Distress Tolerance Techniques: How to Get Through a Crisis Without Making Things Worse
Life inevitably presents us with moments of intense emotional pain, urges to act impulsively, and situations that feel overwhelming. For individuals navigating conditions like Borderline Personality Disorder (BPD), these crises can be particularly challenging, often leading to actions that, while providing temporary relief, ultimately exacerbate the situation. This is where Distress Tolerance (DT) techniques, a core component of Dialectical Behavior Therapy (DBT), become invaluable. These skills are designed to help you survive intense emotional pain without making things worse, allowing you to tolerate distress until the situation improves or you are in a better position to address it constructively.
Understanding Crisis Survival Skills
Distress tolerance skills are not about eliminating pain, but rather about enduring it skillfully. They are short-term strategies to help you navigate immediate, intense emotional pain when you cannot quickly resolve the problem. The primary goal is to prevent impulsive or destructive behaviors that might offer fleeting relief but lead to long-term negative consequences. These skills are particularly useful when:
You are experiencing intense pain that cannot be immediately resolved
You feel a strong urge to act on your emotions in a way that would be harmful
You need to stay functional despite feeling overwhelmed
Let’s explore some of the most effective DBT distress tolerance tchniques.
1.The STOP Skill: Pausing Before Reacting
The STOP skill is a foundational technique for interrupting impulsive reactions and creating a moment of mindfulness in a crisis. It encourages a deliberate pause, allowing you to regain control before acting on intense emotions.
Stop: Freeze! Do not react. Whatever you are doing, just stop. This prevents you from acting impulsively.
Take a step back: Physically or mentally remove yourself from the situation. Take a break, breathe, and create some distance from the intense emotion.
Observe: Notice what is happening inside and outside of you. What are your thoughts, feelings, and bodily sensations? What is happening in your environment? Observe without judgment.
Proceed mindfully: After observing, consider your goals and values. What is the most effective way to respond now? Act with awareness and intention, rather than impulsivity.
2.TIPP Skill: Physiological Regulation
The TIPP skill targets your body’s physiological response to stress, rapidly reducing emotional arousal. By changing your body chemistry, you can quickly calm your nervous system.
Temperature: Use cold water to trigger the dive reflex. Splash cold water on your face, hold an ice cube in your hand, or put your face in a bowl of ice water for 30 seconds. This can rapidly decrease heart rate and calm intense emotions.
Intense exercise: Engage in brief, intense physical activity to expand pent-up energy and shift your focus. Run, jump, or do push-ups for 10-15 minutes. This helps to release endorphins and reduce physiological arousal.
Paced breathing: Slow down your breathing. Breathe deeply from your diaphragm, inhaling for 5 seconds, holding for 1 second, and exhaling slowly for 7 seconds. This activates the parasympathetic nervous system, promoting relaxation.
Paired muscle relaxation: Tense a group of muscles tightly for 5-10 seconds, then completely relax them. Move through different muscle groups. This helps to release physical tension and promote a sense of calm.
3.ACCEPTS: Distraction Techniques
When distress is overwhelming and you cannot immediately solve the problem, distraction can be a powerful tool to shift your focus and reduce emotional intensity. The ACCEPTS skills provide various ways to divert your attention constructively.
Activities: Engage in activities that require your full attention. This could be cleaning, doing a puzzle, playing a game, or engaging in a hobby.
Contributing: Help someone else or volunteer. Focusing on others can shift your perspective and provide a sense of purpose.
Comparisons: Compare your current situation to a time when you were less distressed, or to others who are less fortunate. This can help put your current pain into perspective.
Emotions (opposite): Engage in activities that create different emotions. Watch a funny movie, listen to uplifting music, or read an engaging book.
Pushing away: Mentally push the situation away for a while. Imagine putting it in a box, or visualize a stop sign. You are not ignoring it permanently, just postponing dealing with it until you are calmer.
Thoughts: Engage your mind with challenging mental tasks. Do a crossword puzzle, count backwards from 100 by 7s, or read a complex article.
Sensations: Create intense physical sensations that are not harmful. Hold an ice cube, take a cold shower, or squeeze a stress ball tightly.
4.IMPROVE the Moment: Adding Positive to Distress
IMPROVE skills focus on enhancing positive experiences and finding meaning even amidst distress. These techniques help you to cope by adding pleasant or meaningful elements to you present moment.
Imagery: Use guided imagery to visualize a peaceful place, a successful outcome, or a comforting memory. Engage all your senses in this mental escape.
Meaning: Find purpose or meaning in your suffering. This could involve reflecting on what you can learn from the situation or how it aligns with your values.
Prayer: Connect with a higher power or your inner spiritual self. This can provide comfort, hope, and a sense of connection.
Relaxation: Practice relaxation techniques such as deep breathing, progressive muscle relaxation, or taking a warm bath. Focus on calming your body and mind.
One thing at a time: Focus all your attention on the present moment and the task at hand. Avoid multitasking or dwelling on past regrets or future worries.
Vacation (brief): Take a short mental or physical break from your routine. This could be a walk in nature, listening to music, or simply closing your eyes for a few minutes.
Encouragement: Practice self-encouragement. Remind yourself of your strengths, past successes, and your ability to get through difficult times. Use positive affirmations.
5.Self-Soothing: Engaging Your Senses
Self-soothing involves comforting yourself through your five senses. This technique helps to ground you in the present moment and provide a sense of calm and security.
Vision: Look at beautiful things—nature, art, and photos. Focus on colors, shapes, and details.
Hearing: Listen to calming music, nature sounds, or a podcast. Pay attention to the rhythm and melody.
Smell: Use pleasant scents like essential oils, a favorite candle, or the smell of baking. Inhale deeply and focus on the aroma.
Taste: Savor a small treat, a warm cup of tea/coffee, or a piece of fruit. Focus on the flavors and textures.
Touch: Engage your sense of touch with comforting textures—a soft blanket, a warm bath, petting an animal, or holding a smooth stone.
6.Pros and Cons: Weighing Your Options
When faced with an urge to engage in destructive behavior, listing the pros and cons can help you make a more mindful decision. This technique encourages you to consider the short-term and long-term consequences of both acting on the urge and using distress tolerance skills.
Pros of acting on the urge: What are the immediate benefits? (temporary relief, escape from pain)
Cons of acting on the urge: What are the long-term negative consequences? (guilt, shame, damaged relationships, worsening situation)
Pros of tolerating the distress (using skills): What are the benefits of not acting impulsively? (maintaining self-respect, avoiding negative consequences, building coping skills)
Cons of tolerating the distress: What are the immediate difficulties? (continued pain, discomfort)
Conclusion
Distress tolerance techniques are powerful tools for navigating life's inevitable crises without making things worse. They provide a vital bridge, allowing you to survive intense emotional storms until you can find a more effective way to address the underlying issues. While these skills are particularly beneficial for individuals with BPD, anyone can learn and apply them to build resilience and improve emotional regulation. Practice these techniques regularly, even when not in crisis, to build your muscle memory and make them more accessible when you need them most. Remember, the goal is not to eliminate pain, but to learn to bear it skillfully, fostering a path towards healing and stability.
