Building Tolerance for Distress
What is Distress Tolerance?
Distress, pain, and frustration are all part of life. The more tolerance we have for these difficult parts of life, the easier it is for us to navigate hard days and to regulate our emotions. When we can tolerate distress, we allow the world around us to stay as it is, without resorting to unhealthy or maladaptive behaviors. As adults, we must regulate our own emotions and tolerate our own distress before we can help children with their emotions and distress.
A resource I frequently provide is a Dialectical Behavioral Therapy technique called TIPP. TIPP skills can be incredibly helpful for panic, rage, or feeling frozen (basically any type of distress). The reason they work is because they bring the body back into the present moment and out of a “threat” response.
So what does TIPP stand for?
T. Temperature
I. Intensity
P. Paced Breathing
P. Progressive Muscle Relaxation
Let’s break these down.
Temperature - Cool Down
Research published in 2023 demonstrated the positive impacts of cold water immersion on both brain function and mood, both of which are impacted when the body is in a state of distress. Taking a cold bath or shower can help decrease distress and nervousness and increase alertness and attention. Other ways to use temperature change that don’t rely on having the time or means to take a bath include the following:
Holding an ice pack to your chest.
Holding an ice cube in both hands.
Washing your face with cold water.
Drinking ice water.
Intensity - Flavor or Movement
Movement. Under distress, the body releases adrenaline and cortisol which contribute to the physical symptoms associated with the stress response. Intense movement like jumping jacks and sprinting allows the body to release these neurotransmitters, and also helps the body make sense of the introduction of physical reaction. During a panic attack or other distress response, the body does not have a physical present trigger (such as a bear to escape), and thus we experience a lack of control related to these sensations. Intense exercise realigns the way our brain and body perceive a threat and allows us to feel more in control as the threat response lowers.
Flavor. Extremely spicy or sour flavors can be incredibly grounding for the body in times of stress, as they are such an overwhelming experience for our senses that they can pull us out of a stress response and back into the present.
Ideas for on-the-go intense flavors:
Warheads or lemonheads
“Toxic waste” candy
Vicky’s Hot Tamarind Candy
Spoonful of hot sauce (maybe not as delicious but still effective)
On a lower level, mints and ginger candy can be helpful for grounding out of a less intense state, such as anxiousness or irritability.
Paced Breathing
A go-to for anxiety and calming skills, paced breathing is a simple but often ignored way to help calm the body down during a stress response.
A quick caveat: The reason many people feel paced breathing is ineffective is not due to its lack of benefit, but a lack of practice and time commitment. For breathing techniques to work in our time of need, we have to engage in long term practice being calm and taking deep breaths. A recent study focused on understanding breathing practices denoted three important components of breathing as a coping skill; the breathing must be slow paced, must be practiced for at least five minutes, and that these slow breathing sessions be a long term practice for highest effectiveness.
I find it most helpful to follow along to a video or audio during breathing practice. There are tons of resources on apps like Headspace, Calm, and Insight Timer.
Here are a few examples:
Breath bubble - super simple and can be watched as many minutes as you need
Yoga with Adrienne Breathing - a little more body connected but still simple
Progressive Muscle Relaxation
PMR (or as I call it with kids, “Squeeze and release”) is the intentional activation and release of different muscle groups. Starting at your feet, moving up through your stomach and chest, all the way through your neck and head, focusing on tensing and letting go can help your body feel more grounded and calm. I find it’s easiest to watch a video or listen to an audio directive for PMR as well.
Here are a few examples:
Geared toward children
https://www.youtube.com/watch?v=cDKyRpW-Yuc
https://www.youtube.com/watch?v=dZfK2PDR1j4
Geared toward adults
https://www.youtube.com/watch?v=1nZEdqcGVzo
You can also lead your child through progressive muscle relaxation yourself, using a simple script. This might be useful at bedtime, before naptime, or just when transitioning from a high energy activity to a lower energy one.
Example:
Lay down on your back and close your eyes. Take a big breath in, filling your belly up with air as much as you can. Now let it out slowly. (Model this aloud).
Let’s see how your toes are feeling. Let’s give them a wiggle to wake them up. Now squeeze your toes as hard as you can. Squeeze, squeeze squeeze! Now relax your toes and imagine them melting down into your cozy bed. Let out another big breath before we move to your ankles.
(Move up to ankles, calves, thighs, bottom, stomach, chest, hands, arms, then face. Then you can have your child squeeze their whole body as hard as they can for their final squeeze and release.)
If you want a longer guided script, this one uses the idea of making orange juice as a metaphor to help children understand how to squeeze and release.
So… when do I use these skills?
Distress tolerance skills are helpful in a variety of situations, but the most important part of getting these skills to work is practice, particularly for paced breathing and progressive muscle relaxation. The more we build upon our ability to feel calm as a baseline, the easier that state of being is to reach. As silly as it is, the way to help our bodies regulate back to homeostasis in a stressful situation, is to have built the foundation of what it feels like to be calm and safe. As with any skill, creating a habit of practicing can help us make progress. Building regulation time into you and your child’s routine can be a great way to practice skills, engage in co-regulation (using your calmness to help your child access their calmness), and build connection between you.
Fun summer tip: popsicles! After your child has been running around, perhaps practicing the intensity component of TIPP, let them cool down their body and feel more grounded with an icy treat.