Using Dialectical Behavior Therapy (DBT) in Daily Life to Cope with Overwhelming Emotions
Whether you have yet to acknowledge it or maybe you are aware of frequent, recurring patterns, all of us will experience dysregulating emotions at some point in our lives; most of us more than once. Early in our lives, this may look like what many of us call a “tantrum” and can occur from being disappointed, not getting our needs met, feeling unheard, and many other factors. When a young child has a temper tantrum, it may look like screaming, crying, or physical outbursts. As we age, disappointment, invalidation, and not having our needs met are things we may continue to experience, but we may attempt to cope with the emotion in a different way. This may come out as an anger outburst (the grown up version of a tantrum, so to say), urges for self harm, avoidance, eating disorder behaviors, urges for substance use, isolation, and many other forms of coping. From the framework of Dialectical Behavior Therapy (DBT), we call these “target behaviors”.
When working with a therapist, you may start to notice and observe which of these behaviors are effective versus ineffective, helpful and unhelpful. For behaviors that are ineffective or unhelpful, you may try implementing a skill (or maybe a few) before going automatically to the target behavior, which for many has unintended or undesired consequences. When we are experiencing intense emotions and distress, it can be helpful to draw from what the founder of DBT, Marsha Linehan, named “Distress Tolerance Skills”. One of the most helpful skills I have found, from both my practice as a DBT therapist and simply as a person, are TIPP skills. TIPP is an acronym for skills to remember when we are in a sea of distress and need to regain control of our body and emotions.
Temperature: When using the temperature part of this skill, we want to focus on cold temperatures rather than warm. While warmth can be soothing and calming, the goal of cold temperature is to activate the Dive Reflex (the same part of our brain that turns on when we dive into a swimming pool!). The traditional way of practicing this skill is to put your face in a cold bowl or bucket of water. When we do this, our dive reflex is activated and the body naturally decreases it’s heart rate. This is helpful because when we become dysregulated our heart rate tends to increase as we become more and more distressed. The goal is to bring the body back to a place of homeostasis. Other ways to practice this part of the skill are to put a cool wash clothh on the back of the neck, hold ice cubes until they melt, or rub ice cubes on your cheek bones.
Intense Exercise: Exercise can be a helpful outlet and tool when feeling distressed, especially if you are experiencing a very active emotion, such as anger, rage, or anxiety. Intense exercise can look like a run around the block, a walk, or cardiovascular exercises, but it doesn’t have to. Other forms of exercise that help meet the goal with this skill can include wall pushups, planks, pushups, or crunches. If you struggle with exercise or overexercise as a target behavior, please proceed with caution and discuss with your treatment team if this is an appropriate skill to practice for you at this time.
Paced Breathing: breathwork is a great practice for all of us, even in times of regulation. The more we practice it in both times of distress and when we are at a baseline, the more regular and natural it becomes. This is a tool you can take anywhere with you and use at anytime! A good practice for paced breathing is simply counting your inhales and exhales. It is important to remember that we should aim for exhales to be slower than inhales. This will activate the parasympathetic nervous system and begin the process of regulation. Another good breathing technique to practice here is square breathing, as seen below by Calmerry:
Paired muscle relaxation: This is a technique that helps to release any tension we are holding in our bodies and provide a physical sense of release and relief. This is another skill you can practice anywhere at any time. When I orient clients to this skill, I guide them through an exercise that begins at the top of the head and ends at the toes. One by one, you squeeze and release a particular muscle, noticing the sense of relaxation and tension dissipating as you progress through the practice. For those that struggle with self guided practices, there are many resources available online to help provide structure to paired muscle relaxation. I encourage you to take some time to explore what works for you!
TIPP skills, as well as the other distress tolerance skills DBT provides us with are meant to be stabilizing so that we can tap into other skills and be present in our daily lives. We are unable to address communication issues with our partner, conflict at work, or other stressors when we are activated to a point of feeling out of control. The goal is to provide you with the skills to stabilize, so that you can return to your life and continue to cope effectively.
Please feel free to reach out to schedule with one of our clinicians to learn more about how skills practice and therapy can help you with those unwanted or ineffective behaviors.