Robin Barstow, LCSW, MA, PhD on Mar 23, 2023 in Mood and Feelings
A teenage boy is in the hallway of his high school when he receives a text from his boyfriend that he can't meet up after school as they had planned. The school day was done, and the bell had rung. He is surrounded by his peers talking and laughing and slamming lockers and everyone bumping up against each other on their way to busses and cars and after-school practices. He reads the text and feels a stinging heat in his chest and face. He is furious. He wants to push that feeling away and text him back, “It's over!”
This teenage boy is in a situation where he is feeling distress. In other words, he is freaking out. We can all relate to this teenage boy. We have all freaked out. There are individual differences in the extent to which each of us withstands agony, anguish, and angst, but we can all benefit from developing distress tolerance. What is distress tolerance? It’s a skill for not acting out when we are freaking out. We learn distress tolerance so we don’t make a difficult situation worse.
Pain is a part of life, and if we can’t deal with our pain, we may act impulsively and end up hurting ourselves, hurting someone else, or not getting what we really want. If we are so intensively emotional that we feel like we can’t stand it, we might do something we later feel guilty about and deeply regret, like trashing things, relationships, or worst of all, ourselves.
How do we learn distress tolerance? The place to begin is emotional awareness. We can learn to notice when we are in pain. The teenage boy knows how to do this because he has been practicing cognitive behavior therapy (CBT), a method that teaches greater degrees of emotional acceptance, mindfulness, and self-awareness. The teenage boy is learning to notice when he is hit with a terribly strong emotion. He does not want to impulsively act on it. He wants to consider things before acting. In this case, he knows he does not really want to break up with his boyfriend.
The teenage boy puts in his earphones, floods himself with music he likes, and walks out of the school. On the bus home, he also watches some puppy videos on YouTube that always make him laugh. When he gets home, he puts on his running shoes and goes for a run. When he gets back, he makes himself a snack. Only then did he write back to his boyfriend. His fury had dissipated to the point where he could act the way he actually wanted to act. Instead of breaking up with him, he wrote, “I’m disappointed. I was looking forward to hanging out tonight, but I know your job is important to you.”
Sometimes when pain shows up as a big, powerful wave, it can sweep us off our feet. It can make us understandably afraid to feel things because we don’t want to get swept away by our emotions. Often the pain feels like it will never end, and we struggle with it in unhealthy, unsuccessful ways because we don’t know what else to do. When we are in pain, it’s hard to be rational and to think of a good solution.
So the teenage boy was using some distraction skills. We can distract our attention from our pain. There are lots of ways to do this — as he did, by listening to music, watching something, exercising, eating — but also possibly writing, spending time with pets, taking a shower, cooking, doing something in nature, reading, or anything healthy that soothes.
Distraction is not avoidance. When we avoid a distressing situation, we choose not to deal with it. When we distract, we intend to address it later when we have calmed down. Distracting does not fix the situation, and it does not make you feel better about the situation. A distress tolerance skill like distraction does not get rid of the pain and make us feel good. The goal is simply to tolerate the pain until it passes. The goal of distress tolerance is to get through a short-term crisis of pain without making it worse. When the high emotional state passes, then problem solving can occur.
Using CBT, the teenage boy had gotten better at noticing his pain and therefore better at going right to his distraction tools. He had gotten better at tolerating his pain. Next, he began to understand his stressful thoughts causing that pain. He learned he had a habit of thinking and believing that whenever his boyfriend changed their plans, he was rejecting him. That was very painful. Using CBT to question these stressful cognitive distortions, he found they were not true. This shifted something in him. The teenage boy believed his stressful thoughts less, so the pain didn’t last as long. In other words, he could both tolerate distress better, and also he had less distress to tolerate!
We can learn to notice acute pain when it arrives; we can use distraction skills to help us in the time it takes for the pain to pass. Then, once it does, we can regain the ability to problem solve and identify the stressful thoughts causing the pain. The more we practice distress tolerance, the more we grow our faith in ourselves. We can do it. We can grow in happiness.
Carol Landau, PhD (2020). Mood Prep 101: A Parent’s Guide to Preventing Depression and Anxiety in College-Bound Teens. (Chapter 8; Distress Tolerance, Distraction, and Mindfulness Matters). Oxford University Press. New York, NY.
Lotan, G., Tanay, G., & Bernstein, A. (2013). Mindfulness and Distress Tolerance: Relations in a Mindfulness Preventive Intervention. International Journal of Cognitive Therapy. Vol. 6. No. 4.