Coping with emotional stress, whether it is real or perceived, can be difficult, particularly for people who have experienced trauma in the past. This difficulty can be further exacerbated during times of crisis when we feel powerless and unable to regain control. The capacity to navigate through emotional challenges without becoming overwhelmed is referred to as distress tolerance.
Having the ability to effectively manage intense emotions enables us to restore our equilibrium more swiftly when confronted with new sources of stress. Enhancing our distress tolerance is achievable, and thus, this article explores the necessary skills to accomplish this goal.
Distress Tolerance Skills Explained
Distress tolerance skills serve the purpose of preventing the escalation of immediate emotional crises, enabling us to navigate through challenging situations without exacerbating them. Additionally, these skills aid in accepting the reality of circumstances in which we feel helpless, acknowledging that we cannot change the situation.
Another advantage of distress tolerance skills is their ability to assist us in managing our emotions when we are uncertain about our desires or needs in the moment.
Often referred to as "crisis survival skills," distress tolerance skills provide valuable support during times of perceived or actual crises.
These skills are intended as short-term coping strategies to effectively address emotional distress. In moments of extreme emotional turmoil, the inclination to avoid or evade that pain can lead to harmful behaviours such as self-harm (e.g., cutting, burning), escaping or avoiding the situation, substance use, or denying the existence of the stressor. Engaging in avoidance strategies to evade emotional pain can result in further hazardous or risky behaviours that have long-term repercussions.
During a crisis, whether real or perceived, our fight-or-flight response is triggered, leaving us in a heightened state of alertness. It becomes challenging to implement adaptive coping techniques when our minds are already agitated.
By employing distress tolerance skills, we can effectively reduce the intensity of emotional pain, thereby opening the door to utilising other coping mechanisms such as emotional regulation and mindfulness.
The most frequently used distress tolerance skills are:
Self-soothing techniques
TIPP skills
The STOP skill
Weighing the Pros and cons
Radical acceptance
Distraction
Improving the moment
Self-Soothing Techniques
Distress tolerance skills play a vital role in effectively managing intricate emotions, particularly when we feel a loss of control.
When confronted with anxiety or stressful circumstances, utilising self-soothing techniques often proves to be the most efficient coping mechanism.
People tend to develop their own personalised approaches to self-comfort during times of distress, akin to how a child finds comfort in stroking a beloved stuffed toy or sucking their thumb. These techniques are considered appropriate for a child's development. However, as adults, we modify these practices to align with socially acceptable behaviours.
Certain people may not have acquired the ability to adapt these self-soothing behaviours into suitable strategies for adults. Consequently, they encounter greater challenges in managing distress and must acquire new adaptive self-soothing techniques to navigate through novel emotional stressors.
Self-soothing using your senses
Some adaptive self-soothing techniques include using all of your senses to ground yourself mentally and emotionally. Engaging the sense in the following way:
See: look at all the colours and textures in the environment
Hear: listen to the sounds around you, even to your own breathing
Touch: focus on what the seat feels like under your legs, the clothes on your skin, the breeze in your hair
Taste: eat a small piece of food and pay attention to the way it tastes in your mouth
Smell: acknowledge the smells in the room, light a candle, or use aromatherapy
TIPP Skills
TIPP is an acronym for Temperature, Intense Exercise, Paced Breathing, and Paired Muscle Relaxation.
TIPP skills have rapid effects, typically taking only a few seconds to a few minutes, in soothing the limbic system and reducing emotional arousal levels. They are simple to perform and can be practiced anywhere, including public settings. With regular practice, TIPP skills can evolve into a versatile coping technique that is accessible to anyone, regardless of location.
Comprehensive List of the Skills
TIPP skills include:
1. Temperature with cold water
Cold water provides a shock to the system. If you are having difficulty regulating your emotions, splash cold water on your face, take a cold shower, or hold ice cubes in your hands.
These are tasks that will not hurt you, but the cold temperature will prevent you from remaining in an elevated emotional state.
2. Intense Exercise
Similar to cold temperatures, intense exercise changes the biochemistry of the system adaptively. During intense exercise, the heart rate is up and adrenaline is pumping. When adrenaline floods the system, it provides a euphoric feeling.
Intense exercise is useful as it is difficult for us to feel distressed and elated simultaneously.
3. Paced Breathing
With paced breathing, inhale through your nose slowly for a count of two, hold the breath for three seconds, and then exhale slowly through your mouth for a count of five.
Paced breathing helps us regain a sense of control by controlling our most basic biological function: our breath.
When you learn to breathe slowly and calmly, your blood pressure will lower, and you will feel more relaxed and less stressed. This can help address the effects of anxiety, insomnia, and fatigue, among other problems.
4. Paired Muscle Relaxation
In Paired Muscle Relaxation (PMR), a pair of muscles, such as the toes on both feet, are
tensed while breathing in and then relaxed while breathing out. Work on the muscles in a particular order, from the top of the head to the feet or vice versa.
When the body is physically relaxed, it is difficult to be emotionally agitated.
The mind–body connection is very strong, so to calm the mind means to calm the body. PMR also teaches mindfulness of the body and self-awareness.
Resetting the system
When the limbic (fight or flight) system is in a state of extreme arousal, it may be difficult for us to regulate our emotions. Similarly, when a computer is working so hard that it is overheating, it will eventually become overloaded and freeze. The only way to recover from this is to restart the system, thereby returning it to a working state.
