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February 24, 2025
The Art of Distress Tolerance: Navigating Life’s Unchangeables
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Join Dr. Twitchell to learn about the importance of increasing distress tolerance for managing anxiety and negative emotions. This episode examines how resisting anxiety amplifies it and explores methods to accept negative emotions like anger, sadness, and fear by viewing them as temporary and necessary aspects of life. Dr. Twitchell shares personal anecdotes, discusses adaptive functions of emotions, and explains the value of understanding near-death experiences in reducing anxiety related to mortality. Concluding with practical tips and philosophical insights, Dr. Twitchell guides listeners on embracing distress and mortality to achieve a more peaceful and meaningful life.
Hi, everybody. Welcome back today. We get to talk about another tool, really crucial tool, for your toolbox today. And that is, it doesn't sound very nice, but it is increasing your distress tolerance. We're going to delve a little bit deeper into something that we've referred to in a couple of our other episodes where we've talked about, how, when you resist your anxiety, that magnifies it. That what keeps anxiety high is the attempt to keep it low. And part of our ability to learn to not resist, but to accept, is to increase our tolerance for distressing negative emotions. So actually we want to not just increase our tolerance to feeling anxiety, but our tolerance to be able to feel all the different families of negative emotions like disgust, like anger, like sadness, and like fear. So we need to learn to not label these emotions as aversive and threatening and harmful, something that we can't cope with, but instead, just being able to see them as something that's temporary, something that's normal, maybe even something that's necessary, and something that will pass. Now, first of all, I want to clarify what I'm not talking about. I am not talking about, I'm not advocating increasing your tolerance for distress that you can change. I'm not talking about learning to handle the distress and just tolerate the distress of that stifling job which is keeping you from meeting your life goals. I'm not talking about just getting used to the distress of a destructive and abusive relationship and just staying in that relationship and tolerating the distress. I'm not talking about learning to accept and and tolerate the distress of situations that you can and should change. What I'm talking about is really encapsulated in what's called the serenity prayer that is used in alcoholics anonymous, which goes like this: "God grant me the serenity to accept the things I cannot change, the courage to change the things that I can, and the wisdom to know the difference." So we want to change the things that we can change, but there are certain things that we cannot change, that are not changeable, that we want to learn to accept. Now, this is the type of distress, the unchangeable distress, that we want to learn to tolerate. If we can learn to accept and be at peace with this non-negotiable element of distress, which is present in the fabric of life, the leftover stress, distress, after we have changed everything that we can change, if we can learn to accept these non-changeables, then we will drastically and dramatically change our relationship with our anxiety and the amount of anxiety that we feel. At least that's what's happened to me as I was able to learn to tolerate the distress of two key unchangeables in life. So I want to talk about these two unchangeable today. And discuss those with you so that you can understand a little bit more about what they are and what they aren't, and how they might help you with your anxiety.
So the first non changeable that I learned to accept that dramatically reduced my anxiety was the truth that nobody is happy all of the time. So, of course we should make those changes that we need to make that things that we can change to increase our happiness and to reduce our negative emotions. But even after all of those things have been done that we can do, there will be a remainder. There will always be negative emotions inherent in the fabric of life. And that is because as I learned, as I was doing my doctoral research, emotions have functions. Even negative emotions have adaptive functions. And there are situations in which negative emotions are adaptive and helpful for us. For example, the negative emotion of disgust. The function of disgust is rejection, so that we will reject the thing that we are disgusted with. So, for example, we tend to feel disgusted around sewage. And that is an adaptive reaction because sewage is a health risk. And so it's good that we have that feeling of disgust and that we feel like rejecting sewage and getting away from it. This is this type of adaptive function is present in all different types of negative emotions. The function of fear is to protect us from dangers.
