What Is Distress Tolerance and How to Build It?

Distress tolerance is your capacity to withstand negative emotional states without falling apart or resorting to impulsive behavior to make the feeling stop. It is not the absence of suffering; people with high distress tolerance still feel pain, frustration, and anxiety. The difference is what happens next. Someone with strong distress tolerance can sit with that discomfort long enough to choose a response rather than just react. The concept has become central to modern clinical psychology, influencing how therapists treat everything from addiction to eating disorders to suicidality, and research over the past two decades has revealed that it is both more trainable and more complicated than it first appears.

What Distress Tolerance Actually Looks Like

At its core, distress tolerance involves two related but distinct abilities. The first is the perceived capacity to endure emotional discomfort: your belief that you can handle feeling awful for a while without it destroying you. The second is behavioral persistence: whether you actually keep going on a difficult or frustrating task when the urge to quit is strong. These two facets sound like they should line up neatly, but a consistent finding across multiple studies is that they often do not. Self-report questionnaires, where people rate how well they think they handle distress, tend to correlate well with each other. Behavioral tasks that induce frustration in a lab also correlate with each other. But the two categories barely overlap.

Across three separate studies, researchers found that self-report distress tolerance measures did not show significant associations with behavioral frustration tasks like the computerized mirror-tracing or paced auditory tasks commonly used in labs.¹ A more recent confirmatory factor analysis echoed this, finding that behavioral and self-report assessments do not comprise a single dimension of distress tolerance, nor even two neatly correlated dimensions.² In practical terms, this means that how tough you think you are in the face of emotional pain may not predict how you actually behave when the pressure is on. Neither measure is wrong; they are tapping into different aspects of the same broad territory.

Where Distress Tolerance Lives in the Brain

Neuroimaging research has started to identify what happens in the brain when someone endures distress rather than giving up. Among people with substance use histories, greater activation in the insula, anterior cingulate cortex, and prefrontal regions during a frustrating task predicted higher distress tolerance. Stronger functional connectivity between the right medial frontal gyrus and areas involved in emotion regulation was also linked to better tolerance, but only in substance users, not in healthy controls.³ The pattern suggests that people who have struggled with addiction may recruit prefrontal control networks more heavily when tolerating distress, almost like a muscle that gets called on harder because the pull of impulsive relief is stronger.

Animal research adds another layer. In a study using rats, activity in the prelimbic cortex, a region that corresponds roughly to parts of the human prefrontal cortex, tracked distress tolerance in males and predicted later cocaine-seeking behavior. Males with low distress tolerance after a period of abstinence showed significantly more drug-seeking.⁴ Interestingly, this relationship did not hold for females, pointing to possible sex differences in the neurobiology of distress tolerance that researchers are only beginning to untangle.

How Childhood Experiences Shape It

Distress tolerance is not a fixed trait you are born with. Early life experiences, particularly adverse ones, appear to shape it in lasting and sometimes contradictory ways. Research on childhood maltreatment and distress tolerance in adults has found that higher levels of child abuse are associated with lower distress tolerance and higher anxiety.⁵ That finding aligns with what you might expect: growing up in an environment where emotional pain was frequent and unmanageable leaves people less equipped to handle it as adults.

But the picture is more nuanced than “bad childhood equals low distress tolerance.” A multimodal study looking at specific types of childhood trauma found that physical abuse was actually associated with higher self-reported distress tolerance, while witnessing family violence was linked to lower behavioral tolerance on a physical task. These two forms of adversity pushed distress tolerance in opposite directions depending on how it was measured.⁶ One interpretation is that children who are directly subjected to physical pain may develop a kind of psychological toughness narrative about themselves, rating their perceived tolerance high, while their bodies tell a different story. This split mirrors the broader measurement gap between self-report and behavioral assessments.

The Addiction Connection

Distress tolerance is one of the most studied predictors in the addiction literature, and the relationship runs in both directions. People with lower distress tolerance are more vulnerable to problematic substance use, and using substances erodes distress tolerance further, creating a feedback loop. A longitudinal study tracking people after substance use treatment found that longer periods of abstinence were associated with increasing distress tolerance over time. In contrast, higher frequency of use at later follow-up points predicted lower behavioral distress tolerance.⁷ The implication is encouraging: staying sober appears to gradually rebuild your capacity to handle discomfort, but slipping back into use can chip away at the gains.

