Using DBT Skills to Deal with Emotional Reactivity and Stop Unwanted Behavior

Have you ever noticed that you are more likely to fly off the handle or easily break into tears when you are stressed out? This makes sense. When your resources are depleted as a result of excessive stress, you have fewer resources available to manage your emotions. Consequently, there may be times when you feel much more emotionally reactive or when your emotions feel out of control. When you are experiencing a tremendous amount of stress, it is hard to not be emotionally reactive. Although you may not be able to control how emotional you are, you can control your behavior. A couple of DBT skills focus on how to control your behaviors when you are experiencing intense emotions. Two of the skills that we believe can be most helpful in this regard are the mindfulness skill of noticing your experiences and the distress tolerance skill of focusing on the consequences of your behaviors before you act. Here is a list of steps you can take when you feel like you’re at the end of your rope and almost ready to snap.

1. Stop whatever you are doing. Sit down in a comfortable, alert position someplace where you won’t be bothered, and don’t move a muscle.

2. Step back and notice your experience. Use the mindfulness skill of noticing your experience (Linehan 1993b) to step back in your mind and observe how you are feeling. Notice what emotion you are experiencing and where you feel it in your body. Use the spotlight of your attention to scan your body and figure out where you are holding tension, what your heart rate and body temperature feel like, and what other sensations you are having. If your mind wanders, that’s okay; just return your attention to your body. Don’t push any of your sensations away or try to escape them. Just notice them for now.

3. Notice any urges to act. If you feel really angry, irritated, or frustrated, maybe you have the urge to lash out at someone. If you feel despair, shame, or sadness, perhaps you want to rush away and curl up in your bed. Whatever you feel like doing, which we would call your action urge (what you feel like doing when you feel an emotion), just simply notice that. Notice what you feel like doing, observe and notice the urge or desire to act, and let it come and go, rise and fall like a wave on the ocean. Simply step back and pay attention to it for a little while. Don’t push it away or try to keep it around. Try to visualize yourself riding this urge as if it were a wave on the ocean (this is the skill of “urge surfing, ” and it comes from Dr. Alan Marlatt’s 2011 work on mindfulness-­based relapse prevention) (Bowen, Chawla, and Marlatt 2011). See exercise 5.5 for practice in urge surfing.

4. Think through the consequences of what you want to do. One of the best ways to steer yourself onto a more effective course when you are stressed out and feel reactive is to think through what might happen if you were to simply act on impulse and do what you feel like doing. When you’re stressed out, the immediate positive consequences of actions like yelling, drinking, using drugs, throwing things, and so on are likely to seem pretty attractive. So, you need to get your brain focused on the negative consequences of these behaviors. One of the ways to do this is to make a list of all of the consequences of various behaviors, both positive and negative, short term and long term. Exercise 5.6 can help you do just that.

The following exercise in urge surfing is adapted from our book Freedom from Self-­Harm: Overcoming Self-­Injury with Skills from DBT and Other Treatments (Gratz and Chapman 2009).

Exercise 5.5 Urge Surfing: A Mindfulness Skill to Cope with Urges

Find a quiet place where you will be relatively free of distractions and won’t be bothered by anyone. Sit in a comfortable position. Write down how strong your urge is on a scale from 0 (no urge at all) to 10 (the strongest urge you have ever had). Then, write down how much you feel that you can handle your urge, using a scale from 0 (can’t take it for one more second) to 10 (could handle it for ten hours straight if you had to). Imagine that you are standing on a surfboard on the ocean in a warm, tropical place. You can see the white, sandy shore in front of you, there is a slight breeze, and you can smell the salt of the ocean. There are a few fluffy, white clouds overhead, and the sun feels warm on your back. Really transport your mind to this scene.

Now, imagine that your action urge is the wave that you are about to catch. As your urge rises and becomes stronger, the wave gets higher, but you keep right on top of it. Imagine that you’re an excellent surfer who can handle any wave that comes your way. As the urge gets stronger and stronger, the wave gets higher and higher until it crests. Imagine that you are riding the wave to shore. As you watch and surf the wave, notice what happens to it. Notice if it gets higher and stronger, or if it starts becoming lower and weaker. When it gets weaker, imagine that you are sliding into shore on your surfboard. When it starts to build again, imagine that you are back out there on the wave, just riding it. Keep doing this for about ten minutes, or until you feel that you have a handle on the urge and will not act on it. At the end, write down how strong your urge is on a scale from 0 to 10 and how much you feel that you can handle your urge on a scale from 0 to 10.

Use the following exercise to come up with as many short-­term and long-­term consequences of impulsive behaviors as you can. Make sure you fill in each of the four boxes in the table and include both positive and negative consequences. There are three important steps to remember about this skill: (1) write down only the important consequences; (2) memorize your list of consequences so that you can use it next time you need it without much thought or effort, or make a copy of this list and carry it with you; and (3) pay a lot of attention to the negative consequences of the problem behavior. Use this strategy to get yourself motivated to go down a different path when you’re stressed out.

Exercise 5.6 Positive and Negative Consequences of Impulsive Behaviors

Use this table to help you focus on all of the consequences of impulsive behaviors, both positive and negative. First, identify your action urges, or what you feel like doing when you are at the end of your rope and feel as if you could snap.

Action Urge: ___________

Then, fill in the likely consequences of doing what you feel like doing, making sure to focus on both the positive and negative consequences (both short and long term). Then, review the list and decide what will be the best choice for you, taking all of the consequences into account.