Tolerating Distress

One of the things that has been very difficult for me in DBT is the idea of “distress tolerance”. For the most part, American society does not promote the idea that there are times that things will suck and you’ll just have to let that be and you can’t do anything to fix it. We’re a society of fixers. There’s always a solution if you try hard enough right?

Unfortunately that’s not the case. There will be times when we simply have to wait out unpleasant feelings. In general those unpleasant feelings will dissipate or be relieved with time, or after some time we will be able to change something to improve our situation. Sometimes we also just have to accept things that are shitty: certain people will not change their behavior, your health may not improve, politics might always suck. These are things that you might just have to let be. And for these things, you have to learn that your feelings may stick around and there’s not a whole lot you can do about it. This is where distress tolerance comes in.

Distress tolerance is hard. It’s not about making yourself feel better, it’s rather about making it to the end of the bad feeling without doing anything to make your situation worse. This is one of the hardest things to remember while trying to tolerate nasty feelings, and it also makes it a lot harder to be successful because it’s hard to feel like it’s working. However it’s not a bad thing to feel like crap for a while. This is hard to understand for many people. It is normal, acceptable, and in fact healthy to feel like crap sometimes.

So what is distress tolerance? There are a number of elements to it and I’m not going to touch on all of them here, but I do want to talk about how many people give tips for distress tolerance and how we can really improve on those tips. I see lots of lists floating around about what to do if you’re tempted to self-harm, or how to resist purging. These lists are GREAT. They include things like holding a piece of ice, drawing on yourself with red marker, ripping something up, all great suggestions. Unfortunately not all of these things work for everyone, and it can be extremely frustrating when you look at the list and can’t find anything that speaks to you.

It seems to me that there might be a better way to approach distress tolerance that is more individualized. Of course sharing ideas and letting others know what’s helped you is great, but not everyone likes or responds to the same things. One of the things that we’ve been discussing in DBT are larger categories that can help you: things like using your senses, imagery, taking a mini-vacation, or relaxation. Each of these categories is then open to all of your personal ideas. Let’s look at a couple of examples:

Senses. I’ve heard a lot of people give examples of this without quite realizing it: finding something soft, holding ice, listening to music. However I’ve often found the examples unhelpful until I heard the larger idea that you should think about your senses and try to pinpoint what sensory experiences really ground you. What makes you feel like you’re really in your body? I’ve heard people suggest scented candles, but those make me sneeze a lot and I don’t much like them, so I basically just discounted nice smelling things. When I heard that scent was something I could think about, I immediately thought about my dad’s spaghetti sauce. It makes me think of home, of youth. It grounds me. I got some from my parents to put in my freezer and now I can pull it out on a bad day and heat it up, letting that smell permeate my whole apartment. This personalization is far more effective for me than the generic suggestions were.

You can do this same sort of thing with any of the skills: what kinds of images calm me down? What would be a “safe place” I could picture? What has calmed me down in the past? What kinds of things do I find relaxing? What places feel “away” for me in my daily life? What’s out of the ordinary that I could use as a small vacation?

It’s a good idea to take some time when you’re NOT distressed to think about these things so that you have a small stockpile. For an explanation of each distress tolerance skill you can go here. I don’t think we spend enough time personalizing our coping skills, but it is important to think about what works for YOU.

When Negative is Positive

I posted last week about my lovely sweet kitty passing away, and since then I’ve been largely quiet on the subject. This is probably because my general coping strategy is to try to get rid of anything that makes me feel bad. I am amazing at distracting, at acting opposite to my emotions, at looking like I’m coping fairly well by going to work and doing everything I’m supposed to do. Interestingly enough, this strategy often gets praised: people tell me that I’m doing well, that I’m getting through things, etc. In conjunction with this, I’ve seen a lot of people lately talking about taking the negative influences out of their life. I think that one of the coping methods that our society promotes right now is to simply abandon, ignore, or run away from things that hurt you. On some level this is good: leaving a toxic relationship behind is a great idea, or getting yourself away from a horrible job. If you cannot fix a situation, it might be the best idea in the long term just to leave it.

 

However I think that this method of coping has gotten extended from one that applies to long term or never-ending situations (in which it’s good) to something we apply to short term situations (which are often good learning experiences or can gain you something in the end). Excising things that are negative is a good coping strategy when there is something in your life which is bad for you and will not end, and whose positive consequences don’t outweigh the negatives. It is not useful in situations that are short term and which you need to be in: for example you need to grieve a loss in order to heal from it. You might need to be able to cope with being temporarily bored because boredom will happen in your life. You should be able to tolerate an unpleasant class because it will end and you know that you need the credits. Removing ALL of the negative things from your life leaves you unprepared to process and tolerate distress. It also often requires stuffing some of the negative emotions you do feel simply by not thinking about bad things that you can’t get rid of (for example the loss of something). Those emotions have nowhere to go, and generally build. A healthy relationship with emotions requires you to be able to tolerate distress in order to process it. Avoiding all distress doesn’t let you do this.

