DBT Skills for Overwhelming Moments

 

There are moments when emotions may feel more than uncomfortable. They might seem too fast, too intense, or just too much to endure.

These emotions might come up in any number of daily experiences. One might feel a sudden and intense rush of panic when shopping for groceries. One might feel completely disconnected from reality when arguing with a partner. One might feel strong anger when cut off in traffic. In any of these moments, these emotions might feel disproportionate, embarrassing, or even impossible to explain.

These instances are not indicative of emotional immaturity, nor do they mean that you lack the ability to persevere when confronted with adversity. Rather, these instances actually indicate that your nervous system is overwhelmed.

Thankfully, Dialectical Behavior Therapy (DBT) was developed with these moments in mind. Simply put, DBT is a type of talk therapy that works to teach skills geared toward mindfulness (e.g., tolerating distress, managing intense emotions, and attaining interpersonal effectiveness in relationships).

Before delving into skills, it’s important to understand what’s happening in our minds. When emotions feel overwhelming, a common reason can be that we have moved outside of our “window of tolerance.” In other words, our nervous system has become stressed to the point where we struggle to think clearly, stay connected to others, and regulate emotions effectively. This can happen due to accumulation of daily stressors, trauma triggers, relational conflicts, sensory overload, sleep deprivation, and even feeling misunderstood.

Once outside of the window of our tolerance, the part of the brain responsible for logic effectively “turns off.” The parts of our brain responsible for survival take over instead. That’s when people experience things such as panic and anxiety, emotional flooding (e.g., crying, raised voices, rage), shutdown (e.g., dissociation and numbness), and/or urges to flee the situation.

As important as it is to reflect, gather insight, and discuss emotions, we first need to implement skills intended to encourage our “logical brain” to “come back online.” DBT works because it respects a core truth: you can’t think your way out of nervous system overload. You have to regulate first.

Distress tolerance skills are not about fixing the problem at hand. Instead, they’re intended to help us handle intense emotions without making things worse.

There are a number of acronyms commonly used in DBT that prove to be highly effective in real-life emotional regulation.

1. STOP (Stop — Take a Step Back — Observe — Proceed Mindfully)

• Stop: When you feel that your emotions seem to be in control, stop! Don’t react. Don’t move a muscle. Just freeze, especially those muscles around the mouth. Freezing for a moment helps prevent you from doing what your emotions want you to do (which is to act without thinking). Stay in control. Remember, you are the boss of your emotions. Name the emotion — put a label on it.
• Take a Step Back: When you are faced with a difficult situation, it may be hard to think about how to deal with it on the spot. Give yourself some time to calm down and think. Take a step back from the situation. Get unstuck from what is going on. Take a deep breath and continue breathing deeply as long as you need and until you are in control. Do not let your emotions control what you do. It is the rare incident, indeed, wherein we need to make a split-second decision about anything. Hence, it is okay to take our time to decide how to respond.
• Observe: Observe what is happening around you and within you, who is involved, and what are other people doing or saying. Listen to the Automatic Negative Thoughts (ANTs) that occur…remember those are based on an outdated Belief System that was programmed before you were seven. To make effective choices, it is important NOT to jump to conclusions. Instead, gather the relevant facts so you can understand what is going on and what options are available.
• Proceed Mindfully: Ask yourself, “What do I want from this situation?” or “What are my goals?” or “What choice might make this situation better or worse?” or “What act will allow for success?” Stay calm, stay in control, and when you have some information and how that may impact your goals, you will be better prepared to deal with the situation effectively. Remember your brain needs time to think all of this through.