In an extreme emotional crisis, TIPP skills are the fastest way that you can restart your body chemistry to return to a calmer state of mind. Again, this is similar to restarting a computer when nothing else works.
The STOP skill
The STOP skill is a cognitive-behavioral technique that can help people stop themselves from engaging in impulsive or harmful behaviours. It focuses on teaching people skills to manage their emotions and improve their interpersonal relationships.
The acronym STOP stands for:
S - Stop: The first step is to physically stop whatever you are doing or about to do. Pause for a moment and bring your awareness to the present moment.
T - Take a breath: Take a slow, deep breath. Focusing on your breath can help you ground yourself in the present moment and create a brief pause before you continue.
O - Observe: Take a moment to observe your internal and external experiences. Notice your thoughts, emotions, and physical sensations without judgment. This step is about becoming aware of what is happening within you and around you.
P - Proceed mindfully: After observing, make a conscious decision about how you want to proceed. Consider the potential consequences of your actions and choose a response that aligns with your long-term goals and values. This step involves responding in a more thoughtful and deliberate manner rather than impulsively reacting.
The STOP skill aims to introduce a moment of pause and self-reflection between the impulsive urge and the action. By using this technique, we can create space to consider alternative responses and make choices that are more in line with our goals and values, rather than being driven solely by impulses or automatic reactions.
It is important to note that practicing the STOP skill may take time and repetition to become effective.
Weighing the pros and the cons
Even though it may appear to be a straightforward technique, during times of crisis our tendency is to make decisions driven by emotions rather than rationality. Our body and mind enter a fight or flight mode, and our primary objective becomes escaping the distressing situation as quickly as possible.
When we fail to pause and carefully consider our options, we may end up making hasty and impulsive choices that can have negative consequences. Taking the time to evaluate the advantages and disadvantages entails momentarily stepping back and employing logical thinking in relation to our circumstances and future actions.
Creating a written list of pros and cons for our plans can be beneficial when we are feeling particularly emotional. It serves as a means to restore ourselves to a state of "wise mind" or "middle path." These states involve integrating rational thinking and emotional insight to make well-balanced and effective decisions, avoiding extremes, and seeking a compromise or middle ground.
Radical acceptance
Radical acceptance is a technique that may require significant practice but, once embraced, can prove highly valuable. At times, circumstances may feel overwhelming, leading to heightened anxiety and distress.
Radical acceptance involves acknowledging the current state of affairs as they are, without striving to alter them. Essentially, it means recognising and accepting that "it is what it is." By relinquishing the need for control and understanding that certain aspects are beyond our influence, the pressure to fix or modify things often diminishes.
Radical acceptance entails impartially observing a situation and acknowledging that we are not all-powerful beings, and there are certain aspects that lie outside our sphere of control.
When we exert ourselves to control things, failure may intensify our distress. However, when we cease trying to control and simply accept the reality of the situation, we can progress without becoming emotionally entangled. It is no longer our responsibility to effect changes in the circumstances.
Distraction
When other strategies prove ineffective, the most beneficial skill to employ might be distraction. Despite our inclination to believe in our multitasking abilities, our working memory has limitations on the amount of information it can handle simultaneously.
During moments of heightened overwhelm, finding temporary distractions can be helpful in diverting our attention away from the distressing situation until we are capable of addressing it calmly. Distraction can take various forms, such as physically leaving a place or engaging in activities like calling a friend, watching TV, reading a book, playing with pets, and so on.
Improving the moment
The IMPROVE skills stand for:
Imagery
Meaning
Prayer
Relaxation
One thing in the moment
Vacation
Encouragement
These are smaller distress tolerance skills that can be utilised as needed. You can visualise (Imagery) a different situation or find a sense of purpose (Meaning) from the traumatic event.
Prayer doesn’t have to be religious but can involve reciting a mantra or quote to connect to the world spiritually.
Relaxation can be something like deep breathing or Progressive Muscle Relaxation, which will be discussed further below.
“One thing in the moment” means to slow down and break a problem down into parts, addressing each part at a time rather than feeling overwhelmed by the whole situation.
Vacation is similar to the distraction skill - taking a break from the stress (a vacation from your thoughts).
At the same time, Encouragement is a form of self-soothing that involves self-talk and a reminder that this distressing state of mind is merely temporary.
Conclusion
Everyone deals with stress differently. Some of us learned how to cope with stressful situations as children, while others never developed adequate coping skills. Distress tolerance skills can be learnt by anyone that needs to improve their crisis coping techniques.
Sally Edwards Counselling
I am a fully qualified counsellor based in Orpington, Kent
I work with clients with problems including: depression, anxiety, panic attacks, stress, low self-esteem, low self-confidence, identity issues, relationship problems, self-destructive behaviours, self-harm, childhood sexual abuse, sexual violence, domestic violence, domestic abuse, trauma, PTSD, eating disorders and body image problems.
I am easily accessible from local areas near me including Orpington, Bromley, Chislehurst, Petts Wood, Sidcup, Beckenham, Sevenoaks, Tonbridge, Knockholt, West Wickham, Chelsfield, Swanley and Bexley
Face-to-face in person or online counselling