Learning how to tolerate distress

Pushing away unpleasant emotions 

Dialectical behavior therapy (DBT) from Dr. Marsha Linehan offers a behavioral intervention most of us have probably done at least once in our lives and didn’t even think about it. The skill is called “pushing away” and refers to the act of making a mental or concrete note of an unpleasant emotion and its trigger (person, place, or thing) and setting it aside temporarily.  

Here’s an example from one of my clients that worked especially great for her: 

Sally (name has been changed) was going through an ugly divorce from Tom (name has been changed) and could not help but break down in tears or begin hyperventilating at the mere thought of her estranged husband and the loss of their 20-year marriage. She was having trouble sleeping, could not eat, and felt like she was walking around in a fog.  Sally knew the marriage was over, but no amount of words could shake the emotional turmoil she felt inside.  Her emotions were overwhelming and debilitating.  We both agreed she needed to find some relief from her pain, and fast. 

And so, one day during a therapy session, we agreed to do something different.  Sally wrote down her and Tom’s name on a piece of paper like so:


As illustrated above, Sally noticed how intricately linked her identity had become with her husband’s, an emotional attachment that was keeping her literally held hostage.  Sally and I then decided to tear the paper in half so that her name and his name could be separated like so:
Sallya | ndTom

We then placed each piece of paper in a Ziploc baggie with some water and stuck it in a freezer.  I encouraged Sally to go home and plan a shopping trip to her local gardening center where she could buy some seeds to her favorite spring flowering plant.  

The following week we removed each of the Ziploc bags from the freezer.  We went outside to the back of my office building and carried out the following ritual.

First, we removed Tom’s ice cube paper from his bag and decided to throw him away, literally.  After showing Sally where the trash receptacle was outside, she walked over, opened the lid, held her nose to keep from breathing the stench of garbage inside, and tossed the ice cube with Tom’s name on it inside.  

Second, we removed Sally’s ice cube paper from her bag and set it aside carefully on the ground.  I had brought a small shovel with which I encouraged Sally to dig a hole in the ground and place the seeds she had bought at the store since her last session.  I then told Sally to carefully place the ice cube containing her name into the hole after the seeds and to cover the hole with potting soil. We put a place mark over the planted seeds so that we would know where to look for the flowers come the springtime.  

Sally reflected on her experience after this experiment and identified feeling lighter and stronger, and more capable of focusing on her recovery from the breakup of her relationship.  In addition, she looked forward to witnessing the birth of her favorite flower, a metaphor she felt was perfectly in tune with the kind of rebirthing process she herself was going through. 

Pushing away is a skill from DBT’s Distress tolerance module, a set of behavioral skills designed to help us survive an intense emotional crisis without making the crisis worse; to hold on like a rock on the shore of an angry ocean, until the waves settle.  


fear push away.jpg