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Facing Your Feelings 01 Understanding Distress Intolerance (Services Australia)

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How Does Dist ress Intolerance Develop?
The information provided in the document is for information purposes only. Please refer to
the full disclaimer and co pyright stat ements available at www.cci.h ealth.gov.au re gardin g the
information on this website before making use of s uch information.
• Psychot hera py • Res earc h • Training
Module 1: U nde rst andi ng D istr ess I ntole ranc e
We all experi ence emotion s. Emotions a re an imp ortant par t of being human, and ar e essential to our
survival. As humans we are designed to feel a whole range of emotions, some of which may be comfortable
to us, and others may b e uncomfortable .
Most people dis like feeling uncomfor table. There are many different wa ys that humans c an feel
uncomfortable…we can be ho t, cold, tired, in pain, hungr y, unwell, and the list c ould go on. The type of
discomfort we will be talking about in th ese modules is emotional discomfort, or what is often called
distress . We may not like it, but experiencing uncomfo rtable emotio ns is a na tural part of life.
However, ther e is a differ ence betw een disl iking unplea sant emotions, but nevert heless accepting t hat they
are an inevitable part of li fe and hence riding through them, vers us experien cing u npleasant emotions as
unbearable and need ing to get rid of them. Some people tell us that they “can’t face”, “can’t bear”, “can’t
stand”, or “can’t tolerat e” emotional distress. Being intolerant of experienci ng emotional discomfort can
actually bre ed a whole bunch of problems, as it interferes with living a fulfilling life, and can make worse any
emotional discomfort we might be experiencing. If d ifficulty facing your feelings or tolerating distress
sounds like y ou, then r ead on to learn ways to ov er come this pat tern.
There are ma ny different definitions of distres s intoleranc e. What we mean by distr ess intolerance is a
perceived ina bility to f ully ex perie nc e unple asa nt, ave rsiv e or unc omf ort able em otio ns, an d is
acc ompa nied by a de sper ate need to es cap e th e unc omf ortab le emot ions . Difficulties tolerating
distress are often linked to a fear of experiencing nega tive emotion. Often distre ss intolerance centres on
high intensity em otional ex periences, that is, when the emotion is ‘ho t’, strong and powerful (e.g., intense
despair after an argument with a loved one, or intens e fear whils t giving a speech).
However, it could also occur for lower intensity emotions (e.g., ner vousness about an upcoming medical
examinatio n , sadness when rememberi ng a pas t relati onship break - up). I t is not the intensity of the
emotion itself, bu t how much you fear it, how unpleas ant it feels to you, how unb earable it seems, and how
much you want to get away from it, that determines if you a re in tolerant o f dist ress.
There are varying types of negative emot ions that could potentially be distressing for peop le. We thought
it might be helpf ul to ca tegori se these emo tions into t he following 3 clusters:
This group incl udes emo tions th at reflect sadness at varying degrees of intensit y. This would include
disappointment, hurt, despair, guilt, shame, sadness, depress ion, grief, misery, etc. These emotions
can be accompanied by either low physiological aro usal (e.g., low energy, fati gue, heaviness) o r
heightened physiological arousal (e.g., intense crying, restlessness), thoughts of hopelessness, loss,
regret and inadequacy, an d the urge to hide away from life.
This group include s emotions that reflect anger at varying degrees o f intensity. This would include
irritation, agitation, frustration, disgust, jealousy, anger, rage, hatred, etc. T hese emotions are
usually accompani ed by high physiological arousal (e.g., tension, increased h eart rate, feeling sweaty
or hot, etc), thoughts of unfa irness, injus tice and wron g doing, a nd the ur ge to las h out in some way.
This group includes emotions that reflect fear at var ying degrees of intensity. This would include
nervousness, a nxiety, drea d, fear, panic, terror, etc. The se e motions are usually accompan ied by
high physiolo gical arousal (e.g., increased heart rat e, increased breathing, tension, sweat ing, shaking,
butterflies in s tomach, etc), thoughts of threat, vulnerability and helplessnes s, and the ur ge to av oid
• Psychot hera py • Res earc h • Training
Module 1: U nde rst andi ng D istr ess I ntole ranc e
For some people their distress intolerance might be v ery broad, in that they find all negative emotions
distressing, for other peopl e their distress int olerance might be very select t o just one type of em otion
(e.g., anxiet y). How about you? What N eg ative Emo tions do you find difficult to deal with?