2. ACCEPTS (Activities — Contributing — Comparisons — Emotions — Pushing Away — Thoughts — Sensations)

• Activities: Engage in activities that require thought and concentration. This could be a hobby, a project, work, or school.
• Contributing: Focus on someone or something other than yourself. For example, you can volunteer or do a good deed.
• Comparisons: Look at your situation in comparison to something worse. Remember a time you were in more pain, or when someone else was going through something more difficult.
• Emotions: Do something that will create a competing emotion. Feeling sad? Watch a funny movie. Feeling nervous? Listen to soothing music.
• Pushing Away: Push negative thoughts out of your mind. Imagine writing your problem on a piece of paper, crumpling it up, and throwing it away. Refuse to think about the situation until a better time.
• Thoughts: Occupy your mind so you don’t have room to dwell on painful feelings. Count backwards from 1,000 by 7, recite a poem in your head, or read a book.
• Sensations: Find safe physical sensations to distract you from negative emotions. Wear a rubber band and snap it on your wrist, hold an ice cube in your hand, or eat something sour like a lime.

3. TIPP (Temperature — Intensive Exercise — Paced Breathing — Progressive Muscle Relaxation)

• Temperature: Briefly immerse your face in cold water while holding your breath, repeating 2–3 times. Other options include taking a cold shower, applying an ice pack or ice cube to your skin (avoiding extreme or prolonged cold), or holding a wet cloth on your face or neck.
• Intensive Exercise: Exercise at moderate intensity for around 15 minutes, being careful not to overdo it. Some options include walking briskly or jogging, swimming laps or riding a bike, jumping rope, or doing jumping jacks.
• Paced Breathing: One example of this could be to inhale through your nose for a count of 4. Hold your breath for a count of 7. Exhale through your mouth for a count of 8. Repeat several times.
• Progressive Muscle Relaxation: An example of this could be: Sit or lie down in a comfortable position. Tense the muscles in your feet for 5 seconds. Slowly relax these muscles as you say the word “relax.” Repeat these steps with your calves, thighs, mid-section, back, chest, arms, and face.

4. IMPROVE (Imagery — Meaning — Prayer — Relaxation — One thing in the Moment — Vacation — Encouragement)

• Imagery: Imagine a peaceful place far from your worries. What are the sights, sounds, and smells you notice? Alternatively, vividly envision the best possible resolution of your current challenge. Use each sense to imagine relaxing on a beach. Visualize a stressful conversation going well.
• Meaning: Is there any meaning you can find or create from your situation? Reflect on ways you can use your current experience to gain insight or help others. Name any positive aspects of your struggle. List the ways you can grow from this experience.
• Prayer: Use prayer to accept what you cannot control or seek guidance on navigating a difficult situation. Connect with a higher power or your own wise mind. Say a prayer. Repeat a mantra. List five things you’re grateful for. Meditate.
• Relaxation: Find a quiet place where you can practice a relaxation technique of your choice. If you notice your attention wandering back to your worries, gently bring it back to your practice. Practice deep breathing. Use progressive muscle relaxation. Stretch. Practice yoga.
• One thing in the Moment: One thing in the moment Immerse yourself in a simple or repetitive activity that requires your full engagement. This could be a household chore or a mental task like counting or memorizing. Pull weeds. Organize your clothes. Memorize a poem. Count backward from 100.
• Vacation: Take a short break from your worries and do something fun or nourishing. This can refresh you and lead to a fresh perspective when you resume your day. Call a good friend. Go on a hike. Read something that interests you. Watch a favorite movie.
• Encouragement: Practice being your own best advocate by repeating words of support to yourself. Be sure to select a phrase that feels authentic and motivates you to keep going. “I got this!” “This too shall pass.” “I survived before, and I’ll survive again.” “I’ll be OK.”

The mistake many people make is trying to force motivation or productivity. What helps instead is restoring safety and presence first. When emotions feel overwhelming, many people try to tell themselves that they’re “sensitive,” “dramatic,” “overreacting,” etc. — this doesn’t help. What is actually effective is utilizing the aforementioned techniques to reestablish yourself in the present moment. While not every technique will work for every single person, it is important to try. Take a moment to look over those acronyms and give them a spin — more than likely, you’ll find a few that seem to work.

If you or someone you know is looking for support, feel free to reach out to Behavioral Health Clinic at 855.607.8242or visit BHClinic.com.