What is Distress Tolerance? A Therapist Explains Why It's Your Easy Pandemic-Era Coping Tool
Welcome to the new age of anxiety. Come in, get comfortable and let’s learn how to deal, together.
That’s the pandemic-era message we’ve learned through a practice called distress tolerance. It’s part of a school of therapy known as Dialectical Behavior Therapy (DBT) that offers practical solutions to lingering discomforts, whether you’re struggling with minor irritability or major depression. Originally developed in the 1970s by a formerly suicidal young woman who went on to become an award-winning psychology professor, DBT is today utilized by a wide range of adolescents and adults trying to deal with ongoing trauma…like, a global health crisis that seems to have no end date in sight.
We asked Dr. Karol Darsa, psychologist and author of The Trauma Map: Five Steps to Reconnect with Yourself, for tips on using distress tolerance and DBT in our daily lives.
PureWow: Let’s start with a speed round. Say I’m in a crowded subway with maskless riders and I’m concerned about a breakthrough Covid infection. What can I do?
Karol Darsa: There are two DBT skills you can use.
- Practice mindfulness. This is a simple way to focus on the present without any judgment or feeling. It helps you pay attention to that is happening inside you (your thoughts, feelings and body sensations) in nonjudgmental ways.
- Practice radical acceptance. Basically, this means to fully accept what you can’t change. We can’t change the fact that we are stil in the midst of a pandemic and being angry at the facts of the virus only increases our stress.
PW: Do you think the current open-ended, no promises, ongoing uncertainty and risk of the pandemic is potentially more harmful to some people (like trauma survivors)?
KD: For survivors of past trauma, emotions such as depression, anxiety and posttraumatic stress disorder (PTSD) symptoms increase, because any current stressor can trigger memories and feelings of past trauma. For example, someone who comes from a troubled home might struggle with community stay-at-home orders during the pandemic, because being forced to stay at home as an adult might trigger childhood memories of being unable to escape dysfunction, or emotional or physical abuse. Individuals who become ill might have extra difficulty because of being reminded of being powerless as a child while being bedridden with serious illnesses or taking care of an alcoholic parent who was often sick. Worries about finances might stir memories of witnessing domestic violence when a parent lost their job.
PW: Can you give us an easy-to-remember technique we can use when we are feeling upset? With an example?
KD: There’s a distress tolerance tool in DBT known by the acronym STOP. It was useful to a client of mine who, when the COVID hospitalization numbers were increasing, felt paralyzed with fear that he was going to be sick, because he was reminded of being hospitalized for four weeks following a gunshot wound. We worked through the following:
- Stop! Stop and don’t react to whatever stimuli you may be facing. Stay in control of your emotions and your physical body. (I taught my client to slow down and not react while he was reading the news.)
- Take a Step Back. Remove yourself from the situation. Take a quick break or deep breath. (My client wanted to constantly read the news and obsessively test himself for the virus. Instead he agreed to stop reading the news for a while and put his attention elsewhere.)
- Observe. Take a moment to look around and your surroundings and environment, both in and out. How do you feel? What are others doing and saying? (My client learned to challenge his fears and pay attention to other feelings as well as his distress.)
- Proceed Mindfully. Think about your goals in the situation and act with total awareness, including what will make the situation better, and what will make it worse. (Finally, through increased mindfulness, my client realized the obsessive fear toward the virus was rooted in his unresolved trauma. In continued therapy, we helped him resolve those issues.)
PW: Any other general tips?
KD: Here’s an example of mindfulness. Let’s say you had an argument with your spouse. Simply notice your feelings, don’t label them as bad or good. Don’t try to get rid of them, just observe yourself having the feelings without judging any of them. If you’re overwhelmed, go for a walk and notice everything you see, hear and smell. Pay attention to your body sensations. At the same time, notice your thoughts, but don’t try to change them and don’t fight them. Be an observer. This practice eventually helps your nervous system to calm down.