Distress Tolerance in Everyday Life

July 11, 2018
Distress Tolerance in Everyday Life Stress is an important and complex part of our experience as human beings.  Some stress can be beneficial as a motivator (eustress) and some stress can be harmful to our minds and bodies (distress). When life pushes us too far and we become distressed, the long term effects can be overwhelming. In moments of severe distress, our bodies can begin to feel emotionally and physically under attack, leading to behaviors and decisions that can make a distressful situation worse. Distress Tolerance skills are everyday practices that a person can start to incorporate into their daily life to reduce the trauma of distress and regain control of their wellbeing. This blog will cover two groups of skills that come from Dialectical Behavioral Therapy (DBT) and Cognitive Behavioral Therapy (CBT). For more information on DBT and CBT, additional links and resources are included at the end of this blog. These skills are arranged into acronyms; STOPP and TIPP. These acronyms are a helpful way to remember these tools because when you are in the middle of distress, it is common to get tunnel vision and hard to concentrate on what to do. Implementing these techniques in the moment can give your mind and body just enough time to prevent a reaction that may make a distressful situation worse. The first acronym, STOPP, comes from Cognitive Behavioral Therapy (CBT). When a distressful situation hits, this acronym directs your mind to: S- Stop what you are doing T- Take a deep breath. Inhale for three seconds, hold for three seconds, breath out for three seconds O- Observe – What are you feeling in this moment? What is your mind and body telling you? i.e. “I am feeling hurt” “I am feeling misunderstood.” P- Perspective – How is what you are feeling fitting into the larger perspective? For this intervention, some people will carry a picture that reminds them of a larger perspective in their life or provides emotional comfort. Others may use visualization exercises. P – Practice – Any healthy skills that have worked for you in the past, practice those in this moment. The second acronym TIPP, comes from Dialectical Behavioral Therapy (DBT). When a distressful situation hits, this acronym directs you to: T- Temperature – When in a distressful situation, often your fight or flight response is activated, and the temperature of your face increases. This intervention involves lowering the temperature of your face.  Some people will excuse themselves to a restroom and run cold water on their hands and face as a way to relax themselves and reduce the impact of the fight or flight response. I- Intense Exercise – This can be done in the moment to release the adrenaline and cortisol that is activated in distress (stress hormones can take anywhere from 20 minutes to several hours to metabolize after a stressful situation). Walk around the block, hit golf balls into the woods, or try any physical movement that gives you a release of tension. Intense exercise can also be done regularly as a preventative way of releasing tension before a stressful situation happens. P – Paced Breathing – Breathe in for 3-4 seconds, hold your breath for 3-4 seconds, and breathe out for 3-4 seconds. This is known as controlled breathing or “box breathing.” Details of box breathing techniques and effectiveness are provided below in references and resources P- Paired Muscle Relaxation – If you struggle to relax, this active relaxation technique can be used with paced breathing to relax each muscle in your body. If you tense a muscle when breathing in, and then relax when breathing out, the muscle will relax more. More information on muscle relaxation techniques can be found in the resources below. References and Resources Dialectical Behavioral Therapy (DBT) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963469/ Cognitive Behavioral Therapy (CBT) https://beckinstitute.org/get-informed/what-is-cognitive-therapy/ Stress Hormones https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079864/ Eustress and Distress http://www.selyeinstitute.org/wp-content/uploads/2013/06/The-legacy-of-Hans-Selye44.pdf Box Breathing http://time.com/4316151/breathing-technique-navy-seal-calm-focused/ Paired Muscle Relaxation https://www.law.berkeley.edu/files/Progressive_Muscle_Relaxation.pdf