Self-Distress and Distress Tolerance

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Early in my graduate studies regarding professional care for mental, emotional, and behavioral health (collectively “mental health”), I chose to practice Rational Emotive Behavior Therapy (REBT), a psychotherapeutic modality developed by the late psychologist Albert Ellis.

REBT uses the ABC model to illustrate that when an undesirable Action occurs and you Believe an unhelpful narrative about the event, it’s your unfavorable assumption, not the occurrence itself, that causes an unpleasant Consequence. This is known as distress or disturbance.

In common parlance, disturbance is defined as the act of disturbing (to interfere with) someone or something, as in an interruption of a state of peace, quiet, or calm. Alternatively, the American Psychological Association (APA) thusly defines distress:

1. the negative stress response, often involving negative affect and physiological reactivity: a type of stress that results from being overwhelmed by demands, losses, or perceived threats.

It has a detrimental effect by generating physical and psychological maladaptation and posing serious health risks for individuals. This generally is the intended meaning of the word stress.

2. a negative emotional state in which the specific quality of the emotion is unspecified or unidentifiable. For example, stranger anxiety in infants is more properly designated stranger distress because the infant’s negative behavior, typically crying, allows no more specific identification of the emotion. —distressing adj.

Noteworthy, with virtually any undesirable Action that occurs, it’s your unfavorable Beliefs which cause unpleasant distress or disturbance (Consequence). Given this framing of self-distress and self-disturbance, it’s worth noting that one REBT source states (page 71):

REBT conceptualizes [distress] as healthy even though it is intense. Other approaches to therapy have as their goal the reduction of the intensity of negative emotions. They take this position because they do not keenly differentiate between healthy negative emotions (distress) and unhealthy negative emotions (disturbance).

Now, REBT keenly distinguishes between healthy distress and unhealthy disturbance. Healthy distress stems from your rational beliefs about a negative activating event [Action], whilst disturbance stems from your irrational beliefs about the same event.

Complete elimination of distress is highly unlikely in an impermanent and uncertain world wherein people conceptually suffer, struggle, and battle with, or merely experience hardship. Still, individuals often make matters worse for themselves by disturbing about such instances.

In particular, there are four predominate irrational beliefs which people often use to distress or disturb themselves: global evaluations, low frustration tolerance (LFT), awfulizing, and demandingness. When contemplating these unproductive beliefs, think of the acronym GLAD.

Worth noting, the two forms of should, must, and ought demands with which people most often distress or disturb are associated with use of absolutistic and conditional beliefs. Generally speaking, these scripts serve as inflexible commands used toward oneself, others, and life.

An absolute must narrative is, “You absolutely must do as I say!” A conditional should narrative is, “Either you should do as I say, or you should be punished!” Importantly, in REBT literature, demandingness of this sort is said to function as a primary appraisal mechanism of self-upset.

Global evaluations (i.e., self-downing, other-downing, and life-downing), low frustration tolerance (also known as frustration intolerance), and awfulizing (e.g., terrible, horrible, etc.) function as secondary appraisal mechanisms. Together, GLAD will make you sad or mad, etc.

While still functioning as prescriptive rather than descriptive, flexible use of recommendatory, preferential, ideal, empirical, moral and ethical, and legal ought beliefs won’t inevitably cause disturbance, as they may align with distress. Rigidity versus flexibility makes a difference.

Additionally, from a psychological standpoint, people distress or disturb themselves using a Belief-Consequence (B-C) connection. Of course, this isn’t to suggest that in the context of the naturalistic or physical world there is no Action-Consequence (A-C) connection.

From an A-C view, Ellis was unlike many other psychotherapists of his time (Action), as he was described as “cold and aloof with an abrasive demeanor” (Consequence). Nonetheless, when perceived in this way, it’s the B-C connection that causes a self-disturbed outcome.

From a B-C perspective, Ellis was viewed as “cold and aloof with an abrasive demeanor” (Action). One may’ve then Believed, “Ellis was an inadequate therapist [G], as I can’t bear non-empathic people [L], because they’re terrible [A] and mustn’t be in the mental health field [D]!”

With this self-narrative, one may then become enraged (Consequence). Worth noting, when using the ABC model, one recommendatorily should practice personal responsibility and accountability (collectively “ownership”). Thus, self-disturbance is a matter of one’s own doing.

Addressing how people upset themselves with unhelpful attitudes, the ABC model incorporates Disputation of unproductive philosophies of life in order to explore Effective new beliefs. Whereas rigid beliefs cause self-disturbance, flexible beliefs result in an un-disturbed condition.

Suppose that rather than using a self-disturbing script, one instead used a narrative that resulted in self-distress. For instance, one could conclude, “Although I’d prefer that all therapists would use empathy, I can tolerate and accept mental health practitioners such as Ellis.”

Worth mentioning, REBT uses the technique of high frustration tolerance (HFT) when encountering LFT narratives (e.g., I can’t bear non-empathic people). Specifically, HFT is a matter of distress tolerance, as the APA thusly defines this term:

[T]he level of either (a) one’s unwillingness to experience emotional distress as part of pursuing desired goals or (b) one’s inability to engage in goal-directed behaviors when experiencing distress.

Low distress tolerance [i.e., LFT] is related to a range of disorders, including borderline personality disorder, substance abuse, and eating disorders; some treatments (e.g., dialectical behavior therapy) are designed in part to raise an individual’s level of distress tolerance [i.e., HFT] by habituating them to the experience of adapting to distress and other negative emotions.

In simplest terms, tolerance is defined as the capacity to endure pain or hardship. Ergo, distress tolerance is a matter of withstanding pain and hardship, not eliminating it. This is a key distinction between REBT and many other psychotherapeutic modalities.

REBT recognizes the difference between negative and healthy reactions, versus negative and unhealthy responses, as the former is the objective of distress tolerance or HFT. When taking personal ownership for one’s own outcomes, purging all negative reactions isn’t the aim.

Thus, when Effectively believing, “Although I’d prefer that all therapists would use empathy, I can tolerate and accept mental health practitioners such as Ellis,” a plausible result would be something along the lines of frustration, annoyance, or disappointment (Consequence).

Presuming that you comprehend the distinctions between distress and disturbance, LFT and HFT, and negative though healthy and negative but unhealthy reactions, I invite you to practice the ABC model as frequently as possible. Tolerating, yet not eliminating, distress is the goal.

If you’re looking for a provider who tries to work to help understand how thinking impacts physical, mental, emotional, and behavioral elements of your life—helping you to sharpen your critical thinking skills, I invite you to reach out today by using the contact widget on my website.

As a psychotherapist, I’m pleased to try to help people with an assortment of issues ranging from anger (hostility, rage, and aggression) to relational issues, adjustment matters, trauma experience, justice involvement, attention-deficit hyperactivity disorder, anxiety and depression, and other mood or personality-related matters.

At Hollings Therapy, LLC, serving all of Texas, I aim to treat clients with dignity and respect while offering a multi-lensed approach to the practice of psychotherapy and life coaching. My mission includes: Prioritizing the cognitive and emotive needs of clients, an overall reduction in client suffering, and supporting sustainable growth for the clients I serve. Rather than simply trying to help you to feel better, I want to try to help you get better!

Deric Hollings, LPC, LCSW

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