Distress Tolerance

Emotions are an important part of being human and are essential to our survival. We have a vast range of emotions, some of which may be comfortable to us, and others may be uncomfortable. Most people dislike feeling uncomfortable, physically and emotionally. We are quite familiar with uncomfortable physical discomfort but what about emotional discomfort - also known as distress?

Distress tolerance is the ability to manage emotions without becoming overwhelmed or resorting to unhealthy behaviors. There are two categories of activities that typically help build this tolerance: activation and soothing. Activation is about engaging in an activity that puts you in the moment - such as being active or involved in something. Soothing is about exploring activities that make you feel cared for and warm - such as self soothing techniques.

We may not like it, but this is a natural part of life. This handout will help you discover a variety of things that may help to improve your distress. Experiment and find out what works for you.

Let’s start with the STOP acronym. When you’re noticing signs of distress, remember to STOP and proceed mindfully:

S - Stop, pause, and don’t react.

T - Take a step back, take a breath, and walk away

O - Observe, notice your surroundings and acknowledge how you feel.

P - Proceed mindfully.

Once you’ve acknowledged your emotions, you’re ready to apply some skills. The next acronym we will be looking at is TIPP:

T - Temperature (to calm down immediately)

I - Intense Exercise (to calm the body down)

P - Paced breathing (to slow your breathing)

P - Paired Muscle Relaxation (to help relax the body)

Temperature

For information on why this trick works, search “mammalian diving reflex”

Keep a soft ice pack in the freezer for times like this.

Once you have the soft ice pack or even a bag of frozen peas, you want to make sure you're sitting so you can lean forward.

Cover your eyes with the ice pack, lean forward and hold your breath as you count to 20 or 30 seconds in your mind.

As you lean back and remove the ice pack from your face, breathe out slowly and notice as your heart rate slows down.

Don’t have anything cold to use?

Fill a bowl or a sink with cold water that is ice cold - water from the tap with some ice cubes works a treat.

In order to do this, you'll need to bend over so make sure you are comfortable, sit down if you need.

Hold your breath and submerge your face into the cold water for as long as is safe for you - try for 30 seconds.

As you can sit back up and open your eyes, notice your heart rate and your breathing start to slow down.

Intense Exercise

• engage in intense exercise for a short period of time

• expend your body's stored up energy

• Some examples are: jumping jacks, going for a run, dancing, or anything you feel may be useful

Paced breathing

There are many different breathing techniques, below is only two examples of many, so do some research to find what works for you.

Box breathing:

Breathe in for four seconds, hold for four seconds , breathe out for four seconds, hold for four seconds

Draw an imaginary box or use the one at the top of the page and trace it with your finger. Up one side as you inhale, over as you hold, down as you exhale, and across as you hold again. Repeat as needed.

3-5-7 breathing:

Breathe in for three seconds, hold for four, and exhale for five.

Paired Muscle Relaxation

This technique is a very well known one, and can be done in many ways. Below is the very basic steps on how to approach body relaxation when in a panic. But for more in depth exercises, check out the article on mindfulness.

- work on one section of your body at a time

- while breathing in, tense your muscles

- while breathing out, relax your muscles