Distress Tolerance: Learning to Accept Life on Life's Terms

In the post on emotion regulation you read about how, when people become emotionally dysregulated, they use energy toiling over something and trying to “unfeel” an unpleasant emotion.  That same energy could, instead be used to move them toward those things that are important to them and their goals.  I call this purposeful action.  So, aside from preventing vulnerabilities and mitigating their impact when they do occur, what can you do?  That is where radical acceptance and distress tolerance come in.

When I explain radical acceptance to people, I encourage them to think of it as saying “It is what it is.  How can I improve the next moment?”  I then remind them that their emotions are basically their body's automatic response to what is going on, and designed to protect them.  If they feel angry or anxious, their body/brain thinks there is a threat.  Okay, cool.  “Thanks Brain for being on the lookout.”  Regardless of whether there actually is a threat, the brain perceived one.  Does it make sense to argue with your brain and try to convince it that it is wrong?  No.  It makes more sense to accept that you are feeling _______ and then figure out what to do to address it.  This is particularly important for people who tend to get upset or feel threatened easily.  In counseling they can deal with the things that trigger their distress, but when life actually hands them lemons, they need to be able to get out of the emotion-driven (impulsive) state, step back and make a conscious decision about the best course of action based on their particular goals and needs (purposeful action).

This is where distress tolerance comes in.  Distress tolerance skills allow you to acknowledge your unpleasant emotion, and take action to either let it go until you can think clearly about it, let it go until you can do something about it, or just let it go, because it is out of their control.  Think about a time you got really upset about something.  Were you thinking clearly in that moment?  If you reacted at that time, did you later look back and think….”That was not my best choice,” or “Why did I waste my energy on that, I know good and well there is nothing I can do to change that situation.”  I think most of us have had those moments.

Sometimes there are things that happen that are scary or make you angry, but it isn't something you can resolve right away.  Dwelling/ruminating on the situation does nothing to move you toward your goals.  It actually drains you of energy.  When you feel that way, ask yourself, “Is dwelling on this helping me move closer to my goals and the people and things who are important to me?”  If the answer is no, acknowledge that you feel angry/anxious/depressed, and then make a conscious choice to stop ruminating.

IMPROVE the (Next) Moment

There are a variety of skills mentioned in the presentation that you can use to help get distance between you and an unpleasant feeling, and allow you to get out of the emotional/impulsive frame of mind.  This is necessary before trying to really problem solve.  Get grounded.  These techniques also work well to help you if you cannot get immediate resolution on, or change a situation.  I have included some suggestions for how to do each of these in group.  Remember that part of the richness of the group experience is the different perspectives.  Participants can learn from each other.

