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Therapy Skills

100

What does the STOP skill stand for?

• S - Stop: Do not react immediately. Freeze. Your emotions are trying to make you act without thinking. Pause your body, close your mouth, and do not say a word or make a move. 
• T - Take a step back: Physically or mentally remove yourself from the situation for a brief moment. Walk away, uncross your arms, AND take a deep, slow breath to lower your heart rate and let the initial wave of intense emotion peak and pass.
• O - Observe: Gather the facts like an outsider. Notice what is happening inside you and around you. Ask yourself: "What am I feeling right now? What are the actual facts of the situation? What are others doing?" Avoid judging or exaggerating. 
• P - Proceed mindfully Ask yourself what the most effective next step is. Do not ask what you feel like doing, but what will make the situation better rather than worse. Choose an intentional, constructive response (such as practicing Opposite Action).

200

What does the DEAR MAN skill stand for?

D - Describe: Stick to the objective facts of the situation without judging or exaggerating.

• Example: "We agreed to split the bill, but I paid for the whole meal last night.

• E - Express: Clearly state how you feel or what your opinion is using "I" statements. Do not expect the other person to read your mind.
  • Example: "I feel stressed and taken advantage of when expenses aren't shared as planned." 
• A - Assert: Ask clearly for what you need, or say a firm "no." Be direct rather than hinting or beating around the bush.
  • Example: "I would like you to Venmo me half of the total bill today." 
• R - Reinforce (Reward): Explain the positive effects of them agreeing to your request, or the negative consequences if they don't.
  • M - Mindful: Stay focused on your goal. If the other person gets defensive, changes the subject, or attacks you, do not get distracted.
  • A - Appear Confident: Use an effective physical tone. Maintain eye contact, and speak in a clear, steady voice.
  • N - Negotiate: Be willing to give to get. If your ideal solution isn't possible, offer or ask for alternative options.

300

What is Urge Surfing?

a mindfulness technique that helps you ride out intense cravings or impulses without acting on them. Instead of fighting or suppressing an urge, you acknowledge it as a temporary "wave" that builds in intensity, peaks, and naturally subsides

400

What is ACCEPTS?

• Activities: Engage your mind and body in a consuming hobby, puzzle, or chore to break the cycle of distressing thoughts.
• Contributing: Shift your focus outward by doing something kind for someone else, such as volunteering or sending a supportive text. 
• Comparisons: Put your current distress into perspective by comparing your situation to a harder time you successfully overcame, or to someone less fortunate. 
• Emotions: Change your current emotional state by doing something that evokes an opposite feeling, such as watching a comedy to shake off sadness. 
• Pushing Away: Temporarily block distressing thoughts from your mind by putting them on a shelf until you have the time and calm to address them. 
• Thoughts: Overwhelm your brain with a different, engaging thought to interrupt negative loops. Examples include counting backward by 7s, naming all 50 states, or reading a complex article.
• Sensations: Trigger a safe physical sensation to shock your nervous system out of an emotional spiral. You can try holding an ice cube tightly, splashing your face with cold water, or listening to intense music.

500

What is opposite action?

Opposite action is a skill that helps you regulate overwhelming emotions by deliberately doing the exact opposite of what your emotion is compelling you to do. By changing your physical behavior, your brain interprets the new action and reduces the intensity of the distressing feeling.

Distress Tolerance

100

What is distress tolerance?

The ability to endure painful emotions, stressors, and crises without becoming overwhelmed or resorting to impulsive, destructive behaviors (like lashing out, using substances, or avoiding the situation). The goal is to survive a crisis without making it worse

200

What is Radical Acceptance?

Radical Acceptance is a distress tolerance skill that means fully acknowledging reality as it is in this moment, even when it is painful, unfair, or not what we wanted. Acceptance does not mean that we approve of what happened, agree with it, or give up on making changes in the future. Instead, it means recognizing that fighting against reality often increases our suffering. When we stop saying, “This shouldn’t have happened,” and begin saying, “I don’t like this, but this is where I am right now,” we create space to respond thoughtfully instead of staying stuck in anger, denial, or resentment. Radical Acceptance allows us to focus our energy on what we can control rather than exhausting ourselves trying to change what has already happened or cannot be changed in the present moment.

300

When should someone use TIPP?

When emotions become so overwhelming that it is difficult to think clearly, solve problems, or use other coping skills

400

True or False: Distress tolerance skills solve the original problem

False

Distress tolerance skills help you survive the emotional crisis until you are calm enough/at a more balanced place to work through the problem/challenge

500

Your anxiety is a 10/10 after receiving bad news. Your heart is racing, your hands are shaking, and you cannot think clearly. 

What DBT skill might be most helpful to try first?

TIPP

Temperature - Change your temp!  

Intensive Exercise -Running up and down stairs, light jog or run, punching a pillow etc

Paced Breathing - box breathing, long exhale breaths

Paired Muscle Relaxation - PMR

Mindfulness

100

What are the three states of mind in DBT?

