Unlocking the power of distress tolerance

Distress tolerance ^[1] is the ability to tolerate challenging emotions. It can help you accept difficult situations and cope with any emotional discomfort they might cause. 

People with low distress tolerance may find that they’re often overwhelmed by their emotions. Having low distress tolerance can increase your risk of mental health concerns and lead to unhealthy coping mechanisms, like self-harm and harmful substance use.

Why is distress tolerance important?

Distress tolerance is essential for managing difficult emotions in healthy ways. It may not change how you feel, but it can empower you to stay grounded and avoid impulsive reactions. Distress tolerance can strengthen self-awareness, confidence, and emotional resilience. It can also improve communication and problem-solving abilities, which may lead to stronger relationships. 

On the flip side, people with low distress tolerance often struggle to cope with their emotions in stressful situations. Without distress tolerance skills, you might find it difficult to accept something like losing a job or going through a breakup. People with low distress tolerance may also be more likely to develop mental health conditions ^[1] like depression, substance use disorders, and personality disorders. 

Signs and causes of low distress tolerance

Low distress tolerance affects how people view and respond to difficult emotions. People with low distress tolerance may have beliefs like: 

• “This is unbearable.”

• “Life never goes my way.”

• “I feel like I’m losing control.”

• “This feeling is going to last forever.”

Low distress tolerance also affects your ability to deal with those emotions. When you don’t know how to manage uncomfortable situations in healthy ways, you’re more likely to turn to unhealthy coping mechanisms. 

These may include: 

• Self-harm*

• Unhealthy substance use

• Bed rotting 

• Binge eating

• Excessive exercise

• Compulsive gambling

People might have low distress tolerance for several reasons. Some research suggests a biological link, meaning your genes can play a role ^[2] in how well you tolerate emotional distress. 

Environmental factors can also influence your distress tolerance. People who grow up in unstable or unsupportive environments may not develop the skills to cope with stress and other challenging emotions. For example, you might have been taught that your feelings didn’t matter or that alcohol was a normal way to deal with problems.

It’s also linked to a history of trauma, chronic stress, and other health challenges. According to some research, it can be a symptom of mental health conditions ^[3] like anxiety disorders, eating disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD).

The good news is that you can always learn to improve your distress tolerance skills. In particular, research shows that mindfulness practices can increase distress tolerance ^[4] in people with anxiety disorders and depression.

*The 988 Suicide and Crisis Lifeline offers 24/7 confidential support through trained crisis counselors. If you or someone you care about is experiencing emotional distress, self-harm, or a suicidal crisis, please call or text 988. For life-threatening emergencies or immediate assistance, call 911. 

Techniques for building distress tolerance

Distress tolerance is a key component of a type of talk therapy called dialectical behavior therapy (DBT). In addition to distress tolerance, DBT focuses on mindfulness, emotional regulation, and effective communication. Together, these skills are designed to help people create a life that feels meaningful ^[5] and worth living.

Distress tolerance techniques ^[6] teach people to regulate their emotions and remain present in the moment — even when that feels hard. The methods may seem simple, but they can make a significant difference in how you live your life. There are many different techniques, so here are just a few. 

1. Radical acceptance

Radical acceptance means acknowledging reality as it is, even when it’s painful or difficult. You don’t have to approve of what’s happening or pretend it's OK. Instead, you recognize the situation for what it is so you can respond more effectively and move forward.

2. ACCEPTS

ACCEPTS is a technique used to distract people from their emotions ^[7]. Some examples of healthy distractions include:

• Activities: Do an activity that requires focus and concentration. For example, read a book or write in your journal.

• Contributing: Do something that requires you to focus on someone else. For example, text a friend or bake cookies for a neighbor. 

• Comparisons: Find a way to put your emotions into perspective. For example, think of a time when you overcame a struggle.

• Emotions: Find an activity that evokes different feelings and emotions. For example, practice some deep breathing or watch a funny movie.

• Pushing away: Temporarily set aside a stressful situation until you’re in a better place to cope with it. For example, tell yourself you'll come back to the problem after work or later that evening.

• Thoughts: Find something to keep your mind busy. For example, do a puzzle or recite the alphabet backward.

• Sensations: Use your five senses to distract you from your emotions. For example, take a hot bath or eat something salty.

The goal is to create enough emotional space to get through a difficult moment, not to avoid the problem permanently. People with conditions like obsessive-compulsive disorder (OCD) may benefit from a different approach, since some forms of distraction can unintentionally reinforce avoidance behaviors over time.

3. Make a pros-and-cons list

Making a pros-and-cons list can help you decide how to respond to difficult situations. It encourages you to pause and reflect before giving into emotional impulses. 

To start, describe the behavior you’re trying to avoid. For example, maybe you don’t want to start a project for work or school. From there, list the pros and cons of following through on that urge to procrastinate. The pros are that you can ignore your problems and do whatever you want. The cons might include future stress and regret about not meeting your goals. 

4. IMPROVE

The IMPROVE skill offers ways to replace negative emotions with more positive ones. If something happened to make you upset, consider:

• Imagery: Picture somewhere that makes you feel happy and safe, like the beach or home in bed.

• Meaning: Look for some sort of purpose or meaning in your current situation. For example, think about how getting through this challenge may help you grow or prepare for future obstacles. 

• Prayer: Take a moment of self-reflection, and look for strength within or from a higher power you believe in.

• Relaxation: Find ways to relax, like doing deep-breathing exercises or listening to music. 

• One: Focus your attention on one thing in the present moment. 

• Vacation: Take yourself on a mental vacation by thinking about something other than what's causing you distress.

• Encouragement: Use positive self-talk to help shift your mindset. If possible, try reciting positive affirmations while looking in the mirror.

5. TIPP 

Have you ever felt like your emotions were taking over? If so, TIPP is a great skill to have in your toolbox. TIPP can help you regulate your body’s stress response ^[8] during crisis and extreme distress.

• Temperature: Change your body temperature by splashing cold water on your face or taking a hot shower.

• Intense exercise: Make time for cardio, like running, power walking, or dancing. Ten minutes can be enough to help you expend some energy and reset your emotions.

• Paced breathing: Find somewhere comfortable to sit and engage in slow, paced breathing. One example is to inhale for five seconds, hold your breath for five seconds, and then exhale for five seconds.

• Progressive muscle relaxation: With progressive muscle relaxation, you slowly tense and relax the muscles in your body. Starting with the top of your body, notice how each body part feels and where you’re holding onto tension.

Clinician’s take

As a therapist, I've found that some of the most effective distress tolerance skills are also the most practical. Grounding exercises, paced breathing, and learning to pause before reacting can help clients get through intense emotions without making things worse. With practice, many people discover that they're more capable of handling distress than they once believed.

Brandy Chalmers, LPC

Clinical reviewer