How to Use DBT Skills to Cope in Crisis

If you’ve ever felt your emotions are so completely overwhelming that you can’t restabilize yourself and may return to unhealthy or high risk behaviors, DBT can help. 

 Helping individuals to cope in crisis situations is one of the primary goals of Dialectical Behavior Therapy (DBT). The skills and tools taught throughout DBT can be used in a variety of circumstances and throughout many daily experiences to minimize stress and reduce emotional suffering. If you’re dealing with a high-stress environment, relationship, PTSD, depression, anxiety, or other mental health conditions, DBT skills may help diminish the severity of your symptoms and promote a better quality of life. 

Distress Tolerance 

The Distress Tolerance module of DBT incorporates both the ability to non-judgmentally accept yourself and your situation, and the ability to tolerate and survive that crisis point. Remembering that stress and pain are a part of life is one of the first steps to acceptance. It’s also important to recognize that most of our stress is heightened by fighting this reality - when we focus on tolerating the moment, rather than avoiding or negating it, we usually move through the emotional distress much faster.  

 

Distraction with ACCEPTS

Distracting yourself from crisis when the situation is out of your control can help you diminish the impact of negative thoughts and feelings. The acronym ACCEPTS in DBT stands for: 

  • ACTIVITY: Do something else (work out, clean, listen to music)
  • CONTRIBUTE: Do something for someone else (volunteer, write a note, help take out the trash or mow the lawn) 
  • COMPARISON: Recognize your situation and its differences and similarities to the situation of others (this helps shift your focus) 
  • EMOTION: Find a way to channel a different emotion through music, videos, conversation, etc. 
  • PUSH AWAY: Set a timer to keep yourself from obsessively fixating on the crisis situation - use that time to do something else before you go back to focus on the problem. 
  • THOUGHTS: Choose other thoughts to distract yourself such as saying the alphabet, counting to 100s in 3s, doing a puzzle, or challenging yourself in a mentally stimulating way that makes it difficult to fixate on the problem at hand. 
  • SENSATION: Focus on another physical sensation, such as petting your dog, eating food with strong flavor, smelling something potent, or squeezing a stress ball.

Acceptance

Refusing to accept reality does not make it any less painful. In fact, studies have shown that this type of denial can prolong our suffering. Acknowledging and enduring painful situations through acceptance, however, decreases the pain of the situation and can shorten the time we feel emotionally vulnerable or distraught. 

Basic DBT Acceptance skills include breathing exercises and awareness exercises where you can acknowledge and accept your emotions and your circumstances, breathe through them, and remind yourself to accept and tolerate your reality with purposeful willingness. 

TIPP

“TIPP” the scale with these strategies to help control intense emotions or impulsive urges in crisis: 

  • Temperature: Run cold water or an ice cube over your inner forearms or chew ice to physically cool down. 
  • Intense Exercise: Do short sprints or jumping jacks, pushups, mountain climbers, or run in place for a minute. 
  • Paced Breathing: Slow down, count each breath, and try counting to 5 as you inhale, then hold for 5 (or any number), then count to 5 as you exhale, hold for 5 and repeat. This is called Square Breathing. 
  • Progressive Muscle Relaxation: In a calm space, focus on squeezing and then releasing one muscle at a time throughout your entire body. 

Self Soothing

Use your 6 senses to ground yourself in the present moment. For instance: 

  • Hearing: listen to relaxing music or focus on specific sounds around you like the wind, cars, crickets, birds, etc. 
  • Vision: Look at soothing images or focus on trees, the skyline, or anything in nature. 
  • Smell: Choose a smell that relaxes you, such as peppermint or lavender. 
  • Taste: Eat or drink something you like that has a calming effect on the body (like herbal tea)
  • Touch: Use texture to relax your body (a soft blanket, your dog’s fur, etc)
  • Movement: Try moving your body through dance, a run, or any form of exercise. 

These and many other skills are taught in DBT to increase Distress Tolerance and can help you navigate crisis in a healthier way without resorting to impulsive or risky behavior or sending you into panic attacks, freeze mode and other common reactions to emotional distress. You have the power to improve your situation through purposeful application of DBT skills. 

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