Distress Intolerance: Dialectical Behavior Therapy Informed Communication for Serious Illness Care

Patients with serious illness coupled with a history of difficulty coping with challenging situations often exhibit behaviors consistent with emotion dysregulation and low distress tolerance. Dialectical behavior therapy (DBT), an evidence-based psychological treatment originally developed for patients with borderline personality disorder and now widely applied across clinical settings, offers skills-based tools to support patients navigating the intense and understandable distress that arises with illness. This article explores the care of a patient with advanced cancer who presents with significant emotion dysregulation and low distress tolerance, which negatively affects their interactions with the medical team and generates secondary distress among clinicians. Drawing on foundational DBT principles, including distress tolerance skills, emotional validation, dialectical thinking, and clinician self-regulation, we demonstrate how DBT-informed communication strategies can help patients manage distress more effectively. We also explore how clinicians can use these skills to manage their own distress while interacting with patients experiencing high distress.