Build Your Distress Tolerance
By: Lauren Milton
June 4, 2024

Build Your Distress Tolerance

If you have ever taken a Dialectical Behavioral Therapy (DBT) course, then you are likely familiar with the idea of distress tolerance. This is a common thing for people who have Borderline Personality Disorder (BPD) to struggle with which can lead to impulsive behaviors to try to ease the discomfort they are feeling in their body. Distress tolerance is also a good thing for people who suffer from anxiety to learn. When people are not taught healthy ways of coping with uncomfortable feelings from a young age, their tolerance for distressing feelings (such as anger, anxiety, fear, sadness, etc.) can be very low. Those feelings may seem to go away on their own but if we are taught A: that those feelings are “wrong” or “bad” and/or B: that they just have to be muscled through/ignored, this leaves us without healthy ways of dealing with those feelings. If the feelings become too intense, such as when we experience trauma, or we simply don’t have a lot of resources to otherwise manage the stressors of everyday life, this can lead to people engaging in numbing behaviors (whether that be alcohol, drugs, sex, etc.) While there is nothing wrong with giving yourself a break, regularly engaging in numbing leaves you less likely to be able to experience the joys of life and can ultimately cause more of the feelings that you are trying to numb. Our bodies and brains need us to deal with the painful things in life so that our nervous systems can be more regulated and that is where distress tolerance comes in.



            So how do we build distress tolerance? DBT workbooks have many acronyms for their exercises, one of which is TIPP. This stands for Temperature, Intense Exercise, Paced Breathing, and Paired Muscle Relaxation. This list is also helpful for people who experience panic attacks. The goal of these exercises is to get you out of your head and bring you back into awareness of your body. (I once started having a panic attack in Kroger and I grabbed a bag of frozen peas and stuck it on the back of my neck. The shock of the cold brought me back into my body and helped me get through the panic attack.)

Temperature – Often when we’re feeling anxious or starting to panic, our heart starts racing, we begin to sweat, our face flushes, etc. Our body’s reaction is to start heating up. So like my Kroger example, the goal is to help counteract that physiological response with something cool. If you can, splash cool water on your face. Grab a bag of frozen peas and put it on the back of your neck or on your forehead. If you’re driving, turn up the air conditioning and let it blow on you.

Intense Exercise – For some people this may mean going to a 5-mile run but that not necessary or always possible. Do a bunch of jumping jacks in your office or sprint down the aisle in the grocery store. (Just be careful not to run into anyone!) The goal of this exercise is to increase your oxygen levels which decreases your stress.

Paced Breathing – Everyone has heard that when you’re upset you’re supposed to take deep breathes. This particular advice never worked well for me until I learned about 4-7-8 Breathing. The counting was enough to distract me from my racing thoughts and gave me something else to focus on. Keeping a steady, even beat in your mind, breathe in while you count to 4, hold your breath while you count to 7, then breathe out while you count to 8. Try to be mindful of breathing into your belly as opposed to your chest. Do this several times in a row. This one and the next exercise are good for when you’re someplace that you can’t get up and move around, such as on an airplane or in a meeting at work.

Paired/Progressive Muscle Relaxation – When we tighten a muscle and then relax it, this actually allows the muscle to relax even more than before we tightened it, which leads to the muscles needing less oxygen. If you work your way up your body from your feet to your face, this is known as Progressive Muscle Relaxation. You would start by squeezing the muscles in your feet as tight as you can, holding it for a few seconds, and then releasing. Then tighten the muscles in your calves, hold for a few seconds, and release. Work your way up through your thighs, glutes, stomach, shoulders, arms, hands, neck, and finally your face/forehead. Allow your body to completely relax after each set of muscles.

If you think that these exercises would be helpful, I highly recommend practicing them when you’re not in a distressed state. The more you practice when you’re feeling okay, the more naturally it will come when those moments of stress arise. Just like building a new muscle with weights takes time and practice to get strong, so does learning a new coping skill.