DBT Video Text: Crisis Review 1

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These are scripts from videos by Dialectical Behavioral Therapy creator Marsha Linehan describing DBT skills. You can purchase the videos from Behavioral Tech LLC.

Ok. So, we’ve gone over a lot of material. Let’s put it all together. And we’re going to review. And as I review with you, you try to review with me. Ok so see if you can remember what you’ve learned in the program. Ok.

What’s a crisis? Remember it’s got three criteria or three components. What are they? Do you remember? Well first, crisis is highly stressful or traumatic. Second, it’s momentary – that means its short term. Crisis is not your entire life. And third, there’s a really strong urgency and pressure to get it resolved right now. Seems like sort of an emergency. Alright? So that’s a crisis. 

What are the skills that we covered in this particular program on how to do that? I’m sure you remember. There were two sets: distracting skills and self-soothing. Remember now there are 7 distracting skills and the way you remember all 7 is with the word ‘ACCEPTS‘.

A? What’s A stand for? Activities. You want activities that will fill up your mind or take your mind off your stress.

C. C? Well C is contributing. You want to contribute to other people and take your mind off yourself or your current mood. The idea is to sort of throw your mind to somebody else.

Ok, what’s the third one? Well, it’s another C. C, comparisons. In this one you compare yourself, your state of mind, your current distress, trauma or crisis to either another time in your life when it’s actually been worse. Or to someone else whose life is a lot worse than yours. The idea here is to try to replace distress with a sense of relief. You’re trying to kind of generate the idea that it could be worse.

What’s the fourth letter? E. E for emotions. Here we’re looking for opposite emotions that are intense, opposite to the one you’ve got now. So don’t try to get your current emotions more intense. That would just make things a whole lot worse. If you remember you’ve got to switch emotions.

Alright. We’ve got P. What’s P? You remember? Pushing away. The idea here is to push away your troubles. Put them on the shelf. Wrap them up. Put plexiglass in front of you. Get distance. Push your problems away.

Ok. What’s the next letter? T. Know what’s T stand for? Thoughts. Now the idea here is to try to switch your thoughts. You’re going to try to fill your mind up with some new thoughts that are not distressful thoughts. So you’re going to try to push out your current worries by throwing you mind onto some other thoughts. A word, a mantra, a verse – any source of thoughts. It could be a saying. 

And the last letter? S. S stands for sensations. Now remember you’re looking for sensations that are really strong and ones that are going to distract you. So what would those be? Do you remember? Well, you could do hot water. My favorite one though, and I recommend you try it if you haven’t tried it before. It’s in a real crisis when you feel like you’re going to fall apart, you’re emotionally aroused, you just can’t stand it – run don’t walk for the freezer and take out some ice. Put ice in your hands and hold it.

DBT Distress Tolerance: a chunk of ice floats above a hand as if thrown into the air.

Now, I have to ask one thing. How many distracting skills have you written down?  Have you written some down? Do you realize that if you get in a crisis you’re not going to be able to remember any? Your mind just won’t be able to think any out. That’s what most people experience. So if you didn’t write any down, my suggestion to you is, put the program on pause again and write some down. Now you can’t just write the word ‘Activity’.  You’ve got to write ‘Activity? What am I going to do? Ok, my activities will be…I will 1, 2, 3…I’ll go running. I’ll bake a cake.’ Alright? So get activities written down. Go through the whole list. Write something down for each one. Because you need lots of distracting skills to try. 

Alright, so that’s the Distracting Skills.

Now the next set that we went over were the self-soothing skills. And you can probably remember self soothing if you can remember the five senses. So let’s go through them.

First, vision. You’re going to want to find beauty to soothe your eyes.

Second, hearing. You’re going to want to find some sounds that’ll soothe your ears.

Next, smell. You’re just going to try to figure out a way to get some wonderful aromas to soothe your nose. 

How about taste? Well, delicious foods. Really nice drinks. You’re going to soothe your appetite. Soothe your tongue.

And how about touch? Well, the idea here is to try to find something sensuous that you can put close to your skin to soothe your body. 

DBT Distress Tolerance: A fuzzy dog wrapped in a bathrobe reclines on a bed with a bottle of sparkling water

So those are the Self-Soothing Skills.

Alright so that’s the Self-Soothing and the Distracting Skills. Now. If you remember all those skills what do you have to do to make it work? 

What do you have to remember to make all this work? First, you’ve got to know when a crisis is coming your way. You’ve got to notice when you’ve got the urge to do something destructive. So, you’re going to try to get yourself to be a little more aware. Second, when a crisis comes your way and you have an urge to do something destructive, you need to immediately say, ‘What’s the problem? And can I solve it?’ If you can solve the problem right now, well, why not solve it. Now, if you can’t solve it you’re going to want to remind yourself that making things worse is going to make your life worse. You’ve got to remember that.

You’ve got to repeat that over and over. ‘Making things worse will make my life worse.’ Got to remember that.

Then, once you decide ok, I don’t want to make things worse, you’ve got to figure out a skill to use. Now the problem is there are lots of skills. The question is which one do you use.  Well, it’s really helpful if you actually have them written down. If you’ve got my workbook or if you’ve got some of the handouts, you can go look at the list and just see if you can figure out one to try. The idea is to try any skill that you think might work. If that skill doesn’t work, well, go to the next skill. That one doesn’t work, well, go to the next. If that one doesn’t work go to the next. You just keep going right through the skills until you get to the bottom. 

What if none of the skills work? What do you think you should do then? Start over. Just start right back over from the top. The idea is don’t give up. Keep trying skill after skill after skill after skill. You’ll find one sooner or later.

And, you have to remind yourself that Crisis Survival skills work if you survive the crisis.  All you’re trying to do in a crisis when you can’t make it better is to not make it worse. Some people think, ‘Oh, I didn’t feel any better, therefore these skills don’t work.’ Well, feeling better is almost always going to require solving the problem. Or at least starting to solve the problem. 

Crisis survival is when you can’t solve the problem. And you can’t even start solving the problem so they’re just trying to get you through it. So you have to ask yourself, ‘Did I get through it? Did I carry on? Did I avoid making it worse?’ If you can say yes then you can say, ‘I was skillful.’ So that’s the whole point of these skills. 

Listen, I know making your life better is going to take a lot of work. I’m not forgetting that little detail. I know it’s true. And these skills…they may seem sort of trivial, like they’re not important. But take it from me, they are important. Because to make your life better, to get where you want to get, you have to survive crises. There is no other way. You can’t make it if you don’t. It’s life and death. You’ve got to do it. And these skills, I think, will help.

This text is the unofficial transcript of Behavioral Tech, LLC.
Chaos to Freedom Skills Training Video. Posted with permission from Behavioral Tech.
Transcribed by Sylvia James, May 15, 2006