What is distress tolerance in simple terms?

It's your ability to sit with a hard emotion, urge, or sensation without acting on it right away or forcing it to stop. The feeling doesn't disappear; you just get through the moment without making it worse.

Where does the term distress tolerance come from?

Psychologist Marsha Linehan named it as one of four core skill modules in Dialectical Behavior Therapy (DBT), first published in her 1993 skills training manual, alongside mindfulness, emotion regulation, and interpersonal effectiveness.

Is distress tolerance something you're born with, or can you build it?

Both views exist in the research. DBT treats it as a teachable skill with specific techniques. Other researchers measure it as a trait that varies person to person, though traits like this can still shift with practice.

What are examples of distress tolerance skills?

DBT's TIPP skill (cold water, intense exercise, paced breathing, paired muscle relaxation), healthy distraction, self-soothing through the five senses, and urge surfing, riding out a craving without acting on it, are common examples.

Distress tolerance: definition and why it matters

Q: What's the difference between distress tolerance and emotion regulation?

Emotion regulation changes how you feel, by calming down or reframing a thought. Distress tolerance means staying steady while the hard feeling is still there, unchanged, without acting on it or making things worse.

Q: Can low distress tolerance actually cause problems?

Research suggests so. A 2022 meta-analysis of 81 studies linked lower distress tolerance to substance use, disordered eating, and borderline personality disorder symptoms alike, suggesting it works as a shared vulnerability behind several different struggles.

Distress tolerance is your capacity to sit with a hard emotion, urge, or physical sensation without acting on it right away or forcing it to stop. Psychologist Marsha Linehan built it into Dialectical Behavior Therapy (DBT) as one of four core skill modules. Researchers also study it as a trait: some people can tolerate more discomfort than others before reacting.

Where does the term come from?

Marsha Linehan introduced distress tolerance in 1993, as one of four skill modules alongside mindfulness, emotion regulation, and interpersonal effectiveness. That original manual has since been revised into the DBT Skills Training Manual, now in its second edition. She’d worked with people who had intense, hard-to-manage emotions and noticed that pushing someone to change a painful feeling before they could first tolerate feeling it tended to backfire. Her distress tolerance skills, TIPP (cold water, intense exercise, paced breathing, paired muscle relaxation), healthy distraction, and self-soothing through the five senses, are built to get you through a crisis without making it worse.

Is distress tolerance a skill or a trait?

Both, depending on which researchers you ask. Linehan treats it as a teachable skill.

A separate line of research, starting with a 2005 paper in Motivation and Emotion by Simons and Gaher, measures it as a trait that varies from person to person. Their 15-item Distress Tolerance Scale scores how well someone tolerates, appraises, and stays functional under emotional distress. A 2010 review in Psychological Bulletin defines the construct simply: the perceived capacity to withstand negative emotional states, plus the actual behavior of withstanding them once a stressor hits.

Why does distress tolerance matter?

Low distress tolerance shows up across a wide range of struggles. A 2022 meta-analysis in the Journal of Affective Disorders pooled 81 studies on the topic. It found low distress tolerance moderately and consistently linked to substance use, disordered eating, and borderline personality disorder symptoms, regardless of which of the three was being studied. The lower someone’s distress tolerance runs, the more easily a hard feeling can push them outside their window of tolerance and into acting on it rather than feeling it through.

How is this different from emotion regulation?

Emotion regulation changes how you feel: calming down, reframing a thought, shifting your mood. Distress tolerance means staying steady while the hard feeling is still there, unchanged, without acting on it or making things worse in the meantime. Urge surfing, riding out a craving without giving in to it, is distress tolerance in its most concrete, everyday form.

Practicing bilateral stimulation is one way people build this capacity over time. EmEase, a self-guided EMDR app, lets you practice bilateral stimulation on your own time at app.emease.com, with customizable pacing for everyday stress. For distress that feels constant or unmanageable rather than occasional, a licensed professional is the safer next step, not a sign the skill has failed you.