So I just want to show you a chart. And for those of you who are just listening, I'm going to describe it in as much detail as I can. This is from a chapter in a book called the Handbook of Affective Sciences. And it is, the chapter's called Appraisal Processes in Emotion. And I'll put a link for this chapter in the show notes. But I just want to show you this table, because it really crystallized for me, the understanding that negative emotions have a certain function. Now in this table, we're examining four different kind of core emotions. We have the emotion of joy or happiness, the emotion of anger or rage, the emotion of fear or panic, and the emotion of sadness. So in this table, these emotions are kind of broken down into what causes them, what is the appraisal that causes these emotions. And we talked in another episode in the past where we talked about how emotions are organized by our appraisals. And our appraisals, they're really the story that our brain is telling about the situation and how it's going to affect us. How good or bad is this situation? What's my coping potential? How's it going to develop? And this table right here is kind of trying to help us to see how our brains answer those questions when certain emotions are going to be generated.
So for example, we have the emotion of joy or happiness. And this is going to happen when our brain decides that it looks at our goals, a lot of this is unconscious, of course, but it decides that whatever just happened is very, probably conducive to our goals. And that we have a high amount of control and power in the situation. So these elements in the appraisal will end up giving us that emotion of joy or happiness, which is calculated to help us to behave in ways that will be adaptive in that situation.
Now for those of you who remember, and who have watched the movies Inside Out and Inside Out 2, they portray in a really memorable and clear way, this idea that all different emotions are useful depending on the circumstance. And as you might remember in the first movie, we basically saw illustrated how the emotion of joy or happiness is not always the most adaptive emotion for every situation. And this chart is going to help us to see a little bit more why that is the case.
So for example, moving on now to the emotion of anger or rage. So when our brains decide that whatever just happened was very probably obstructive to our goals, it was very probably going to get in the way of our goals and what's important to us, and that it is very urgent, and that we have high control and power in the situation, then that appraisal is going to produce the emotion of anger, which will give us the energy to come up and combat whatever it is that is in the way of our goals, because our brain's decided it's urgent. So it needs to be taken care of right away, and that we have a lot of control and power, so it's worth going for, confronting whatever is blocking our goals.
Now looking at the next emotion, the emotion of fear or panic, and that's going to be related to our focus of anxiety, right? So when our brains decide that whatever just happened was very probably obstructive to our goals, again, just like in anger, with fear, our brain decides that what happened was obstructive to our goals, that it is very, very urgent that we do something about it, and that we do not have very much power in the situation to change it or to adjust to it, then the emotion of fear will be produced. So the difference here between the appraisal that produced anger and the appraisal that produced fear was that with anger, we, our brains decided that we had a lot of control and power in the situation, so then we're motivated to confront whatever it is, that is in our way. But with fear and panic, our brain decided that we do not have a lot of power to adjust and to change the situation. And so instead, it produces this emotion, which is going to motivate us to basically run away from the stressor, runaway from whatever it is that is confronting us.
And the last emotion that we have on this chart is the emotion of sadness. And remember sadness was highlighted in that movie Inside Out. And um, the character of Joy thought that she was always the best one to be driving the brain's control panel, but she discovered that sometimes sadness was important for certain situations. Now, so let's explore this emotion of sadness. So when our brain decides that whatever happened just now was very, very probably obstructive to our goals, but it is not urgent, and also we have very low control and very low power in the situation, then it will produce this emotion of sadness. So different than anger, we don't have a lot of control and power. Different than fear and panic, it's not urgent. Sadness, as was illustrated in that cute movie, showed us that it, it can help us to adjust to changing circumstances. It can help us to let go of old goals and old ways of things, seeing things, that won't work for us anymore. And to be able to shift to something different. To be able to let go of things and make room for something new. That can be the function of sadness.
