Affect Tolerance: What Is It, And Why Does It Matter For Your Mental Health?
If there were just one idea you could latch onto when thinking about mental health, “affect tolerance” would take you a long way. I’m not saying it’s the single most important component to mental health, but it’s up there. Before explaining why this idea is so important, let’s first define some terms.
Simply put, affect is your feeling-state—or your feeling-experience in a given moment. While it may be splitting hairs to distinguish affect from emotion, we might think of affect as less personal than emotion; that is, it’s the experience of emotion. While we often use the word “mental health,” our experience of emotion isn’t located somewhere inside of our head or thoughts only. Rather, emotion also includes a bodily experience or an embodied experience. We might call this experience our affectual state.
Now that we’ve got that definition out of the way let’s talk about the idea of affect tolerance. What’s so important about tolerating our embodied emotional experience? Let me give you a concrete example. Everyone knows about the idea of anger management, but what really is the inability to manage anger? If we can not tolerate the embodied experience of being angry, we will likely need to compensate for this somehow. That is, if we can not tolerate the affect of anger, we are going to have to get rid of it somehow.
Most often, we think of people needing anger management when they have an issue with controlling outbursts of anger. They can not tolerate the affect of anger inside themselves, and therefore they express it in ways that are verbally or physically harmful to themselves or others. This is a pretty concrete example of a negative outcome of low affect tolerance.
Another option is that one could suppress or deny their anger. A seemingly good choice, for a period; however, it just so happens that suppressed feelings and feeling-states don’t just disappear into thin air. While we may think this option is “better” than outbursts of anger, both of these approaches come with the potential for severely negative outcomes from a mental health perspective. I won’t go into all the problems that suppressed feelings can cause, but let’s just say they are too many to count.
But affect tolerance does not just apply to anger. It also applies to our ability to tolerate the experience of feelings of sadness, jealousy, shame, fear, and really any emotion. If we cannot tolerate the felt sense of these feelings, then we have to try to get rid of them somehow either by transforming them into something else, acting them out, or suppressing them. Often (but not ALL the time) this difficulty in tolerating affect can then start to show up as one or more mental health symptoms. For example, if I can not tolerate my feelings of sadness, maybe I start to feel anxious whenever something reminds me of my sadness. Over time, my unexpressed sadness might build up so that more and more things remind me of it, and thus more and more, I feel anxious. Then bang, a therapist might say I have an “Anxiety Disorder.” But really, what I have is difficulty tolerating my feeling-state of sadness.
The prior example is very simplified. I’m not saying things are always that straight forward. However, I am saying that without the ability to tolerate our affect, we are more likely to experience mental health symptoms. Therefore learning to tolerate our affect can be thought of as a primary goal in therapy work. The good news is that it is a very learnable skill.
Before ending the article, I’d like to give you some tips and tools to better develop your affect tolerance. I’d also like to point out some behaviors that can negatively impact affect tolerance and contribute to issues for you now or down the road.
Activities That Support Affect Tolerance:
Mindfulness Meditation- You probably guessed this one if you read this far. Mindfulness is all the rage in mental health, and there is a good reason for that. In Mindfulness practice, we begin to learn how to observe our thoughts and feelings without reacting to them. This effectively helps us develop the skill to tolerate our feeling-states.
Journaling- When we journal we express our thoughts and feelings and can see them in front of us. Over time this process can allow us to accept our feelings as they are without acting them out or shutting them out.
Drawing- You do not have to be an artist in order for drawing to be helpful. I know I’m not. However, drawing or coloring touches into the right side of our brains which is thought to be the side connected with our emotions. Even if we just choose a color to represent our affect state and start scribbling that color, we give ourselves an opportunity to develop a tolerance for and express that affect state.
Therapy- One goal of therapy is about learning the skill to tolerate our affect. Most therapists have developed this skill through their own therapy process, or through sitting with other folks for countless hours as they express their feeling-states. When looking for a therapist, try to find one that helps you feel at ease in sharing your feeling-states, no matter what they are.
