Crisis survival skills

In DBT, there are a few skills to help you ride out, or get through, a crisis or emotional storm (Linehan 1993b). Some of the most fundamental tools for dealing with overwhelming distress are self-­soothing or relaxation strategies. One of the most difficult things to tolerate about anxiety and other emotions are the physiological experiences that go along with them: increased heart rate; feelings of muscle tension; having butterflies in the stomach; feeling flushed, too hot, or too cold; or other such experiences. In DBT distress tolerance skills, as you will learn throughout this book, you are taught strategies to physiologically soothe yourself and calm your body down so that your anxiety is a little more manageable. These strategies may not eliminate anxiety or other emotions, but they can make them less intense and help you get to the point where you can think and make effective decisions about how to deal with your problems.

Another way to deal with overwhelming distress is to distract yourself, at least temporarily. Distraction involves doing something that temporarily gets your mind off whatever is upsetting you. We’ve already written at length about the problems with avoiding your problems, and it might sound as if distraction were just another way to avoid your problems. If you’re thinking this, you’re correct. The important points here, however, are that distraction has been found in research to be an effective way to cope with emotional distress, and you are to use distraction temporarily, not to distract your entire life away. Another very important point is that for distraction to work, you have to do it mindfully. Pay close attention and throw yourself into whatever activity you are using to distract yourself. If you engage in distracting activities but think about your problems the whole time, then it won’t work.

Distraction could involve any activity that temporarily gets your mind focused on something other than whatever is bothering you. A few examples of distraction strategies often used in DBT are (ibid.):

· Engaging in activities that focus your mind on something other than your problems. Examples include spending time with people; going for a walk or exercising; getting out of your immediate environment and going somewhere else; doing arts, crafts, or hobbies; getting some work or studying done; and eating (not too much or too little). The trick is to do activities that really grab your attention and give your brain some temporary relief from your problems.

· Doing something that helps other people, organizations, animals, or the world. Really throwing yourself into helping activities can draw your attention away from your problems and make you feel a sense of self-­respect. Examples include cooking a nice meal for someone, contributing to a charity, helping someone get across the street, smiling and being extra friendly to people you see in public, and calling up a friend who you know needs support.

· Another way to use distraction is to get your mind busy. For example, you might subtract from 684 by 7s until you get to 5 (assuming that you don’t have a problem with compulsive counting); do a crossword, sudoku, or other type of puzzle; work on a demanding or challenging project; or play video games.