Distress. It is impossible to avoid, no matter how charmed your life may be. Emotional pain and distress are an inevitable part of life. The inability to learn how to effectively cope with intense emotion and distress only leads to increased suffering. According to Dr. Marsha Linehan, a world-renowned psychologist credited with the creation of Dialectical Behavior Therapy, distress tolerance is “the ability to perceive one’s environment without putting demands on it to be different; to experience one’s current emotional state without attempting to change it; and to observe one’s own thoughts and action patterns without attempting to stop or control them” (Linehan, 1993, p. 147).

10 Effective Strategies to Tolerate Distress

Now that we understand what distress tolerance is, how do we begin to cultivate it within ourselves? What follows are some excellent ways to practice distress tolerance, adapted from The Dialectical Behavior Therapy Skills Workbook (McKay, Wood, & Brantley, 2007).

(1) Radical Acceptance

Getting angry in response to a situation that is (perhaps understandably) upsetting prevents you from seeing what is really happening. Intense emotions have a way of blinding us from the reality of the situation, which only allows the emotions to escalate. By responding in anger and telling yourself that this situation “should” not be happening, you are missing the point that it is happening: with you or without you.

Radical acceptance suggests that we acknowledge the present moment (no matter what it is) without judging the events as good or bad. It encourages us to recognize that our current situation exists as the result of a very long chain of events that started way in the past. It does not suggest that we approve of or agree with bad behavior of others. It simply tells us to stop trying to resist what is happening by denying it through anger or sadness. As long as we resist our present situation, we are powerless to change it. For change to come, we must first accept: This is where I am right now. Now what?

(2) Distract Yourself from Self-Destructive Behaviors

As strange as it may be, engaging in self-destructive behaviors often brings temporary relief from emotional pain. It is a distraction from whatever emotion pain we may be feeling, which we experience as far worse than the self-destructive behaviors. Consider this … emotional distress is often the result of being hurt by others – does it make sense to continue this hurt by turning it on yourself?



(3) Relax and Soothe Yourself

Learning to relax and self-soothe is crucial to healthy emotional functioning. When you are relaxed, your body is not in a constant state of “emergency,” preparing to fight or run away at any given moment. Most importantly, your brain is much more capable of coming up with healthy ways of coping with distress when physically relaxed. There are many ways to relax – it’s about finding what works for you: taking a hot bath/shower, taking a walk, listening to calm music (i.e., not emotionally stimulating music). See my upcoming post about Self-Care Strategies.



(4) Safe-Place Visualization

Your brain and body often cannot tell the difference between what’s “really” happening and what you are imagining. Use this to your advantage. Find a place where you can be alone and undisturbed – practice visualizing a real or imaginary place that makes you feel safe and relaxed. Explore this safe place in vivid detail … colors, shapes, sounds, smells. You can visit this place anytime.



(5) Cue-Controlled Relaxation

This is a quick technique designed to reduce stress level and muscle tension. In this case, the “cue” is a trigger or command intended to bring on relaxation. It can be something as simple as the words “relax” or “calm.” The goal is to train your body to release muscle tension in response to your cue word. Further details about how to practice this exercise are forthcoming on my blog.

(6) Rediscover Your Values

Your values are the standards, morals, principles, and ideals that fill your life with meaning, worth, and importance. These are the reasons that we have to wake up in the morning – why we are motivated to keep going. Sometimes we may feel adrift in life, unsure of the reason for doing much of anything – these are the times when we feel lost and empty. Discovering or rediscovering your values can help you tolerate emotional distress and begin to build a life worth living.



(7) Live in the Present Moment

Now matter what you do, it is always now. No matter how much you would like to go back in time to fix something that went wrong or blame someone who hurt you, it is impossible. The fervent desire to live in the past or in the future creates suffering. All of the time spent dwelling in the past or focusing on the future results in something tragic: missing out on life. It’s happening right now – all around you.

(8) Use Coping Thoughts

It is helpful to hear encouraging words during times of intense emotional distress. Sometimes a loving other is not around to provide us with the emotional support and comfort that we may desire. In these times, we must be capable of providing ourselves with this comfort. Coping thoughts consist of reminders of times when you’ve been strong in the past and words that give you strength. “I’m strong enough to handle what is happening to me right now.”

(9) Self-Affirming Statements

A big part of learning how to tolerate distress involves having a strong foundation of yourself as a healthy capable person. You must believe in yourself first. Behind intense sadness, rage, and despair there is a caring, loving, and strong person who is capable of handling intense negative situations in a healthier way.

(10) Create New Coping Strategies

Reflect back on some intensely distressing situations that you have experienced in the past and identify how you have coped with them. Can you identify a pattern or theme to your typical ways of coping (in both healthy and unhealthy ways)? What were the consequences of these healthy and unhealthy coping strategies? Can you begin to imagine how you will handle future distressing events in a different way?

Distress tolerance skills require us to accept our current situation in a nonjudgmental way. We must learn how to tolerate discomfort without demanding that people or things be “different.” As long as we fight what is, we are powerless to change the situation. In many ways, this may sound counter-intuitive. It might feel that when something is happening to us that we do not like, the way to change it is to deny it or to fight back against it. As long as we react in this volatile way, we are blind to the reality of the situation (i.e., we are overwhelmed by emotions) and are thus powerless to change it.

Be careful to remember that mindful acceptance of negative situations is not the same thing as approving of these situations. As long as we exert will by resisting a reality that we do not want, we are doomed to repeat our mistakes over and over again. Instead of practicing willfulness, try practicing willingness instead. Surrender yourself to the present moment, accept it fully, and notice your reality with mindful awareness. What do you have control over? The way you choose to respond. What will you choose?

Specific exercises designed to practice distress tolerance in your own life (based on the principles of Dialectical Behavior Therapy) will be available in the future on my blog.

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Linehan, M.M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: The Guilford Press.

McKay, M., Wood, J.C., & Brantley, J. (2007). The dialectical behavior therapy skills workbook. Oakland, CA: New Harbinger Publications, Inc.

Featured Image: cardamine-pratensis by mindfulness / CC BY 2.0