Dialectical Behavior Therapy (DBT) – Part 4 – Distress Tolerance is an Indispensable Tool for Difficult Times

This is part four of a six-part series based on Dialectical Behavior Therapy (DBT), a highly researched set of practical tools to help manage emotions even in crisis, as well as replace old, ineffective behaviors with new, effective ones. Many individuals who value DBT desire relational support and freedom from emotional difficulties, which is why one of the four DBT modules is called distress tolerance. It is important to note that distress tolerance is most effective when the other DBT skills (mindfulness, emotional regulation and interpersonal effectiveness) have been learned, practiced and mastered.

Here is why distress tolerance is so important: learning the skill allows you to get through difficult times and events without making them worse. Distress tolerance offers researched based yet practical, easy-to-recall tools that will help you create a peaceful life. This skill allows you to take control of your emotions before they feel unmanageable. Distress tolerance teaches you how to effectively soothe your mind and body. 

Escaping your pain

Most of the self-destructive behaviors associated with the experience of extreme emotional dysregulation are often an effort to escape severe emotional pain. Distress tolerance skills can offer a healthy collection of ways to distract your attention from the pain rather than self-destruct or act impulsively. The primary focus is to shift your awareness away from the hurtful thoughts and emotions to healthier means of coping. For example, clients who use cutting as a release of intense emotion learn to use distress tolerance skills instead. These skills have also been shown to be effective for people struggling with addictions.

Three keys to learning, practicing and mastering the skill of distress tolerance

1) First, pain is part of life. Everyone finds themselves in distressing circumstances at different times in life. There is no avoiding difficult situations and the emotions that come along with these situations. By accepting this, and learning how to manage these emotions, you are less vulnerable to the intensity and longevity of stressful events and experiences.  

2) Second, with better distress regulation comes improved physical health. Think of the last time you experienced intense distress. Where in your body did you feel it? Your mental and physical health are connected, and when your mind is in distress, your physical health suffers. This stems from being outside your window of emotional tolerance for too long, causing your mind to stay on alert. This releases chemicals like adrenaline and cortisol in amounts not suitable for your body.

3) Third, with better distress tolerance, healthier relationships can happen. Learning to tolerate pain can improve your relationships because your pain always affects others around you. Whether this is by projecting your distress onto others, or being emotionally unavailable, painful emotions tend to impact your closest connections when left unmanaged. When your emotions are regulated, you can stay engaged with people even while you are hurting. This vulnerability helps to develop strong bonds with the people you love.


These are just a few of the benefits you could experience by using distress tolerance to manage pain and overwhelming negative emotions. These skills take time to develop and require patience with self and others as you work toward healing. However, as anyone who has practiced distress tolerance knows, the development time is well worth it!



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