___ _____ ____ ____ _____ ____ ____ __ _____ ____ ____ _____ ____ _
___ _____ ____ ____ _____ ____ ____ __ _____ ____ ____ _____ ____ _
___ _____ ____ ____ _____ ____ ____ __ _____ ____ ____ _____ ____ _
Note : Some people can be distressed by po sit ive e moti ons, not just the nega tive ones. It is no t unc ommo n for peopl e to be
concerned that posi tive emotio ns will make them lose control in some way. T hese modules wil l only focus on i ntolerance rel at ed
to negative emotions, but some of the strate gies may be re leva nt i f you ha ve t roubl e e xperie nci ng po sit ive e moti ons t oo.
It is i mpor tan t to rea lise that t he term distress that w e are using throughout the se modules , refers to
emotions that are experien ced as av ersive, unpleas ant, uncom fortable and upsetting. N ow, the 3 clusters
of negative emotion previously mentioned, are not ne cessarily in themselves distressing. For example,
some people like the e mpowering feel ing of being angry, a nd don’t find it at a ll an ups etting emotion. Some
people like watching horr or movies bec ause they enjoy the feeling of being sca red. Some people d on’t
mind feelin g sad, because it gets their creative energy going when it comes to art, music or writing, or they
may hold the attitude “it’s good to have a cry every now and then”. These examples s how that negative
emotion in itself is not necessarily di stressing , and as you will see in the n ext module, these emotions
are normal and often helpf ul to us. We only be gin to f eel dis tres sed w hen we eva luat e our
emoti onal e xp eri enc e as a ba d thi ng .
Now, it makes a lot of sense to try to get away from things that feel unpleasant. This strategy seems to
work for othe r things tha t make us u ncomfortabl e (e.g ., heat, cold, pai n, hunger, etc). Howev er, when we
appl y the same strategy to our emotions, it seems to backfire. This is the paradoxical nature of distress
intolerance. That is, the more we f ear, struggle with, and try to avoid any form of distress,
generally the worse that distress gets . Our fear and avoidance of the distress actually magnif ies the
Imagine your emotional dis tress is a pud dle of wa ter bl ocking your pa th. If y ou c an recognise t hat
emotional distress is not s omething to be fear ed, nor something to run away fro m, then all y ou hav e is a
puddle of water. If you jus t wait there it will eventually dry up enough to jump over it, or you could just
splash through it and keep on goin g. However, if instead you fear your distress, struggle with it and try
everything to escape from it, all you do is add more and more water to the puddle, and very soon you are
faced with a d eep pond that it imp ossible to ju mp ove r or spla sh through. The bi gger the pond, the harder
to find a wa y through it, and hence the longer you w ill feel stuck a nd unable to m ove forwa rd.
• Psychot hera py • Res earc h • Training
Module 1: U nde rst andi ng D istr ess I ntole ranc e
u are s till a bit unclear as to whether distress int oleranc e is a proble m for yo u, take a lo ok at the
follow ing s tate men ts. Put a tic k ne xt t o the sta teme nts you strongly agree
li ng distressed or upset is unbeara ble to me
When I feel distressed or upset, a ll I can think abou t is how bad I feel
I can’t handle f eeling distre ssed or ups et
My feelings of dis tress are so intense that they comple tely take over
There is not hing wors e than feeling distresse d or upse t
I don’t tolerate being dis tress ed or upset as w ell as m ost peo ple
My feelings of distress or being upset are not acce ptable
I’ll do anything to avoid feel distr essed or ups et
Other people seem to be a ble to tole rate fee ling distr essed or upse t better than I ca n
Being distre ssed or upset is always a major ordeal for me
I am ashamed of myself when I f eel distressed or upset
My feelings of dis tress or being upset scare me
I’ll do anything to stop feeling dis tressed or upset
When I feel distressed or upset, I must do something about i t immediately
When I feel distressed or upset, I c annot help but co ncentrate on how bad the di stress actually feels
The above sta tements are an adaptation of the Distress To leranc e Scal e (Simon s & Gahe r, 2005 )
u find y ourself agree ing with a lot of the above statemen ts, then this can be a sign of having diffic ulties
with tolerating emotional distress.
