Exploring the Components of DBT: Distress Tolerance

Dialectical behavior therapy, or DBT, is a type of psychotherapy that utilizes a cognitive-behavioral approach to emphasize the psychosocial aspects of treatment. In the next couple of blogs, we’ll be exploring the four different components of DBT, and breaking them down to understand their respective roles within the treatment protocol. Our first blog in the series covered the component at the core of DBT: Mindfulness. From there we move onto Distress Tolerance – what is it, why is it important, and how is it used in DBT protocol?

What is Distress Tolerance?

In dialectical behavior therapy, distress tolerance skills are taught to address the tendency of individuals who experience negative emotions as overwhelming and unbearable. Those who have a low tolerance for distress can become overwhelmed at what others may perceive as relatively mild levels of stress, and therefore may react with negative behaviors. Other traditional therapeutic approaches for this issue focus on avoiding painful situations, but in the distress tolerance module of DBT, clients learn that there will be times when pain is unavoidable, and the best course is to learn to accept and tolerate distress.

Why is Distress Tolerance Important?

Unfortunately, suffering and pain are part of life – we experience a variety of stressful events whether it’s the end of a relationship, the death of a loved one, or loss of a job. As previously mentioned, some individuals, especially people with borderline personality disorder feel the pain and discomfort of these situations more intensely than others. If people with BPD haven’t learned to use healthy coping skills to tolerate the distress they feel, they may resort to unhealthy behaviors like self-harm, substance use, or other impulsive behaviors that may seem like an immediate “fix”, but in the long-term these behaviors can make the pain worse. Distress tolerance helps these highly sensitive people learn to navigate uncomfortable or painful situations and manage urges to engage in harmful behaviors, in order to maintain balance in the face of crises, and to accept and cope with it in healthier ways.

How Is Distress Tolerance Used in DBT?

What, then, do these skills entail? Distress tolerance skills are a type of intervention in DBT where clients learn to manage distress in a healthy way and learn to manage their response in a situation where they may not feel in control. A key ingredient of distress tolerance is the concept of radical acceptance – experiencing the situation and accepting the reality that it is out of your control and cannot be changed. By practicing radical acceptance without trying to fight reality, the client will be less vulnerable to intense and prolonged negative feelings. Within the distress tolerance module, there are four skill categories: Distracting, Self-soothing, Improving the moment, and Focusing on pros and cons. The first skill, distracting, helps clients change their focus from upsetting thoughts and emotions to more enjoyable or neutral activities. Self-soothing then teaches clients to utilize their senses to nurture themselves in a variety of ways. In improving the moment, the goal is to use positive mental imagery to improve one’s current situation. Finally, focusing on pros and cons, the individual is forced to evaluate the short-term and long-term pros and cons to understand the benefits of tolerating pain and distress in the moment, based on past experience.

Because these skills are so critical to one’s mental well-being in times of extreme distress, they should be taught accordingly by someone with the proper qualifications. Meredith O’Brien is a Licensed Clinical Social Worker in New Jersey with advanced training certificate in Dialectical Behavior Therapy. Following the DBT treatment module, Meredith and her team provide individual therapy sessions in a nurturing environment to help clients to achieve treatment goals, as well as offer DBT Skills Groups to strengthen treatment. To schedule your appointment with Meredith today, visit www.meredithobrienlcsw.com.