Distress Tolerance in Post Traumatic Stress Disorder

Using Distress Tolerance to Manage Intense Emotions

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Distress tolerance is your actual or perceived ability to stand up to emotional distress. Distress tolerance is also surviving an emotional incident without making it worse.

Do you have posttraumatic stress disorder (PTSD)? If so, chances are that many things in life cause you emotional distress that's hard to manage.

Fortunately, learning distress tolerance techniques can make a very positive difference in your ability to handle distressing emotions.

What's the Impact of Out-of-Control Intense Emotions on People With PTSD?

People with PTSD often feel very intense negative emotions such as shame, fear, anger, anxiety, guilt, and sadness. These can be frightening, and the stronger your emotions are, the harder it can be to control them.

You may even find it hard to identify the specific emotions you're experiencing--which can make them feel even more frightening, unpredictable, and out of your control.

People with PTSD sometimes choose unhealthy behaviors, such as deliberate self-harm, binge eating, substance abuse, or other impulsive behaviors, as ways of coping with intensely distressing emotions.

Unfortunately, the relief these measures provide is short-lived, and to make matters worse, the distressing emotions often return even stronger and more upsetting.

The good news is that learning distress tolerance techniques can help you:

  • Prepare in advance to cope with intense emotions
  • Enjoy a more positive long-term outlook for coping with them

What Distress Tolerance Techniques Are Available?

If you have PTSD, you can select from a number of treatments that include teaching distress-tolerance skills. For example, a treatment called dialectical behavior therapy (DBT) can provide you with skills that are directly focused on increasing distress tolerance. Another treatment, called interoceptive exposure, can help increase your ability to tolerate the effects of intense negative emotions on your body, such as increased heart rate and muscle tension.

Distraction can be a very effective way of taking action to increase your distress tolerance. Many practical and effective behaviors for distracting you from intense emotions are emphasized in DBT. They include:

  • Getting Active. Do something you enjoy, such as taking a walk in beautiful surroundings. Or do something you'd be doing now​ if you weren't feeling so upset.
  • Contributing. Go outside of yourself by focusing your attention on helping others (for example, volunteering at a school or nursing home).
  • Comparing. Think of a time when you were even more emotionally distressed than you are now. Give yourself praise and credit for getting through that crisis--and for doing all you can to get through this one.
  • Triggering Opposite Emotions. Ask yourself: What's the opposite feeling to the distress I'm feeling now? Then do something to make you feel that opposite way! For example, if you're feeling very angry, watch a comedy show or movie that always makes you laugh.
  • Thinking Big. The idea is to fill your brain with other thoughts so there's no room for the distressing ones. You need a lot of detail for this one, so imagine something like decorating a beautiful new home room by room or, if you're in a crowd, guessing each person's profession.
  • Self-Soothing. You may already be familiar with this calming technique, in which you use sight, sound, smell, touch, and taste to "treat" yourself to comforting, pleasurable experiences. But this time, think of how you'd comfort a loved one who's in the situation you're in now--and then comfort yourself in the same caring way.
  • Putting Your Body in Charge. Some mental health professionals consider this the best way to get unstuck from the grip of intensely distressing emotions. It's based on the idea that where your body leads, your emotions will follow. So get going! Run up and down stairs. If you're inside, go outside. If you're outside, go inside. Your body and your emotions will thank you.

As you can see, learning distress tolerance skills can not only help you get through emotional crises but can also bring more enjoyment into your life. Although the distress tolerance treatments described here were not originally designed to treat PTSD, their use now for this purpose often brings very positive results.

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  • Contois K. (2010). Distress tolerance skills: helping the clients through the tough times (and yourself). Seattle, WA: University of Washington-CHAAMP/Harborview.
  • Vujanovic, A.A., Bernstein, A., & Litz, B.T. (2011). Traumatic stress. In M.J.Zvolensky, A. Bernstein, & A.A. Vujanovic (Eds.), Distress Tolerance: Theory, Research, and Clinical Applications (pp. 126-148). New York: Guilford Press.