Activities That Do NOT Support Affect Tolerance
Substance Use- Any substance use that alters our mood in a significant way can negatively impact our ability to tolerate affect— especially if it is habitual use. This really deserves a longer post, but in essence, even if I don’t use alcohol or marijuana or something else because I WANT my anger or sadness to go away, the process of getting high or taking the edge off does change my feeling-state from one state to another. If this is repeated over time, I may become LESS tolerant of my feeling-states because I’ve learned that I can change my mood almost instantly with little effort. The problem is not only can I start to depend on the substance to tolerate my affect even if I don’t intend to, but if you take away the substance I haven’t practiced other skills for affect tolerance, thus I will have start from square one every time…
Raging, Blaming, or Shaming Others- Sometimes people think that the opposite of suppression is to unapologetically let their anger and hostility out onto others. This may allow them to experience some temporary relief, as they have discharged their intense feeling-state. However, this is NOT what is meant by affect tolerance… rather it indicates an inability to tolerate affect. As we do this, we may become accustomed to managing our feeling-states by placing them onto others. However, the end result is that we will experience MORE conflict in our relationships, more pain, and less peace of mind. These are the opposite outcomes of true affect tolerance.
Disavowing, Suppressing, Denying Our Feelings- Disavowing means that we say that we don’t feel some way when we actually do. Suppression is when we “stuff,” our feelings away, hide them, or deny that they exist. These are all indicative of an underdeveloped ability to tolerate affect. While these may function as a short-term coping strategy, in the long term they could contribute to mental health symptoms, unsatisfying relationships, and/or poor self-esteem.
Conclusion: This article is an introduction to the idea of affect tolerance and its importance to all of our mental health. Developing affect tolerance is a consistent practice that is very attainable for most people. It isn’t always easy, however, and it takes work. But the reward is worth it as we start to notice ourselves feeling more at ease with our feelings, ourselves, and able to talk about our emotions more readily in our relationships.
Is Cannabis Good For My Anxiety or Depression?
There are some folks out there who consider cannabis to be a panacea—a substance that is effective for all ailments. When it comes to mental health, I've read that some believe marijuana helps anxiety, depression, and PTSD (1), …but is this really true? Does weed actually help with these issues? When one does some research into this subject, it is very likely they will find mixed messages.
The reality is that there are many unknowns about marijuana use and mental health. However, just because there are unknowns doesn't mean we should throw caution to the wind. Rather, I would be inclined to interpret that such results suggest exercising extraordinary caution when it comes to using cannabis in any way related to mental health. Let's look at why…
Research has shown a correlation between marijuana use and depressive symptoms. A 15-year study of a group of nearly 2,000 adults in the US showed that marijuana use increased the risk of major depression at the follow up by nearly four times (2). According to the same study, marijuana use was specifically associated with an increased risk of suicidal thoughts and chronic low-energy (anhedonia), both symptoms of depression. Similarly, the CDC noted an increase in suicidal thoughts of heavy cannabis users compared to non-users. That being said, it is unclear if these results are causally related to marijuana use or simply due to already depressed people trying to medicate themselves with weed. I myself am reluctant to turn a blind eye to the correlation.
In another study, researchers found that cannabis use was correlated with a significant self-reported reduction of depressive symptoms in the short-term. The same study noted that repeated marijuana use led to no long-term symptom reduction or remission and may increase depressive symptoms over time for some people (3). Another way of thinking about this research's findings is that marijuana is often used to alter mood. Still, over time such mood alteration does nothing to actually change the patterns of this mood or the individual's relationship to the mood. Lastly, I will state that long-term marijuana use has been associated with amotivational syndrome, a term to describe apathy, social withdrawal, and lower level of everyday functioning (4). We will return to some of the ideas in the following paragraphs. Still, for now, let's look at how cannabis may impact anxiety.
What should we expect in regards to marijuana and anxiety? Most are aware of the paranoia and anxiety that can accompany early exposure or overexposure to marijuana. Of more interest to me in this segment is the interplay between marijuana as it impacts the processes of anxiety over time and the impact of self-medicating anxiety with marijuana.
