The purpose of this skill is to help patients distract themselves from harmful urges using multiple domains. The skill includes the following:

A- Activities

C- Contributing

C- Comparisons

E- Emotions

P- Pushing Away

T- Thoughts

S- Sensations


ACCEPTS Skill in Crisis Survival Skills Within Distress Tolerance of Dialectical Behavior Therapy

This skill is meant to help patients be able to soothe and calm themselves in moments of distress. It includes encouraging patients to use their senses to focus on what they see, hear, feel, smell, and taste around them to help them ground themselves in moments of crisis and distress.

Self-Soothe Skill in Crisis Survival Skills Within Distress Tolerance of Dialectical Behavior Therapy

In order to reduce extreme emotions, changing the state of your body is critical. This skill is helpful in reducing the physical symptoms of extreme emotions. The skill is divided into the following:

T- Tip the temperature

I- Intense Exercise 

P- Paced breathing

P- Paired muscle relaxation (PMR)


TIPP Skill in Crisis Survival Skills Within Distress Tolerance of Dialectical Behavior Therapy

This set of skills is intended-as the title suggests-to improve the current moment you are in. It is a set of skills meant to guide you in finding stability during an emotional storm and after the storm. The set includes:

I- Imagery

M- Meaning

P- Prayer

R- Relaxing actions

O- One thing in the moment

V- Vacation

E- Encouragement



IMPROVE the moment Skill in Crisis Survival Skills Within Distress Tolerance of Dialectical Behavior Therapy

This skill is usually the first skill used to address a situation. Essentially, it is freezing yourself completely and taking a step back to observe what is happening to you externally and internally. The STOP skill is broken down into the following:

S- Stop

T-Take a step back

O- Observe

P- Proceed mindfully 


STOP Skill in Crisis Survival Skills Within Distress Tolerance of Dialectical Behavior Therapy 

The skill is used when you have to decide between two actions or choices but are unsure which way to go. Additionally, when overwhelming harmful urges arise, it is good to make a pros and cons list of the actions that are urged on paper. The skill consists of two parts: 

-Pros 

-Cons


Pros and Cons Skill in Crisis Survival Skills Within Distress Tolerance of Dialectical Behavior Therapy

-STOP

-Pros and Cons

-TIPP

-ACCEPTS

-Self-Soothe

-IMPROVE the moment


Eastern Michigan University

Boston University

The purpose of crisis survival is to get through a mental health crisis. A crisis could be urges to harm self and others, extreme emotions, panic attacks, or PTSD episodes. The set of skills within crisis survival aim to reduce the intensity of our reactions to the crisis and bring us to a stable ground.

Part One of Distress Tolerance Module: Crisis Survival 

Schimelpfening, N. (2021, July 9). What is dialectical behavior therapy (dbt)? Verywell Mind. https://www.verywellmind.com/dialectical-behavior-therapy-1067402. 

What Is Dialectical Behavior Therapy (DBT)?

Linehan, M. M. (2015). DBT Skills Training Manual (2nd ed.). The Guilford Press. https://survivingcptsd.files.wordpress.com/2018/01/dbt_skills_training_handouts_and_worksheets_-_linehan_marsha_srg_.pdf
- The manual has 3 modules: distress tolerance, emotion regulation, and interpersonal effectiveness. Each module has handouts, which are essentially the lesson plans with descriptions and teachings of the skill. 

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