So I would just wanted to point out this table, show this table to you because it really helped me to understand that emotions, even negative emotions, have functions. And that positive emotions like joy and happiness won't be the best emotion for situations where something happens which is obstructive to our goals. The very happy person will not recognize that something just happened which is obstructing their goals, and so they might not confront whatever it is, or flee from the danger, or be able to let go of whatever it is that isn't serving them anymore. So emotions have functions. What this table really helped me to understand is that our brain is using different values and criteria to evaluate the situations that we're in. You know, it's asking, how will this affect my goals? How will it develop? How good or bad is this? And that there may be situations where these negative emotions, where it is adaptive for us to act on these negative emotions, where it's adaptive for us to be angry, where it gives us the energy to confront something which needs to be confronted. But there might be other situations where it's not adaptive to act it out. But even in those situations, we can be curious about that negative emotion, about what it is, teaching us about what we value, what these values are behind the emotion, that produced the emotion.
So, let me give you an example that I'm not terribly proud of from my own life, but an example of when I got angry at my daughter. When my daughter was very small, she got into my box of jewelry and she got ahold of this pair of earrings that my parents had given me from Russia. And these earrings were hand painted and they were, they had silver on them. And they, I just thought they were really beautiful. I really liked these earrings. And she ended up losing a part of the earrings. If it broke off and she lost it. When I discovered that she had gotten into this, I felt very angry. And I said some things to her that were harsh, which I regretted later. So unfortunately, in the moment I was not able to perceive that acting out my anger would not be adaptive for the goals that were most important to me. But in looking back on this situation after it happened, in hindsight, I was able to look, work on trying to see what it was that was behind my anger. So what were the goals that my brain felt were obstructed by my daughter's behavior? What were these things that were so important to me, that my brain felt were being obstructed, and that were urgent to resolve? Well, in thinking about it some more, I discovered that it was really important to me to have some things that my children couldn't get into and couldn't destroy. Some things that were just for me. And in thinking about that some more, I realized that what was really behind that was this need to have a certain level of self care, certain level of taking care of my basic needs so that I would have a reservoir to give to my children from. So behind that anger was this value of needing to take care of myself so that I could take care of others. So being curious about that anger helped me to recognize what it was that I needed, and then put some changes into place in my life. Unfortunately, only much, much later, not when my children were young. I didn't perceive this at that time. This is something I only figured out later. But finally, I was able to put into place, recognize the importance of taking care of myself so that I could take care of others. And prioritizing that. So I was able to make those changes. So this is one illustration of how that negative emotion of feeling anger, how it would have been better for me not to act it out, but how being curious about what was behind it actually could help me to discover something which did need to be changed, and which I could then work on changing.
So the second thing that I would like to talk to you about, the second unchangeable distress that is inherent in the fabric of life, that if we can learn to tolerate it, that we can, if we can learn to accept it, that it will greatly reduce our overall anxiety, is learning to accept our own mortality. Now, this is a big one. This is the arch fear. The fear of death is really behind a lot of our other anxieties. When I talk to my coaching clients and they're talking about different things that they're anxious about, and we try and get beneath that anxiety. And why is it that you're so afraid of not doing well in school? Why is it you're so afraid of losing your job? Why is it so why is it that you are so afraid of social rejection? Well behind those fears is a fear of not being able to support myself, not being able to have the, the necessities of life that I need. Even behind the fear of social rejection, we can trace that fear that evolved in hunter gatherer times where we were part of social groups. If we were cast out of our social group, we were not going to survive very long, because we weren't, we wouldn't have good protection against predators. We wouldn't have as much help to find food that we needed, et cetera. So our brains evolved to be very afraid of social rejection because it ultimately meant death. So this is just an illustration of how behind a lot of our basic anxieties, even though we're not conscious of it, at the back of it is this fear of mortality. And so if we can get to where we have a different relationship with our own mortality this will just undermine a lot of our anxieties. A lot of our anxieties will just dissipate that are essentially based on that fear of our own mortality. Now, but this is a difficult thing to work on.