One thing is relatively certain regarding chronic marijuana use and anxiety. Research indicates that long-term users are more likely to develop social-anxiety than non-users (5). Additionally, while using cannabis could help relieve anxiety with the correct dosage in the short term, one study reported that anxiety symptoms returned upon cessation of marijuana use (6). In considering the usage of cannabis as a treatment for anxiety disorders, it is important to note that regular use is likely to include tolerance. This pattern may increase the risk of anxiety upon cessation of use and, thus, psychological dependence on marijuana (7). According to Volkow et al. (2017), as of the time of that study, there have been no randomized controlled trials to show sustainable benefits of marijuana as a treatment for anxiety disorders (7).
What’s the issue with “dependence” If I think cannabis helps with my anxiety or depression? Most people know that marijuana does not include the same physical dependence that heroin or alcohol does. However, there is evidence that there can be withdrawal symptoms associated with long-term use which may include: aggression, anger, irritability, anxiety, insomnia, anorexia, depression, restlessness, headaches, vomiting, and abdominal pain (8). Perhaps not everyone would experience such symptoms, however it is important to note that these are genuine possibilities.
Some cannabis advocates may argue that it is more natural than pharmaceuticals, which may carry their own set of side-effects and potential withdrawal symptoms. While it is true that pharmaceuticals may entail negative side-effects and withdrawal symptoms, these are closely monitored by a psychiatrist, whereas marijuana is most often self-administered. While I can understand the reservation about pharmaceutical intervention for anxiety or depression, I also want to bring attention to an aspect of cannabis dependence that I don't see many marijuana advocates talking about: psychological dependence.
Psychological dependence is often over-looked by pro-pot advocates for reasons I can only chalk up to a lack of knowledge. Stea (2019) described this issue clearly:
“cannabis can reward by enhancing positive feelings and can also be relieving insofar as it can almost immediately take away the experience of uncomfortable emotions. But evidence-based psychological treatments of many psychiatric conditions involve learning skills to confront and engage with difficult emotions, not avoid them. If cannabis is being used to avoid uncomfortable emotions, thoughts, and memories, it can lead to the development or worsening of symptoms. In other words, repeated temporary relief from psychiatric symptoms by using acutely-mind altering substances is not therapy, and in fact, often runs counter to therapy” (1).
Let me break this down a little more. When we use a substance like marijuana, we alter our mood. This mood-alteration is what people often call “getting high.” That is, using cannabis in any form changes our mood from one state to another. This is why people think marijuana can help with anxiety or depression because they may feel immediate relief. The problem with this is that if we are using cannabis—or any other substance or behavior—to try and change how we are feeling, we are avoiding some aspect of our experience. While this may bring short-term relief, we can grow to depend on marijuana more and more so that we turn to weed every time we feel down, anxious, upset, or angry. If we do this, we may never develop the skills to accept and manage our emotions. Most people have heard of the popular show Arrested Development. Arrested development literally means that we have stopped developing psychologically speaking. Chronic marijuana use or use of any substance may keep us from developing healthy coping strategies that will allow us to function fully in our lives and relationships.
Our emotional health is directly correlated to our mental health. If we are not able to accept, talk about, and cope with our emotions, then we are much more likely to have issues with our mental health AND our relationships. Why is that? Our emotions are innately part of us. They guide our self-care and our relational needs. That is part of why I prefer to use the term emotional health as opposed to mental health. Paradoxically, even difficult emotions are essential to our emotional health. If we are constantly trying to get away, change, or manipulate difficult emotions, we are more likely to experience anxiety or depression. Why is that? Because difficult emotions are simply a part of life. Therefore, learning how to accept and tolerate these emotions is going to be the best for us in the long term. Emotional well-being includes the capacity to experience the full range of human emotions, while continuing to be in touch with a sense of purposefulness in life.
