Dialectical Behavioral Therapy: Distress Tolerance
Humans are emotional beings, experiencing an array of emotions throughout the span of a lifetime. Because of this a person will inevitably feel emotional distress and overwhelmed. These emotions present themselves in the form of stress, angst, fear, loneliness, anger, rejection, and/or failure. The practice of Dialectical Behavioral Therapy, an evidence-based therapy created by Marsha M. Linehan who is a psychology researcher at the University of Washington, states that one must first accept their emotions, saving themselves from what Buddhist Psychology states is the second dart of blame or shame, then work to temporarily distract and soothe the mind, and finally create a new behavior/ habit of mind to better work through emotional upheavals. Doing this builds one’s distress tolerance allowing them to better handle difficulties that may come their way.
The first step to developing distress tolerance is acceptance. Remember, acceptance does not mean giving up or surrendering. The DI in DIALECTICAL Behavior Therapy means holding two opposing viewpoints together. The first being acceptance. The second, taking deliberate action to change, which is addressed in the final step of this process, creating new coping skills. Rather than give up, one must work on truly allowing what is happening. One strategy for this is to use different phrases, known as self-talk, such as “This is what happened” and “This is where I am now”. This allows a person to state the facts of the situation without blame or shame. This is similar to the naming used in mindfulness meditation which involves labeling thoughts as they arise, for example, “thought” “past” “worry” “projection” “anger” “anxiety” etc. The practice of labeling takes one out of the emotional mind, which during high emotional states can be irrational, and brings one back to the factual/rational mind.
Remember, acceptance takes time. Often, one must pause for a moment (or five) to calm the nervous system before true acceptance can occur. This can be accomplished buy seeking out a tactical and temporary distraction, followed by returning to the practice of acceptance. Often the second time acceptance is addressed a person has enough time and space away from the event to be able to fully embrace the event, situation, or emotion.
Distraction, step two of developing distress tolerance, doesn’t mean avoidance. Distraction refers to taking some time to move the mind away from the emotion, event, or situation to calm the nervous system with the plan of coming back. The time frame can be minutes, hours, or days depending on the situation. With the situations and events which are familiar triggers of emotional upheaval, 30 minutes may be all that’s necessary in terms of distraction. Other strong emotions or unplanned life events may take days, weeks, or months to work through enough to gain the capacity to come back with a rational mind to work through an issue.
Occasionally, if one is not purposeful about using this temporarily, a person can become stuck in the cycle of experiencing uncomfortable emotions and distracting themselves, never coming back to the issue until something else comes along which disturbs their equanimity only to repeat the cycle. This means never growing emotionally and leads to a forever state of poor self-regulation and upheaval. To avoid this cycle, always make a plan to revisit the emotional event. One can do this by writing the event in a journal and coming back to it when there is time to fully contemplate the event and move through the subsequent steps. If the emotion or event feels too big to revisit by oneself, see a professional counselor or therapist to help move through the situation with support.
The first form of distraction covered is for individuals who use self-harm or Self Injurious Behavior (SIB) to move their mind from the distressing thought, event, or emotion by means of cutting, having unsafe sexual encounters, abusing drugs, alcohol, tobacco, or food among many other options. If you are one who tends to self-harm when distressed, utilize a different means to move the mind using harm-reduction. Harm reduction involves using a substitute means of SIB to distract the mind which is less harmful than the familiar self-injurious behavior. Examples of harm-reducing replacement behaviors include squeezing an ice cube, taking a cold shower, writing on body with marker, snapping a rubber band, popping balloons, tearing paper, throwing socks, writing letters to people you hate, holding your breath. The eventual goal is to discontinue self-injurious behavior and instead use positive behavioral replacements, which I go into later in this post.
It is worth noting that stopping or reducing the use of self-injurious behavior can take time and requires conscious effort. I suggest getting in touch with a professional counselor, therapist or coach, a community of supporters such as book clubs, churches, or 12-step programs. You could even recruit friends and family to support you. You deserve to live a happy life free from harm. That means freedom from harming yourself. If you tend to think self-injuring/bullying thoughts use the same method: distract the mind, then follow by soothing yourself. Think of what a loved one would say about you and come up with a new thought and seek out the support of a professional and/or community of supporters.
The second form of distraction I will go over involves positive or pleasurable experiences which naturally elevate serotonin, a mood-boosting hormone released in the brain. Examples include moderate exercise, spending time outdoors, calling or meeting with a friend, listening to music or going to a concert, taking a drive, having safe-sex (with a committed partner preferably), writing letters to people you admire, journaling, meditating, gardening, watching a movie, laughing, cooking, rearranging a room, etc. This distraction should serve two purposes, to soothe the nervous system and expose oneself to supportive and healthy experiences. At this point, it can be helpful to circle back to step one, acceptance, which can lead to a deeper sense of acceptance, clarity and forgiveness.
Now that we have accepted the emotion, thought, event or situation, then successfully distracted the mind temporarily, followed by soothing the nervous system while exposing oneself to new experiences, one is now ready to create a new way of perceiving and reacting to the event. By perceiving and reacting to an event differently one creates a new way of coping with the difficulty.
Creating a new habit is different than simple distraction and diversion. Distraction is temporary and focuses of the short term. Creating a new habit involves setting the intention for permanent life change and is the second aspect of dialectical behavioral therapy, taking deliberate action to change. The motivation behind this deliberate action is important to ponder. One might ask themselves, “Am I creating this habit to get out of a certain uncomfortable thought or feeling? Or am I creating this new habit to support my health and well being over the course of my life?” and, “Do I truly value and enjoy this new habit? Or am I doing it for someone else?”. If the new habit is not in line with one’s values, it will not stand the test of time and will only serve as a detriment to oneself, creating uncomfortable feelings and emotions, starting the vicious cycle over again.
If the deliberate actions taken are directly in line with one’s values, while also seeking to becomes aware of upheavals as a learning opportunity, a persons’ capacity to overcome the negative effects of distress will be limitless. This is not to say emotional distress will not be experienced, but rather that when distress presents itself, a person will not be completely knocked off their equilibrium. An event which once sent a person into an emotional down-spiral lasting three weeks will now only last three days. One which upset a person for an hour or two might come and go in the flash of a thought.
In your pursuit to become better is where life is lived. Enjoy this. Not every living creature has the opportunity to feel or have emotions. They definitely do not always have the ability to look at such emotions and take action to handle themselves in a way which would support their own health and well being long term. Enjoy the experience of being human.
Tell me how this works for you by writing me an email or writing a comment below.
McKay, M., Wood, J. C., & Brantley, J. (2007). The dialectical behavior therapy skills workbook: Practical DBT exercises for learning mindfulness, interpersonal effectiveness, emotion regulation & distress tolerance.