 

I think that in general as a society we have lost the skills for distress tolerance because we have so many tools available to us to be able to take ourselves out of negative situations. Unfortunately, this means that we often might miss out on a big payout at the end, or leave ourselves floundering when something we can’t avoid comes along. Now I think that when we see a clear physical payout, we’re fine with putting in hard work and tolerating distress: we can work long hours or wait in line for tickets to our favorite band, but that’s because we know exactly what we’re getting out of it.

 

However in emotional terms we’re far worse at this. I think that in relationships people are not very good at putting up with bad times, because they assume it means things will always be bad. We may be willing to tolerate boredom (although only with our smartphones at our sides), but when we’re put into a situation that makes us feel unwanted or anxious, we bail. We haven’t learned that we can learn skills to help us calm down, to stand up for ourselves, to effectively get what we want and need, and to still validate the other person in a given situation. We haven’t learned that some bad emotions can teach us things.

 

The problem with this is that when we hide from things that scare us or make us feel bad, we never get around to processing that information, and our brain never gets to the point where the threat feels like it’s gone. We walk around carrying this DANGER sign in our mind indefinitely, still feeling every loss or anger or frustration or fear that we haven’t yet turned off. Our brains need to be told that a threat is gone by understanding the new shape of the world, and in order to do that we have to look at things that hurt. This can be hard. It’s uncomfortable. It feels bad. But it’s also necessary and good, and in the long run will leave us with less stress and anxiety, less anger, and less worry, more content with where we are.

 

There are ways to feel negativity without it getting out of control. You can give yourself a concrete amount of time to feel it, give yourself something positive to look forward to afterwards, or have other people around. Emotions don’t have to be overwhelming.

 

And so I suggest that we all take a minute today to be with whatever’s bothering us. Just a minute. A contained moment by ourselves to feel it, well and truly, and then to move on and let it be.

Mandatory Mental Health Education

Lately I’ve been spending a lot of time talking to people about concrete ways to deal with stress or improve their mental health. It’s been really interesting and kind of exhilarating as I notice how much I’ve learned in the last year or so and how wonderful it is to be able to share with others. However as I do this, I’ve begun to notice that even those people who are supposedly “normal” often don’t have a whole lot of skills around managing their mental health. Many of them have struggled to regulate emotions, to understand interpersonal effectiveness, or to tolerate distress. While they likely don’t feel emotions as strongly or have as few skills as those with diagnoses or who have been medicated, there is almost no one in this world who is an expert in navigating their emotions and mental health. To use the featured pic as an example, while not everyone is hanging out in the burning basement, few people are on the roof and everyone could enjoy being a few steps higher on the ladder.

 

The odd thing about understanding emotions is that it’s something we’re never taught. We are taught how to interact with other people, we are taught how to learn, we are taught how to budget or do our laundry or care for an animal. We’re particularly taught how to take care of our physical health. But for some reason everyone is expected to just pick up how to manage emotions and mental health. Now many of us have things modeled for us by our parents, but they were often just as clueless as we were and have cobbled something together out of their life experiences to get the best version they can. And rarely do they spend a lot of time consciously helping us sort out our emotions. All of that seems a little bit ridiculous to me. If there are two things that are really really useful to be successful anywhere else in life it’s stable mental health and stable physical health. If you don’t have those two things, everything becomes infinitely more difficult. So why don’t we give our children the tools to succeed?

 

Especially as I’ve been participating in DBT, I’ve been noticing that it really would not be all that hard to include education like that in schools. I only go once a week for two and a half hours. And I’m supposed to figure these skills out in a year. If we began implementing some of the knowledge that we have from psychology in schools from the time children start and teach them skills that will actually help them regulate emotions and deal with interpersonal relationships, we wouldn’t have to devote much time each week to it. Think of how helpful it would be to kids to understand what being judgmental is and how to cut down on judgments without feeling ashamed or bad about it. Or how helpful it would be to give them clear strategies for calming themselves. Or to help them recognize and name their emotions. Or to learn that emotions are acceptable and that they can feel emotions and simply sit with them. Holy cow I would have done so much better in life if I had had some of this basic training.

 

I don’t know if there’s any way to make this happen, but if we could adjust education in any way, I would suggest that we should add in a basic curriculum of emotional regulation. Most schools have a school therapist: it could be something they do once a week or once a month, or it could be something that teachers start getting trained on in school. It would include skills like how to make requests, set boundaries, validate, or be generous to and with others as part of interpersonal effectiveness. It would include techniques like breathing, distraction, or self-soothing for tolerating bad situations. And it would include some measure of work on identifying emotions, accepting emotions, fighting judgments, and using mindfulness to accept situations. Does anyone have a suggestion of how to make this into a petition or move it into the broader dialogue? I never hear a question of emotional education being brought up when we talk about improving mental health, but this could be a huge step towards decreasing stigma and increasing access.