  • Imagery.
    • Safe place: Imagine your safe, happy place.  This is a place you can mentally go when you are feeling stressed/anxious.  This can be a useful technique to use to help you fall asleep as well.  As you drift off, imagine your safe place. As an art therapy group people can draw or do a collage or write a narrative describing this place.
    • Successfully dealing with this: Envision yourself successfully dealing with the situation.  As an art therapy project, the first half can represent where you are now.  The second half can represent what a successful resolution looks like.
    • A force field: Some people find it helpful to imagine a force field that can protect them from other people's judgement, or even just the stress of the day.  With the popularity of Marvel comics right now, you could envision what superhero you would be and why.  You could also identify which superhero you wish really existed and how he or she would help you get through the tough times.  This can be a fun group activity, paring participants with the same superhero and having them explain why that superheros powers are so important for happiness. Then… discuss how they could develop (or already have) similar capabilities.  For example, you cannot read minds, but how can you improve your interpersonal and communication skills to be more intuitive about what is going on?  Or, maybe the force field would block you from having unpleasant thoughts…so, how can you push away or block unpleasant thoughts now?
    • A coach/fairy godmother/angel/Higher Power:  Creating your own vision of what your person/being looks like and how he or she can help you.
    • Envision feelings and thoughts as clouds in the sky.  When I have done this with kids I have had them write on a paper cloud what they were feeling and why.  I attach each cloud along a string and start rolling it up.  I have them look for theirs as it comes by.  I encourage them to notice it without feeling like they have to discuss it or engage it at that moment.  Sometimes we go outside (I find this works better with adolescents and adults) and I have them pick a cloud and tell me what shape the cloud is.    I then tell them, okay, that shape in that cloud is your feeling (anger/fear/grief).  See it.  Notice it,  Let it move.  You cannot hold onto it.  It will inevitably change.  With kids, especially it is important to make sure they understand that what you are talking about here is a feeling or unpleasant thought.  You are not telling them to ignore or minimize a stressful situation, just to realize that feelings and thoughts can come and go, and do not have to overwhelm them every moment or every day.  For example, if they break up with someone, thoughts about that person will come up a LOT at first.  They have the ability to choose to pay attention to those thoughts and feelings at that moment, or let them go, like the cloud.
  • Meaning
    • Changing how you think about yourself and your situation.  Many times you may focus on what is awful about the situation.  This activity encourages you to think about the positives.  For example, nobody likes to fail; however, failure can be envisioned as the courage to step out of your comfort zone and the opportunity to learn.  Some failures aren't even about you.  For example, if a relationship fails or a group project at work bombs, it is important to evaluate your contribution and give yourself credit for what you did well.  It may have been more about the other person in the relationship or the people judging the project.  If your child experienced something similar, how would you help them find meaning/come to terms with it?
    • Make lemonade. Find the silver lining.  Anytime you have a negative thought or feeling, try to find the silver lining.  This applies to everything from being irritable that you have to wait in a line at the store to not wanting to go to work to more catastrophic things.  We recently experienced a tornado and lost several hundred feet of fencing and had some roof damage.  Yes, in the moment it was overwhelming, but the silver lining was, none of the farm animals were injured or escaped, the damage could have been much worse, and we were in a financial position that the destruction was not going to make us go bankrupt.
  • Prayer.  If you believe there is some type of higher power, prayer can be useful.  If you are in addiction recovery, the serenity prayer can be very useful in times of turmoil.  Actually write down what things you can change and what things you cannot change in the situation.  If you are a person if faith, you might find particular scriptural passages or spiritual sayings that are helpful too you.  Some people also like having a “God-Box”  Write down the things that are bothering you and put them in the God Box, symbolically giving them to your higher power.  Making a God Box is a great art therapy activity.  It can be called the Universe box if your group isn't particularly fond of the term God.
  • Relaxation:  This one can be tough during times of turmoil, so prepare in advance.  Make a list of a few things you can do to relax when you are distressed. (Exercise, yoga, meditation, hot tub, bubble bath, paint…)  In group you can teach progressive muscular relaxation, and point members toward online resources for recorded relaxation scripts (Youtube is a great place to start).  You can also do groups on other relaxation skills such as journaling, aromatherapy, animal therapy. The key is to have participants try each method.  Practice it once or twice to see if it is a good fit for them.
  • One thing in the Moment:
    • Focus on one thing you are doing right now, or choose something to do that will help you move toward the things that are important to you.  Maybe you can't change something bad that happened, but dwelling on it only burns up your energy.  Pick something else, maybe something totally unrelated, you can do with that energy.
    • Sitting in a chair/driving/crocheting/shooting:  Whatever you are doing, stay as focused in the present moment as possible.  What are you doing?  What do you see? Hear? Feel? Smell?  If your mind drifts, just bring your focus back to the present.
  • Vacation
    • Mental vacation: Go to your safe place, or just daydream for a few minutes.
    • Take a short break: Walk around outside.  Watch a short television show or video online.
    • Leave stress at work: Try and maintain work life balance so you have a break from work when you are not there.
  • Encouragement
    • Be your best friend.  Think about how you would want your best friend to react to you.  Do that.  If you are doing this in group, have members share how they would want a best friend to encourage them.  By the end of group, you have a menu of ideas which members can write down in their notebooks.
    • Create a mental coach.  Mental coaches are sometimes a bit more demanding that best friends.  They know what you are capable of and will push you to be your best.    I like doing this one using a drawing of a coach with thought bubbles.  What types of things would your coach say to you?  You can also have members cut phrases out of magazines and personalize their coach.

Distress Intolerant Thoughts

The following are some examples of distress intolerant thoughts.  Those are thoughts you tell yourself that urge you to fight your feelings or do something to escape from them.

I can’t stand not knowing how this will resolve
The pain of this loss is unbearable
I hate this feeling, and I must stop feeling this way
This feeling will keep going on forever…
It is wrong/stupid/weak to feel this way

I promised you some group activities.  Identify 4 distressful situations your clients have experienced.  If you are a therapist working with clients, examples include breakups, death of a loved one (or even a pet), job loss, arguing with a friend, surviving a victimization.  If you are a supervisor, examples might include employee not getting a promotion, staff feeling overwhelmed and overburdened by duties, staff getting stressed out about an upcoming audit, an employee having a complaint/grievance filed against them.   Whichever scenarios you  choose, make sure the people in your group can relate to them.  Write each on a piece of flip-chart paper and post one in each corner of the room.  Have group members go around and identify the distress intolerant thoughts they might have in that situation.  That is, what things do they tell themselves that keep them ruminating about the situation and stuck in the unpleasant emotion.  (Notice I don't say negative emotion.  Emotions are not positive or negative.  Feeling angry or anxious is not negative, it is simply an indicator of a threat (albeit an unpleasant one).

After the group has visited each station, review the distress intolerant thoughts.   For example, after being victimized someone might have thoughts like:

  • I am broken, nobody will ever want me.  I will be alone forever.
  • I will never feel safe again.
  • I can't stand being afraid all the time.  I feel like I am going crazy.

Review the statements and have them come up with compassionate responses which highlight the feeling, for example:

  • I have been through a lot, and am afraid that I will be alone.
  • I do not feel safe right now, and I am terrified.
  • It is exhausting being scared all the time.

From here it is easier to develop a game plan to address what is going on and ask…okay, what it the next step.