Distress Tolerance: Skills for when things don't go our way

It is the morning after the election, and I am in shock with the results. People around me are in shock also. I am posting for myself as much as for others, but I feel an amazing source of energy to serve here.  I want to share what I know about Distress Tolerance*. 

When things don't go our way, we tend to go into either fight or freeze, or a vacillation between the two.  Meaning, we either gear up to resist reality, or we go limp and give up.  Distress tolerance is about finding a middle way, a way that accepts reality as it is. This does not mean we agree with the reality or are complicit with it, but rather we have the wisdom to ask: how much can I relax into what I cannot change right now?  How I can survive this?  It is much like the Serenity Prayer from AA: I commit to change whatever I can, also accept what I cannot change, and pray for the wisdom to know the difference.

The benefit from these Distress Tolerance skills is that we can focus on what works in the moment.  We can let go where we need to let go.  Here is an analogy: Let's say I really need to get somewhere by car and I must be on time. But I find myself in a standstill traffic jam and there is no visible way out in this moment.  What can I do in this moment?  Blare my horn and rage at my car or at myself?  Understandable choices, but not so effective.  I can soothe myself.  I can have compassion for myself and the others around me.  I can breathe.  I can laugh about how much I am not in control in this moment.  These are Crisis Survival Strategies, or Distress Tolerance skills. There are other DBT skills that help us make external changes, and we will need these skills in the upcoming months too.  But also in equal force we might need skills that help us accept reality as it is.  This does not mean we approve of the current conditions, but we are surviving them with as little harm as possible.

Some specific ways to foster Distress Tolerance with examples of each skill:

1) Distract with:

  • Activities: clean, visit a friend, chop wood, move your body.
  • Contributing to others: do something for others.
  • Comparisons: put your experience in perspective.
  • Emotions: do things that produce an opposite emotion (for example, jump on a trampoline, watch a funny movie).
  • Pushing away: put the pain away for a while.  You can come back later.
  • Thoughts: get your mind to do other things, like puzzles.
  • Sensations: hold ice in your hand, take a hot shower, have sex.


2) Self-soothe with your five senses

  • Vision: look at beautiful things, go to a new place and take it in.
  • Hearing: listen to soothing or invigorating music.  Pay attention to sounds in your environment or in nature. 
  • Smell: Use a favorite lotion or scent.  Boil cinnamon.  Use lemon oil on furniture.  Smell a fire or burn incense.
  • Taste: Have a good meal.  Drink tea and really notice the flavors.  Chew on fennel seeds.  Enjoy flavors mindfully.
  • Touch: Take a bubble bath.  Pet a dog or cat.  Put lotion on your hands.  Hug someone.  Lay on a soft rug.

3) Improve the moment

  • Imagery: imagine a safe place and let yourself go there in your mind, filling out the details of your sensory experiences.
  • Meaning: create some purpose or value in the pain. 
  • Prayer: open your heart to greater wisdom or something larger.  Ask for strength.
  • Relaxation: try muscle relaxing by tensing and releasing each large muscle group.  Breathe deeply.  Massage your own scalp.
  • One thing at a time: focus your entire attention on just what you are doing right now.
  • Vacation: give yourself a brief vacation.  Hide under your covers for 20 minutes.  Unplug your phone.  Take a break from hard work.
  • Encouragement: tell yourself statements like "This is temporary." "We can do this." "I am doing the best I can."

4) Use Pros and Cons

Make a list of the pros and cons of tolerating the distress.  Make another list of the pros and cons of not tolerating the distress.  Focus on long-term goals.   Remember what has happened in the past when you used impulsive action to escape the moment. 

*This material comes from DBT (Dialectical Behavior Therapy), a treatment whose roots come from Buddhist practice, and specifically from the book Skills Training Manual by Marsha Linehan (1993). 

All the world is full of suffering, it is also full of overcoming it.
— Helen Keller