Frustration intolerance, a close relative of low distress tolerance, also correlates with relapse risk. In people with substance use disorders, higher frustration intolerance was linked to greater risk of relapse.⁸ This makes intuitive sense: if you cannot tolerate the discomfort of cravings, boredom, or emotional pain without reaching for a substance, your chances of staying clean drop sharply.

Chronic pain complicates matters further. Among people living with both chronic pain and opioid use disorder, higher distress tolerance was actually associated with increased odds of having an opioid problem, and those with fewer weeks of abstinence from opioids had higher distress tolerance scores.⁹ That seems backwards until you consider that people who can tolerate a lot of discomfort may also tolerate the negative consequences of opioid use longer, staying in a harmful pattern because their high threshold keeps them from hitting a breaking point. The finding is a reminder that distress tolerance is not inherently virtuous; its value depends entirely on what behavior it is sustaining.

Eating Disorders and Emotional Eating

The connection between distress tolerance and disordered eating follows a more straightforward pattern than the chronic pain findings. Low distress tolerance consistently predicts bulimic symptoms, even after accounting for depression, anxiety, and impulsivity. One study found that deficits in distress tolerance predicted bulimia scores on a standard clinical measure and that low distress tolerance interacted with urgency, the tendency to act rashly during strong emotions, to amplify the effect.¹⁰ In other words, the combination of “I can’t stand this feeling” and “I need to do something about it right now” is particularly potent for driving binge-purge cycles.

More recent work has unpacked the mechanism a step further. Distress tolerance moderated the link between difficulty regulating emotions and loss-of-control eating, with lower tolerance strengthening that relationship and higher tolerance weakening it.¹¹ Among women with clinical eating disorders, avoidance of negative emotions was higher than in non-clinical groups, while the ability to accept and manage distress was lower.¹² The thread tying these findings together is that eating behavior becomes a way to escape emotional states that feel unbearable, and strengthening distress tolerance may weaken that escape route.

Distress Tolerance and Its Conceptual Neighbors

One reason distress tolerance has proven hard to pin down is that it overlaps substantially with other psychological constructs. Anxiety sensitivity, the fear of anxiety-related sensations, and distress tolerance appear to be related lower-order facets of a broader factor that researchers have called affect sensitivity and tolerance.¹³ Think of it as a family of traits rather than a single clean construct. Some people are sensitive to internal sensations of panic and also bad at tolerating frustration, but others are anxious about their heartbeat pounding without being especially bothered by a tedious task. The family resemblance is real, but the members are not identical.

Taking this further, one ambitious study pooled data from both clinical and university samples and tested whether distress tolerance, emotion dysregulation, experiential avoidance, and anxiety sensitivity could be distinguished as separate factors. The answer was essentially no: a single broad factor fit the data well, and that factor was almost perfectly correlated with a dimension representing borderline personality features.¹⁴ The researchers argued that the boundaries between these constructs are “fuzzy” and that the field needs to rethink how distress tolerance is defined to better separate it from the broader landscape of emotional difficulty. For you as a reader, the takeaway is that “low distress tolerance” rarely shows up in isolation. It tends to arrive alongside a cluster of emotional vulnerabilities, and addressing one often means addressing the others.

Distress tolerance also functions as a mediator between anxiety sensitivity and health anxiety. In structural equation modeling, both distress tolerance and emotion regulation strategies partially explained why people who are sensitive to anxious sensations develop health anxiety.¹⁵ If you can tolerate the discomfort of a weird body sensation without catastrophizing, you are less likely to spiral into worry that something is medically wrong.

