Distress Tolerance Strategies
Updated: Oct 23, 2019
Dr Liza Chervonsky, Clinical Psychologist and Director of Inlight Psychology
Note, before reading these strategies, be sure to read the blog post on “Understanding emotions and distress: When knowledge is power.”
A brief recap on emotion:
You are safe and will not die from your emotions.
Emotions are adaptive and are there to protect you.
Emotions have both a psychological and physical component. The physical component is to prepare you for the behaviour related to that emotion.
Emotions come in waves, with a beginning, middle, and an end.
The hardest part of the emotion wave is in the middle, but it will pass.
The thoughts you have at the peak of the emotion are often untrue and unhelpful.
General thinking strategies
The way you think about your emotion, your distress, and yourself can have a major impact on your experience.
Challenge incorrect or maladaptive beliefs about your emotion and distress. Remind yourself that you are safe, cannot die, won’t go crazy and that this emotion cannot harm you. Having negative and untrue beliefs about emotions creates “distress about the distress” and can greatly exacerbate your experience of the emotion. Understanding that you are safe and going to be ok can really help minimise the snowballing effect of “distress about the distress”.
“This shall pass”, “this is temporary”, “I will be ok”, “I will survive”. Although cliché, these statements are true and very important to remember when experiencing high levels of emotion.
Imagine the emotions as waves, with a beginning, middle, and end. This will help them feel more containable and limited.
The thoughts you have at the peak of the emotion are often untrue and unhelpful. Postpone making any decisions or taking any major action until the emotion has passed, just in case you no longer believe the thoughts you had during the peak of the emotion.
Bringing yourself back to the present moment and grounding. When your mind feels like it has taken you far away and you barely feel present anymore, you can start feeling like you are drowning in your thoughts and emotions. Grounding strategies help take you out of your mind and back into the world.
Name 5 things that you can see, touch, hear, smell, taste. Add adjectives to each thing to make the process even more engaging. Really try to take it in each sense as you focus on it. This strategy helps by both bringing you back into the present and also engaging the thinking part of your mind (which can then be used to challenge inaccurate or unhelpful thoughts in the moment).
Grounding with the feet. Press your feet on the ground and rock them back and forth very slowly and gently. Allow your feet to peel off the ground slowly and observe all the little sensations as you do. This helps you take your attention away from what is in your mind to a very specific, focused, and safe feeling.
The mindfulness approach to emotions involves being with and observing emotions, without trying to control or change them. The experience is one of open and interested curiousity, without judgment or criticism. This approach can help you sit with the wave of emotion without struggling or resisting it, which in turn can ease the whole experience of that emotion. It can also allow you to be more objective about emotions and start seeing them for what they are – unpleasant at times, but not dangerous.
Observe the emotion and mentally label the sensations objectively as they are in that immediate moment (e.g. I notice faster breathing, tension in my shoulders).
Only describe what is happening in the immediate moment. Stay present. Don’t make negative assumptions or predictions about the future. If you are to think about the future, it is simply to remember that nothing lasts forever and this shall pass. This is very different to catastrophic interpretations which often lead to the exacerbation of emotion (e.g. this is bad, this is never going to stop, this is going to kill me).
When you are in distress, your body is likely in fight-or-flight mode. Your body tenses, your heart rate speeds up, and your breathing rate increases. These are all normal and temporary reactions to stress and anxiety. One way of reducing distress is by mimicking physical processes that would be occurring if you were calm. This tells your body and mind that you are safe, and helps return your body into a state of calm.
Deep, slow breathing using your diaphragm. Breathe in slowly for 3 and out for 3. Do this for at least 3 minutes.
Progressive muscle relaxation. Start from the top of your head or from your feet, and systematically move through each muscle group tensing hard and then releasing. You can breathe out during the release to increase the effect. The releasing of the muscles helps release tension and bring your back into a state of relaxation.
There are numerous activities that you can engage in that will help soothe your mind and body. Take some time to make a list of which activities work best for you. First, write down 5 headings for the 5 senses (vision, touch, hear, smell, taste). Then, make a list of things you can do that might help distract or soothe you. The point of these activities is that they should feel nice and soothing. Examples below:
Watch videos of rainforest, nature, water, ocean, fish.
Imagine yourself in a safe space, real or imaginary.
Go out into nature and take in the scenery.
Look around the room and find the object that feels most safe to you. Focus on it and try to describe it in your mind.
Hug a soft pillow.
Run circles gently on your palm.
Hold a hot water bottle.
Splash water on your face.
Listen to music.
Listen to sounds that you enjoy – e.g. nature, rainforest, beach, traffic, white noise.
Try to make out as many sounds as you can wherever you are in that moment.
Sing or play an instrument.
Use scented candles or oils.
Smell the scent of a nice tea.
Drink an ice cold drink.
Drink a warm beverage.
Eat something mindfully.
