Distress tolerance, in essence, is learning that even though we may feel pain and suffering, it can be tolerated and life can be lived in spite of the pain. Distress tolerance skills allow us to tolerate these difficult moments, in order to heal and continue our recovery journey.

Many of us with BPD and similar conditions use coping skills to tolerate distress in our every day lives – these may be helpful coping skills like holding ice cubes, snapped elastic bands on our wrists, counting, midful breathing or using stress balls, or they may be unhealthy coping skills like substance misuse or reckless behaviour.

All four of the main skills have a different focus, but you will see that they all interlink at times and can be used in conjunction with each other:

• mindfulness is about oberserving and allowing thoughts to come and go
• emotion regulation is abour recognising the emotions we are feeling int he moment
• interpersonal effectivess allows us to say no or ask for help

Distress tolerance is about learning how to tolerate pain or use crisis intervention skills to cope with what is happening.

There are two main goals in distress tolerance:

1. crisis survival – to help us tolerate difficult situations, emotions or urges that we cannot immediately resolve
2. reality acceptance – to help us accept the life we live, and reduce suffering

Of course, everyone is different, so you may find that your therapist recommends different goals to these, this is just a broad example of goals in this skillset. 

Distress tolerance is about non-judgmentally observing your situation without attempting to change it or control it – this doesn’t mean you are condoning or approving what is happening, but recognising and accepting the facts of the situation so you can apply distress tolerance skills in the moment.