DBT during intense emotional episodes

I have been doing DBT from workbooks. I recently purchased a copy of Marsha Linehan's handouts and worksheets book. It's over 400 pages! I find when I am moderately upset I can use the DBT skills successfully to calm down. However, at times when I am severely stressed I can't calm myself down enough to use the skills. I just stay in my head thinking the same obsessive thoughts over and over.

I also have the habit when I am severely stressed to send emotional emails I later regret. This one habit really negatively affects my relationships.

Has anyone who has worked with DBT have any suggestions? What skills should I apply when I am over the top stressed?

And are there any suggestions as to how I can break the habit of sending emotional emails when upset?

Hi DechanDawa,

I have spent time studying Marsha Linehan's work. I think her theory on "Radical Acceptance" is helpful. Another thing that has helped me a lot is waiting to send an email and using "Wisemind" the balance of emotion and intellect in order to how and what I say in the email.

Thanks. I do sometimes wait and edit emails but they are still emotional. I think maybe I need a 48 hour period to cool down. However, I would rather not write them in this way at all.

Radical acceptance is great and having practiced Buddhism for many years I use it. However, it is during stressful times I have the most difficulty and was looking for more specific DBT skills related to high stress situations.

Mindfulness? I just recently started going to a day treatment program and several of the groups use DBT. So I don't know very much about it but I would think practicing breathing exercises could helpful

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Yes, breathing is good. I have tried hypnosis tapes and they are also good. I don't know. These are like feather dusters for anxiety and I am looking for a hammer! Believe it or not one intervention is to stick your head into ice water! I take bags of frozen vegetables out of the freezer and hold them to my face. Ask someone in one of your groups - they will tell you!!!

I recently read "ride the emotions like a wave" and I have been trying that today (my birthday) and it is working okay.

Happy Birthday!

Yummy! That looks soooooo good. Thank you!

I feel similar to you. I find that DBT has worked well for day to day stressors but for big things, especially my PTSD, it's like trying to put a bandaid on a gaping wound.

Thanks for this feedback. Maybe for us the key is to keep working with DBT on these things when we can...and get other help for the bigger issues. I recently managed to tone down a few emails. Maybe the DBT stuff just takes time to learn, which is why I guess people take the classes for a year, and sometimes two years. Best of luck to you.

DBT does take time to learn. In a proper DBT program you have 24/7 assistance - either with your therapist or, as my program was set up, a therapist on call. The idea is that when you find yourself in a crisis situation, you call your therapist and get coaching on what skills to try.

I did my first class about seven years ago and I decided to do a refresher about a year ago. The refresher was helpful because it showed me how far I'd come. I used to really struggle with the skills and now many of them have become internalized. In fact, they always told us it was like learning to walk. You can't really fail. You might fall, you might scrape a knee, but you learn and you get better.

When you're in that sea of dyscontrol where you can't seem to apply the skills, you want to utilized skills from Distress Tolerance. They're designed to get you through the moment to the other side at which point your other skills become accessible again.

If you have the opportunity to do a properly done DBT class with a DBT trained therapist, I highly recommend it. It's not group therapy in the traditional sense. It's very skills focused and it's mainly about learning and practicing. (And so you know, I hate group things, I also strongly dislike social settings, so I don't recommend the group aspect lightly).

Thanks. I like educational and skill building group things myself, but this is just not going to be something I am going to realistically be able to do for various reasons. I can also see where having a coach/therapist to call might be good. I don't have either of these in place. However, I am not going to give up doing DBT on my own. I think perhaps because of the way I am going about learning DBT I may need to initially lower my expectations. Recently I needed some medical intervention (anxiety medication) during a bad period and it really helped. That doesn't mean I have stopped doing DBT. I am still committed.

I used to send emotional texts, by emotional, I mean it was me spewing vitriol, usually at my bf.





I bought a "*****ing out bf" journal... So whenever I want to send emotional walls of texts, I write it out in the journal instead, there's no "send" button to impulsively click on.


I sit on it, edit and rewrite for a few days, and if by the end of day 5 I actually had a valid message in there, all the editing and proof reading has been done, so I type it out and we discuss it calmly.

I should mention, that after doing this for a few months, maybe a yearish?

I very rarely have a strong compulsion to write and send these types of communication. Being able to sit with the thoughts and feelings have now become second nature, and second is better than not in my nature at all.

Ps. DBT does take a lot of practice, so go easy on yourself, I'm doing my second round this year.

Congrats on your second round of DBT. That is really impressive.

