Distress tolerance: how to be ok when things are not ok

Katy Kandaris-Weiner, LPC

In Dialectical Behavioral Therapy another important set of skills addresses distress tolerance. Distress tolerance is an individual’s ability to manage feelings of emotional distress. Emotional distress is another way of saying feeling overwhelmed. When individuals do not feel like they have distress tolerance skills, they may use unhealthy coping mechanisms to manage their overwhelming emotions. Learning distress tolerance skills can help an individual manage stress and choose how they deal with their emotions.

In Dialectical Behavior Therapy, there are three types of distress tolerance skills: crisis survival techniques, sensory body awareness, and reality acceptance.

Crisis survival techniques are helpful when an individual is dealing with intense physical/emotional pain or when an individual feels overwhelmed but needs to meet demands of a situation. These skills are best used for crisis situations and are not best suited to everyday situations.

Crisis Survival Technique: STOP

Stop! Do not react to what is happening and choose to stay in control of your emotions and body.

Take a step back! Take a break from the situation and refrain from acting impulsively.

Observe! How do you feel? What are others saying? What can you notice about this situation?

Proceed mindfully! Think about what you are trying to achieve and act with mindfulness and awareness.

Sensory body awareness skills help connect our brains to what we are experiencing in the present moment and creates the opportunity for us to accept the realities we are facing. This awareness and acceptance can help decrease feelings of distress.

Sensory Body Awareness Skill: Half Smile with Willing Hands

The point of this skill is to allow us to physically take control of our expression and body posture in a mindful and positive way. By changing the posturing of your body, your brain can stop producing and receiving signals of distress, and you will feel more present and connected to the situation.

Half Smiling involves relaxing your face and purposefully releasing tension moving down from the top of your head to you chin and jaw. Once you have released tension, try a relaxed half smile with lips turned up slightly at the corners.

Willing hands is the practice of relaxing your arms while turning your palms upwards. Mindfully release the tension from your shoulders all the way down to your fingertips and then turn hands so palms face forward (if you are standing) or upwards (if you are sitting).

Practicing these skills together can help you develop the ability to take control of your body even when you feel distress and can leads to feelings of confidence and relaxation in difficult moments.

Reality Acceptance skills help us accept the challenges we are presented with that we are unable to change. Oftentimes, when painful situations are encountered, an individual will try to ignore, reject, or numb to avoid the reality of the situation. By accepting reality and facing the discomfort of the situation, an individual can make more informed decisions and manage their feelings.

Reality Acceptance Skill: Radical Acceptance

Radical acceptance involves choosing not to fight reality, choosing to stop acting impulsively and destructively, and letting go of bitterness. As we practice radical acceptance, we work to understand the facts about past and present situations and the pain we experience. Instead of rejecting the reality we are facing, acceptance breaks the patterns of suffering. In radical acceptance we learn that we can accept reality, even though we do not approve of it – and this leads to real and empowered change.

If these distress tolerance skills have been interesting, or if you want to learn other distress tolerance skills, please reach out to us and make an appointment today.

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Katy Kandaris-Weiner, LPC

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