Crisis Survival Skills are distress tolerance skills that help us survive a crisis without making things worse. There are six crisis survival skills in DBT, each of which is described in the video below:
- The STOP Skill
- Pros and Cons
- TIP Your Body Chemistry
- Distract with Wise Mind ACCEPTS
- Self-Soothe with the Five Senses
- Improve the Moment
DBT Skills: Distress Tolerance & Crisis Survival
This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.
Distress tolerance involves learning to tolerate and survive crises without making things worse. The two elements of distress tolerance are crisis survival skills and reality acceptance skills. And i have a couple of videos about acceptance that explain reality acceptance in a lot more detail, and you’ll find links to these in the pinned comment and description. But basically reality acceptance involves a willingness to accept reality as it is and by doing so we relieve any excess distress we cause ourselves when we try to fight against reality and struggle against things that are outside of our control.
Crisis survival skills are skills for tolerating painful events urges and emotions when we can’t make things better right away. A crisis often but not always starts with an external trigger like some interpersonal conflict, which could be an argument with your partner or falling out with a friend. Or some conflict at work. Or maybe you’re overwhelmed by stress at work, with your family, or a combination of things. Or there’s some distressing event like finding out you’ve lost your job a relationship ending, the death of a loved one, and so on.
And then this external situation triggers a number of distressing inner experiences like difficult and painful feelings and emotions, negative thoughts, and uncomfortable physical symptoms and sensations. And this inner distress can also arise without anything external to trigger it. And then when our emotions reach a boiling point and it all becomes too much we find ourselves in crisis
There are six basic crisis survival skills we’re going to look at, starting with techniques to help stop the crisis and allow you to take a step back from it. And then once you’ve been able to get some distance from the crisis, the skills focus on helping you recover from the aftermath and calm whatever after effects remain.
The first skill is called stop which is an acronym for stop, take a step back, observe and proceed mindfully. So when you stop you don’t react. You freeze. Don’t move a muscle. Your emotions may try to make you act without thinking, but stay in control.
And then take a step back from the situation. Take a break. Take a deep breath .and don’t let your feelings make you act impulsively.
And then observe. Notice what’s going on inside and outside you. What is the situation? What are your thoughts and feelings? And what are others saying or doing?
And then proceed mindfully. Act with awareness. In deciding what to do consider your thoughts and feelings, the situation, and other people’s thoughts and feelings/ think about your goals, and ask wise mind which actions will make it better or worse. And if you’re not sure what wise mind refers to check out the list of videos in the pinned comment and description.
So stop is basically an advanced form of time out. Sometimes stop alone is enough to calm the crisis. But it can also be a great first step before proceeding to another distress tolerance skill, like the next distress tolerance skill we’ll look at, pros and cons.
Now a pros and cons list is nothing new, but for distress tolerance we use a specific type. When we’re in a crisis we’re driven by our emotions, which creates urges for us to act impulsively often in ways we’ll later regret. So first we consider the pros and cons of acting on these impulsive urges and giving into them, giving up, or avoiding what needs to be done. So the pros might look something like this. It’s what we want to do right now based on what our emotions are telling us to do. It might release our pent-up energy and frustration, and it might make us feel better at least for a few moments. And it’s hard and takes a lot of effort to resist such a strong urge.
And then the cons of acting on these urges, such as it’s not strategic, it doesn’t help the situation, and there’s no regard for the consequences. It’s often self-destructive and leads us to do things we later regret. And it can damage our relationships and friendships.
And then we look at the pros of resisting our impulsive urges, of doing what needs to be done and not giving in or giving up. These can be things like, it allows us to make better choices and act strategically in ways that benefit us and have positive consequences. In the long run we’ll feel better about ourselves if we stay in control and don’t act impulsively. And it’ll improve our relationships with people we care about.
And finally the cons to this might be things like in the short term we continue to feel bad. We have to keep tolerating some distress and discomfort. And it can take all of our self-control to try to resist doing what our emotions are telling us to do.
And once you have all these pros and cons in front of you it can allow you to see that acting on your impulsive urges isn’t in your best interest, and help you resist regardless of how strong the urge is. And then instead of relying on your ability to come up with this list in the midst of a crisis when you’re probably not thinking very clearly, plan ahead and create a pros and cons list in advance. And then keep it with you perhaps in your phone. Because when we’re in a crisis and our emotions are driving our thoughts it can be hard to access the rational reasonable part of our minds that we need in order to be able to create something like a pros and cons list.
The next skill is tip which stands for: tip the temperature of your face with cold water, which is pretty self-explanatory. Splash some cold water on your face. Dunk your head in a sink of cold water, or hold some ice up to your face. You can even take a cold shower. These can all help shock you out of your emotional state of mind and help snap you out of a reactionary crisis mode long enough to be able to start acting a little more strategically.
And then intense exercise. A lot of times doing some intense exercise can give an outlet to the physical energy and adrenaline that’s been building up during a crisis and get it out of our system enough to calm some of our distress. Many people find that when their mind is racing and they’re feeling distressed exercise is the only thing that can clear their minds enough to allow them to start to calm down.
