Thursday, June 2, 2016

Distress Tolerance and Acceptance

Distress Tolerance and Acceptance

Karen Connell, LPC, COTA/L

When faced with hard situations or strong emotions in life we find ourselves looking for relief from experiences that seem overwhelming or all consuming. We often focus on changing circumstances or events to relieve ourselves of the distress caused by the circumstances. Reality is, however, that we will experience pain and distress as a part of life. Anxiety, worry, fear, shame, sadness, anger and more are all human experiences- believing they are uncommon or should be easily avoided can create more pain and distress for ourselves.

Our efforts are more effective when we understand that we have options of how to deal with strong emotions. Yes we can try to affect the situation or change circumstances and we can be successful in doing so. It is important to see yourself as effective in these areas.  However, the goal of tolerating or accepting distress and suffering in the moment is truly a skillful option of managing the emotionally overwhelming moments to find peace for ourselves. Learning to accept and find meaning for these strong and uncomfortable emotions is an opportunity for your growth in relation to yourself and your perception of these struggles.

The beauty of this lesson is that in tolerating distress we find we are capable of coping through a difficult situation- “making it through without making it worse” and in practicing acceptance of distressful moments we find freedom from the fear, anxiety, worry, pain or suffering that we long to escape. When we resist emotions the power within them seems to grow. When we stop resisting them and see them for what they are: a current situation or experience we are having that we may or may not be able to change or control- their power diminishes. Trying to avoid pain generally leads to more problems than it solves. Obsessively avoiding stressors that cause pain or grieving without resolve are two examples of ensuring the pain will only continue.

Acceptance of unwanted emotions is a difficult concept for us to understand and embrace. It is most important to distinguish between accepting or tolerating distress in the moment and approving of the distressful situation. Just because we aim to accept these circumstances does not equal our approval of them. Practicing acceptance involves seeing reality for what it actually is- without attachment to it or judgment of it. It is letting go of our biases and opinions of how something should be (trying to push it away or telling ourselves it should be different), and instead finding what actually is at this moment. When we mindfully look at the moment we are in- however overwhelming or infuriating it may be- we can see it as just the moment we are in, causing emotional responses, thoughts and feelings. It is freeing when you can get to that place in a moment of emotional chaos or overwhelm.

For example, we can accept the fact that our loved one is in an unhealthy relationship we cannot get them out of, but we do not approve of this relationship. We can tolerate that our parent does not endorse our choice in career, but we do not approve or agree with their opinion or judgment. We can tolerate painful feelings of being alone or uncertain about our future and not approve of them as a way of life for ourselves. Releasing the attachment we have to these emotions and situations is a very powerful and healthy thing we can do for ourselves in times of high distress and emotional chaos.

Acceptance of emotions in the moment can be done in a practice of observing the breath while distressed. We quietly turn our attention to our breathing and notice ourselves in this moment as we actually are- no judgment, no fighting against the emotions- just recognizing the strong experience we are having of sadness, fear, pain or overwhelming frustration. Observing the breath brings us into the moment and accepts what is. With time this practice quiets the emotions and we are loosened from their grip. Radical Acceptance is a concept of saying to oneself when in the moment “the past is in the past” “it is what it is” “I can’t change what has already happened” “this moment is an accumulation of so many previous moments in which people were doing the best that they could”. This is powerful when current or past situations are the source of our distress.

Since we are not always able to accept strong emotions in the moment we must at times just tolerate them and do the best that we can until they have passed for the time being. The idea is to deal with the strong sometimes almost intolerable feelings and get through without making it worse. As said earlier when faced with strong emotions we can be reactive when trying to avoid them and create more problems as a result. At other times we are not in a situation to be able to process these strong feelings, such as in the workplace, yet we still feel upset, alienated or the like and have to tolerate the emotions.

Tolerating distress in the moment can be done with skills that distract us from the current emotion, reduce contact with the source of the distress or change our emotional experience in the moment. The have a temporary effect and often have to be repeated when emotions are strong in order to get through without acting on our emotions. For example, finding an activity to get busy with like filing, coloring, a game on your phone, cleaning, going to the bathroom, cleaning out emails or any other activity that is accessible to you at the time can change our thoughts, images and physiological experiences in the moment. Finding someone you can assist or focus your attention on to contribute to them in some way shifts our attention to something else and increases our sense of meaning in that moment. Reflecting on other times when things may have been worse, when you have coped in difficult situations previously or comparing your situation to someone who is worse off can all change your perspective on your current situation. Self-soothing with sensations (drink hot tea, listen to calming music or sounds, wash cold water on face, stretch your body, massage your scalp, smelling essential oils) creates a different physiological experience than the negative emotion you were previously experiencing. Prayer, imagery or relaxation exercises are all powerful in the moment ways to tolerate distress and make it through.  These skills are all about making them your own- finding what works for you and trying new things when you feel nothing is working in the moment. And sometimes breathing and practicing acceptance of what it- just in this moment-is the quickest way to honoring our self and finding relief.

Linehan, M. (1993) Skills Training Manual for Treating Borderline Personality Disorder.