Managing Distress

Imagine this…

Close your eyes and think back to the most recent time you felt “distress”-- maybe it was intense anxiety about something at work, or hurt and anger within an important relationship.

What was the situation? What did your body feel like, during that moment of high emotion? Then, what did you do in response?

Human beings all experience distress, and we all cope with these moments of distress in different ways. Do any of these sound like what you?

Try to control the situation by constantly planning, worrying, and stressing.
Avoid difficult situations or conversations completely.
Use alcohol or other substances to calm down or feel better.
Spend too much time on mindless activities, like playing on your phone or computer, to numb out?
Blame others, or get excessively angry.
Blame or punish yourself (even just in your mind) for messing up.
Avoid activities that will feel good, like socializing or exercising, because you are "too stressed."
Spend a lot of time thinking about past mistakes, pain, and problems to try to “figure them out.”
Constantly seek reassurance from those around you to feel okay.

Distress Tolerance - what is it?

Distress tolerance is the ability to encounter distressing sensations, thoughts, emotions, and urges, and to be able to observe and allow these experiences to take place rather than denying or avoiding them, trying to fix them, or letting them control you.

Usually when we feel strong emotions, sensations, or pain, we also experience strong “action urges” that drive us to avoid or escape the pain.

Obviously, action urges can be helpful, like when you jerk your hand back from a hot stove to avoid damage.

But often, action urges have us pulling away from painful but important things, like exercise, or difficult conversations, or doing our taxes. Or action urges can push us to lash out, or say something we regret later.

If we give in to action urges that come with distress, they can backfire and lead to bigger problems down the line.

Is there another way?

What if you could simply tolerate those uncomfortable feelings, instead of trying to escape or control them?

This lets you choose how to act, so you can make a choice that is effective and in line with your values.

But it does mean you have to tolerate some uncomfortable feelings.

When might you use distress tolerance skills in your life?

Examples might be something like: "to choose public speaking at work even when it's frightening," "to choose to go to the gym, even when I feel ashamed I haven't been in a long time," or "to sit with feelings of anger or frustration in order to continue making eye-contact and listening to my partner."

But don't get discouraged if it feels extremely difficult or even painful at first.

That's part of the point -- helping your brain learn that intense emotion is uncomfortable, but won't harm you. You still have the power to choose how to act even when you are feeling bad in some way- those emotions don't need to control your choices.

Tools

Grounding, Coping, and Accepting

Improving your capacity for distress tolerance means learning and practicing particular skills while you are upset or emotionally activated. Grounding, coping, and accepting are three related (but slightly different) skill sets that can help with distress tolerance.

Grounding Skills

Grounding skill help you take your mind off your distress and instead engage with your immediate environment.

Grounding is not used to completely avoid your emotions or a situation- they are used to get through the most intense part of an emotion until you once again have the resources to make decisions in line with your values.

These are simple exercises to center yourself and engage with your environment. They take your mind off of your distress and back into the world around you.

The ABC Game

Look around the room and name an object (out loud if possible) that starts with an “A.” Then move on to “B,” and so on, until you’ve made it through the entire alphabet.
If there are no objects that match a specific letter (for example, X can be tricky!) you can close your eyes and imagine an object that matches that letter appearing in the room. Get creative! You might conjure a zebra in the middle of your office, or Xena, Warrior Princess in your kitchen.

The 54321 Game

Name 5 things you can see in the room with you.
Name 4 things you can feel (“chair on my back” or “feet on floor”)
Name 3 things you can hear right now
Name 2 things you can smell right now
Name 1 good thing about yourself or your life right now

Coping Skills

Coping skills help you to experience your distress, and then "regulate" it by lowering the intensity or somehow changing your experience.

Coping is not making the emotions go away, or fixing them, but rather helping you recognize what you can do to monitor and shift your body and mental processes.

Try these guided meditations below to practice coping skills.

Try "Flip" to practice acknowledging and coping with distress in the body:

Try "Manage," a quick exercise using the breath to calm difficult emotions.

Accepting Skills

Accepting skills help you acknowledge your feelings and your situation, without resisting or trying to change them.

Acceptance is not giving up, or accepting that you will always feel this way. It simply means fully allowing yourself to have your experience without trying to make it go away.

Try these guided meditations below to practice coping skills.

Try "Names," a mindfulness exercise that helps you to observe and label your internal processes without reacting.