get an even be tter idea if distress intolerance is a pr oblem in your life, keep a tally over the next week
or so of any negative emotions y ou feel. Then mak e a rating o f how in tolerable (i.e., unbear able,
unmanageable) these feelin gs were for y ou. Also n ote how you rea cted to these emotions (i.e., Did you
frantically t ry to st op the fe eling? Did y ou ride i t out? Di d you do things that see med helpful or unhelp ful to
coping with the emotion ?). You c ould use a n otepad to keep tra ck of these thing s, and it migh t look
something like the example below. A fter having tuned in closely to how you tole rate negative emotio ns,
you may then be in a better position to as sess if distress intolera nce is a problem for you.
y/Time Negativ e Emotion Intole rabl e (0 - 5)
pped the anxiety by callin g in sick
to work. This was unhelpful given h ow
many sick days I have had, and I will
jus t have t o face w or k tom orrow
• Psychot hera py • Res earc h • Training
Module 1: U nde rst andi ng D istr ess I ntole ranc e
n important thing to co nsider when ass essing your own lev el of dis tress toleran ce, is tha t like many things
in life, doing any thing a t the extreme can be unhelpful. Think o f distress to lerance as a continuum where at
one end people ca n be ext remely intolerant of dis tress, and at t he other end people can be ex tremely
tolerant of dis tress. Si tting at ei ther end of the spec trum isn’t good for you.
f you were always overly tolerant of exp eriencing all unpleasant e motions, then problems migh t result suc h
as tolerating bad situations or bad people in y our life. If you were tolerant in the extreme, you w ould
never take ac tion to chang e unhappy circumstanc es in your life tha t need to be chang ed. As you read
through the r est of this module, you will ge t a sense of all the negative consequen ces that occur on the
other side of the spectru m when pe ople are intolerant of distress . When working through these m odules
we will be aiming for some where in the middle of the continuum, s o that yo u learn to balance tolerating
emotional discomfort when it does arise, with taking action to improve your em otional experiences.
ou m igh t li ke t o put a cro ss t o ma rk w he re yo u th ink yo u are on th is cont i nuum at the momen t.
How Does Distres s Intol erance D ev elop?
t is likely a combination of biological and environmental factors that lead some peo ple to be more
intolerant of em otional dist ress than o thers.
here is some sugg estion tha t biologically some peopl e are more sensitive to nega tive emotions,
experiencing n egative emotions more easily, at a higher level of inten sity, and for a longer durat ion t ha n
other people. This may mean tha t some p eople expe rience negative e motions a s more painf ul, and henc e
have greater diffic ulty copi ng with the experience.
is likely your exper iences growing up throug h childh ood, adolescenc e and through adult li fe, may shape
how you deal with emotions. Some people may not have been shown ways to t olerate emot ional
discomfort appropr iately, for e xample being punished for expres sing normal emotions l ike cry ing when they
were sad. Other s may have only been shown u nhelpful way s of dealing w ith thei r emotions, s uch as s eeing
a loved one use alcohol to deal with their own em otions.
inally, if we hav e stumbl ed upon unh elpful ways to es cape our e motions, these methods ma y have bee n
reinforced by temporarily m aking us feel better. As s uch, we ke ep using unhel pful methods and don’ t have
a rea son to l ook for other mor e helpf ul w ays of deal ing with our distre ss.
