How to Deal with Negative Emotions: A DBT Approach to Distress Tolerance and Mindfulness

Dr. Tracey Marks introduces distress tolerance, a core technique from Dialectical Behavior Therapy (DBT), as a method for managing negative emotions without resorting to maladaptive coping behaviors. She explains that while DBT is primarily known for treating Borderline Personality Disorder, modified forms are beneficial for a range of conditions including bipolar disorder, anxiety, eating disorders, depression, and PTSD. The central idea is to accept and make room for emotions like sadness, anger, and fear, rather than attempting to escape them, which often leads to long-term problems.

The podcast delves into the origins of emotional tolerance, highlighting the interplay of temperament (nature, or 'factory-installed reflex') and upbringing (nurture). Marks illustrates how societal or familial beliefs about certain emotions, such as anger being 'bad,' can lead to unconscious suppression, manifesting as anxiety or depression. She identifies common maladaptive coping mechanisms like avoidance (seeking reassurance, futile distraction), numbing (alcohol, drugs, binge eating, over-sleeping), and self-harm (cutting, punching, hair pulling), emphasizing their short-term relief but long-term detrimental effects.

The core practical insight is a mindfulness-based exercise for distress tolerance. This involves a three-step process: (1) Recognize and allow the emotion, even 'blowing it up' to its most intense form (e.g., 'I hate him') without judgment, making space for it without fear of acting on it. (2) Watch the emotion, observing its presence in the body (e.g., tension in shoulders) and labeling it, likening it to an ocean wave to be floated with, not fought. (3) Be present, redirecting attention to the five senses or the breath as an anchor, and repeating the observation process if the emotion returns.

Marks clarifies that accepting distress does not mean enjoying it or faking indifference. Instead, it involves a fundamental shift in perspective: seeing the emotion for what it is (e.g., rage) and changing how one pays attention to it, fostering a sense of detachment from its 'sting.' This mindful observation allows individuals to experience emotions without being consumed by them, ultimately altering their impact. The episode concludes by encouraging listeners to try the exercise, offering a template in the description for practical application.

"Distress tolerance is the skill of being able to accept the emotion that you're feeling without resorting to coping behaviors that make your situation and your overall condition worse."

"We're built to experience a wide spectrum of emotions, from happiness to sadness to anger to fear."

"Being afraid and wanting to run is an adaptive response for self-protection."

"How you tolerate and experience the different emotions is molded and shaped by your temperament, which is your nature, and your upbringing, which is how you were nurtured."

"If you grow up believing this, then you're going to have serious issues dealing with and being or feeling angry."

"Escaping the distressing emotion only works in the short term. What you do to escape it can cause more problems for you in the long term."

"It means you accept it, make room for it, sit with it, and let it pass on it's own time."

"When you think mindfully, you focus on what's going on at the moment with acceptance and no judgment. It's just observation."

"I am not my emotions. I simply watch my emotions."

"Accepting the emotion is about changing the way that you look at it. You see it for what it is... and then I change how I pay attention to it."