Distress tolerance

Joining me today is Dr. Suzanne Wallach, a licensed psychotherapist and the founder and executive director of SoCalDBT, where she specializes in high-fidelity dialectical behavior therapy.

Her work focuses on helping people develop practical skills for emotional regulation, distress tolerance, mindfulness, and interpersonal relationships.

Today, we're talking about how to regulate your emotions without shutting them down, how to create space between feeling and reacting, really important, and how DBT can help us take care of ourselves when emotions feel overwhelming.

Dr. Suzanne, I'm so excited to have you on Project Loving Myself today.

So how can we learn to regulate an emotion without suppressing it, without shutting it down and then choosing the best response to that? So

I think it's a multi-step process.

And so it actually involves, that's where the four things that you just mentioned, like mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness all sort of start to layer upon one another.

And it's a process of using skills in all four of those areas.

So that's tolerating that discomfort, and that's a big one.

You know, and I think that's the reason why like, right, distress tolerance.

Yeah.

I think maybe, oh, I just had a good thought.

Like, as you tell me that, what do you notice happening in your body? Well, I noticed some sadness.

Boom, there's the door.

Let's open it, you know? All right, so what would it be like if you'd allow yourself to stay with that sadness? What do you notice happening? Can you put a hand on the sadness? Where is it located? Can you actually let the sadness increase? Can you let it grow top to bottom, front to back? How big can you get it? You know, because this starts to really help them with distress tolerance.

You know,

I have to actually learn how to see it as an aspect of being human and wanting to have an individuating relationship.

If I wanna be differentiating, if I wanna actually be doing that work, then I have to be able to increase my distress tolerance to experience you as truly other.

Yes, absolutely.

Thank you.

That's a good way to say it.

I have to increase my distress tolerance to see you as other, as someone with your own [laughs] agency and autonomy and different to me with different likes and desires and dreams and, and, right?

And in my experience, that was easier when I had the mirage of monogamy-

Right

... you're gonna need a lot more, um, of this, this guardrail before sometimes you go into an experience.

You in a sense have to both work on your abilities of distress tolerance in the moment when you experience big emotions, but you also have to realize you won't win a ton of fights in the middle of a battlefield.

You're gonna go down the path on that train.

If you bought that ticket, you're gonna go down there until the train slows down, you know? So, so accepting that when it comes to your emotions, they're more explosive.

A- a hundred percent.

And, and, and, and that is why one of the biggest tips I give to people with ADHD is the, is the fact that if you wanna tolerate your ...

If, if you wanna practice distress tolerance skills, start when the distress is low.

And, and it sounds obvious, but it's actually a lot harder because someone with ADHD, when they start to feel their emotions rising, they look at it, th- they, they look at it and they go, "Oh, well, my emotions are still minimal, so I can continue working.

But what it did was put me in a room, virtual at first, with a bunch of other anorexics and bulimics who were struggling and who had very different stories from mine, but similar struggles, and we were together looking at why this is making life so hard and why the thoughts, thoughts and underlying beliefs are actually the things we need to, to tackle.

And so the skills that we worked on that were so helpful was that we did some, uh, distress tolerance, DBT, and that was incredible, first of all, because the purpose of it wasn't to solve the problem.

It was to get through it without making it worse.

And that doesn't maybe sound huge, but it was a really big game-changing thing for me.

Well, after going through that treatment process of trying to start to center pleasure and fun and creativity and all that and, and use those DBT skills, it was even more apparent that what we had started working on in terms of connecting to body instead of living in my mind all the time, living in fear all the time, was more essential than ever.

Scarier than ever, but more essential.

And while the treatment had been really good in giving me the theory and providing the structure for distress tolerance, DBT, getting some leisure back into my life, it was hard to do a lot of that and to go through those experiences in a meaningful way without connecting to my body, without connecting to what I was feeling.

Because if I can't sense what's pleasurable or what's joyful, then how, how do I even do that? And so it was clear I was still very much living in my head, where all the sort of fears and eating disorder voices just kind of run rampant.