“Out of suffering have emerged the strongest souls; the most massive characters are seared with scars.” (Khalil Gibran.)
If you have found yourself drawn to this particular page, possibly you may be feeling overwhelmed, or saturated with an emotion? Perhaps you have found yourself resorting to an old, “go-to” strategy, in order to try and cope? Maybe you have, and it “didn’t work” as you now feel worse, or perhaps you did, and now feel a second emotion on top of the original one? Maybe you’re contemplating an old go-to strategy?
Whatever your situation or circumstances, please take some comfort in the knowledge that as human beings, we will all have “collected” various strategies, usually from childhood, that we find we tend to revert to using when the going gets tough. Why? Because, we are all creatures of familiarity and habit. If something appears to “work” the first time, whether we consciously realise it at the time or not, our brain will have arrived at a rather over-generalised conclusion about what to do when encountering that emotion again in the future. These over-generalised conclusions are often developed by our primitive brains, early in childhood, when we lack the skills, experience and ability to be able to organise our thoughts sufficiently in order to choose a considered response. Instead, as young children, we absorb all information we are exposed to (good, bad and ugly), unequivocally without logic or reason. If it “feels” accurate, therefore it is accurate.”
And so our brain “learns” to repeat the behaviour the next time it is exposed to the undesirable or unwanted emotion. We revert back to using our go-to strategies every time we encounter a problem that reminds our brain of the original unwanted emotion or feels similar to it. And so on.
Very often, by the point of accessing therapy, many clients will acknowledge that their “solution” to their emotional problem has become a problem in it’s own right. Meaning that we can start off with one problem, implement a “solution” in the form of a not-particularly-helpful coping strategy, to then find down the line that we have two problems rather than one. Whether your “solution” has taken the form of binge-eating, alcohol consumption, illicit drug use, or even shopping – pretty much anything if it’s done to excess – and/or it’s a strategy that you feel you “have or need to use” in order to cope, then you’re likely experiencing the concept of Distress Intolerance.
Understanding Distress Intolerance:
An analogy I frequently use to depict this, is the following:
Imagine yourself standing on a beach. You are standing at the shoreline. You can see larger waves out at sea, gathering initial momentum as they come in before breaking on the shoreline in-front of you and dissipating. Let’s consider for a minute that perhaps this is your first time at a beach, or one of only a few times. You may be experiencing some emotional discomfort as you watch the waves… perhaps they look big and ominous? Perhaps you have formed some unhelpful interpretations or predictions about the sound that they make as they come into shore… Maybe you think that you might be in danger or under threat? Possibly you think that they might sweep you up in their energy; immersing you as they drag you out to sea? This fear may be magnified further if you have doubts about your swimming abilities? The more you connect with these thoughts, the more distressed you become. You may be having strong thoughts, possibly images, of yourself running away up the beach as quickly as possible, to avoid getting hit by the waves?
The waves represent the emotion(s) that you may be struggling with. The nature of the problematic emotion can vary from person to person, but what remains central to this concept is the relationship between our difficulty tolerating the distress, and our desire to avoid or get rid of our distress, as quickly as possible. How we come to avoid or rid the emotion can vary. Some clients will use numbing techniques (alcohol; substances; food; sex; gambling; any behaviour when done in excess.) Others employ avoidance strategies, whilst others notice that they develop urges to increase other behaviours (such as in the case of OCD) in an attempt to “neutralise” the undesirable emotion, a bit like removing the sting left behind from a bumblebee.
Ultimately no-matter how we try to avoid or get rid of the emotion, over time the greater our intolerance to it will become.
Now imagine yourself back on the beach. This time however you are feeling a combination of anxiety and hope. As you stand watching the waves, you notice that nearby lie a number of objects. Amongst them, a bodyboard; a canoe and a small rowing boat and a snorkel with flippers. You recognise these objects as tools that you have practised during CBT treatment. All are available to you. All are familiar to you.
You consider each one before selecting your choice, and entering the sea with newfound mastery as you “ride your waves.”
Sitting with distress – learning “its ok to not be ok”:
In recent years, the evidence-base surrounding third-wave approaches including Mindfulness; Compassion-Focused-Therapy (CFT); Acceptance and Commitment Therapy (ACT) has grown exponentially. These approaches, whilst offering different perspectives for treatment, all share a similar message that ultimately, “its ok to not feel ok.” By accepting ourselves for the emotional beings that we, as humans, we give ourselves permission to experience our emotion, whatever the emotion may be. Whether we hold helpful or unhelpful beliefs about the presence of a particular emotion (anger; sadness; guilt; shame are all commonly-reported examples by clients) ultimately ALL emotion is there to be felt.
By learning to “sit; to be with” our emotion at times when it is there, without having to “do anything” to try to remove, avoid, block, or escape it in any way we gain invaluable counter-evidence regarding our capacity to tolerate our emotions, and our resilience and capabilities.
Distress Tolerance and Emotional Regulation:
Learning to tolerate our distress and regulate our emotions are essential skills that we all learn as part of the stages of our childhood development. How accomplished we become at these skills by adulthood will however depend on the consistency of our experiences gained in childhood, and the quality of our “teachers” (usually our parents as our primary caregivers, although wider family units and society can also contribute.) For some of us, sadly, this may take the form of the presence of negative experiences (such as abuse; a trauma; bereavement/loss; illness) whilst for others, a paucity in or the absence of positive experiences (such as receiving love; soothing; compassion) can prove just as damaging.
The key message I want to reinforce here is this – that CBT treatment offers hope and opportunity through the achievement of meaningful change. CBT treatment will help you to update your historical experiences and drop your unhelpful and unwanted behaviours, through the substitution of effective, alternative replacement behaviours that you will practice and consolidate throughout your sessions.
These techniques may include forms of relaxation (such as focused-breathing; body-scan/progressive muscle techniques that focus on reducing physical tension in the body; and those that are imagery-based.) Additional techniques may include the use of a mindfulness approach to help you to step-back from your distress (De-Centering) in order to help cultivate your awareness by observing the experience; “being with” your emotion, rather than “being your emotion.” Exposure Response Prevention can also offer a valued role for clients who report particularly ingrained/habitual behaviours, or where strong cravings or urges to engage, exist. Learning that it is possible to Delay, acting; Distract themselves from the behaviour, long-enough to be able to then consciously-Decide whether they still want to engage in their original behaviour, or not, can be a empowering and freeing experience.
If the concept of Emotional Regulation is integrated within treatment, the relationship between your physical self and the emotional self will be explored, using in-session experiments to help you explore the influence that these two variables can have on each other; both favourably and unfavourably. By firstly exploring the physical behaviours that your body adopts that serve to maintain your distress, you would then be actively encouraged to “do the opposite” behavioural action in order to observe the positive influence that these important micro-changes have on your body’s ability to continue to maintain your original undesirable emotion. For example, imagine that you have just bumped into an old friend. You are pleased to see them and feel warmth and happiness. Instinctively, your facial muscles relax; your forehead lifts as your eyes widen and you smile. Now instead, force a frown. Scowl. Drop the corners of your mouth, cease smiling, look downwards. Now try to say that you are pleased to see them. How do you sound as you say that? Do you still sound as convincing? Are your behaviours in line with your emotions, i.e. are they congruent, or are they incongruent? This is Emotional Regulation in practice.