10 Major DBT Strategies to Manage a Crisis in BPD

Introduction: When Emotions Feel Like an Emergency

For some people living with borderline personality disorder (BPD), emotional distress can become overwhelming very quickly.

A delayed text message might trigger intense fear of abandonment. A disagreement may feel like the end of a relationship. A perceived rejection may bring waves of shame, anger, panic, or emptiness.

Sometimes the intensity of these feelings creates an urgent need to do something—anything—to make the emotional pain stop.

Dialectical behavior therapy (DBT) was developed by psychologist Marsha Linehan and is one of the most extensively studied treatments for BPD.

DBT teaches practical skills for navigating difficult emotions, improving relationships, and reducing harmful behaviors.

The following 10 strategies draw from DBT's four core skill areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

They are educational tools, not substitutes for individualized therapy or emergency care.

Comprehensive DBT is structured psychotherapy that may include individual therapy, skills training, between-session coaching, and therapist consultation. Practicing these educational skills alone is not the same as receiving comprehensive DBT treatment.

1. The STOP Skill: Interrupt the Emotional Reaction

STOP is a DBT distress-tolerance skill that helps create space between an emotional trigger and your response.

S — Stop: Pause. Avoid acting immediately on the impulse.

T — Take a step back: Give yourself a moment before responding.

O — Observe: Notice your thoughts, emotions, physical sensations, and surroundings.

P — Proceed mindfully: Choose an action that supports your longer-term goals.

Example

You send someone a message and they do not respond.

You immediately feel rejected and want to send several more messages demanding an explanation.

Instead, you pause, notice the fear, and choose to wait before responding.

2. TIPP Skills: Lower Physiological Arousal

TIPP refers to four DBT strategies designed to reduce acute physiological arousal.

T — Temperature: Use a cool washcloth on your face or hold a cool object.

I — Intense exercise: If medically appropriate, briefly engage in physical activity, such as brisk walking.

P — Paced breathing: Breathe slowly and comfortably, allowing your exhale to be longer than your inhale.

P — Paired muscle relaxation: Gently tense and release muscle groups while noticing the difference between tension and relaxation.

Example

After a painful disagreement, your heart races, your muscles tense, and your thoughts become difficult to organize.

Rather than immediately returning to the argument, you use paced breathing and gentle muscle relaxation.

As your physical activation decreases, you may find it easier to decide what to do next.

3. ACCEPTS: Distract Yourself Temporarily

ACCEPTS is a DBT distress-tolerance acronym describing several ways to redirect attention temporarily.

• Activities: Engage in a manageable activity.
• Contributing: Do something helpful for another person.
• Comparisons: Recall challenges you have overcome without minimizing your present suffering.
• Emotions: Choose an activity that evokes a different emotion.
• Pushing away: Temporarily set aside a problem you cannot solve immediately.
• Thoughts: Engage your mind with a neutral task.
• Sensations: Use safe sensory experiences to redirect attention.

Example

You feel overwhelmed after an interpersonal conflict and cannot stop replaying the conversation.

You decide to organize a small space, watch a familiar television show, or complete a puzzle.

The problem may still exist afterward, but the emotional intensity may become more manageable.

4. Self-Soothe With the Five Senses

Self-soothing involves intentionally using comforting sensory experiences.

Examples include:

• Sight: Look at a calming landscape or familiar photograph.
• Sound: Listen to music or soothing environmental sounds.
• Smell: Notice a pleasant scent.
• Taste: Slowly enjoy a favorite beverage or snack.
• Touch: Wrap yourself in a soft blanket or hold a comforting object.

Example

You feel emotionally overwhelmed after a difficult social interaction.

You move to a quiet space, lower the lights, listen to calming music, and focus on the sensation of a soft blanket.

This creates a more supportive environment while the emotional intensity gradually changes.

5. Radical Acceptance: Stop Fighting Reality

Radical acceptance means acknowledging reality as it currently exists, even when you dislike it.

It does not mean approving of what happened, giving up, forgiving harmful behavior, or abandoning efforts to improve your circumstances.

Example

Someone you care about tells you they do not want a romantic relationship.

You may experience grief, anger, or rejection.

Radical acceptance involves recognizing that you cannot control another person's feelings or decisions.

You can still experience sadness while choosing actions that protect your dignity and emotional well-being.

Acceptance does not require tolerating abuse or remaining in an unsafe situation. Your safety and boundaries still matter.

6. Check the Facts: Challenge Emotional Assumptions

Emotions can be valid even when the assumptions surrounding them are inaccurate.

Checking the facts helps distinguish what happened from what you fear it means.

