Distress Tolerance skills are a set of Dialectical Behavioral Therapy skills that are strategies to help you get though difficult feelings and situations, and tolerate (deal with, sit with, accept) the things that you can’t immediately change. Emotions can be extreme and lead to behaviors that are ineffective. You may not be able to change the stressful situation you’re in, but you can change the way you feel. Distress Tolerance skills are aimed to make your response to distress more effective.
DBT Pros/Cons are different from mainstream Pros & Cons in that DBT Pros/Cons looks at the Pros and Cons of tolerating vs. not tolerating distress or coping vs. not coping. In other words, it’s the pros and cons of tolerating the distress of a situation and the pros and cons of not tolerating the distress of a situation. When examining the pros and cons, you are looking at the consequences of potential actions.
Our example comes directly from a DBT Student:
“When I was in a yoga class, the instructor said something to me that reminded me of something my father used to say to me in a negative way. I knew she didn’t mean what my father meant but I still reacted emotionally and felt those old sensations of betrayal and invalidation. Many times in the past, when I experienced a ‘trigger’ situation like this, I would let it overwhelm me and I would never even stop to think about the fact that my life was different now. I would let it build up. In the past, I might have tolerated the feelings throughout the yoga class so I wouldn’t make a disruption, but by the time I went home, I would be out of control.
I knew I wanted to live my life differently and use the skills to help me. I thought about some ideas about what I might do to tolerate this distress:
- I could ‘ride the wave’ of emotions, reassuring myself that my feelings wouldn’t kill me, that I was strong enough to feel the emotions without acting out on them.
- When I went home, if I was still feeling those triggered negative emotions, I could distract myself by watching TV, playing computer games or reading a book.
On the other hand, I thought about what I would do if I didn’t tolerate the distress.
- I could stand up, yell at the instructor and walk out.
- I could go home and engage in self-harming behaviors.
Next, I began to think about the consequences of tolerating versus not tolerating this distress
When I look at this from a distant point of view, the correct thing seems obvious. But when I was ‘mired’ in the emotion, all options seemed equally possible.
Ultimately, I decided to ride the wave of emotion. Nevertheless, it turned out that my instructor had sensed that something was wrong and asked me about it after class. I told her that I was experiencing an emotional trigger from my past and that I needed to go through these emotions and work it out by myself.
By the time I got home, my emotions were less intense. I turned on the TV and found a show I wanted to watch. I allowed myself to get caught up in it and when it was over, I realized I had actually forgotten about the incident.”
| Pros | Cons | |
| Coping | -I’d feel successful for using skills -I might be able to change my state of mind and move on without using too much energy | -I’d have to put effort into self-control -I wouldn’t get the good feeling of creating drama & receiving attention |
| Not Coping | -I’m used to being in distress so it would be comfortable -I could have the temporary satisfaction of punishing myself | –My instructor might not let me return to class, there would be tension between us -I would feel regret, pain, and shame later |
Practice
Since it’s best to practice in less intense situations, when you’re not emotionally invested, write out some pros and cons for things you don’t care about as much. You may not be in distress at the moment but by practicing writing it down, you’ll be better at it when you’re done.
Think about a situation from your recent past. Don’t go for the most traumatic thing that’s happened to you. Think about something like an argument you got in or when you were in your car and yelling at people around you. You already know what you did, but imagine you were still back at that time and the prompting event just happened. Use the pros and cons to think of some other ways you might have behaved. Ask yourself if the same thing happened in the future, would you act differently? There’s no right or wrong. You’re just practicing thinking in a way that is different.
Next time you are in distress and considering acting rashly, try to take a moment to write a pros and cons square. Not only will the act distance you from your distress, it will help you decide how to tolerate it (or not). Eventually, the pros and cons square will become second nature and you’ll be able to make a quick draft in your head when you need to.
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