Because I have a background in studying Buddhist thought, I will also mention a Buddhist perspective on this topic. The Buddha’s principal teaching was to say that dissatisfaction in life is caused by craving. This isn’t just a craving for chocolate or even weed. Craving here means attachment or aversion to however life is showing up for us. That is, when we are attached or averse to anything, we suffer. Please don’t take my or Buddha’s word for it; observe your own experience. When we use weed to try and alter our mood, we are in effect averse to an experience that we are having…From the Buddhist perspective, there can only be one outcome here… and that outcome is dissatisfaction… needing more… and a lack of lasting contentment.
However, you don’t have to believe in Buddhist philosophy to change the patterns of marijuana—or any other—dependence. The first step is always to be aware of the consequences that this pattern of behavior is having on you. Sometimes folks are not even fully aware of these negative consequences until they have some time away from the substance. I know that was how it was for me. The good news is that you can change this pattern. The best motivation happens inside of you, with your own clarity as to how this behavior is an obstacle to you living the life you want to live. Here are some ideas if you want to cultivate a change in your relationship to marijuana or any other problem behavior.
Things to try:
Make a list of consequences of your substance use. Be honest. Notice if there is a part of you present that wants to rationalize or minimize these consequences. Ask others (see below) if they have observed negative consequences from your use.
Practice meditation. This helps you develop an awareness of your mental patterns, and with greater awareness comes greater choice. Also, meditation is a coping strategy that can provide us with sustainable changes in our state of mind.
Attend a Marijuana Anonymous meeting. Yes, they exist. They are full of stoners like me, and maybe you. If you allow yourself to get over your own judgments, you may find a new family of loving, supportive people.
Ask your friends and family about their perceptions of your use. Sometimes if all of our friends and family smoke weed, they may not see the negative impact it has on us. However, if you have friends or family that use less than you or don’t use… ask them about their experience with your weed usage.
Journal before and after you use cannabis. Journaling is an excellent practice to help us develop an awareness of our patterns. Journaling before we smoke can help us learn about the feelings we may be trying to get away from by smoking. Journaling when we are coming down or after using may help us develop an awareness of the less desirable side-effects from our use.
Consult a therapist. When someone comes to me with a chronic weed habit, my first order of business is to try to educate them on how this pattern may be negatively impacting their emotional well-being. Typically, I will tell someone that it is hard to make sustained progress in therapy while regularly using marijuana to self-medicate. That is because therapy is meant to help us learn new ways of coping… If someone is using weed to deal with challenging emotions, they are unlikely to be able to get an accurate readout of how these new coping strategies are helping. That being said, I have extensive experience working with substance use and can work with folks at whatever level of readiness they are to change. Look at my page on addiction here or contact me for a free phone consultation.
(1)Stea, J. N. (2019). "Is cannabis good or bad for mental heath?" https://blogs.scientificamerican.com/observations/is-cannabis-good-or-bad-for-or-bad-for-mental-health/
(2)Bovasso, G.B. (2001) Cannabis abuse as a risk factor for depressive symptoms. Am J Psychiatry. 2001 Dec; 158(12):2033-7.
(3)Cuttler C., Spradlin A., Mclaughlin R.J. (2018). A naturalistic examination of the perceived effects of cannabis on negative affect. J Affect Disord. 2018;235:198-205. doi:10.1016/j.jad.2018.04.054
(4)Lac A., Luk J.W. (2018). Testing the amotivational syndrome: Marijuana use longitudinally predicts lower self-efficacy even after controlling for demographics, personality, and alcohol and cigarette use. Prev Sci. 2018;19(2):117-126. doi:10.1007/s11121-017-0811-3.
(5)National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. Washington (DC): National Academies Press (US); 2017 Jan 12.
(6)Walsh Z., et al. (2017). Medical cannabis and mental health: A guided systematic review. Clinical Psychology Review 2017;51:15-29.
(7)Volkow N.D., Hampson A.J., Baler R.D. (2017). Don't Worry, Be Happy: Endocannabinoids and Cannabis at the Intersection of Stress and Reward. Annual Review of Pharmacology and Toxicology 2017;57:285-308.
(8) Grinspoon, P. (2020). Harvard Health Blog. https://www.health.harvard.edu/blog/if-cannabis-becomes-a-problem-how-to-manage-withdrawal-2020052619922