At some point in their lives, everyone experiences extreme emotional states and variances. For some people, the presence of overwhelming or uncontrollable feelings in response to stress occurs regularly. Distress tolerance describes an individual’s ability to manage their internal emotional state in response to stress-inducing factors. If someone has a low distress tolerance they will likely become overwhelmed by mildly stressful situations, potentially responding in negative mental and behavioral ways.
Fortunately, for individuals who struggle with an inappropriate stress response, several therapeutic strategies may prove helpful. Traditionally, treatment often focused on stressful situational avoidance, but newer practices and therapies have emerged which individuals can both pursue on their own or with the aid of a care professional. These newer treatment modalities involve embracing the stressful situation(s) and learning to engage with them appropriately. One popular new treatment is called dialectical behavior therapy (DBT). It involves a combination of psychologists and psychotherapy (talk therapy), to help patients build adequate distress tolerance skills for optimal living.
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Significance for Patients
Frequent periods of severe emotional distress can be crippling on many different levels. Frequent or uncontrollable stress can have significant effects on the body, on the mood, and on the mind. This includes symptoms like headache, muscle tension, fatigue, sleep problems, anxiety, restlessness, over or undereating, irritability, angry outbursts, feelings of overwhelm, social withdrawal, and change in sex drive. These symptoms have the potential to damage social or marital relationships, decrease work performance, wreak havoc on the physical body, and lower overall quality of life.
Distress tolerance is a priority in situations where an individual’s stress factor can’t be practically avoided, or the individual has no realistic means of escaping their negative feelings. Distress tolerance skills for anxiety and depression (which globally affect over 500 million people) have also proven extremely important in the current healthcare landscape. Building right stress handling skills is also particularly important for patients who suffer from any kind of mental illness, as they can be life-saving for those at risk of self-harm.
Common Practices and Strategies
The fundamentals of distress tolerance revolve around an individual becoming more aware of their internal emotional state and its effect on their current thought patterns or actions. Essentially, a patient needs to learn the practice of self-soothing, or the ability to both calm the body and maintain self-awareness. Common practices for self-soothing that patients can employ at home and/or on their own include controlled breathing, meditation, yoga, and progressive muscle relaxation.
According to the National Alliance on Mental Illness, distress tolerance skill work must include an individual’s development of a positive identity and the ability to healthily manage inwardly directed negative emotions. Many people choose to incorporate tangible objects, rewards, or physical actions into their routines of self-soothing and positive identity work. This may include indulging in a small snack, exercising, or listening to a favorite song in response to intense negative emotion. Care must be taken with these practices, as they are appropriate behavioral responses only when they are utilized in healthy ways.
Embracing Radical Acceptance
Many care providers claim that the concept of radical acceptance is a key ingredient in the development of distress tolerance and they actively encourage their patients to fully embrace the idea. Radical acceptance applies to situations in which the source of the painful or crippling emotions can’t be avoided, so a person must instead learn to accept them. Because a patient cannot avoid the source(s) of their pain, they need to learn how to confront it and (hopefully) slowly change the way they feel about it over time.
This process cannot and does not happen overnight. Radical acceptance typically takes place in several stages. Four common skills that are taught in these stages are:
- Distraction: The ability to shift negative thought to a more enjoyable place; neutrality
- Self-soothing: The ability to “nurture self;” often through engagement of the five senses
- Improving the moment: The ability to use positive mental imagery to improve a stressful situation
- Focus on pros and cons: The ability to list the pros and cons of tolerating or not tolerating the stressful situation well; past consequences for past poor responses may be brought up as cons
The development of these skills in response to stressful situations should ease patients towards a state where they can both accept their reality and control their reactions to that reality.
Application in Dialectical Behavior Therapy
Many clinical psychologists help patients learn how to tolerate sources of distress through a DBT program. DBT is a cognitive-behavioral therapy that is talk-based. There are three many components to DBT; it is support-oriented, cognitive-based, and collaborative. Patients of DBT usually have individual psychotherapy sessions and group sessions. The individual sessions are meant to assist the patient in learning and/or improving basic social skills, while the group therapy sessions should help teach interpersonal communications, reality acceptance skills, emotional regulation, and mindfulness.
Like many other psychological practices, programs are patient-oriented and are developed around the specific needs of each individual. In general, therapy is designed to help the patient regulate their emotions, worry less, and tolerate ongoing sources of stress. Therapy also helps patients build social skills (especially through group therapy) to help them create more positive relationships and situations for themselves in the future.
Many different tips, tactics, and therapies can provide relief from frequent periods of extreme emotional distress. Some can be achieved at home and on one’s own, while other individuals are going to need assistance from a care provider. Because every case is defined by different circumstances and different biological makeups, personalized solutions are fundamental to long-term successful improvement. Though it may take time, money, and vulnerability to build adequate distress tolerance skills, accomplishment can lead to tangible and lasting improvement in multiple areas across one’s life.
ABA Programs Guide Staff
Updated April 2020
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