• Psychot hera py • Res earc h • Training
Module 1: U nde rst andi ng D istr ess I ntole ranc e
egardless of how a person’s distress intolerance em erged, we take the view th at this intolerance keeps
having a hold over people’ s lives due to certain beliefs they have developed about experien cing negative
emotions. These beliefs tend to cen tre on the notion that nega tive emoti on is b ad in some wa y,
unbearable, unacceptable, or will lead to disastrous consequences. These b eliefs tend to make any negative
emotion that we may feel, bec ome a highly dis tressing emotional experience. Below are s ome of the
common beliefs that pe ople with distress intolerance ha ve when they start to ex perienc e negative emotion:
This feeling w ill keep going on forever
Let’s try to uncover your common Distress Intole rant Belief s . Firstly, do any of the statements above
ring true f or y ou? If so, j ot down the s ta temen ts re lev ant to y ou. Secondly, ask yourself the foll owing
hat does it mean to me when I star t to feel uncomfortable e motions? What d o I think wil l happen if I let
myself feel distressed? What must I do when I feel any emotional discomfort?
___ _____ ____ ____ _____ ____ ___ ___ _____ ____ ____ _____ ____ _
___ _____ ____ ____ _____ ____ ____ __ _____ ____ ____ _____ ____ _
___ _____ ____ ____ _____ ____ ____ __ _____ ____ ____ _____ ____ _
___ _____ ____ ____ _____ ____ ____ __ _____ ____ ____ _____ ____ _
___ _____ ____ ____ _____ ____ ____ __ _____ ____ ____ _____ ____ _
• Psychot hera py • Res earc h • Training
Module 1: U nde rst andi ng D istr ess I ntole ranc e
s mentioned earlier, a clear sign of dis tress intolerance is when someone takes desperate urgent
measures to e scape or get r id of uncomf ortable emo tions. This can be done in a number of differ ent ways,
and each way can lead to signifi cant problems in a pers on’s life.
One method is via avoidance, and avo idance can take many forms. Firstly, there is
situati onal avoida nce . This is when yo u avoid any situation, scenario, place,
person, cue or activity tha t you know is likely to bring on distressing emotions.
Examples of t his might be av oiding a par ticular family member wi th whom you
become angry, avo iding studying because you become frustrate d, avoiding
socialising or leaving the ho use becaus e you beco me anxious, a voiding things that
change your physical stat e because you feel nervous (e.g., sittin g in a hot car,
drinking caffei ne), avoiding medical app ointments or tests because you are
frightened, or a voiding re minders of the past or certai n topics of conversation becaus e they sadden y ou.
second method, is a more subtle form of avoidance known as reass uran ce se eking or checki ng . Th is
is when you try to quickly allay your distressing emotions by excessively
people or engaging in som e repetitive checking b ehaviour. Checking or reassurance seeking temporarily
brings you comfort and takes away your distress, but the relie f is short lived and you have to keep doing
these things t he next time you feel distress ed. Examp les might inc lude having to repetitively check things
on your body (e.g., a physical sensation, symptom or feature) or in your environment (e.g., arou nd the
home), over - preparing f or things (e.g., projects, work, social events), keeping thin gs in excessive order, or
overly questio ning or cons ulting other people’s opinions to calm you dow n (i.e., family, friends, medical or
mental health professionals, internet resea rch).
ally, there is a third met hod called distra ction and supp res sion which involves trying t o push away
t he distress, rather than sitting with the emotion and feeling what needs to be felt (i.e., telling yourself to
“stop it” as soon as you feel any distress, finding any mental or physical activit y to distract yourself from the
slightest hint of emotion su ch as coun ting or r epeating positiv e statements, etc). The problem with
distraction and s uppression is that yo u can’t keep it up for long, and the e motion ends up being like a bea ch
ball you are trying to hold under the wa ter with your hands . You ca n only h old it at bay for so long, it
becomes exhaus ting, and e ventually it pops back u p and hits you in the fac e!
Numbing and wi thdrawing capture things you do t o tune ou t from the distress . The mos t common ways of
doing this would be by u sing alcohol or drugs to es cap e emo tional disc omfor t. Bin ge eati ng is also a
common me thod use d to try to all eviate di stress. Excessive sleep can also be used in an unhelpful w ay to
zone out from and es cape unplea sant emotions .
We have used the ter m ‘ha rmful release s’ to capture behav iours we mig ht engage in to relea se or vent our
distress, that are also d irectly physically damaging to ourselves. Rat her than allowing our emotions to run
their natural c ourse, we might injure or harm ourselv es as a w ay of st opping the emotional
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