BPD Distress Tolerance Skills

Smiling woman enjoying group therapy session

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Distress tolerance skills training is a core feature of dialectical behavior therapy for borderline personality disorder (BPD). The distress tolerance skills are meant to reduce impulsive behavior which can often result from an inability to tolerate strong emotions.

What Are Distress Tolerance Skills?

The distress tolerance skills are a set of tools that will help you manage intense emotional states without doing anything destructive.

Be aware that these skills will not necessarily wash away the emotional pain you are feeling or even make you feel less distressed. Instead, the goal of these skills is to prevent you from doing something that will make the situation worse.

These skills are best used when you are faced with a situation that you can’t fix—there are many events in our life that we can’t change, but that cause tremendous pain. In these situations, distress tolerance skills can be critically important.

Why These Skills Are Important

One of the most destructive symptoms of borderline personality disorder is impulsive behavior. Many people with BPD have problems with substance abuse, alcohol abuse, overspending, reckless driving, physical violence, and impulsive sex.

In many cases, all of these impulsive behaviors are preceded by strong emotions. Here’s how this works:

  1. You have a strong emotion that is triggered by some event (e.g., rejection by a loved one).
  2. You feel and believe that the emotion is intolerable (e.g., “I cannot stand this feeling.”)
  3. You engage in impulsive behaviors in order to reduce the seemingly intolerable emotion (e.g., drink alcohol).
  4. The behavior is reinforced because it works in the short term (e.g., you feel better temporarily).
  5. Once the temporary effects of the impulsive behavior have worn off, you feel worse because: (a) the thing that was causing you to feel bad in the first place hasn’t gone away, and (b) now you feel shameful about the impulsive behavior and its destructive consequences.

As you can see, impulsive behaviors are a pretty unhealthy way to deal with strong emotions, because while they sometimes “work” in the short-term (e.g., reduce distress), in the long term they actually make things worse. So, distress tolerance skills are an alternative to this cycle.

These skills help you get through the emotional pain without doing anything impulsive. In the long run, these skills lead to a healthier pattern and reduce psychological distress. You are no longer engaging in destructive acts.

How to Learn Distress Tolerance Skills

The best way to learn the distress tolerance skills is to find a trained DPT practitioner in your area.

In Dialectical Behavior Therapy, you will attend group skills training classes in which you will learn four types of skills: mindfulness skills, emotion regulation skills, distress tolerance skills, and interpersonal effectiveness skills. In addition, you will practice these skills in your day-to-day life and get support from an individual DBT therapist. DBT programs are highly effective in reducing some of the key features of borderline personality disorder.

You can try a few exercises that might help you begin to work on your distress tolerance skills, including tools for accepting your emotions, the Pros and Cons Tool, mindful breathing.

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  • Linehan MM. Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: Guilford, 1993.

  • Linehan MM. Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford, 1993.

By Kristalyn Salters-Pedneault, PhD
 Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University.