What Is Distress Tolerance?

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.