative thoughts. Try digging into a new project around the house or start up a new hobby that you’ve been wondering about.

Exercising and spending time with friends can also be a great way to elevate your mood and cope with post-breakup stress. Research has also shown that writing about what you are feeling or positive experiences can improve coping after a traumatic event.

Breakups can interrupt your sense of personal agency and even challenge your self-concept. Focusing your attention on the aspects of your life where you do have more control, such as your work or your hobbies, can help you restore your sense of mastery and help you feel more empowered.

ADHD and Asperger’s are two conditions that are often confused because they have some overlap in characteristics such as social difficulties and impulsiveness. Additionally, it’s common for people to have both conditions. However, there are also several key differences between the two conditions.

Asperger’s syndrome is now more correctly referred to as an autism spectrum disorder. It is mainly characterized by social and communication difficulties. Meanwhile, ADHD is characterized by hyperactivity, impulsivity, and inattention.

Symptoms of ADHD and Asperger’s

The characteristics of Asperger’s and ADHD can overlap, but there are also some key differences. Both conditions can cause social difficulties, but people with Asperger’s typically have more significant problems in this area. They may have trouble understanding social cues and may prefer to be alone.

People with ADHD, on the other hand, may be more likely to seek out social interaction but then have difficulty sustaining it due to their impulsivity and hyperactivity.

Key Differences Between Asperger’s vs. ADHD

Below is a bullet point list of some of the characteristics of each condition and how they are similar or different.

• People with Asperger’s often have narrow interests and may become obsessed with certain topics. People with ADHD tend to have broader interests that may change frequently or impulsively.
• Asperger’s is characterized by repetitive behaviors, while ADHD is not.
• People with Asperger’s may have difficulty with change and need routines, while people with ADHD may seek out change and dislike routines.
• People with Asperger’s often have problems with motor coordination, while people with ADHD do not typically have this problem.

Causes of ADHD and Asperger’s

Asperger’s and ADHD are both neurodevelopmental disorders, which means they are caused by problems with brain development. It is not known exactly what causes these problems, but it is thought that both genetics and environment play a role.

Causes of Asperger’s

Some research suggests that Asperger’s may be linked to a problem with the wiring and connections in different networks in the brain.

It is also thought that Asperger’s may be linked to abnormalities with the neurotransmitter serotonin.

Causes of ADHD

Some research suggests that ADHD may be linked to a problem with the neurotransmitters dopamine and norepinephrine. This theory is supported by the fact that people with ADHD often respond well to medications that affect dopamine and norepinephrine levels.

Diagnosing ADHD and Asperger’s

Both ADHD and Asperger’s are diagnosed based on symptoms. There is no medical or laboratory test for either condition. Instead, doctors typically use history, interviews, and behavior rating scales to make a diagnosis.

Asperger’s Diagnosis

Asperger’s is typically diagnosed in childhood. To be diagnosed with Asperger’s, a person must have significant problems with social interaction and communication and restricted, repetitive behaviors, while typically having good verbal skills.

The term Asperger’s was replaced with autism spectrum disorder in the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5). Below are some of the diagnostic criteria for a diagnosis:

• Significant problems with social interaction
• Deficits in non-verbal communication
• Repetitive behaviors or interests
• Insistence on sameness and inflexibility

ADHD Diagnosis

ADHD is also typically diagnosed in childhood. To be diagnosed with ADHD, a person must have problems with hyperactivity, impulsivity, and attention.

ADHD can be divided into three subtypes: predominantly inattentive, predominantly hyperactive/impulsive, and combined presentation.

Below are some traits associated with each type:

Inattentive:

• Problems with paying attention
• Easily distracted
• Difficulty following instructions

Hyperactive/impulsive:

• Excessive activity
• Problems with waiting for turns or taking turns
• Talking excessively

Combined:

• Symptoms of both inattentive and hyperactive-impulsive types.

Treatment for ADHD and Asperger’s

It is important to properly diagnose ADHD and Asperger’s because the treatments are different. There is no cure for either condition, but there are treatments that can help people function more effectively in their environments.

Asperger’s Treatment

There is no medication to “treat” Asperger’s because it is not a condition that needs to be cured or fixed. Instead, it is a neurotype characterized by differences in how a person’s brain functions.

Sometimes, medications or therapy may help people with Asperger’s manage certain aspects of mood, anxiety, and behavior.

There is no specific treatment for Asperger’s, but there are treatments that can help people cope with challenges. These treatments typically involve accommodations, speech-language therapy, and occupational therapy.

ADHD Treatment

Treatments for ADHD typically involve medication, educational accommodations, and neurodiversity-affirming therapy.

Medications used to treat ADHD include stimulants and non-stimulants. Educational accommodations involve working with teachers to help children with ADHD learn better in school.

Prevention

There is no known way to prevent Asperger’s or ADHD, given that the causes are unknown. However, early diagnosis and treatment can help minimize symptoms and improve functioning.

Below are some tips for parents of children with Asperger’s or ADHD: