Dealing with Emotionally Stressful Situations: A Skill for Distress Tolerance from DBT
By Sanjita Ekhelikar, PsyD
Have you ever felt so overwhelmed or upset, that you felt lost in your feelings? Maybe a panic attack or emotionally charged situation where it feels like you can’t even think of what to do next? Perhaps you felt so unsure how to deal with all that you were feeling that you responded by lashing out at someone, drinking or using, withdrawing from others, or doing something you later regret ? You are not alone.
Life can often present us with difficult and stressful moments that truly test our ability to stay rooted in ourselves. In such moments, having tools to tolerate strong or big emotions is essential to center ourselves. Having these tools allows us to approach crisis situations feeling as though we’re in the driver’s seat, as opposed to acting on impulsivity. As with learning any new skill, distress tolerance takes practice and self-compassion.
What is distress tolerance?
Distress tolerance is our ability to handle and navigate challenging situations without reacting in ways that often make the moment worse.
It is how we handle our emotional duress without resorting to solutions that may hurt ourselves, hurt others, or strain our relationships with other people.
Learning to tolerate distress is often seen as a skill that can be strengthened to better prepare ourselves for future instances when we might need them. While there are many ways to manage emotional pain and discomfort, several tips and tools that are recommended by mental health providers are rooted in Dialectical Behavioral Therapy (DBT).
What is DBT?
Dialectical Behavioral Therapy is geared toward four main skills: managing and regulating emotions, mindfulness, distress tolerance, and improving interpersonal dynamics. This approach was developed by Dr. Marsha B. Linehan, a psychologist who created the therapy to help treat her own struggles with Borderline Personality Disorder, part of which can be difficulties with responding to intense emotions. While we can all struggle at times with big emotions, if this is something you’re particularly interested in, DBT may be a good approach for you.
Does distress tolerance mean invalidating how I feel?
From a DBT lens, tolerating distress can involve several components, including acceptance of the stressors and of situations that we do not have control over. You might ask, why should I accept a stressful situation at all? Fair question! Sometimes when we hear the word “tolerance” or “acceptance,” we think of just needing to deal with something as it is and put up with a challenging situation.
The goal of distress tolerance is not to resign yourself to a negative experience or invalidate your emotions. In fact, it is a way of acknowledging big feelings - while also recognizing how they may impact decisions we make when we are in the midst of a tough time.
The goal is not to say “I just need to be ok with what is happening,” but rather, “This current circumstance is upsetting, and how can I give myself grace and space to feel settled to decide what to do next?”
This is extremely salient when we consider distress and pain that is caused by oppressive systems, such as racism, sexism, etc. In my experiences working with BIPOC folks, I have received questions about tolerating distress and whether this means that they should “just be ok” with prejudice they experience - the answer to this is no!
The purpose of learning skills to handle tough emotions is not to give in to injustice we are experiencing or not work to change them; it’s to support us in these moments in ways that allow us to care for our mental health and act in ways that are aligned with our goals.
Distress tolerance can also involve regulating our physical bodies (e.g. our breathing, heart rate, our head “racing” with thoughts) and emotions so we can make a decision that will best support and serve us. When we do not engage in distress tolerance, we’re more likely to make choices such as yelling at someone, stress eating, impulse spending, or making big decisions in relationships or career on the spot due to feeling overwhelmed by our emotions.
The goal isn’t that you become a stoic, robotic person that isn’t bothered by curveball situations or disconnected from your own feelings. The hope is to stay connected to your feelings, but discover ways to respond that are chosen and aligned with who you are and who you want to be.
Do people tolerate stressful situations differently?
Just as we are all different human beings with various lived experiences, our abilities to navigate challenges and tolerate distress can also differ. While it is not completely clear through research why some people may be more reactive to certain stressors than others, we know that past experiences, our upbringing, ways in which we have seen distress handled by family members and others in life, and even genetics can have an influence. While these circumstances are often out of our control, we can learn and practice skills for distress tolerance even as adults to help us navigate difficult moments.
There are many distress tolerance skills, all of which can be useful in varying situations. One that I’m introducing in this blog is the TIPP skill.
