Distress tolerance refers to the ability to withstand negative emotions. Low distress tolerance occurs when someone displays symptoms such as anxiety and depression.
Sometimes, people with low distress tolerance may adopt coping mechanisms such as substance misuse or eating disorders.
This article explains distress tolerance and provides different techniques to help manage distress. It also discusses the benefits of different techniques, risks of low distress tolerance, and possible challenges.
Anecdotally, people report that distress tolerance involves “navigating” an emotional or stressful incident. This may mean preparing to manage any symptoms and regulating any negative emotions. Those who do not have tolerance may react impulsively or show maladaptive behaviors.
People who have low distress tolerance are unable to avoid distressing emotions, which experts consider an underlying feature of anxiety, depression, and several other psychological disorders.
Individuals can consult a counselor or mental health specialist to help determine the most effective techniques for managing distress tolerance.
Dialectical behavioral therapy (DBT) helps people tolerate how they react to intense emotions or events. It is a modified cognitive behavioral therapy that focuses on problem-solving and assisting people to accept life situations.
DBT
- distress tolerance
- emotional regulation
- mindfulness
- interpersonal effectiveness and acceptance
DBT techniques can include:
- Radical acceptance: This is about accepting the reality of a situation that is out of one’s control.
- Self-soothing: This technique involves doing things that provide comfort and relief during a difficult situation.
- Distraction: This method uses the acronym “ACCEPTS” to distract a person from their emotions. It stands for:
- activities
- contributions
- comparisons
- emotions
- pushing away
- thoughts
- sensations
- IMPROVE: This method aims to “improve” a negative emotion with a positive act by thinking about:
- imagery
- meaning
- prayer
- relaxation
- one
- vacation
- encouragement
- Pros/cons: This involves examining the advantages and disadvantages of a situation.
- Problem-solving: This technique aims to look at a problem and find a way to solve it, such as addressing negative emotions.
- TIPP: The TIPP method aims to calm emotions with:
- temperature
- intense exercise
- paced breathing
- progressive muscle relaxation
The following examples indicate how a person may use these different methods:
Radical acceptance
Examples of radical acceptance:
- letting go of negative emotions
- understanding limitations about the future
- accepting that pain cannot be avoided in all areas of life
- consciously accepting reality rather than resisting
Self-soothing
People can soothe each of their senses and, in turn, their emotions by focusing on:
- Sight: Looking at landscapes, scenery, or photos of nature.
- Hearing: Listening to calming music or sounds in nature.
- Smell: Smelling fragrances, such as perfume, or natural scents, such as flowers.
- Taste: Eating favorite foods or treats.
- Touch: Soothing the skin or touching something that brings comfort.
Distraction (ACCEPTS)
A person can try different distraction techniques, such as:
- Activities: Engaging in recreational tasks and hobbies, such as reading, walking, or playing games.
- Contributions: Volunteering or helping someone may provide a break from a person’s distress.
- Comparisons: Comparing current emotions with a time they may have felt worse might help someone gain perspective.
- Emotions: Reading or watching something that invokes emotions.
- Pushing away: Leaving a situation or blocking out a thought temporarily until ready to manage.
- Thoughts: Counting to 10 or focusing on a mental activity that helps distract thoughts.
- Sensations: Listening to music or taking a cold shower to influence the senses.
IMPROVE
The “IMPROVE” method may help people manage their emotions with:
- Imagery: Visualize a peaceful scene or a safe place to improve emotions.
- Meaning: Find a purpose or meaning in daily activities to help grow and learn.
- Prayer: Ask for strength in managing difficult situations, if spiritual.
- Relaxation: Breathe, take a hot bath, or meditate.
- One: Focus attention on the present and avoid trying to multitask.
- Vacation: Take a short vacation away from the usual environment.
- Encouragement: Say positive affirmations aloud.
Pros/cons
The Pros/cons method requires people to:
- Describe a dilemma or crisis they are trying to avoid.
- Examine the advantages and disadvantages of the behavior.
- Consider how effective the behavior is in the short and long term.
Before crisis behavior occurs, it may help someone to write out the list of advantages and disadvantages to remind them of this skill.
Problem-solving
There are several ways to solve problems effectively:
- stopping to realize that a situation is a problem and it may take time to find a solution
- defining the problem in detail
- describing how the problem interferes with goals
- identifying all possible solutions
- understanding the consequences of all options
- identifying the steps needed to resolve the problem
- evaluating results of the solution
TIPP
The TIPP method focuses on:
- Temperature: To help someone calm down quickly, apply cold water or an ice pack to the face for 10 to 30 seconds.
- Intense exercise: Try short bursts of exercise, such as:
- running
- fast walking
- jumping
- playing basketball
- weightlifting
- Paced breathing: Breathe deeply, slowing the pace of inhalations and exhalations. Breathe out more slowly than breathing in.
- Progressive muscle relaxation: Tense and then relax each muscle group from head to toe.
People report that these techniques help by:
- enhancing ways to manage distress
- increasing resilience
- regulating emotions
- cultivating relationships
- promoting mindfulness
- reducing avoidance behaviors
- increasing problem solving
- improving communication
- supporting physical health
- anxiety
- depression
- substance misuse
- eating disorders
- borderline personality disorder
Anyone who is displaying low distress tolerance may benefit from consulting a mental health professional for strategies to manage their mental health.
If a person or someone they know is experiencing suicidal thoughts, they can call 988.
Help is out there
If you or someone you know is in crisis and considering suicide or self-harm, please seek support:
- Call or text the 988 Lifeline at 988 or chat 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
- Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
- Not in the United States? Find a helpline in your country with Befrienders Worldwide.
- Call 911 or your local emergency services number if you feel safe to do so.
If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.
If you’re not in the same household, stay on the phone with them until help arrives.
Anecdotally, people suggest that it may be challenging when using distress tolerance techniques due to the following:
- overcoming a situation without an immediate fix may cause frustration or people to abandon the methods altogether
- lacking practice and feeling low in self-confidence
- being overwhelmed by emotion may mean someone cannot practice these techniques in all situations
- not trusting the methods as part of a process
- not resolving underlying issues that the techniques may not be able to fix
- comorbid mental health conditions may affect how well people tolerate the techniques
A person can consult a mental health professional for advice on incorporating these methods into their routine. Support circles or community groups may also help them learn and use these skills.
Mental health resources
Visit our dedicated hub for more research-backed information and resources on mental health and well-being.
Distress tolerance refers to someone’s ability to resist negative emotions and impulsive reactions to anger or fear.
Low distress tolerance occurs when someone displays symptoms such as anxiety and depression in the wake of a challenging or stressful situation. In some cases, people may adopt maladaptive coping mechanisms such as substance misuse or eating disorders.
Techniques to help manage low distress tolerance include radical acceptance, self-soothing, and distraction strategies. These can benefit a person’s ability to regulate their emotions, develop better relationships, and promote mindfulness.
Individuals can seek support from a mental health professional and support groups to help them overcome emotions and develop techniques to manage their distress.