DBT Crisis Survival Skills: What to Do When You Can't Think Straight

What are DBT crisis survival skills?

Crisis survival skills are one category within the distress tolerance module of Dialectical Behavior Therapy (DBT). DBT, created by psychologist Marsha Linehan at the University of Washington, was originally developed for individuals with borderline personality disorder but has since been validated for a wide range of conditions including depression, anxiety, PTSD, eating disorders, and substance use disorders.

DBT includes four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Crisis survival skills fall under distress tolerance — the module focused on getting through painful moments without resorting to destructive behaviors. The fundamental philosophy is: you cannot always change the situation, but you can survive it without making it worse.

The DBT crisis skills tool provides guided access to each skill category so you can quickly find the right technique when you need it most.

TIPP: the fastest way to change your emotional state

TIPP is the go-to skill when your emotional intensity is at its peak — a 9 or 10 out of 10. Each letter represents a physiological intervention that works within minutes:

T — Temperature. Submerge your face in cold water or hold ice packs to your cheeks and forehead for 30 seconds. This triggers the mammalian dive reflex, which automatically slows heart rate and redirects blood flow to vital organs. It is one of the fastest ways to reduce extreme emotional arousal. If you cannot submerge your face, holding ice cubes in your hands or placing a cold pack on the back of your neck achieves a similar effect.

I — Intense exercise. Engage in vigorous physical activity for 10–20 minutes. Running, jumping jacks, fast walking, or even doing burpees in your living room. Intense exercise burns off the adrenaline and cortisol flooding your system during acute distress, and releases endorphins that naturally shift your mood.

P — Paced breathing. Slow your breathing rate to 5–6 breaths per minute. Breathe in for 4 seconds and out for 6–8 seconds, making the exhale longer than the inhale. This activates the parasympathetic nervous system via the vagus nerve, directly counteracting the fight-or-flight response. Box breathing is one effective pacing method.

P — Progressive (Paired muscle) relaxation. Systematically tense and release muscle groups throughout your body, starting from your feet and working upward. Tense each muscle group for 5 seconds, then release for 10 seconds. This technique directly addresses the muscle tension that accompanies emotional distress.

ACCEPTS: distraction that works

When emotions are intense but not at a crisis peak (a 6–8 out of 10), ACCEPTS provides structured distraction strategies. The goal is not to avoid your feelings permanently — it is to create enough distance to prevent impulsive actions while the emotional wave passes. Each letter represents a distraction category:

• Activities: Engage in absorbing tasks — cleaning, cooking, exercising, playing a game, doing a puzzle. Activities that require focus occupy the cognitive resources that would otherwise feed rumination.
• Contributing: Do something for someone else. Send an encouraging text, volunteer, help a neighbor, or donate. Contributing shifts attention outward and activates reward circuits associated with prosocial behavior.
• Comparisons: Compare your current situation to times when you have coped with something difficult before, or to people who are facing greater hardship. This is not about minimizing your pain — it is about accessing perspective when perspective feels impossible.
• Emotions: Generate a different emotion intentionally. Watch a funny video, listen to upbeat music, read something inspiring, or look at photos of good memories. Emotions are not permanent states — you can shift them with deliberate input.
• Pushing away: Mentally push the distressing situation away temporarily. Visualize putting the problem in a box and placing it on a shelf. You are not denying it exists — you are choosing to return to it when you are in a better emotional state to handle it.
• Thoughts: Replace distressing thoughts with neutral mental tasks. Count backward from 100 by 7s, recite song lyrics, list state capitals, or describe a process step by step. Occupying working memory reduces rumination.
• Sensations: Create strong physical sensations to interrupt the emotional experience. Hold ice, snap a rubber band on your wrist, take a cold shower, eat something with a strong flavor (sour candy, hot sauce). The 5-4-3-2-1 grounding exercise uses a related sensory approach.

Self-soothe with the five senses

Self-soothing is the practice of providing comfort to yourself through gentle, pleasant sensory experiences. It is the opposite of the intense sensory input used in crisis-level grounding — here, the goal is to calm and nurture rather than alert and redirect.

• Vision: Look at beautiful images, nature, art, or anything visually pleasing. Watch a sunset, look at photos of loved ones, or light a candle and watch the flame.
• Hearing: Listen to soothing music, nature sounds, rain, or a calming podcast. Avoid content that is emotionally activating.
• Smell: Use scented candles, essential oils, fresh flowers, or bake something fragrant. Lavender and chamomile scents have been associated with reduced anxiety in research studies.
• Taste: Have a warm cup of tea, a piece of chocolate, or a favorite comfort food. Eat slowly and mindfully, savoring each bite.
• Touch: Wrap yourself in a soft blanket, take a warm bath or shower, pet an animal, or use a weighted blanket. Gentle pressure activates the parasympathetic nervous system.

IMPROVE the moment

IMPROVE is a set of cognitive and behavioral strategies for making an unbearable moment more bearable. These skills work well when physical TIPP interventions have brought your arousal down enough to think more clearly:

• Imagery: Visualize a safe, peaceful place in vivid detail. Imagine a positive outcome. Use mental rehearsal to see yourself getting through this.
• Meaning: Find purpose or meaning in the suffering. This is not toxic positivity — it is recognizing that difficult experiences can lead to growth, empathy, or motivation for change.
• Prayer or connection: Connect with a higher power, spiritual practice, or sense of something larger than yourself. For non-religious individuals, this can mean connecting with nature, community, or personal values.
• Relaxation: Engage in deliberate relaxation — progressive muscle relaxation, gentle stretching, yoga, or slow breathing.
• One thing in the moment: Focus entirely on the present task. Do not think about the past or future. Just be here, doing this one thing, right now.
• Vacation: Take a brief mental or physical vacation. Step outside for 10 minutes, go for a walk, or simply sit somewhere different. Changing your physical environment can shift your emotional state.
• Encouragement: Talk to yourself the way you would talk to a friend in crisis. "You can get through this. This feeling is temporary. You have survived hard things before."

How crisis skills fit with other DBT modules

Crisis survival skills are designed for acute moments. They are not meant to be your only strategy. In the full DBT framework, they complement three other skill modules:

• Mindfulness teaches present-moment awareness and non-judgmental observation of thoughts and emotions. It is the foundation for all other DBT skills.
• Emotion regulation provides tools for understanding, labeling, and changing emotional responses over time. These are preventive skills that reduce the frequency of crises.
• Interpersonal effectiveness teaches communication, boundary-setting, and relationship management skills that reduce interpersonally-triggered crises.

Think of crisis skills as the emergency toolkit and the other modules as the maintenance program. The DBT crisis skills tool provides quick guided access to the distress tolerance skills when you need them in the moment, while the other modules are best explored with a therapist or through a structured DBT skills workbook.

When to seek professional support

Crisis survival skills are powerful self-management tools, but some situations require professional support beyond self-help:

• You are experiencing suicidal thoughts or urges to self-harm — call 988 or go to your nearest emergency room
• Emotional crises are happening frequently (multiple times per week)
• You are using substances to cope with distress
• Relationships are being seriously affected by emotional intensity
• You have a history of trauma that contributes to emotional overwhelm
• Self-help strategies are not sufficient to manage your symptoms

A therapist trained in DBT can provide the full treatment program — including individual therapy, skills group, phone coaching, and consultation team — which has been shown in randomized controlled trials to be significantly more effective than the skills alone. If you also experience thoughts of self-harm, a safety plan can provide structured guidance for keeping yourself safe. SAMHSA's National Helpline (1-800-662-4357) provides free, confidential referrals.