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. 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 those situations, distress tolerance skills can be critically important.
Why Are Distress Tolerance Skills Important?
One of the most destructive symptoms of BPD is impulsive behavior. Many people with BPD have problems with substance abuse, alcohol abuse, spending, 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:
- You have a strong emotion that is triggered by some event (e.g., rejection by a loved one.)
- You feel and believe that the emotion is intolerable (e.g., “I cannot stand this feeling.”)
- You engage in an impulsive behavior in order to reduce the seemingly intolerable emotion (e.g., drink alcohol).
- The behavior is reinforced because it works in the short term (e.g., you feel better temporarily).
- 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 emotional pain (because you are not engaging in so many destructive acts).
How Can I Learn the Distress Tolerance Skills?
The best way to learn the distress tolerance skills is to find a trained DBT practitioner in your area. For some ideas on how to find a DBT program, see “Find a BPD Therapist.”
In DBT, 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 BPD.
Here are a few exercises that might help you begin to work on your distress tolerance skills:
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.