Dialectical Behavior Therapy: Simple Distress Tolerance Tools to Manage Emotions and Survive Crises

This podcast episode, part of a continuing education webinar, delves into Dialectical Behavior Therapy (DBT) techniques for distress tolerance, building upon prior discussions of emotion regulation. Dr. Dawn Elise Snipes explains that individuals benefiting from DBT often experience emotional dysregulation, characterized by heightened and prolonged emotional responses. The core goal of distress tolerance is to accept, find meaning for, and tolerate distress, recognizing that pain and discomfort are inherent parts of life. The episode emphasizes that refusing to accept this reality leads to suffering, and that any attempt at change, even positive ones, will inherently produce some level of distress, making distress tolerance skills universally beneficial.

The discussion highlights common reasons why clients might resist distress tolerance, often choosing to remain distressed or act out due to perceived short-term gains. These behaviors, such as yelling, substance use, overeating, or self-injury, provide temporary relief or control over others, but offer few long-term benefits and often exacerbate the underlying issues. The episode challenges common distress-intolerant thoughts like "I can't stand it" or "This feeling will keep going on forever," encouraging clients to recognize their past resilience and the temporary nature of intense emotions, often peaking and dissipating within 20-30 minutes, akin to a wave.

Practical DBT skills are introduced, starting with the STOP skill: Stop, Take a step back, Observe, and Proceed mindfully. This technique helps individuals pause between a trigger and their automatic reaction, allowing them to identify underlying beliefs and choose responses aligned with their long-term goals and values. The episode also covers the Pros and Cons analysis, a decisional balance exercise from motivational interviewing, to help clients weigh the benefits and drawbacks of impulsive urges versus using distress tolerance skills. The aim is to understand the reinforcement behind maladaptive behaviors and find healthier alternatives that meet similar needs.

Further practical tools include TIPP skills (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) which provide immediate physiological shifts to reduce emotional intensity. The concept of "urge surfing" is presented as a powerful metaphor for experiencing intense urges with acceptance rather than fighting or succumbing to them, allowing them to crest and dissipate naturally. Ultimately, the episode advocates for non-judgmental acceptance of one's feelings and current situation, building self-confidence, and developing an emergency plan to navigate overwhelming emotions, empowering individuals to survive crises and move towards their desired life.

"The goal of distress tolerance is to accept and find meaning for and tolerate distress realizing that you know some days we're going to walk in and we're going to be starting with a full inbox."

"Pain and distress are part of life and refusing to accept this leads to suffering."

"Any attempts at change will produce distress therefore distress tolerance skills are necessary."

"Distress tolerance means surviving crises and accepting life as it is in the moment."

"Tolerance and acceptance of reality don't equate with approval though."

"Every time you have an urge think I have a choice."

"What you do is experience the feeling of the urge with acceptance not judgment and be aware that it's there a wave."

"STOP skills include hey stop it this is the hardest part in my experience working with clients is getting them to be able to pause between the triggering event and the action."

"You are not your emotions become a fly-on-the-wall become a lab technician put imagine yourself in a lab coat stepping back with a board and just observing what's going on your thoughts your physical sensations your urges."

"When you are in the midst of a crisis at first at least this is not the time to start brainstorming well what positive thoughts could I have they need to have something there."

"A stark change in temperature can kind of jolt you out of a particular emotional state because again your mind goes from this emotional distress to okay this is really unpleasant."

"I firmly believe that the way people feel is very accurate and OnPoint for the experiences that they've had leading up until now and the knowledge that they have right now."