Residential service settings enable workers to interact with young people experiencing a full range of emotions including distress, to observe the strategies they use to cope with distress, and to provide clear, predictable and respectful feedback. For this reason residential settings offer many opportunities for working on distress tolerance strategies. Because of the intensity of time spent together while a young person is in residential care, this is a good time to focus on talking in depth about painful feelings, the ways the young person has dealt with them before, and learning about new skills.

It is important to note that residential settings alter the presence of contextual stressors that may trigger distress and problematic responses. They also change the range of strategies that are available for coping. In terms of contextual stressors for example, although young people are removed from stressors in their natural environments that may exacerbate distress (e.g. conflict in the family home) they may also be exposed to new stressors or challenging situations.

In terms of strategies for distress tolerance, residential settings remove access to some methods that young people currently use, and this may lead to a shift in the methods used. For example, an increase in the incidence of self-harm is sometimes observed in young people while they are in residential settings. This may occur because substance use is banned in residential settings and is no longer available as an option for coping with painful feelings.

Outreach settings offer workers the opportunity to spend time with the young person in a variety of natural contexts in which the topics of distress and how to cope are likely to arise regularly. Even if it is not the main focus of the work, distress tolerance is often highly relevant to the work being done on a range of other goals. Learning about how young people are coping with painful feelings, and teaching and practicing coping skills in varying contexts, helps the client to generalise the core understandings and skills across situations.