Now I had a shortcut to this because during the time that I was very sick, With COVID I had an experience where I almost died and I had what researchers have come to call a near death experience. And through this near-death experience, I essentially lost my fear of death because of what happened in that experience. Now, these near-death experiences, as I said, have been studied by a lot of researchers. There's a particular article that I'm going to cite now, which is by Dr. Bruce Greyson, which is called Western Scientific Approaches to Near Death Experiences. So when I'm talking about near death experiences, I'm talking about a very specific type of experience. It's a vivid, realistic, subjective experience that often occurs in life-threatening conditions, such as in cardiac or respiratory arrest, head injury or states of shock. Now Dr. Greyson talks about how these near-death experiences are reported in 10 to 20% of people who come close to death. So they are fairly common. And they are present in all different cultures. Some of the content of these near death experiences can vary depending on what culture the person is, who had them, but there are certain core elements that are part of these near-death experiences that are present through all different cultures and through reports that we have through, throughout history as well.
Studies have shown consistently certain types of changes in people who have these experiences. And some of these changes include uh, loss of the fear of death. And that certainly consistent with my experience. Um, a sense of purpose and a heightened sense of self-esteem, increased compassion and love for others, less concern for material gain and recognition and status. So for me, this really was true. After my experience, I was able to perceive clearly what was really important to me and what wasn't. And I realized a bunch of things that I had thought previously were important were not, including material gain and recognition and status. Um, It's common for people to have a greater desire to serve others. And increased ability to express their feelings after these experiences, greater appreciation and zest for life, increased focus on the present, uh, deeper spirituality, greater search for knowledge and greater appreciation for nature. So all of these different changes that have been documented in people that have these experiences bore out in my experience as well.
Because in my experience, I came up against death,- I came close to death. And yet had this intense experience in which I I felt, part of it was this uh, vivid feeling of peace, joy, unity, and love. And this in part contributed to my change in perspective toward death, it didn't seem scary to me anymore. And so this dismantled a lot of my anxieties that were based on fear of death.
Now, you can't orchestrate a near-death experience for yourself and nor would you want to. But this article also details how people who learn about near-death experiences can be profoundly effected by them, even though they haven't gone through them themselves. And Dr. Greyson talks about um, several different studies that were done on college students who studied this phenomenon, who studied, who studied near-death experiences. And how this, uh, led to increased compassion and concern for others that students demonstrated this after learning about it for a semester. That they ended up with more positive attitudes towards death and decreased concern about dying. And an increased sense of purpose. And information about near death experiences has been used by therapists and counselors to help people with suicidal thoughts, to reduce those suicidal thoughts, to comfort people with terminal illnesses. And people that have lost a loved one, and to support soldiers who are going into combat. So it has been used in all of these different types of situations, and been shown to have an effect on people who haven't experienced these things, but who just learn about it. So, I just am a suggesting this as one avenue that you can use to reduce your own fear of death, which has been shown to have effect in other people as well. And I'll put a link to this article in the show notes, if you want to look up more about this and learn more about this. There's a lot of references in his article, which is one place to start. Of course this is not the only way to work on coming to terms with your own mortality. There are many different ways and avenues to do that. Some of them are religious. Some of them are philosophical. But from my own experience, I can certainly witness that working on this relationship with my own mortality dramatically changed my relationship with my anxiety and dramatically reduced it, and just simply eliminated a whole category of anxiety, which I felt previous in my life, a lot of different anxieties that were based on this fear of death that I wasn't conscious of how they were based on it. But when that fear of death is lessened, that those anxieties also lessen in turn.
