Overview of Distress Tolerance

Marsha Linehan states, "DBT emphasizes learning to bear pain skillfully. The ability to tolerate and accept distress is an essential mental health goal for at least two reasons. First, pain and distress are a part of life; they cannot be entirely avoided or removed. The inability to accept this immutable fact itself leads to increased pain and suffering. Second, distress tolerance, at least over the short run, is part and parcel of any attempt to change oneself; otherwise, impulsive actions will interfere with efforts to establish desired changes.

....Although the stance advocated here is a nonjudgmental one, this should not be understood to mean that it is one of approval. It is especially important that this distinction be made clear to clients: Acceptance of reality is not equivalent to approval of reality.

.... The distress tolerance behaviors targeted...are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: Distracting, self-soothing, improving the moment, and thinking of pros and cons.

I remember the first time I read these words I actually had conflicting thoughts. On the one hand It was an eye opening concept to think that accepting a situation was not the same as approving of the situation. My own parents had a problem with this concept and passed it along to me. For example: I became pregnant with my youngest son when I was single. My parents wanted me to have an abortion ( I was 30 and living 180 miles away). I told them I didn't want their approval just their support in my decision. They could not give it and did not give my son the same attention they gave his brother as a new born.  I often have difficulty with reacting in a disapproving manner. It usually just makes me feel worse, because no one changes their behavior just because I have chosen to disapprove of what they are doing (can you imagine that :-).

On the other hand my feelings about  the distress tolerance skills was "Yea, sure!" But the reality is that when I put my faith in the skills and did them anyway they started to work.

Distress Tolerance: Crisis Survival Strategies

DBT teaches us four sets of skills for tolerating (dealing with, getting through, accepting) the distressing events and activities in our lives.

Distracting - Wise Mind ACCEPTS


Improving the Moment

Thinking of Pros and Cons

We can think of these as Crisis Survival Strategies. Some of them will seem easy, some difficult. Out of these skills, you will probably want to try most everything, and then pick some that especially work or apply to you. I have certain ones of these that I use more than others. But it can really benefit you to try things that are new.  You never know  what might be a big help to you.