Distress Tolerance: Coping Skills for Managing Eating Disorder & OCD Anxiety
How to Stay Present, Reduce Suffering, and Reclaim Control Without Compulsion
Recovery from an eating disorder or obsessive-compulsive disorder (OCD) is filled with moments of discomfort. Whether it's resisting a food ritual, tolerating a full stomach, or facing intrusive thoughts without giving in to compulsions, one of the hardest parts of healing is learning to sit with distress without escaping it.
This is where distress tolerance becomes a vital skill.
Developed as part of Dialectical Behavior Therapy (DBT), distress tolerance helps individuals manage emotional pain in the moment — without engaging in behaviors that sabotage recovery. For those with co-occurring eating disorders and OCD, distress tolerance skills offer a way to ride the wave of anxiety and respond with intention, not impulse.
This post offers practical tools for building distress tolerance and applying them to real-life recovery challenges.
What Is Distress Tolerance?
Distress tolerance refers to the ability to:
Withstand emotional or physical discomfort
Stay grounded through intense urges or anxiety
Avoid reacting impulsively or self-destructively
Accept the moment as it is — without judgment
Unlike emotion regulation, which focuses on changing feelings, distress tolerance is about enduring them without making things worse.
In eating disorder and OCD recovery, distress might show up as:
Urges to restrict, binge, purge, or over-exercise
Intrusive thoughts about food, weight, or contamination
Shame after eating or breaking a ritual
Anxiety when facing a feared food or resisting a compulsion
These moments don’t require perfection — they require tools.
The Role of Distress Tolerance in Eating Disorders and OCD
Both eating disorders and OCD often involve:
High anxiety sensitivity: even minor discomfort feels unbearable
All-or-nothing thinking: “If I don’t follow the rule, everything will fall apart.”
Compulsions to reduce distress (e.g., rituals, purging, reassurance seeking)
A lack of safe tools for navigating intense feelings
Without distress tolerance skills, individuals are more likely to fall back on maladaptive coping mechanisms that reinforce the disorder.
By learning to feel distress without reacting compulsively, recovery becomes possible — one moment at a time.
Distress Tolerance Skills for Recovery
1. TIP Skills (Temperature, Intense Exercise, Paced Breathing, Paired Relaxation)
From DBT, these physiological techniques help downshift the nervous system quickly.
T – Temperature: Splash cold water on your face or hold an ice cube for 20 seconds to stimulate the vagus nerve.
I – Intense Exercise: Do 1–2 minutes of jumping jacks, running in place, or brisk walking to release built-up adrenaline.
P – Paced Breathing: Inhale for 4, exhale for 6. Repeat.
P – Progressive Muscle Relaxation: Tense and release each muscle group, starting from toes to head.
These tools help regulate panic and reduce the urge to “do something” to make anxiety go away.
2. The “STOP” Skill
A four-step DBT skill that builds in pause and mindfulness before reacting:
S – Stop: Freeze. Don’t act on the urge.
T – Take a breath: Ground yourself in the moment.
O – Observe: What am I feeling? Thinking? Urging?
P – Proceed mindfully: What’s the next wise, recovery-aligned step?
This is especially useful when you notice the impulse to check a ritual, restrict a meal, or seek reassurance.
3. Distraction with Purpose (ACCEPTS)
Sometimes, the best way to manage distress is to temporarily shift your attention:
A – Activities: Draw, walk, garden, clean, do a puzzle
C – Contributing: Help someone else, write a letter, volunteer
C – Comparisons: Remind yourself of past strength or situations you’ve managed
E – Emotions: Listen to music that evokes a different feeling (joy, calm)
P – Pushing away: Imagine putting the thought in a box for now
T – Thoughts: Count backward, say the alphabet in reverse
S – Sensations: Hold something cold, squeeze a stress ball, light a scented candle
These are not avoidance — they’re short-term coping tools to help you stay safe until the urge passes.
4. Self-Soothe with the 5 Senses
Build a sensory toolbox using:
Sight: Look at calming images or nature
Sound: Soft music, white noise, calming affirmations
Smell: Essential oils, favorite candle, fresh air
Taste: Sip tea, use mints, or eat slowly with awareness
Touch: Soft blanket, fidget toy, warm bath
Eating disorders often disconnect us from the body. Self-soothing reconnects us with safe embodiment.
5. Urge Surfing
A mindfulness-based technique from addiction and OCD treatment:
Visualize your urge or anxiety like a wave
Instead of fighting it, ride the wave — knowing it will crest, peak, and fall
Set a timer for 10–15 minutes and focus on your breath as you observe the sensation
Remind yourself: “I don’t need to act on this. I can feel it and let it pass.”
Urges are temporary. Acting on them makes them stronger. Surfing them builds resilience.
6. Create a Distress Tolerance Plan
When distress hits, it helps to have a written, step-by-step guide. Include:
3 grounding techniques you know work
A short list of distractions
A mantra or affirmation (e.g., “This is hard, but I can survive it”)
A trusted contact to call or text
A “safe space” item — a note, photo, or object that calms you
Keep the plan somewhere visible or in your phone. Use it when you're flooded or struggling.
When to Use These Skills
Distress tolerance is helpful when:
You're sitting with a feared food
You want to perform a ritual but are practicing resistance
You're experiencing body image distress
You're flooded with anxiety and can’t think clearly
You've had a slip and need to prevent a spiral
These moments don’t require perfection. They require presence, courage, and support.
Final Thought
Learning to tolerate distress is not easy — especially when eating disorders or OCD have taught you that control or avoidance is the only way to feel safe. But over time, with practice, you’ll find that distress doesn’t have to be the enemy.
It can be the space where healing begins, where you stop reacting and start choosing.
You don’t have to fix the feeling.
You just have to feel it — and stay.
That’s recovery.
Recommended Resources
“The Dialectical Behavior Therapy Skills Workbook” by McKay, Wood, & Brantley
“Freedom from Obsessive Compulsive Disorder” by Jonathan Grayson
“The Mindfulness and Acceptance Workbook for Eating Disorders” by Emily Sandoz & Kelly Wilson
DBT Peer Connections (www.dbtselfhelp.com)
International OCD Foundation (www.iocdf.org)
National Eating Disorders Association (www.nationaleatingdisorders.org)
