DBT and Distress Tolerance Skills

By Carissa Weber

Photo by Craig Adderley on Pexels.com

One of the hardest things about therapy is gaining the acceptance that emotions are uncomfortable. So many people think they are supposed to feel happy go-lucky all the time, but he truth is, you’re not supposed to feel good all the time. Emotions all serve a purpose. If we ignore their purpose and only feel the emotion, we tend to get stuck in a never-ending pattern of anxiety, depression, and self-loathing. Distress tolerance skills are a way we can learn to accept some of these not-so-nice feeling emotions and tolerate them a bit longer each time they pop up.

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Distress tolerance skills are a set of skills part of a therapy practice called Dialectical Behavioral Therapy (or DBT for short). Developed in 1970s by Marsha Linehan (who was a suicide researcher) as a way to help decrease her clients’ urges for suicidal attempts or self-harming behavior. Her work has expanded to assisting people with various mental health diagnosis like anxiety, depression, substance use disorder, borderline personality disorder, and eating disorders.

“The truth is, you’re not supposed to feel good all the time. Emotions all serve a purpose.”

– Carissa Weber

DBT is very similar to cognitive behavioral therapy (CBT). Both are a form of psychotherapy. Both use structure to help people focus on the present moment. They both focus on what is in your control and what you can change, but DBT goes into a bit more depth and detail about how to your prefrontal cortex can use logic to tell that darn amygdala to hold their horses.

In DBT, the combination of mindfulness skills (like we discussed in the post, Mindfulness: the Art of Becoming Calm, Cool, and Collected), distress tolerance (a.k.a. – learning to cope with situations that put us in the triple F response), interpersonal effectiveness (learning to identify what you need and how to communicate to get your needs met), and emotional regulation (managing your emotions so they don’t shape actions and thoughts in a negative way) to help tame that darn amygdala screaming at us to react in impulsive ways. Sounds too good to be true, doesn’t it?

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DBT is a great treatment modality as it focuses on what is in your control and the changes you can create to decrease your own feelings of distress, essentially rewiring the alarm system that darn amygdala has created. Now DBT comes with some commitments. For starters, a person engaging in DBT therapy should be prepared to participate in therapy for at least one year. This year includes individual therapy, participating in group therapy, doing something called real-time coaching (to be used when you go into distress), take part in their own treatment consultation team (which usually consists of a case manager, a therapist, and a coach), and learning how to be their own advocates and essentially case managing for themselves and their needs.

There are many reasons why DBT works in the brain. First, DBT helps that darn amygdala to lower its activity. We can see this happening as we don’t react as quickly and as strong as we used to do. Second, the volume of the hippocampus and other gray matter in the brain (a.k.a. – the wrinkly pink part of our brain) increases. We can notice this increase by remembering ALL the facts versus just the ones our darn amygdala brings up. Third, there is an improvement of prefrontal cortex function. This translates into being able to tolerate distressful feelings better, process the emotions versus just acting on them, and improve our reactions when we are experiencing an emotional overload.

The bottom line: DBT works to change our brain!

Now that we have taken a bit of time to discuss what DBT is and why it works in changing our brain, let us go over one of the fundamental skillsets: distress tolerance.

As described above, distress tolerance is the art of learning how to sit with uncomfortable situations without them throwing us into a complete amygdala hijacking (more information on that in my post Fight-Flight-Freeze: The Ultimate Coping Skill). Distress tolerance is actually a set of skills that allows you to:

  • Recognize that you are feeling in distress
  • Ways to decrease the level of distress you are feeling
  • Change your behaviors while you are feeling distressed

Distress tolerance works in our brain several ways. First, it offers that darn amygdala a chance to become distracted while the prefrontal cortex takes a minute to gather facts about the situation that is creating distress. As the prefrontal cortex is interpreting the information, the thalamus is working with the hypothalamus and hippocampus to pull information from short-term and long-term memory to help the prefrontal cortex to tell that darn amygdala to politely shut the hell up.

Created by Carissa Weber at www.thatdarnamygdala.com

While this is going on, the brain starts to release the neurotransmitter GABA. This amazing little neurotransmitter starts to quiet down the release of adrenaline and norepinephrine to slow down the triple F response. As the body calms down, it also triggers the body to stop the production of acetylcholine. If you recall from the post, Neurotransmitters: The Language of the Brain, acetylcholine is responsible for muscle tension. When we are distress, what do we do? We tense those bad boys up. Slowing down the release of acetylcholine is quite a nice experience if you ask me.

That was a lot of information in a little post! I want to thank you for taking time to take care of you and tell you how much I appreciate your commitment to help end the stigma of mental health. In my next post, I’ll add on to this list of distress tolerance skills (yes, there are more skills!). Between now and then, take some time to practice these two and see which one helps you more. Remember, practice make progress!

To Recap this post:

– DBT is a form of psychotherapy to help us remain present in the moment and not react to destress

– the core pillars of DBT include distress tolerance, mindfulness, emotional regulation, interpersonal effectiveness

– Some distress tolerance skills are: TIPP, self-soothing, and IMPROVE

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