15.5 — DBT Skills, Self-Applied

Everything in 15.3 and 15.4 assumes you can think. Above about seven out of ten, you cannot (4.6).

DBT was developed for people whose emotions arrive fast, run high and last long. The skills are useful to anybody, and the distress tolerance set in particular is the most immediately practical material in this Part.

Four modules. This page gives the portable core of each.

1. Distress tolerance — for the crisis

Purpose: get through the next twenty minutes without making things worse. Not feeling better. Not making it worse.

TIPP — when the intensity is above eight

These change your physiology directly, which is the only thing that works at that level.

Temperature. Cold water on the face, or hold ice, or cold water on the wrists. Cold on the face triggers a reflex that slows the heart. The fastest available and it works when nothing else can be reached.

Intense exercise. Twenty minutes of hard effort. Burns off the stress response.

Paced breathing. Long exhale, longer than the inhale (7.3).

Paired muscle relaxation. Tense hard, release, notice (7.4).

Distract, deliberately and temporarily

Not avoidance — a bridge across the peak (4.6).

Activities that require attention. Contributing — do something for somebody else. Comparisons, used carefully. Opposite emotions — music or film with a different tone. Pushing away — deliberately shelving it for a set time. Other thoughts — count backwards in sevens. And other sensations — ice, a cold shower, a strong taste.

Self-soothe with the five senses

Something that smells good. Something warm. Music. Something to look at. Something to taste. Simple, and it is what people forget entirely when distressed.

And radical acceptance

For the situations that cannot be changed. Fighting reality adds suffering to pain (5.4).

The phrase: "This is how it is right now. Fighting it does not change it."

Not approval. Not giving up. Acknowledging what is, so that your energy goes to what can be done.

2. Emotion regulation — between crises

Reduce vulnerability first. The DBT version of 6.8: treat physical illness, eat regularly, avoid mood-altering substances, sleep, exercise. The acronym is PLEASE and the content is the stress floor.

Then: check the facts. Does the intensity fit the situation? (15.3.)

Opposite action — the central technique.

When an emotion's urge is unhelpful, do the opposite, fully.

Afraid and want to avoid → approach. Sad and want to withdraw → go out, engage. Angry and want to attack → be scrupulously courteous, or step away. Ashamed and want to hide → tell somebody.

Fully means all the way, including the posture and the voice. Half-hearted opposite action does not work.

And this is not suppression. You are not pretending not to feel it. You are declining the instruction, and the feeling follows the behaviour more often than expected (8.8).

Then build positive experience — daily small pleasant activities, and longer-term work towards things that matter (15.4).

And build mastery — one thing a day that is slightly difficult and that you complete. The completion is the point.

3. Mindfulness — the underlying skill

The DBT version is stripped down and practical.

Three what-skills: observe — notice without words. Describe — put words to it, facts only. Participate — be fully in what you are doing.

Three how-skills: non-judgementally — describe rather than evaluate. One-mindfully — one thing at a time. Effectively — do what works rather than what is right or fair.

And wise mind — the position between pure emotion and pure logic. The question: what does the part of me that is not currently upset think about this? Frequently answerable even mid-crisis, and worth asking.

4. Interpersonal effectiveness — asking and refusing

DEAR MAN, for making a request or saying no.

Describe the facts. "The report deadline moved twice this week."Express how you feel, briefly. "That makes it hard for me to plan."Assert what you want, specifically. "I need forty-eight hours' notice on date changes."Reinforce — the benefit to them. "Then I can get it right first time."Mindful — stay on the point. Repeat it unchanged (13.4). Appear confident — steady voice, eye contact if comfortable. Negotiate — offer an alternative if there is one.

And two others to hold at the same time.

GIVE, for keeping the relationship: be Gentle, act Interested, Validate their position (4.9), and use an Easy manner.

FAST, for keeping your self-respect: be Fair, no unnecessary Apologies, Stick to your values, be Truthful.

The real skill is deciding which of the three matters most in this instance — getting the outcome, keeping the relationship, or keeping your self-respect. You frequently cannot maximise all three, and knowing which you are prioritising is what stops the conversation drifting.

Putting it together

Above eight out of ten: TIPP. Nothing else. Make no decisions and send nothing.

Five to seven: distract or self-soothe, then check the facts, then opposite action.

Below five: the thinking tools work — 15.3, 15.4, or an actual conversation using DEAR MAN.

And between episodes: the vulnerability factors, positive experience, and mastery. This is where the frequency of crises is actually reduced, and it is the part everybody skips.

What to do

Make a crisis card. A physical card, in your wallet, with four things: the two TIPP actions you will use, one person's name and number, one distraction that works for you, and the sentence this will pass. You will not remember any of it in a crisis, which is why it is written down.

Practise the cold-water technique once now, while calm, so it is a known move.

Use opposite action on one thing this week.

And write your next difficult request using DEAR MAN before you make it. Five minutes, and the difference in outcome is large.

Next: 15.6 assembles the whole thing into a session you can run on yourself.