Overview
Distress tolerance refers to the capacity to cope with negative experiences or internal states.
History and Etymology
In the late 1940s, Else Frenkel-Brunswik studied the concept of Tolerance of Ambiguity (TOA) to track how people handled complex, unfamiliar, or vague stimuli. Those with low TOA appeared to respond to those kinds of ambiguities with pushback and potentially destructive behaviors. After WWII, there was a strong interest in studying authoritarianism and fascism psychoanalytically to determine how these systems intersected with personality traits. Frenkel-Brunswik theorized that those with low TOA were prone to authoritarianism because their rigid egos led them to project a need for order onto the outside world. On the other hand, those with high TOA were thought to find ambiguous situations interesting or neutrally, with curiosity or apathy rather than hostility. In 1962, Stanley Budner proposed three types of ambiguity that low TOA individuals can perceive as a threat: novelty, complexity, and insolubility (defined as situations that appear to lack a logical solution). The 1970s saw lots of scientific literature around self-harm and suicide discussed other types of tolerance of negative emotions under the idea that self-harm was an impulsive reaction to ephemeral but overwhelming feelings.
While not wholly pseudoscientific, TOA has been shown to have weak internal consistency, especially since TOA fluctuates highly between different situations. Someone might be able to handle a lot of ambiguity at work or logistical problems, but struggle with any ambiguity in communication with romantic partners.
In 1993, Marsha Linehan, a key figure in the development of Dialectical Behavioral Therapy (DBT) proposed the term “distress tolerance” through an integration between Gerald May’s willfulness and Zen traditions that emphasized acceptance of emotional pain rather than the suppression or rejection of it. She sorted distress tolerance skills into:
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crisis survival techniques: short-term strategies to prevent emotional decision-making from leading to impulsive and self-destructive behaviors that would only worsen the current situation, largely by regulating the nervous system with physical activities or practices that produce “opposite” emotions.
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sensory body awareness: interruptions to cognitive spirals by grounding oneself in one’s body with a sense of presence and mindfulness with somatic techniques, such as progressive or paired muscle relaxation and breathwork.
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reality acceptance: skills to practice endurance of ongoing pain that has no immediate resolution by accepting reality as the result of a long cycle of causes and effects even when emotions like anger might tempt a rejection of reality as it is.
Substance use disorders and behavioral compulsions are addressed with a specialized category that includes:
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Urge Surfing: visualizing cravings as waves to ride out until it subsides
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Clear Mind: balancing thoughts and moods between the “Clean Mind” that believes relapse will never happen again with the “Addict Mind” that wants to surrender completely to a craving
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Alternate Rebellion: practicing creative alternatives to substances or compulsive behaviors that still address an urge to act out or craving to escape
Commentary
I have a strong distaste for the concept of “distress tolerance” as a set of discrete manualized mechanisms that anyone can learn and practice repeatedly like a muscle in a workout routine until it becomes stronger. My intuition is that the vast majority of people who end up seeking treatment have undergone a tremendous amount of distress, and while there’s always room for improvement, the principle of diminishing marginal returns apply.