Distress Tolerance: Acceptance Not Avoidance

People who struggle with addictions, eating disorders, or mood disorders have finely-tuned methods of dealing with emotions by using substances, eating disorder behaviors, or engaging in self harm or other ineffective coping skills; each of these methods keep emotions stuffed inside. And, unfortunately, when not used as intended, Dialectical Behavior Therapy (DBT) Distress Tolerance skills can be one more thing added to the list of ways to avoid emotion. One of the most common mistakes both therapists and clients make implementing DBT is using the Distress Tolerance skills as avoidance techniques instead of the acceptance skills they are designed to be.

The Distress Tolerance skills fall under the “Acceptance” half of the DBT Dialectic of Acceptance and Change. As such, the only goal of Distress Tolerance is to get through a crisis situation without making matters worse; in other words, without engaging in old, maladaptive, coping skills. Noticeably absent from this goal is feeling better; Distress Tolerance skills are not actually intended to improve mood, they are exclusively designed to tolerate the moment as is, with whatever emotion is showing up.

As such, when using Distress Tolerance skills it is vital to first acknowledge the emotion that is difficult to effectively manage. Even stating, “I am feeling very sad,” is an acknowledgement of emotion. After that important step, choosing to shift attention to a Distress Tolerance skill to get through the moment can be an effective way to manage the distress. When Distress Tolerance gets used as a way to avoid emotion, the acknowledgement of emotion is what gets skipped. Leaving out that crucial piece, the distress tolerance skill is employed as yet another tool to avoid or stuff an emotion, and can be just as detrimental to recovery as old coping skills of substance abuse or the like.

So in a moment of distress, take a brief pause to identify and acknowledge the emotion (utilizing Emotion Regulation and Mindfulness skill areas). Stop and notice where the emotion sits in your body, any urges associated with that emotion and the desire to avoid the emotion. Then, if focusing on the emotion will prove too distressful, carefully choose an effective Distress Tolerance skill to focus on. The emotion will continue to show up, but shifting attention to the chosen skill again will allow the moment to pass without engaging in old behaviors.

As recovery progresses, take a longer pause before implementing Distress Tolerance skills, and over months, truly sitting with emotion without needing to utilize any coping skills will be possible. This empowering ability to sit with whatever emotion shows up begins with the first big step of acknowledging the emotion before moving to a skill instead of continuing to stuff the emotion down.