And then paced breathing so slowing down your breathing and a good way to do this is to breathe in through your nostrils and then breathe out through pursed lips because the pressure of your lips forces your exhalation to be slower and once you slow your breathing down for a couple of minutes your level of physiological arousal will naturally start to decrease.
Paired or progressive muscle relaxation, which is a relaxation exercise in which you move through your body tensing and relaxing each muscle group along the way. And for instructions on progressive muscle relaxation check out the link in the description.
Next we have distraction. Distraction is just temporary: you’re not completely ignoring problems or emotions. You’re just setting them aside for a while until they’re cool enough that you can handle them, just like they were a hot pan on the stove, and then once they’ve cooled down you can return to them if you need to and resolve any outstanding conflicts or issues. Or engage in some emotion regulation.
The complete list of distraction skills in dbt form the acronym accepts and some of these skills along with the ones in the next couple of sections will resonate with you and make sense and others probably won’t and that’s fine. The comfort level that people have with these techniques varies from person to person so just focus on the ones that feel right for you.
Distracting yourself with activities: this can be any sort of activity from chores around the house to watching TV or reading a book, to playing a video game to doing something with your friends. Just any activity to take your mind off what’s distressing you long enough for the most intense distress to start to calm down and become cool enough to touch.
Contributing: doing some volunteer work or helping a friend or family member or just doing something thoughtful for someone, which not only provides some distraction, but can help you feel better about yourself by doing something nice for someone else.
Comparisons: compare how you feel now to a time when you felt different think about people who are coping the same or less well than you. Compare yourself to those less fortunate.
Distracting yourself with different emotions: read an emotional book or story or watch an emotional film or TV show or listen to some emotional music. And be sure that what you’re doing creates a different emotion than the one that’s causing you distress.
With pushing away, push the situation away by leaving it for a while. Or leave the situation mentally or put your pain on a shelf box it up and put it away for a while.
With other thoughts: count to 10, repeat words to a song in your head, or work on a puzzle. Watch some TV or read.
And finally with other sensations: squeeze the rubber ball very hard. Listen to some really loud music or hold an ice cube in your hand or mouth. Go out in the rain or snow. Or take a hot or cold shower.
And starting from here the skills shift from focusing on getting some distance between yourself and the worst of the crisis to calming and soothing yourself in the aftermath. And the next skill is self-soothing with your senses. So looking at listening to or smelling something that gives you pleasure or that you find calming or relaxing. Or for taste eating some comfort food or having a soothing drink like a cup of tea or coffee or a smoother or treating yourself to something that you wouldn’t usually eat. And make sure to eat mindfully savoring the taste rather than just binging. And for touch doing something like taking a shower or long bath or soaking your feet getting a massage or feeling the warmth of the sun on your skin or a cool breeze on your face.
And finally improving the moment with the acronym improve. So improving the moment with imagery: imagining a relaxing scene. Remembering a happier time and imagining yourself in it indulging in some pleasant daydreams
With meaning: find purpose or meaning in a painful situation. Focus on any positive aspects of the situation that you can find any silver linings.
With prayer or spirituality: opening your heart to a supreme being or wherever you find meaning in the universe. Practicing some meditation opening yourself up to wise mind. Listen to or read about spiritual values.
With relaxing activities: taking a hot bath massaging your neck or scalp or practicing some yoga or other stretching. Or just doing some deep breathing.
Improving the moment with one thing in the moment. Focus all of your attention on just what you’re doing be mindful and keep yourself in the present moment.
Improving the moment with a brief vacation. Just give yourself a brief vacation get into bed and pull the covers over your head. Go to the beach or the woods for the day. Or turn off your phone go to the park and have a picnic.
And finally improving the moment with encouragement and rethinking the situation. Using some positive self-talk to encourage yourself. I’ll make it out of this. I’m doing the best that i can. Repeat to yourself that whatever this is i can stand it. This too shall pass. Everything’s going to be okay. It’s not going to last forever.
So when you find yourself in distress or in the midst of a crisis you can use these crisis survival skills to help calm things down enough to pull yourself out of emotion mind, step back from what’s distressing you, and get a little distance between yourself and the crisis.
And then once things have calmed down you can return to the situation and resolve things if necessary. Or attend to any emotions you’re still feeling in the aftermath by using some emotion regulation skills. Or just do whatever you need in terms of self-care to help yourself continue to recover from this crisis and the distress that you found yourself in.
So once you’ve become familiar with the skills and had a chance to try them and find out what works for you, come up with a crisis survival plan that lists the steps you want to take and the skills you want to remember to use when you find yourself in a crisis. And then keep this plan with you in your phone so it’s always there when you need. It for more on distress tolerance and how we can stave off a crisis by the way we react to things that have the potential to set one off check out my video on distress tolerance and how pain doesn’t have to lead to suffering.
If you have any questions or comments, please leave them on the YouTube video page.