I know there is a lesson in DBT that says if you are always sort of screeching at people with a high intensity that after awhile they tune you out. I can see where this is true. Sometimes I don't care. I only do this with certain people, and this past year has been the worst. I think they did finally hear me and responded...but it isn't something I can use repeatedly. I can see that. I must, must, must employ wise mind.

Second year? So impressive, and very inspiring...

I will work more on using the Distress Tolerance skills. Thanks.

If it helps, DBT isn't mutually exclusive with medication. I take anti-anxiety medications and I have a medication for depression (ketamine). The DBT has helped me be able to take less of my anti-anxiety meds - but I still need them. Sometimes my body simply has a panic attack and all the deep breathing and distraction in the world won't bring my body down to baseline. So I'll pop a xanax. I also get terrible anxiety at night and it interferes with sleep - taking care of yourself is a big deal in DBT - so I take a low dose of klonopin to help with my restless leg and my anxiety.

And I get not being in a place or able to do a program. Even the program I went through has a waiting list and I've heard from others that there are cost, time, and availability issues.

The way we did the class (if it helps you to go through it like this), was that we would do the core mindfulness (so we'd go over the mindfulness stuff). Then we'd spend several weeks in a unit, like Interpersonal skills really only going over one or two skills a week and focusing on just practicing them in conjunction with core mindfulness. Then we'd review mindfulness again. Then jump into another unit like emotion regulation. Then back to mindfulness and then into Distress Tolerance.

The core mindfulness skills are the foundation on which it's all based and the hardest of those (I think) is non-judgmental stance. Be kind to yourself. Give yourself grace and room to breathe.

The skills are invaluable. Good job wanting to keep trying

Thanks so much for this. It is all very helpful, especially the part about medication. I wasn't sure about that.

I am a little embarrassed to admit I am a certified mindfulness meditation instructor! That is what attracted me to DBT. I wanted to see how Linehan incorporated mindfulness practice into a cognitive behavior therapy structure. Her background is in Zen, mine is mostly in Vajrayana Tibetan Buddhism, although I have done extended (two week) Zen retreats at my local center.

I think if anxiety is present then mindfulness can be distorted and become hypervigilance. Also, there are hundreds of antidotes to mindfulness problems, some address the mental, others the physical. Sometimes distraction is good.

However, if someone is in a highly agitated state it is difficult to do any of these. I was a little disappointed when the medication for anxiety worked instantly. I mean, I was relieved, but the medication did in 20 minutes what I had not been able to accomplish in weeks of DBT work. I was just in too agitated a state, and I wasn't sure of Linehan's take on medication in combination with DBT. The medication calmed my mind down so that I was able to practice some of the DBT skills more effectively. But it felt a little like "cheating" which is simply a stupid thought!!! So it was helpful to hear from you about medication and DBT.

As a meditation instructor I would often refer a student to a therapist or counselor. For years this was not done in the meditation community. There was more of a separation between the so-called spiritual route and the psychological route. But some students had real life problems that needed to be addressed, and could not be "cured" through meditation.

I think maybe that is a problem with doing DBT without going to a therapist. I found only one therapist in my entire community who advertised as DBT trained, and this person worked primarily with adolescents. I was surprised as I am in a community with many therapists. I found the same was true when I tried to find a therapist who specialized in CBT.

Working with the skills books on my own may not be optimal. But it is the best I can do at the present time. I should also add that I have always had meditation teachers but my last teacher of 7 years returned to his home country. So it is the first time in a long time I don't have someone to talk with about mindfulness and meditation practice.

Sometimes all our resources kind of melt away, and we need to rebuild. That's what I am doing. Thank you for responding. You have been extremely helpful.

In DBT my therapist would say, "Be mindful of your judgments!" It's not a stupid thought, it's a perfectly logical thought when we come from a certain background. I came from a background that really emphasized handling things on your own and toughing it out. It took a long time for me to realize that biology, experience, and environment all play into our mental health and sometimes we need things like medication and therapy and that we can use all sorts of things together.

DBT isn't easy so be open to giving yourself credit and be aware of the small steps forward even if you slip and fall after. The fact that there was even a step is worthy of recognition.

(I really am a DBT cheerleader haha - I just found it so freeing once I was able to really get what it was teaching).

Spewing vitriol!! Great description. I still journal out everything when my feelings are intense and go back later to revise.

#Life is a beautiful lie#

Thank you. This was a great read!!! You know your DBT!

Well, I think there is a DBT thing about how to ask for something. My emails of late have been asking for help and support...but I think I did not communicate clearly. I think it is all in the DBT section on interpersonal skills.