All of us experience emotional distress. We may call it anxiety, depression, burnout, overwhelm, sadness, emptiness, loneliness, or stress. These are not identical experiences, but they overlap, and for the sake of this post, I’ll call them all “distress.” Regardless of the label, all of us feel distress at times, and most of us respond to distress in surprisingly similar ways.
Over time, I have started thinking about distress as something we can relate to at four different levels. These are not rigid categories and are not judgments. We move between them constantly. In some parts of our lives we may operate mostly at one level, while in other areas we remain stuck at another. The levels are better understood as different relationships to discomfort.
Lastly, a caveat about this framework. One of my favorite quotes is from the statistician George Box: “All models are wrong, but some are useful.” I think that applies here. Human emotion is complicated, and no framework fully captures it. I share this not because it is completely right, or because it always applies, but because it is useful.
Level 4: One of the ways I think about substance use is that it is fundamentally an attempt to manage distress. The source of the distress may vary tremendously — trauma, shame, anxiety, loneliness, fear, boredom, depression — but the nervous system is trying to accomplish something very simple: it is trying to feel better. Substances, in this sense, are simply an attemp to feel better, to get rid of the uncomfortable feeling.
Alcohol may “take the edge off.” Cannabis may calm someone down. Opioids may numb pain. Stimulants may create energy or confidence. The specific substance matters less than the process itself. Distress appears, something temporarily relieves it, and the nervous system learns to repeat the behavior.
This is an example of unhealthy coping, but turning to destructive behaviors in an attempt to feel better extends far beyond substances. Some of us compulsively scroll on our phones whenever we are uncomfortable. Or, we might isolate, lash out at others, overeat, overwork, shop, gamble, or seek constant distraction. The details vary, but the underlying process is remarkably similar: emotional discomfort arises, and we instinctively search for relief.
We are also not doing things to solve the problem itself. If the distress is arising because of conflict with a family member, we are not trying to work that conflict out; instead, we treating how that conflict is making us feel while not addressing the underlying issue.
At this level, our attempts to escape distress create additional suffering. The coping strategy itself becomes a problem, and another source of distress (which we then likely also avoid). The behavior we are engaging in to try and relieve the discomfort begins damaging our health, our relationships, our finances, or our sense of self. At this level, the distress is something we urgently need to make stop, and we will accept almost any price in exchange for temporary relief from it.
Level 3: At some point, our willingness to pay any price to resolve distress shifts, and while we still want to make the distress go away, we start to pay much more attention to how that distress is resolved. The distress still requires a response, but the response changes. We stop responding to distress purely reflexively. Instead of doing whatever immediately relieves discomfort, we become more intentional about how we care for ourselves. We still want to feel better, but we are no longer willing to destroy our health, relationships, or future in exchange for temporary relief.
As a consequence, we begin developing healthier ones. We exercise, practice deep breathing, journal, go for walks, talk to friends, go to therapy, sleep more, spend time outside, or practice reframing situations differently. We learn ways to regulate our nervous system that do not create additional harm– or perhaps have other benefits. Rather than doing anything to stop feeling lousy, we start to become much more intentional about changing the way we feel.
Equally important, we recognize that distress is manageable. Difficult emotions no longer feel like emergencies that must immediately be escaped. We can influence our internal state in ways that are sustainable, healthy, and consistent with the kind of lives we actually want to live. This shift matters enormously, as it is the foundation that makes living possible. Many people rely entirely on level 3 strategies for getting through adversity. When implemented well and applied consistently, they work tremendously well.
But despite their differences, Levels 3 and 4 share an important assumption: both are still organized around changing how we feel. At level 4, the response will make things worse. At level 3, the response will often make things better. However, both view distress as a problem to be solved, and generally view distress as an unwelcome deviation from normal. The goal is to get back to feeling ok; the means are different. But both are still attempts to move away from discomfort and toward relief.