Ask yourself:

1. What objectively happened?
2. What interpretation am I making?
3. What evidence supports that interpretation?
4. What evidence suggests another explanation?
5. Are there other plausible ways to understand the situation?
6. Does the intensity of my emotion fit the available facts?

Example

A family member cancels plans.

Your first thought is, "They don't want me around."

Checking the facts might reveal that they have been working long hours or are feeling unwell.

The disappointment remains real, but the interpretation may become less absolute.

7. Opposite Action: Act Against an Unhelpful Emotional Urge

Opposite action is a DBT emotion-regulation strategy.

It involves identifying an emotion, recognizing the behavior it urges you to perform, and intentionally choosing a more effective response when appropriate.

Example

You feel ashamed after making a mistake and want to withdraw from everyone.

If the shame is disproportionate to the facts, you might choose to reconnect with a trusted person instead of isolating yourself.

Or perhaps fear makes you want to avoid a safe, manageable situation.

You may choose to approach it gradually rather than reinforcing avoidance.

8. Wise Mind: Balance Emotion and Reason

DBT describes three states of mind:

Emotion Mind: Thoughts and decisions are strongly influenced by current feelings.

Reasonable Mind: Decisions are primarily guided by facts and logic.

Wise Mind: Emotional experience and rational understanding are integrated.

Wise Mind does not require suppressing emotions.

Instead, it involves recognizing that emotions provide meaningful information while facts help guide effective decisions.

Example

After an argument, you feel an overwhelming urge to end a relationship immediately.

Emotion Mind says, "They hurt me. I need to leave right now."

Reasonable Mind says, "One disagreement does not necessarily define the relationship."

Wise Mind asks, "What response respects my feelings, my safety, and my long-term needs?"

9. DEAR MAN: Communicate Needs Effectively

DEAR MAN is a DBT interpersonal effectiveness skill.

D — Describe: Explain the situation using observable facts.

E — Express: Communicate your feelings.

A — Assert: Clearly state what you need or request.

R — Reinforce: Explain the potential benefits of cooperation.

M — Mindful: Stay focused on the conversation.

A — Appear confident: Communicate respectfully and clearly.

N — Negotiate: Remain open to reasonable alternatives.

Example

Instead of saying:

"You never care about me. You always ignore me."

Try:

"When our plans change without notice, I feel disappointed and anxious. Could you let me know earlier when possible? It would help me plan and feel more secure."

10. PLEASE Skills: Reduce Emotional Vulnerability

PLEASE is a DBT emotion-regulation skill focused on physical well-being.

The acronym reminds individuals to:

• PL — Treat physical illness: Address medical conditions and seek appropriate care.
• E — Balance eating: Maintain adequate, consistent nutrition.
• A — Avoid mood-altering substances: Avoid nonprescribed substances that interfere with emotional stability.
• S — Balance sleep: Maintain healthy sleep routines.
• E — Get exercise: Engage in physical activity appropriate for your health.

Example

You notice that emotional reactions become more intense when you have slept poorly, skipped meals, or consumed substances.

Improving sleep consistency and nutrition may reduce some of the physical vulnerability that makes emotional regulation more difficult.

Which DBT Skill Should You Use First?

Different situations may call for different strategies.

No single skill works for everyone or in every situation.

It may take experimentation and professional guidance to identify which strategies are most effective for you.

What If the Skills Don't Work Immediately?

DBT skills are learned behaviors.

They may feel unnatural or ineffective at first, especially during severe emotional distress.

Practicing skills during calmer periods can make them easier to access when emotions intensify.

Some situations require multiple skills.

For example, you might use STOP to interrupt an impulsive reaction, TIPP to reduce physical arousal, and Check the Facts once you feel more settled.

A difficult emotional moment does not mean you have failed at DBT.

Learning emotional regulation is a process.

When a Crisis Requires More Than DBT Skills

DBT crisis-survival skills can be useful for emotional distress, but they are not substitutes for emergency assessment or treatment.

If you are at immediate risk of harming yourself or someone else, have already harmed yourself, or cannot maintain your safety, seek emergency assistance rather than relying on self-guided exercises.

In the United States, call or text 988 for suicide and crisis support. If there is immediate physical danger, call 911 or local emergency services.

For recurrent crises, a collaborative safety plan developed with a qualified clinician can identify warning signs, coping strategies, supportive contacts, and emergency resources.

The Bottom Line

Living with BPD can involve intense emotional experiences, but those experiences do not have to determine every action.

DBT offers practical strategies for recognizing emotional triggers, reducing distress, improving communication, and responding more effectively to difficult situations.

The goal is not to stop feeling.

It is to develop the ability to experience emotions without being controlled by every impulse they create.

You can feel something intensely and still choose what happens next.