This week I’m joined by working therapist and OCD specialist Joanna Hardis to ask the million dollar question … “Is there a secret sauce in recovery?”
The short answer is that there kinda is, and that secret sauce is overcoming your intolerance to distress.
Distress tolerance. Or intolerance as the case may be. The willingness to build an ability to tolerate distress is really at the core of the recovery process.
First we are unwilling to tolerate distress based on the belief that it will be “too much” for us. We believe ourselves to be incapable of handling a walk around the block a drive on the highway, worry about our health, or an intrusive thought. More specifically, we deem ourselves incapable of handling or moving through the uncomfortable emotions and thoughts that accompany those events.
Joanna points out that this intolerance of distress shows itself in what we would term “experiential avoidance”. We are unwilling to even come into contact with those uncomfortable thoughts and emotional reactions, so we engage in external avoidance at the behavioral level to avoid triggering them. We may avoid our triggers by refusing to engage in certain behaviors or we may try to calm our triggers by engaging in safety rituals and compulsions, all because we believe that we are incapable of handling distress and must steer clear of it at all costs.
Ultimately, we struggle with problems like panic disorder, agoraphobia, health anxiety, or OCD (as examples) because we do not trust in our ability to tolerate distress, and therefore become unwilling to even consider trying to do just that. This unwillingness to even entertain the idea that distress is tolerable creates a pretty serious obstacle to starting, then continuing the recovery process.
So … what does tolerating distress look like?
Joanna offers an excellent example of what the building of distress tolerance might look like. Imagine stretching one of your muscles. Consider your least favorite stretch. The one you struggle with the most. It hurts. You are not flexible in that area. It is difficult. When you try this stretch you breathe heavy, your heart may race, and you experience physical discomfort. These are forms of distress. Now imagine that you are asked to perform that distress-inducing stretch. As expected, it hurts. It’s uncomfortable. You do not like it. But instead of hitting the eject button immediately and ending the stretch to eliminate your discomfort, imagine that you resolve to breathe into it and continue the stretch for just 60 second more before bailing out. You decide to remain uncomfortable just another minute, working to relax into the discomfort and breathe into it. The result is another minute of discomfort (of course), but also an experience that shows you that you can handle that discomfort for longer than you thought you could.
Using Joanna’s example can you imagine what choosing tolerance over escape or avoidance might look like for you? Maybe sitting with your anxiety for a few minutes before returning home in a driving exposure. Or maybe postponing your usual reassurance seeking for an hour in the case of health anxiety. In the case of OCD, it might mean refraining from doing your usual compulsions for 30 minutes. Incremental increased tolerance to distress is what we’re learning when we do our exposures, so it may be helpful to look at this issue before starting, or to “prime the pump” before doing an exposure.
“My job today is to be intentionally uncomfortable in my exposure. I must practice tolerating distress that I was previously unwilling to tolerate at all. Like stretching my hamstrings for longer than I thought I could in order to get more flexible. I can do that!”
We can practice tolerating distress in other areas of our lives. Joanna calls them “neutral stimuli”. Find something neutral, outside the realm of your anxiety triggers. What makes you uncomfortable physically or mentally? You can practice by going toward discomfort in that area to help build distress tolerance skills that you can use when working on your anxiety issues. Go to the gym and get uncomfortable.
In the 30th edition of The Anxious Morning, I offered a few tips for practicing the art of “letting go” which is a form of tolerating distress without fighting it. You can find that here:
To clarify, while recovery might be based on increased distress tolerance, this does not mean that your job is to live in continuous discomfort for the rest of your life. Building distress tolerance skills leads us to that place where we don’t see that distress is a problem any more. By definition, it is no longer distress, and we don’t care all that much about it any longer. Mission accomplished.
Joanna recently published two blog posts on this topic on her website:
About Joanna Hardis
A graduate of Cornell and Case Western Reserve with advanced training in both CBT and OCD, Joanna currently treats adults who have an anxiety disorder or OCD spectrum disorder. When you work with Joanna in her Cleveland practice, you’ll get to know the science behind the disorder and the process for change. Joanna also treats parents of anxious children using Supportive Parenting for Anxious Childhood Emotions (SPACE).
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Podcast Intro/Outro Music: "Afterglow" by Ben Drake (With Permission)