Many people tend to become emotionally dysregulated when under stress, as if they’re at the mercy of their anger, sadness, anxiety, shame, or other big emotions.
When this happens, it’s easy to get in your head, worrying about the future or the past in unproductive ways and often turning to unhealthy coping mechanisms like eating, drinking alcohol, isolating, obsessively ruminating, or physically hurting yourself—anything to blunt the emotional pain.
But a powerful model of therapy exists that can help break these cycles, getting people out of their heads and into the present moment: dialectical behavior therapy. DBT can help you get out of the mentality that “everything is horrible and always will be” and into a more compassionate one that reassures you that, “things are difficult right now, and that’s okay.”
Originally developed to manage the patterns associated with borderline personality disorder and suicidality, DBT can be especially helpful for individuals with anxiety, depression, trauma, attention deficit hyperactivity disorder (ADHD), impulsivity-related issues (self-harm, substance abuse, dysregulated anger), and even general stress.
The power comes from the D in DBT. It stands for “dialectical,” a reference to the notion that two opposing things can be true at the same time. You can be angry at someone and also care for them. You can be disappointed in your behavior and also acknowledge that you’re a good person at heart. You can be in deep psychic pain and also trust your ability to survive it. A person can be good and not get it right every time.
This flexible, nuanced approach integrates tenets of Buddhist philosophy, with an emphasis on mindfulness, self-compassion, and non-judgmental thinking. Psychologist Marsha Linehan, PhD, who founded DBT in the early 1990s, emphasized the value of distress tolerance—the ability to sit with painful emotions without judgment or catastrophizing. Distress tolerance helps people better accept life’s ups and downs, including those that bring anger, sadness, anxiety, shame, or other big emotions, and is, in Linehan’s view, a crucial prerequisite to facilitating acceptance of realities that cannot be changed, especially when reality is not what a person wants or hoped for. This is why DBT is often illustrated as a well-balanced teeter-totter with “Acceptance” on one side and “Change” on the other.
Consider these quick examples:
Original thought: “My partner is so lazy. He never helps out around the house or goes out with me for dinner or the theater. I don’t see how this relationship can work.”
Reframed with DBT: “I love my partner and I’m upset and frustrated that he doesn’t help out much around the house or show interest in joining me in activities.”
Original thought: “I want to attend my niece’s wedding but thinking of being around so many people gives me tremendous anxiety, I am an awful person for not wanting to go.”
Reframed with DBT: “I want to attend my niece’s wedding, and thinking of being around so many people gives me tremendous anxiety.”
Original thought: “Nobody will ever love me again now that I am divorced.”
Reframed with DBT: “Things are extremely challenging right now, and I can handle it.”
The and mentality softens the all-or-nothing thinking and self-judgment that keep people trapped in the fight-or-flight cycle. It helps ground you in the present. It acknowledges psychological distress and the discomfort that comes from situations we can’t change, without letting them run the show.
Life is often uncomfortable. Dozens of DBT skills exist to help people get comfortable with that discomfort. Some of these skills counteract the body’s stress response and activate the calming arm of the nervous system to dial down emotional intensity in the heat of the moment. Others allow events and life circumstances to be reframed in a more manageable, empowering light.
The acronym T.I.P.P. represents four strategies that can help people resist impulsive or potentially destructive behaviors, whether that’s going down a rabbit hole of anxiety or having a drink after a stretch of sobriety:
Let’s focus on the T, which usually involves plunging your face into a bowl of cold water for about 30 seconds, eliciting a primitive survival response called the mammalian dive reflex. Tricking the deep recesses of your physiology into thinking you’re underwater slows your heart rate almost immediately, activating the parasympathetic (relaxation) nervous system to calm emotions and help you think rationally Note: If you have cardiac issues, ask your doctor for medical clearance before trying this skill.
The extreme cold also interrupts emotional thoughts and distracts from uncomfortable physical stress sensations, like chest tension or nausea. Practice this when feeling calm to see what you can tolerate.
Sound too intense? Try holding an ice cube, pressing a bag of frozen vegetables against your cheek (cover it in a damp paper towel first), or blasting your face with cold air from the air conditioner. These won’t activate the mammalian dive reflex, but the intense sensation can still help ground, calm, and stabilize you.
When feeling super stressed, the Opposite Action skill encourages you to do the exact opposite of whatever your panic, anxiety, or agitation wants you to do.
Easier than it sounds, I know. So I recommend preparing for Opposite Action with the S.T.O.P technique:
Stop: When an urge hits, like the impulse to text your friend that you’re not coming to their party or to send a harshly worded email or to Google a worrisome symptom you’ve been experiencing even those you know you Dr. Google tends to upset you, stop whatever you’re doing. You can literally say “Stop!” out loud, clap your hands, picture an imaginary STOP sign, or look at an actual one.
Opposite Action and S.T.O.P. interrupt automatic emotional responses to triggers, helping reduce impulsive reactions.
Many people describe the nervous system regulation and mindfulness developed through DBT as life-changing. To find a clinician, visit https://dbt-lbc.org.
