Emotional Overwhelm: How DBT’s Crisis Survival Skills Help

A person with crossed legs holds a cup of tea and reads a b ookHave you ever felt like your emotions are so overwhelming they will never stabilize? Maybe you have an intense urge to return to unhealthy or risky behaviors to make yourself feel better. Dialectical behavior therapy (DBT) has a whole module that focuses on crisis survival skills. These are skills that help you hang in there, or cope, when emotions are overwhelming. It doesn’t make the feeling go away, but these skills can help you get through the intensity of these emotions.

Here is a brief overview of DBT’s crisis survival skills.

Distraction

These strategies are used to distract yourself from distressing thoughts, feelings, or situations that feel overwhelming. The acronym “ACCEPTS” can help with recall in the moment.

  • Activities: Do something. Read, play a sport, clean.
  • Contributing: Do something kind for someone else. Put the dishes away, write a thank-you note, volunteer your time.
  • Comparisons: Compare your situation to someone else’s. This can help shift your focus away from your situation.
  • Emotions: Making yourself experience a different emotion can help distract you. Watching funny online videos, listening to love songs, or catching up on your favorite soap opera are all examples of how you can distract yourself from your overwhelming emotions.
  • Pushing away: Don’t allow yourself to think about it. You can use a timer, type it all out in an email draft (or go “old school” and write it on paper), and put it away so you don’t focus on it for the time being. This skill is a two-parter, though. When you feel more able to hang in there, go back and address whatever it is you pushed away. Otherwise, it will just keep growing.
  • Thoughts: Distract yourself with other thoughts that make it difficult to think about anything else. Say the alphabet backward, count down from 100 by 7s or 3s, or do a crossword puzzle or Sudoku.
  • Sensations: Intensify other physical sensations. Eat a strong mint, pet your dog, squeeze a stress ball.

Self-Soothe with Six Senses

These strategies can help you feel better and in control by using your five senses (and a sixth: movement) to ground you to this person, place, time, and situation.

  • Vision: Look at photos that put you in a good mood, or go to a beautiful place and admire the views in person. These can be related to friends and family, nature, animals, or more.
  • Hearing: Listen to relaxing music or the sounds around you.
  • Smell: Find smells that relax you. Lavender is a solid go-to if you need help getting started.
  • Taste: Eat or drink something calming, such as mint or herbal tea. Focus on how pleasant it tastes.
  • Touch: Touch something relaxing. Curl up in your favorite blanket or pet your cat.
  • Movement: Move around. Dance, go for a run, or do some other exercise.

IMPROVE the Moment

You can’t necessarily change the fact something is happening, but you can change the way you feel, think, or react using these skills.

  • Imagery: Use guided imagery, or even your own imagination, to visualize more pleasant outcomes or circumstances.
  • Meaning: My mother loves to say “everything happens for a reason.” Being able to understand or acknowledge why something happened, or its purpose, can help you feel better about the fact it is happening.
  • Prayer: You can either pray in the traditional sense or use this skill as a form of meditation or journaling. Basically, you can use prayer as a way to connect spiritually or reflect on past, current, and future circumstances.
  • Relaxation: Indulge in something relaxing. Go to the beach, get a massage, or even take a nap.
  • One thing in the moment: Focus on one thing in that moment. You can focus on your breathing, the sounds you hear, the way the chair feels.
  • Vacation: This can be an actual trip or a “mental vacation.” If you can’t leave the situation or you’re unable to take a physical vacation, escape in a book or a movie.
  • Encouragement: Use positive self-talk. Pin inspirational quotes on your Pinterest page or write them in a journal. Reflect on how awesome you are. Reflect on what you’re doing well right now.

Pros and Cons

Considering the short- and long-term pros and cons to a decision can be helpful in deciding how to react to a situation or feeling.

TIPP the Scale

This is a newer skill set introduced in the latest update to the DBT Skills Manual for Adolescents. These skills are used when managing extreme emotions or urges. Using these strategies may help adjust your body chemistry.

  • Temperature: Run cool water over your inner forearms or chew on ice to physically “chill out” and “cool down.”
  • Intense exercise: Do 20 jumping jacks, 10 push-ups, or run in place for 1 minute.
  • Paced breathing: Slow down and count your breaths. You can use “square breathing” (count to four as you inhale, hold for four counts, count to four as you exhale, hold for four counts, repeat).
  • Progressive muscle relaxation: Concentrate on squeezing one muscle, then release. Move on to the next muscle group in your body. You can find scripts online that walk you through this or do it on your own.

It is important to note that one skill might not be enough depending on how intense your emotion or urge is. You might need to try a few to find what works best for you. As with anything, it’s also possible that something might work in one moment and not in another. Have a willing attitude as you give these skills a try, and partner with a therapist trained in DBT if you want support.

Reference:

Rathus, J. H., & Miller, A. L. (2015). DBT Skills Manual for Adolescents. New York: The Guilford Press.

© Copyright 2016 GoodTherapy.org. All rights reserved. Permission to publish granted by Mallory Grimste, LCSW, therapist in Woodbridge, Connecticut

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Olivia

    July 21st, 2016 at 9:20 AM

    Short bouts of intense exercise- great distraction as well as good for the heart health too! Double bonus!

  • Mallory Grimste, LCSW

    July 23rd, 2016 at 3:33 AM

    Yes Olivia- short bouts of exercise is amazing for this! And it’s healthy- I always caution to make sure you are using proper form as well so you don’t end up with a new problem trying to solve the original one.

