By Elaine Collins, Registered Psychologist
Brain Training Australia – CBT for Adult ADHD Program
Summary: This article explores the importance of distress tolerance for adults with ADHD, highlighting how emotional sensitivity, impulsivity, and burnout can undermine wellbeing without proper coping strategies. It explains how distress tolerance helps ADHD adults pause before reacting, regulate emotions more effectively, and build resilience in the face of everyday stressors. Backed by psychological research, the article offers practical tools — including mindful breathing, grounding, self-soothing, and reframing self-criticism — to support emotional regulation and reduce overwhelm.
Living with ADHD Means Feeling Everything More Intensely
For many adults with ADHD, life feels like a pressure cooker. Emotional reactions arrive fast and hit hard. A missed deadline, a friend’s offhand comment, or a disapproving tone at work can cause spirals of shame, frustration, or panic. These intense reactions are not a lack of maturity — they’re often rooted in the unique neurological makeup of ADHD (Shaw et al., 2014).
This is where distress tolerance becomes a life-changing skill.
What Is Distress Tolerance?
Distress tolerance is the ability to endure uncomfortable emotional states without reacting in ways that make the situation worse — like quitting a job impulsively, lashing out at a loved one, or numbing with distractions. It’s about feeling your feelings without letting them control your actions.
While everyone benefits from developing distress tolerance, it is especially critical for adults with ADHD, who experience heightened emotional reactivity and reduced impulse control (Barkley, 2015; Surman et al., 2013).
Why Distress Tolerance Is So Important for ADHD Adults
Without it, adults with ADHD often experience:
Emotional outbursts that damage relationships
Avoidance of responsibilities due to overwhelm
Burnout from masking or overcompensating
Difficulty tolerating boredom, ambiguity, or rejection
Increased risk of anxiety and depression (Emerton et al., 2022)
With it, they gain:
The ability to pause instead of react
Greater emotional self-awareness
Tools to de-escalate intense moods
Resilience during high-pressure situations
Healthier communication and decision-making
Understanding the ADHD Brain and Emotions
The ADHD brain struggles with executive functioning, which includes emotional regulation, time management, and self-monitoring. This means distressing situations — even mild ones — can feel overwhelming or intolerable.
For instance, a common emotional trigger like receiving critical feedback may immediately trigger thoughts like “I’m a failure” or “I can’t do anything right.” Without distress tolerance strategies, this can lead to impulsive decisions, like quitting, arguing, or withdrawing.
Research shows that emotional dysregulation is one of the most impairing symptoms of ADHD in adulthood (Ramsay & Rostain, 2016; Shaw et al., 2014).
Practical Strategies for Building Distress Tolerance
Here are evidence-based strategies I use in therapy to help ADHD adults build distress tolerance:
1. Mindful Breathing
Slow breathing (in for 4, hold for 2, out for 6) helps regulate the nervous system and creates space between emotion and action.
2. Grounding Techniques
Try the 5-4-3-2-1 method:
Name 5 things you see
4 things you feel
3 things you hear
2 things you smell
1 thing you taste
This anchors you in the present and reduces emotional flooding.
3. Self-Soothing Through the Senses
Engage your senses with calming music, a favourite scent, warm tea, or soft textures. These simple actions can help shift your state when emotions run high.
4. Radical Acceptance
This means acknowledging a situation without trying to change it in the moment. Say to yourself:
“This situation is painful. But it’s here. And I can choose how I respond.”
5. Reframing Self-Criticism
Adults with ADHD often carry a history of being misunderstood or labelled as lazy, careless, or difficult. These internalised messages become self-criticism. Use techniques like thought records or self-compassion letters to reframe negative beliefs.
Example: “I’m a mess” → “I’m learning how to manage my ADHD and that takes courage.”
ADHD and Burnout: A Hidden Epidemic
Adults with ADHD are highly susceptible to emotional burnout — especially when they’re constantly trying to meet neurotypical expectations. Burnout may look like:
Emotional numbness
Chronic fatigue
Difficulty focusing
Feelings of inadequacy
Losing interest in previously enjoyable activities
Burnout recovery starts by setting boundaries, integrating micro-rests into your day, and reconnecting with small moments of joy (Kuyken et al., 2018).
How to Build This Skill Over Time
Distress tolerance is not a switch — it’s a muscle. With regular practice, you’ll notice:
More space between a feeling and your reaction
Reduced emotional volatility
Greater confidence in handling setbacks
Here’s how to start:
Track your emotional triggers for one week
Practice one distress tolerance skill daily — even when you feel calm
Celebrate small wins, like pausing before replying to a difficult email
You Don’t Have to Do This Alone
If you find it hard to pause when overwhelmed, or feel like your emotions run your life, know that you’re not broken — you just haven’t been taught the tools your brain needs to thrive.
That’s why I created the CBT for Adult ADHD Programme — a structured, evidence-based online program designed for ADHD adults (diagnosed or undiagnosed) who want to build emotional regulation, self-awareness, and practical life skills.
Final Thoughts
Learning distress tolerance helps ADHD adults stop surviving and start thriving. It’s the key to responding rather than reacting, pausing before spiralling, and ultimately, feeling empowered instead of overwhelmed.
Whether you’re new to this journey or already in therapy, you’re not behind — you’re building skills that will support your wellbeing for life.
References
Barkley, R. A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (4th ed.). Guilford Press.
Brown, T. E. (2013). A new understanding of ADHD in children and adults: Executive function impairments. Routledge.
Emerton, J., Dwan, K., & Dodd, A. L. (2022). Burnout in adults with ADHD: A conceptual review. ADHD Attention Deficit and Hyperactivity Disorders, 14(1), 13–25. https://doi.org/10.1007/s12402-021-00376-w
Kuyken, W., et al. (2018). Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse. JAMA Psychiatry, 73(6), 565–574.
Ramsay, J. R., & Rostain, A. L. (2016). The adult ADHD toolkit: Using CBT to facilitate coping inside and out. Routledge.
Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171(3), 276–293.
Surman, C. B. H., et al. (2013). Associations between ADHD symptoms and emotional regulation in adults. Journal of Attention Disorders, 17(1), 58–64.
Young, S., et al. (2020). A meta-analysis of the prevalence of ADHD in incarcerated populations. Psychological Medicine, 45(2), 247–258.
Article keywords:
ADHD distress tolerance, ADHD emotional regulation, coping skills for ADHD, ADHD burnout, impulsivity and ADHD, CBT for adult ADHD, ADHD resilience tools, ADHD emotional resilience, coping with ADHD overwhelm, ADHD emotion regulation strategies, adult ADHD mental health support, ADHD and emotional sensitivity, distress tolerance CBT ADHD, ADHD burnout prevention, self-regulation skills for ADHD, managing impulsivity ADHD adults, ADHD therapy tools for emotional control.
