With our 2007 E350-V10 & current day Torqshift transmission, towing our 4200 pound Jeep Liberty, I have yet to be worried over the drivetrain except when engine braking. The RPMs can sometimes get very close to red-line. At my second oil change I switched to full synthetic oil in hopes to provide a little extra edge to my concerns.
Whether engine braking or climbing, the Triton series engine, V10 or V8, is designed to rev very high compared to the GM engines. As a result, the engines can get loud which can make you feel you are over-stressing something. But in reality, all is well.
I personally love the tow haul mode. I called Ford twice over the years, asking if Tow-Haul could be reprogramed to be "On" by default, but I get the same disappointing answer.
As Barry said, try not to loose momentum when driving in the mountains. When you do, just take it slow (or slower) in a lower gear. You want the rig to rev high with the least amount of throttle. Once in a great while you will simply find yourself at very high RPMs in a very low gear, going very slow. As uncomfortable as it might feel, the drivetrain is designed to work just like that. As always, give consideration to the other drivers around you.
In answer to your Tow-Haul mode question... It changes the shift points under both conditions, accelerating and decelerating.