So just summarizing, this is what we worked on today. We're talking about the necessity for learning to increase our ability to tolerate certain types of distress. We don't want to tolerate the distress that we can change. A lot of times, pain can be a signal that something needs to change in our lives. And we want to change those things. We want to have the courage to change those sources of distress that can be changed, even when they take a lot of energy and courage to do that. But there will always be a remainder of distress inherent even after we have solved all of these uh, sources of distress that can be changed. There will be a distress which remains. And this comes partly from the fact that negative emotions are part of our human experience. They are simply going to be there because we are human. Nobody's going to be happy all of the time and that's okay. It's okay because negative emotions have a function. And sometimes they help us to adapt to certain types of changes and certain types of situations. And sometimes they help us to discover what it is that we value, what it is that is really important to us in these situations, that we may not have been conscious of, things that can help us to make progress, and change additional things that we may not have been aware of that needed changing. So this concept that emotions have functions even negative emotions. So we're not going to eliminate all negative emotions and that's okay. And the second thing is that we are mortal. We are all going to die. That's terrifying. But there are ways to come to terms with that. There are many different paths. The one that I took is not one that everyone can take because I had a near death experience in which, on the brink of death, I felt the intense love and peace and joy that surprised me. And that basically eliminated my previous fear of death . But there are many other ways that you can go about working on your relationship with your mortality, including religious and philosophical means, but also through learning about near-death experiences from others. So this has been shown uh, to help, to give some of these same life changes in perspective that happened to those who actually have these near death experiences. So don't be afraid to face these unface-ables. The fact of our mortality. There are many different people who have learned to deal with their own mortality. Probably a lot of them are around you in your life. Probably a lot of them are older. Something that we all end up having to face as we age. But talk to people, learn about near-death experiences, investigate different philosophical and religious avenues for coming to terms with your own mortality. But I just want to assure you that the fact of death actually is what makes this life meaningful and precious. And that's partly why I think that those who have these near death experiences have a changed relationship with their lives and they end up valuing and savoring the present so much more than they did previously. And there is a lot of peace and joy to be found in doing that because anxiety lives in the future. Anxiety is all about worry about the future and essentially worry about death. That's why anxiety evolved for us. Sometimes it is adapt, adaptive. Sometimes it is important. But learning to come to terms with the fact of our mortality can give us an underlying assurance and ability to focus on what we want to make of our lives, what we want to make of the time that we have, what we want to contribute, what we want to give, and what we want to create.
So, thanks again, that's all for today, but stay tuned for the kindness narrative, your effortless gratitude practice that will give you so many benefits in your life. Thanks again. Bye bye.
A number of years ago, my fourth child passed away when he was quite young, he was 19 months, and he died suddenly at home. It was really shocking for us. And afterwards, we were all at the hospital with him, and we had a lot of family there and friends helping us deal with that shock and our grief. And after a while, it was, it was time to go home.
We couldn't stay there forever.
And my husband really wanted to, to bring him home. He wasn't wearing anything. He was just wrapped in a blanket, and he wanted to bring him home and get him dressed. Before we brought him to the funeral home, and I'm a nurse myself, and I know that there's policies and procedures surrounding that process.
And I had never seen that happen before. I had never seen the family take their loved one. And I didn't think that it was, it was possible to happen. And so when my husband said that, I said, Oh, they're not going to let us do that. And he said, you go ask. And so I went out and found the nurse, her name was Ruth, and I asked her if we could take Evan home with us and get him dressed before bringing him to the funeral home.
And she said, and I know how busy nurses are, you know, they're dealing with, she was dealing with other patients and lots of other things. And she said, I just expected her to say no. And she said, let me make some calls. So we went back in the room, and after a while, she came in, and she said that they would let us do that.
So we took him home, and my brother in law drove us, and Craig and I sat in the back seat and just held Evan. Brought him in the house and got him dressed. And then we got to have family prayer with him there. And then we took him up to the funeral home and left him there. And I was so grateful for her.
It was so meaningful for us and just helped us so much. In that time of our great need, she was so good to see, to truly see how she could help what she could do, even though she was busy and had other, lots of other things going on, I'll always be so grateful to her for that.
[00:00:00] - Introduction to Distress Tolerance
[00:01:56] - Clarifying Distress Tolerance
[00:04:11] - Understanding Negative Emotions
[00:05:46] - The Function of Emotions
[00:14:02] - Personal Story: Anger and Self-Care
[00:16:57] - Accepting Mortality
[00:18:59] - Near-Death Experiences and Their Impact
[00:26:43] - Conclusion and Summary
[00:31:27] - Kindness Narrative: A Nurse's Compassion