Distress Tolerance
Introduction
Rolling around the recesses of my mind are the lyrics to an old song, The Gambler, sung by the late country music singer, Kenny Rogers. The song describes an encounter between a young man and a wizened old gambler on a train headed west. In exchange for a swig of the young man’s whiskey, the old gambler teaches the youngster some of the lessons that he has learned in his long life.
You’ve got to know when to fold
You’ve got to know when to hold
While I am not much of a card player, the wisdom in these words is not lost on me. Basically, there will be times when it’s best to fold or quit whatever it is that I am involved in. At other times however I will want to hold or stay in the process even as it now seems dreadful.
Put another way, there are times in life when one can choose to change the situation for the better. The core skills of mindfulness, emotion regulation, and interpersonal effectiveness are strategies for changing the situation. Mindfulness skills give you the tools to use your mind and emotions effectively to effect the changes that you want. Emotional regulation skills give you the tools that you need to bring run away feelings and moods under control. Interpersonal effectiveness gives you the tools to develop healthy and helpful relationships with others.
Then there are times however when change is neither possible nor desirable in spite of the pain involved. This is where distress tolerance comes in. Distress tolerance is a set of skills that makes bearing difficulty possible in a way that leaves your energy, dignity, and future intact.
People with borderline personality disorder are often quite gifted in some ways when it comes to distress tolerance. They often find themselves trapped in an unspeakably difficult situations. Yet they often learn to put up with the pain or confusion. They have developed coping mechanisms that allow them some measure of peace.
Unfortunately, these coping mechanisms often have side effects that guarantee that the individual remains on the side line of life. Whether these techniques are denial of the problem, mind and feeling blocking addictions, or victimization, these ‘strategies’ lead deeper and deeper into more pain and frustration.
Distress tolerance skills however offer a better way. These tools offer you the ability to stay where you are without being overwhelmed by pain and chaos. In short, distress tolerance skills will help you weather the storm in style.
So What Is Distress Tolerance?
Distress tolerance is a set of skills that allows the individual to tolerate periods of suffering without causing more damage. As with all of the core skills of dialectical behavioral therapy, distress tolerance flows from a unique way of thinking about the world and our place in it. That world view leads to specific strategies, practices, skills intended to help you tolerate the distress that you find yourself in.
Let’s first consider the world view from which the skills emerge. That world view is called radical acceptance.
Radical acceptance means that we give up any resistance to reality that has manifest itself. Radical acceptance means to openly welcome the experience without any effort to change, alter, modify it, or block it. Radical acceptance means that we exist in a world that is fundamentally
To get a deeper appreciation for radical acceptance, try this exercise:
Think back to something you've lost. Perhaps someone you've loved has died. Perhaps you were denied something that you really wanted. Whatever it is, allow yourself to feel some of the pain and the hard feelings. Some of the feelings may have been:
1. Anger.
2. Shame.
3. Frustration.
4. Fear.
5. Agitation.
Now, bring up some of the thoughts that you had with yourself about the loss. Such thoughts may sound like this:
1. How could this happen to me?
2. How will I survive?
3. This must be a mistake.
4. This is a catastrophe.
And now that you have connected with the feelings and thoughts, say out-loud:
I WILL EVERYTHING TO BE EXACTLY THE WAY IT IS. IN FACT, I CELEBRATE THE REALITY. I PUT DOWN MY WILLFULNESS. I SURRENDER MY OWN AGENDA.
I HAVE WON THE LOTTERY.
This exercise sounds crazy because indeed it runs counter to everything that we Westerners have been taught about suffering, pain, and passivity. We have been taught that suffering and pain should be avoided and that to be passive is to be a loser. We have been brainwashed to believe that anything that is painful can be avoided or should be changed.
Technological advances have even led us to believe that our hatred of suffering is justified. Rampant diseases and medical disasters that were everyday occurrences just a few decades ago have been stamped out by technology. The seeming ease with which problems can be solved and inconveniences be done away with has lulled us into believing that there is no longer any need to adjust to whatever hand of cards life has dealt you.
Seduced or not by technology, a wonderful life, even in this day and age, often requires that we go through periods and episodes of pain. In fact, in the view of authentic Yiddishkeit, pain is the price that each of us must pay in order to succeed in life. Distress tolerance skills offer a helping hand as we journey through the suffering.
Distress tolerance skills offer a helping hand as we journey through the suffering that is often part and parcel of responding effectively to life.
What then are these skills?
Conventional dialectical behavior therapy teaches that there are four categories of distress tolerance skills. They are
These are skills that help you stay with the distress so that you don’t run away from it.
Self Soothing Skills
These are skills that help you return to a state of calmness when the distress threatens to overwhelm you.
Improving The Moment Skills
These are skills that help you lower distress by changing that which causes you pain into something that invigorates your spirit.
Thinking Of Pros & Cons Skills
Determining whether to accept reality or to change it can be confusing. Thinking of Pros and Cons is a set of skills to help you figure out what to do.
Let’s consider the skills in each category.
