Autism is a neurodevelopmental disorder that can include resistance to change and difficulties regulating emotions. Several therapeutic interventions, such as applied behavior analysis (ABA) and dialectical behavior therapy (DBT), include distress tolerance training. 

The application of distress tolerance includes learning how to regulate emotions and manage stress. This can be especially important for children with autism to help minimize emotional outbursts and tantrums and to teach the child how to better control themselves in potentially stressful situations.

Distress Tolerance Explained

Distress tolerance is an essential aspect of DBT, which was initially created to help manage borderline personality disorder (BPD) and suicidal tendencies. Difficulties regulating emotions can lead to depression, anxiety, and self-harm. Distress tolerance can help individuals cope with negative emotions and learn tools to lower the potential for self-harm.

With distress tolerance, acceptance is key because negative emotions are a part of life. Both DBT and ABA therapies can help teach emotional regulation. They also lead to better understanding and recognition of emotions and teach skills for coping through productive outlets. Distress tolerance skills can help a child feel more empowered and more in control of their own self and life.

Importance of Distress Tolerance

A child with autism often prefers to stick to a strict schedule, may have obsessive interests, and can be easily overwhelmed in sensory overloading situations. Difficulties regulating emotions in someone with autism can lead to bigger behavioral problems, including these:

  • Emotional and uncontrollable outbursts
  • Tantrums
  • Aggression
  • Self-harm

Many methods of coping with stress and regulating emotions involve avoiding painful or triggering situations or events. With distress tolerance, however, a person learns to accept that some level of discomfort is to be expected and how to deal with it in a healthy way.

Changes to the schedule happen, and autistic children are often in situations that can feel overwhelming. Distress tolerance can help them learn how to regulate their internal feelings and stress levels and help decrease behavioral concerns and outbursts that can be harmful to themselves or others.

Teaching It

ABA therapy is tailored to each child and can help them with specific skills and coping mechanisms based on their particular needs. 

As a part of ABA therapy, distress tolerance can look different from person to person, depending on what might cause them the most stress. One of the first steps is to learn what the triggers are and what might lead to an emotional outburst. 

Typically, a functional analysis is done first wherein the therapist and caregiver learn what types of things lead to behavioral issues and trouble regulating emotions in a child. To help regulate emotions you first have to know what they are. ABA can help a child explore, recognize, and name their emotions. 

Once the child and the therapist understand emotions and stressors, distress tolerance skills can be taught and learned. This can include learning how to self-soothe and what can provide a distraction from self-harming or destructive urges.

Safety is vital when teaching distress tolerance. Autism can include some intense emotions and outbursts that can be dangerous to the child and those around them. It is paramount to try and keep the stress levels manageable while teaching how to keep the feelings from becoming overwhelming and explosive. 

A trained therapist can help to give both children and parents tools they can to practice to help keep everyone safe.

Examples of Distress Tolerance in Therapy

Children learn to accept negative emotions as natural through distress tolerance teachings. Therapies like ABA can then help teach a child with autism how to handle these emotions. ABA teaches socially acceptable skills and behaviors using positive reinforcement.

Children with autism often have difficulties transitioning from one activity to another. This is where distress tolerance skills can come in handy. An example of this can include asking a child to move from one activity to another — giving a warning — and helping them work through the emotions that come with it. 

The child may initially be resistant; however, they can learn how to articulate what they are feeling and ask for more time in a respectful manner. The caregiver can then reward the child with the extra time. 

Distress tolerance can also include ways to self-soothe through grounding techniques, movement exercises, or the use of a tactile object. Instead of acting out aggressively, a child can instead learn to relax through breathing techniques, exercise, or muscle relaxation.

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