Using the TIPP skill
TIP is an acronym for four strategies to help people in moments of distress. This skill is best purposed for moments when emotions feel very extreme and intense; for example, right before or during a panic attack, right when receiving difficult news, feeling very angry or overwhelmed, etc. The strategies outlined in the acronym are intended to get ourselves out of our heads and into our bodies to feel more grounded. Slowing down and switching gears towards a focus on our bodies can allow us to proceed and act in ways that are most helpful to us. The TIP skill is as follows:
T: Tip the Temperature*
In order to calm our bodies down quickly, it can be helpful to change our physiology using temperature. A common way to do this is to place your face into a bowl of cold water or to hold an ice pack/bag of ice/ice cube to your face. If you’re comfortable and able, hold your breath for 15-30 seconds.
This activates what’s known as the “dive response”, which is a built-in physiological response we have when our brains think that we’re diving underwater, automatically slowing down our heart rate. By holding something cold like ice to a part of your body for 30 seconds, your body and mind will also immediately focus on the sensations from the temperature shift as opposed to what was causing you distress.
*Please note that if you have any concerns regarding blood pressure or a heart condition, take caution and consider consulting your physician when trying any activity intended to increase or decrease heart rate.
I: Intense Exercise*
When we are experiencing intense emotions, it can be helpful to alter our body chemistry by moving and engaging in a burst of exercise. This form of exercise can be intense and brief to again refocus our attention on sensations in our body as opposed to what is causing distress. It also works by giving us an opportunity to release stored up physical energy whenever we’re activated by big feelings.
Some examples of intense exercise can include running, doing jumping jacks, jogging, dancing, walking fast, lifting weights, playing basketball, etc.
P: Paced Breathing
Deep breathing can help slow down our bodies and minds when things feel intense by deactivating the part of our nervous system responsible for the “fight or flight” reaction. Take deep breaths into the belly, imagining that there is a balloon in your belly that you are trying to fill up with air and then deflate. It is important to work on slowing your pace of inhaling and exhaling (five to six breaths per minute), and to breathe out more slowly than you breathe in. For instance, try breathing in for 5 seconds and breathing out for 7 seconds).
P: Paired Muscle Relaxation
When taking deep breaths in your belly, pay attention to the muscles in your body and notice any tension that is existing. Intentionally tense muscles in your body; for example, clench your fists for a few seconds and then let go of this tension. Continue to do this throughout the muscles in your body and notice the physical difference.
While these are some suggestions for how to implement these skills, it is ok to find ways that might work better for you! Perhaps different forms of exercise, alternate breathing techniques, or a different way of exposing yourself to a temperature shift make more sense with your lifestyle. This is perfectly ok! The goal is to find ways to make these skills fit into your life and be beneficial for you.
How do I build my distress tolerance?
The best way to build on tolerating stressful situations is to practice, even in times when you’re feeling great. Think of this as the fire drill - the more you are prepared during moments of calm, the easier it will feel to implement these tips when there might be a fire.
Choose one of the four skills to practice daily and notice how it makes you feel and if it becomes easier to practice them.
Therapy for distress tolerance
It can also be extremely helpful to seek professional support if you’re struggling. While the TIPP skill is one of many skills for emotion regulation, working with a therapist may be helpful in building a bigger toolbox. I hope that this information can serve as a possible starting point for dealing with distress, and want to emphasize that every single person may navigate life and stressors differently simply because of the fact that no two people are the same. Please know that you are not alone, and there can be sources of support to deal with distress! Prioritizing your mental health is important and something you deserve, and therapy is a starting point to taking care of yourself.
About the Author:
Dr. Sanjita Ekhelikar is a postdoctoral fellow at Manhattan Therapy Collective, and she enjoys working with people navigating anxiety, trauma, and looking for ways to cope with stressors and difficult life situations. She is passionate about approaching such work from a culturally sensitive lens and understands that all people’s lived experiences matter in how they perceive the world and react to life events.
Sources:
DBT Skills Training Manual, Second Edition by Marsha B. Linehan
Cognitive Behavioral Treatment of Borderline Personality Disorder, by Marsha B. Linehan