  • Javon

    July 21st, 2016 at 3:13 PM

    I am not sure about what works for others but the last thing that I like to do is to compare my situation to that of someone else, because I think that usually I only think about those who have it way better then what I do and then that only makes me feel terrible. I get it that this is not the intent of that exercise, that this is really supposed to be about getting your mind off of what is troubling you, but you know, I always go for the worst possible so I think more along the lines of what I don’t have but that another person does.

  • Mallory Grimste, LCSW

    July 23rd, 2016 at 3:36 AM

    Javon, you make an excellent point! Not every skill will work for everyone. (And just because one skill works one time doesn’t mean it will work the same the next time). Everyone and every situation is different. One of the reasons I love DBT is that it does a wonderful job outlining a variety of specific skills you can choose from.
    I’d be interested in hearing what skill(s) do work best for you in these situations.

  • mac

    July 22nd, 2016 at 7:36 AM

    I love to just put on some good music

  • Mallory Grimste, LCSW

    July 23rd, 2016 at 3:37 AM

    Yasss Mac! I’m all about the music! It’s definitely one of my top go-tos as well.

  • Beth

    July 23rd, 2016 at 8:58 AM

    Oh yeah… a vacation sounds good right about now. Sadly I have so much going on at work at this moment that getting even a day off can be difficult much less a week or a long weekend. There is an end in sight, but I am still just having to wait it out til I can find the right time to get away for a while.

  • Mallory Grimste, LCSW

    August 8th, 2016 at 9:21 AM

    Beth – I can appreciate that! You can find ways to take “mini-vacations.” For example, sometimes I will take the time to sit in the bath or I might take time to sit and actually watch a TV show instead of checking my texts and e-mails while watching. I’m hoping you can find ways to take mini or mental vacations if you can’t take an actual vacation :-)

  • della

    July 25th, 2016 at 9:15 AM

    When my daughters feel overwhelmed like this i try to steer them in the direction of trying to find something that will take their minds off of it. Just get busy and do something.

  • Mallory Grimste, LCSW

    August 8th, 2016 at 9:22 AM

    Yes Della! That is great to help in the moment! We all know the intensity often wears off over time. Doesn’t necessarily change what is happening but distraction can help you hang in there until you can make a clear plan on how to approach whatever is stressing you out.

  • Phil

    October 7th, 2016 at 1:34 PM

    There is an obvious one missing here…not sure if there is a reason why, but when my partners emotions starts to spin out of control…we get passionate, the combination of intense physical contact and positive conversation about how beautiful she is, what she means to me etc seems to act like a complete reset for her anxiety and whatever issue was occuring, which we normally discuss and process once she is in the post coital bliss state etc.

    So Im curious, is there a reason that intimacy is excluded from BPD treatment? It seems to work extreemly well…obviously its not something a therapist can partake in and without the right partner I imagine it could be destructive but it has halted a 10 year substance addiction and Anorexia where many other therapies had failed, so sort of surprised it isnt mentioned as a postive activity anywhere!?

  • Mallory Grimste, LCSW

    October 10th, 2016 at 7:32 AM

    Hi Phil,
    You do make an excellent point! Physical and emotional intimacy could fit in either the Prayer (as a spiritual experience), the Relaxation category or the physical Sensation/Touch categories depending on how you are using that.
    To be fair, intimacy is listed on some handouts about these skills. I have chosen to exercise caution about identifying skills in such a public and open forum that could easily be used as vices if overused or used in a way that is unhealthy (for example, drinking a glass of wine could also be a Relaxation skill if you are of legal age and drink in a minimal-to-moderate fashion). It’s tough to write about every way a skill category could be used (I could go on and on and on) and even more difficult to write about skills that could be misinterpreted or misused without knowing how the intended reader will interpret it.
    I hope you can understand my reason for not including it in the original examples and I thank you for encouraging a positive dialogue about this topic. I am glad this is continuing to be helpful for both you and your partner.

  • Phil

    October 10th, 2016 at 1:49 PM

    Yes I understand the need to be cautious about therapies that could also be vices, but my concern is that the information available is sanitised to fit with a societial viewpoint.

    When you consider that one of the key issues in this type of personality is anxiety and fueled from a diminished sense of self does this not mean that the medical community is making a moral decision that hide options from patients as this community deems the stigma of using anti psycotic medications and making a patient feel that they require these because they have a “disorder” vs. Just a need to be in what I guess is a form of co-dependant relationship.

    I think the mental health community needs to “take a moment” and consider that the application of religious and societal values could actually be a significant cause of harm to this segment of the community.
    If you looked at the total population base that have anxiety as a key component of their mental state, you are looking at a significant part of the population. If simply being with the right partner / with the right temprement and emotional ability to support them ment they could function normally and life a life of happiness without any medication or social stigma then perhaps their needs to be more debate about the fundamental approach to treating / advising these people!?!

    It just seems to me that rather than face up to the fact that some people struggle to develop self awareness, the personal skills to cope with what is essentially a fairly hostile world or dont have a supportive enough environment that they go off the rails in their teen years or in their twenties. Labelling them as having a disorder and as broken does significantly more harm than counciling them into a lifestyle that a conservative medical professional doesnt approve of…. hmmm …it just seems that it isn’t the patients that are broken!

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