Emotional Overwhelm: How DBT’s Crisis Survival Skills Help
Have 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.
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, or 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 overwhelming emotions.
- Pushing away: Don’t allow yourself to think about it. You can use a timer to set a limit on your thoughts or 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 or Sudoku puzzle.
- Sensations: Intensify other physical sensations. Eat a strong mint, pet your dog, or 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, or the way your 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.
Rathus, J. H., & Miller, A. L. (2015). DBT skills manual for adolescents. New York: The Guilford Press.
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