A note on movement. Movement can also be very helpful in moments of distress. Get up, go for a walk, shake the tension out, and stretch. Movement can help you get out of feeling paralysed in your mind and body.
Distraction can be very useful if you want to take your focus away from your negative thoughts, emotions, or sensations. It is important to not overuse this strategy, as it can take you away from engaging in the world. However, at the peak of distress when you just need a few moments to distract before re-engaging with the world, the following strategies can be helpful:
Look at photos on your phone.
Name animals beginning with a certain letter.
Mentally do yours times tables (e.g. 7x7, 7x8…)
Count backwards from 9s, beginning from 413.
Do a crossword or 9-letter puzzle.
Look at funny or cute videos on the internet.
Try to recite lyrics of your favourite song.
When you try to work out everything in your mind, sometimes there are too many thoughts and it feels too chaotic. By writing out your thoughts and feelings, you will be able to start creating order and structure to your thoughts. It will also allow you to reflect on your thoughts and beliefs, and perhaps even think about things more objectively.
Write out just a few words to describe your thoughts, feelings, sensations, urges, and behaviours.
Write a journal entry.
Write a letter directed at someone who is a good listener and who usually does soothe you. Imagine what they might write back. Sending the letter is not necessary.
Connecting socially can also help you feel less isolated and alone during your moment of distress. Contact people who help you feel more at ease and who give off a sense of calm and safety.
Learning to ride the wave of the urge without acting on it will help reduce the urges over time and increase your confidence in being able to sit with emotions and urges in the future. This will help you feel more in control and less overpowered by your emotions.
Just 1 minute. Delay acting on your urge for just 1 minute. After 1 minute, see if you can do it for another minute. And so forth. In time, you will learn to delay for a longer and longer time. If 1 minute is too long, start with 15 seconds. Give yourself a good chance at succeeding with this strategy by aiming for a manageable amount of time.
Monitor and collect data. Be a curious scientist. Set a timer and every 30 seconds-1 minute, note down the intensity of the urge. If you do it for long enough, you will be able to see the urge intensity increase and then decrease. This will give you further evidence that urges and emotions come in waves.
Continuously acting on urges that take you away from engaging in life, away from friends, and away from a meaningful life, can lead to further sadness and distress. One way you can try to not act on your urge is to carry out an opposite action, which cannot be completed at the same time as your urge. Because they opposite actions can often lead to you re-engaging with the world, it can also help you distract and take the attention away from distressing thoughts, emotions, and sensations.
The main idea here is to “lean in to the discomfort”.
Some examples below:
Urge to withdraw socially -> Refocus your attention on what other people are saying or doing, without judgment, but simple curiousity.
Urge to avoid or escape the situation -> Focus on planting your feet on the ground and “grounding” yourself where you are.
Urge to go to sleep -> Put on clothes that are uncomfortable to wear in bed. Put on your shoes.
Urge to drink alcohol -> drink tea, soft-drink, mocktails, or water. Or chew chewing gum (the taste may not mix well with alcohol).
Sometimes urges can cause us to act in ways that we regret later. Self-harm and destructive behaviour can lead to serious physical consequences, shame, and further distress at the consequences of these actions. Replacement actions are used to replace a seriously harmful action with a less harmful one. Sometimes the replacement behaviour may still cause some discomfort or pain, but it will be far less dangerous and less likely to cause long-term physical damage.
To replace self-harming behaviours
If you self-harm to create pain to punish yourself, hold ice-cubes to create a sensation of pain. Ideally, you won’t use this strategy at all, but if the choice is between seriously harming yourself and creating some level of pain, choose the less harmful option.
If you are using self-harm to create physical pain to distract yourself from psychological pain, try to find other ways to distract yourself. See the grounding or distraction strategies for some tips.
To replace cutting or marking your body, use a pen to draw the lines on instead. Or, draw something innocent on the part of your body that you usually cut, and imagine that by cutting that part of you, you are cutting an innocent part of yourself.
A note on suicidal ideation. If you experience strong suicidal thoughts and want to talk to someone about it, there are a number of helplines available 24/7 to help you through a moment of crisis.
Lifeline – 13 11 14
Mental Health Line – 1800 011 511
Men’s Line - 1300 78 99 78
Beyond Blue - 1300 22 4636
Suicide callback service - 1300 659 467
If you are seriously considering ending your life and your life is in immediate danger, call 000 immediately.
This article was written by Dr Liza Chervonsky. She is a clinical psychologist and director of Inlight Psychology, in Bondi Junction. Liza works with adults and children/adolescents. She has a passion for working with people who have difficulties regulating emotions and who have relationship difficulties that often arise due to these emotional problems. She treats anxiety, panic, mood disorders, anger and emotion dysregulation, relationship issues, low self-esteem and confidence, and work and academic problems. She works from a number of therapeutic modalities, including CBT, DBT, Schema, ACT, and mindfulness.
To book an appointment, call 8320 0566 or email firstname.lastname@example.org