Level 2: I have not yet met anyone who has lived a life free of distress– at times, we all experience anxiety, sadness, overwhelm, and disappointment. We might get really good at managing it (level 3), but the truth is that not every painful emotion needs to be immediately fixed, solved, or escaped. In fact, a great deal of human suffering comes not only from painful emotions themselves, but from our resistance to them. We tense against our own experience. We desperately want reality to feel different than it does right now.
At level 2, we stop fighting against less comfortable emotions, and start just accepting them as a part of the human experience. We will all feel anxious, sad or exhausted at times, and these are not necessarily things that we even should fight against or try to change.
This does not mean we enjoy suffering, nor does it mean passivity or resignation. It simply means we begin recognizing that feelings are temporary internal experiences rather than emergencies. If sadness arises, we can simply feel sad for a while. If anxiety arises, we may not need to immediately distract ourselves from it or force it away. Discomfort itself is survivable, and feelings will change even when we do nothing to change them. We do not need to react to emotion the moment it appears. There is something deeply liberating about realizing that we do not always need to make ourselves feel better immediately.
It is not like we prefer feeling uncomfortable, or that we forget how to make ourselves feel better. Instead, feeling uncomfortable is just recognized as a part of life that we can be with in the same way that feeling good is a part of life that we can be with.
Level 1: If we are constantly distracting ourselves from discomfort, constantly moving away from it or managing it, we can never really understand it. Always trying to suppress anxiety prevents us from hearing what it may be trying to communicate.
Eventually, if we can remain with discomfort long enough (level 2), we can begin listening to it. This is a fundamentally different relationship to emotional pain. Anxiety, burnout, emptiness, resentment, sadness, and loneliness are no longer viewed simply as symptoms to suppress. They become information. Call them a signal from our unconscious that something in our lives is not right, or that our needs are not being attended to. Perhaps anxiety is revealing fear that we have not acknowledged.
Perhaps burnout reflects that our work is not consistent with our values or ideals. Perhaps resentment signals other people not attending to our needs. Anxiety might be a sign that what we are chasing is not what actually brings us happiness or fulfillment.
At this level, distress begins functioning less like an enemy and more like feedback. Viewed in this light, the fears, needs, conflicts, and patterns that drive us start to take shape in a way we can recognize, and we start to see what we have ignored, avoided, suppressed, or denied. Surprisingly often, when something becomes fully conscious, some part of the distress begins resolving on its own.
An unmet need that remains unseen tends to produce chronic tension. Once clearly recognized, we can begin responding to it directly rather than merely managing its downstream effects. This is part of why insight itself can feel relieving. Sometimes the nervous system simply wants something to be acknowledged honestly.
I increasingly suspect that most emotional distress exists for a reason. Something feels unsafe, unresolved, disconnected, unsustainable, violated, or out of alignment. We can attempt to manage the downstream emotional consequences of that distress, and sometimes we absolutely need to. But at the deepest level, healing often comes not from suppressing the signal, but from understanding and addressing what produced it in the first place.
Moving through these levels usually has to happen in order. We cannot meaningfully learn from distress if we cannot effectively sit with it. And we cannot effectively sit with it if the only alternative to it is something destructive.
The point of this framework is not to judge ourselves for where we are, nor is there a goal. In many situations, Level 3 is exactly what we need. When we are overwhelmed, drowning in distress, or barely holding things together, learning healthier ways to regulate emotions and care for ourselves is enormously important work. The next right step might be replacing destructive coping mechanisms with healthier ones.
The value of this framework is simply that it gives us a way to notice our current relationship to discomfort with a little more honesty and curiosity. When distress appears, are we trying to escape it? Manage it? Tolerate it? Listen to it?
And perhaps more importantly: what might the next step look like?
We cannot eliminate distress. For one person, growth may mean learning that they do not need to destroy themselves in order to feel better. For another, it may mean realizing that discomfort itself is survivable. And for someone else, it may mean becoming quiet enough to finally hear what their anxiety, burnout, sadness, or resentment has been trying to communicate all along.
Love,
Doc
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