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What Is Distress Tolerance? (And Why It Matters.)

Recently I’ve become a bit obsessed with the idea of distress tolerance. It’s “An individual’s perceived or actual ability to withstand negative emotional or physical states” (Brown, Lejuez, Kahler, Strong and Zvolensky, 2005).

Note that it’s both your ACTUAL ability and your PERCEIVED ability.

In simple terms, the longer we’re willing to tolerate distress, the greater our ability to act while we’re feeling anxious.

Because remember, the goal isn’t to make the anxiety go away. It’s also not to just suck it up — I’m certainly not advocating we punish ourselves. It’s about reacting differently to our discomfort in order to show our brain there is no danger: we’re just uncomfortable.

Remembering our “why” helps make this process more tolerable. Why do we want to get more comfortable being uncomfortable? Maybe it’s to show up differently as a parent, friend or partner. Maybe we want to get back to things we used to enjoy but no longer due because of our anxiety. Our “why” is important to us when we’re not worrying excessively.

Let’s look at some examples.

If you’re someone who gets really anxious before doctor’s appointments, do you:

a. Cancel the appointment (you’re not really feeling that bad)

b. Go (but have to take a Xanax)

c.  Ask your friends and family if you should go

d. Let the nurse know you’re nervous

When you’re doing cardio, and it’s time to go all out, do you:

a. Skip this altogether because you don’t like how your body feels at high heart rates

b. Hold back because you’re scared of what could/might happen if you go all out

c. Stay at your regular easy(ish) pace

d. None of the above because you’re not an exerciser

For someone struggling with anxiety, both examples could be situations where they want to immediately hit the escape button. Our brains scream AVOID AVOID AVOID. The fight or flight alarm has been activated.

Between all the “what-ifs” their brain may create, the sensations and feelings that go with them, and any memories that may be attached, it can be a lot. Our anxiety equates this distress to danger, whether real or perceived. Thoughts are just thoughts, but, as Drew Linslata says, “thoughts can be strong and also very wrong.”

What we want to do is identify when the alarm is false, and then learn to increase our tolerance of the uncomfortable.

While you may have a lower distress tolerance now, the good news is that it can be increased. Think of it as a muscle — we stretch it, we build it. It gets bigger.

When we’re willing to being open and accepting of however we may feel, we learn how not resist it. And that’s who we change our relationship to our anxiety.

If you have more questions or want to dive in deeper, contact me!