Crisis Survival

You are in crises when the situation is highly stressful, and you feel like you must act on or resolve the crises right now. It’s an intense feeling, one you can’t shake unless you do something this moment.

It may be intense anger. You want to lash out at someone-something immediately, so you can feel better. It may be desolation. You want to end the feeling by using drugs or alcohol- anything that will make you feel better.

It’s really hard to stop yourself. This is crises and one thing to keep in mind (if you can) is it’s usually short term. DBT states that crises survival skills (known as Distress Tolerance) should be used when:
1. You have intense pain that cannot be helped quickly
2. You want to act on your emotions, but it will only make things worse.
3. Emotion mind threatens to overwhelm you and you need to stay “skillful.”
4. You are overwhelmed yet demands must be met.
5. Arousal is extreme, but problems can’t be solved immediately.

A really effective skill to use is called STOP. I’ve used it in times of anger when I wanted to lash out at my job. I wasn’t being treated right. I wanted to get angry at everyone. I wanted to say things I would regret. I just wanted to feel better- to justify myself.
The STOP skill works like this:
Stop. Do not react. Freeze and don’t move a muscle. Stay in control. Your emotions are telling you to act, but before you do, just STOP.
Take a step back. Take a break, a deep breath, take yourself out of the situation. Even for just a moment, do not act impulsively.
Observe. This one can be hard, but you have to notice what you are thinking and feeling as if you are watching it like a movie. What is the situation? What are your feelings about it? What are others saying or doing?
Proceed Mindfully. Act with awareness. Which actions will make it better and which actions will make it worse?

Once we left for vacation on the anniversary of my son’s death. We thought it would be good to get away during that time especially since I didn’t handle the previous anniversaries so well. In the car I had a panic attack. The STOP skill helped me to take a step back and observe what was happening to my body. I took deep breaths and the attack seemed to end quicker than normal. I didn’t cope by using anything and I waited it out. I know in my Wise Mind that it would end. It always does.

Distress Tolerance skills are especially helpful when we are out of control. Once I was so distraught during a therapy session that I was crying uncontrollably. My therapist chose to use a skill called TIP. Which is controlling through temperature, intense exercise or paced breathing with paired muscle relaxation.

We chose the temperature route and she got a pitcher of ice which I placed on my forehead with a paper towel. This calmed me down fast as the change of temperature changed my body chemistry. Fifteen to thirty seconds should be enough time for this “dive reflex” to set in. Some members of my DBT group have also used ice on their wrists or they held their breath and submerged their faces in cold water. As you do this, your blood flow is redirected to your heart and brain. This is for use when you are having a very strong, distressing emotion.

Intense exercise can be used in the same way. Do some jumping jacks even if it’s for a short amount of time. Or run down the street and back. Expend your energy on something physical. People who run regularly often say that it makes them feel good, gets the endorphins going. This is the same principle.

Paced breathing is slowing down your breath. Breathe deeply and breathe out more slowly than you breathe in. Pair this with muscle relaxation. As you breathe in tense your muscles. Notice where the tension is and say “Relax” in your mind as you breathe out. Let go of the tension and notice the difference in your body. Do a body scan while using this skill by starting with tensing your hands, then your lower and upper arms etc.


It’s good to have these skills in your toolkit so when you are in distress you can try them and use whatever works.

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