How to Build It

The good news is that distress tolerance responds to training, and several therapeutic approaches have shown results. The most well-known is dialectical behavior therapy, or DBT, which explicitly teaches distress tolerance as one of its four core skill modules. In a randomized trial, people receiving DBT skills training showed improvements in both mindfulness and distress tolerance, and each of those improvements independently contributed to reductions in general psychopathology.¹⁶ Broader DBT research has found that skills use mediated decreases in suicide attempts, depression, and nonsuicidal self-injury among people with borderline personality disorder.¹⁷

Mindfulness training, even in brief doses, can meaningfully shift distress tolerance. In one experiment, participants who received a short mindfulness training persisted significantly longer on a deliberately uncomfortable hyperventilation task, with the training condition accounting for about 11 percent of the variance in task persistence.¹⁸ Another study found that a brief mindfulness exercise reduced the way distress intolerance amplified anxious reactions to stress among nicotine-deprived smokers, softening the usual escalation from “I can’t stand this” to full-blown anxiety.¹⁹

For people in addiction recovery, mindfulness-based relapse prevention has shown particular promise for those with low distress tolerance. In one trial, people with lower distress tolerance who received mindfulness-based relapse prevention had a greater decrease in substance use days compared to those in standard aftercare, although the effect plateaued by four months.²⁰ Body-based approaches add another dimension. A randomized controlled trial found that women in substance use treatment who received training in interoceptive awareness, learning to notice and tolerate internal body signals, showed improved substance use outcomes, better physiological emotion regulation, and reduced craving at six and twelve months compared to standard treatment.²¹

First Responders and High-Stress Occupations

Distress tolerance takes on particular significance in occupations where exposure to traumatic events is routine. Among firefighters, distress tolerance buffered the relationship between occupational stress and suicidality. At high levels of distress tolerance, the link between job stress and suicide risk was weakened, suggesting that the ability to sit with intense discomfort may serve as a protective factor against the most devastating outcomes of chronic occupational trauma.²²

A separate study of firefighters found that both distress tolerance and distress oversharing (the tendency to talk excessively about distress without resolution) played roles in the link between resilience and anxiety. Higher resilience was associated with lower anxiety partly through higher distress tolerance. For depression, however, only distress oversharing mattered as a mediator, not distress tolerance itself.²³ Among first responders more broadly, lower distress intolerance independently predicted lower stress, greater resilience, and higher life satisfaction.²⁴ These findings have practical implications for training programs: teaching recruits and veterans to tolerate emotional discomfort rather than suppress or avoid it could be a concrete intervention against burnout and suicide in these professions.

Personality and Individual Differences

Your baseline personality affects where you start on the distress tolerance spectrum. Among trauma-exposed young adults, higher neuroticism and lower conscientiousness predicted lower self-reported distress tolerance. Greater extraversion was linked to higher behavioral persistence on frustration tasks, and lower openness was associated with giving up sooner on a physical endurance task like breath-holding.²⁵ These associations are not destiny. Someone high in neuroticism who learns DBT skills can build distress tolerance even if their personality tilts them toward emotional reactivity. But the personality research helps explain why some people seem to struggle with distress tolerance more than others from the start, and why interventions may need to be tailored accordingly.

Cross-culturally, the most widely used self-report measure, the Distress Tolerance Scale, appears to function consistently. A study using responses from over 2,500 adults across the United States, England, Canada, South Africa, Spain, and Argentina found that a refined 14-item version showed strong reliability and invariance across countries, genders, and meditation experience.²⁶ The construct, in other words, seems to travel well. People in different cultures recognize and can report on their relationship with emotional discomfort in broadly comparable ways.

Smartphones and the Distress Tolerance Feedback Loop

A growing area of research is examining how modern technology interacts with distress tolerance. One longitudinal study combined long-term tracking with daily diary entries and found a bidirectional relationship between emotional distress tolerance and problematic smartphone use. Over months, the two predicted each other: lower distress tolerance predicted more problematic phone use, and more problematic phone use predicted lower distress tolerance. In the daily diary component, the direction was more specific: problematic smartphone use on one day predicted lower distress tolerance the next day, but not the reverse.²⁷ The implication is that habitual phone use as a means of escaping uncomfortable feelings may actually erode your ability to tolerate those feelings, making you reach for the phone even more quickly the next time. The mechanism is strikingly similar to what happens with substance use: short-term relief undermines long-term capacity.

This does not mean that using your phone is equivalent to drug use. But the structural parallel is worth noticing. Any behavior that provides instant escape from discomfort, whether it is scrolling social media, having a drink, or eating past the point of hunger, can become a way of avoiding distress rather than learning to tolerate it. The research on smartphones suggests this erosion can happen at a pace that is measurable day to day, not just over years. For anyone trying to build distress tolerance, noticing automatic reach-for-the-phone moments may be as relevant as the more dramatic triggers that clinical research tends to focus on.