Emotion Mind

Reasonable Mind

Wise Mind

200

What is wise mind?

a core mindfulness concept that represents the balance between your logical, fact-driven brain and your emotional, feeling-driven brain. It is your inner intuition or "gut feeling" that helps you make grounded, healthy decisions

The balance place where emotion and logic work together

300

Name one "WHAT" skill.

Hint: its a DBT skill

"What" skills define what actions to take to practice mindfulness.

• Observe: Noticing your internal and external environment (sensations, thoughts, feelings) like a non-stick pan—experiences pass through without you clinging to or pushing them away.
• Describe: Putting words to what you observed, sticking strictly to the observable facts rather than interpretations.
• Participate: Throwing yourself completely into the current activity with undivided attention, acting without self-consciousness.

400

Name one "HOW" skill

"How" skills dictate the mindset and method for performing those actions. Think of "What" as the core tasks of mindfulness and "How" as the behavioral instructions on executing them.

• Non-Judgmentally: Taking a neutral stance. You observe the facts without labeling your experience, thoughts, or emotions as "good" or "bad". 
• One-Mindfully: Focusing on doing just one thing at a time. You are fully present in the current moment without splitting your attention or multitasking. 
• Effectively: Focusing on what works and moves you toward your goals. It means acting logically to achieve a desired outcome, rather than giving in to stubbornness or the need to "be right".

500

You're arguing with your partner/friend or family

Before responding what are three things mindfulness might help you notice about yourself before responding?

Emotions (hurt, fear, fustration)

Thoughts (I'm not being heard)

Urges ( wanting to yell, walk away, defend myself or views)

Body reactions  (Tight chest, faster breathing, warmer sensations)

Emotion Regulation

100

What does it mean to "Check the Facts"

Compare/balance what you know to what you're assuming and feeling before reacting 

200

What Does TIPP stand for?

Temperature

Intensive Exercise

Paced Breathing

Paired Muscle Relaxation

300

When is opposite action helpful?

When the emotion doesn't fit the facts or when we want to acting on the emotion but can be self sabotaging/maladaptive in the end

400

Scenario: You feel embarrassed due to a pervious social interaction that you feel didn't go the way you wanted and want to isolate. 

What skill could help?

Opposite Action

When you feel embarrassed, your biological urge is to hide, shrink, avoid eye contact, and isolate yourself. While avoidant behavior provides immediate relief, it inadvertently reinforces the belief that the event was catastrophic, thereby amplifying the shame. 

Opposite Action works by rewriting this script: 

• Changes brain signaling: Actively engaging with others sends a new signal to your brain that the situation is okay and manageable.
• Prevents the "Shame Spiral": Isolation gives your mind uninterrupted time to replay the event or events. Staying active stops this loop.
• Gathers reality-based data: When you face people, you quickly realize they usually do not care about, noticed, or remembered your mistake as much as you did. 

500

What does the PLEASE skill stand for?

Hint: the PL acronym are grouped together in the definition

Physical illness – PL

The “PL” in PLEASE stands for “physical illness,” corresponding to the first and last letter of “physical.” This is a reminder to take care of any physical illnesses or discomforts we might be experiencing. Neglecting physical health can exacerbate emotional distress. So, if you’re not feeling well physically, make sure to address it. 

Balanced eating – E

The first “E” in PLEASE stands for “balanced eating” (corresponding to the first letter of “eating”) and encourages us to maintain balanced and regular eating habits. Skipping meals or overindulging in unhealthy foods can affect our mood and energy levels. Strive for balanced nutrition to support your emotional well-being.

Avoid mood-altering substances – A

The “A” in PLEASE stands for “avoiding mood-altering substances” and reminds us to be cautious with substances that can alter our mood, such as alcohol or recreational drugs. Overusing these substances can lead to impulsive behaviors, emotional instability and withdrawals.

Sleep – S

The “S” in PLEASE emphasizes the importance of getting enough restorative “sleep.” Sleep deprivation can intensify emotional reactivity and impair judgment. Aim for a consistent sleep schedule to support your mental and emotional health.

Exercise – E

The final “E” in PLEASE encourages regular “exercise.” Physical activity releases endorphins, which are natural mood lifters. Incorporating exercise into your routine can help you manage stress and regulate your emotions.

Scenarios

100

What is the cognitive distortion at play?

"My friend walked by without saying hello. They must be mad at me"

Mind Reading- You're assuming you know what someone else is thinking or feeling 

200

You and your siblings have completely different opinions. You realize you probably wont change their mind today

What distress tolerance skill could help you accept the situation instead of continuing to argue?

Radical Acceptance

Radical acceptance means completely accepting reality as it is, without fighting it or wishing it were different. Acceptance does not mean approval, agreement, or liking the situation. 

Acceptance vs. Approval

• It is not approval: You can completely accept a situation while still finding it unfair, painful, or wrong.
• It is not giving up: Accepting a situation does not mean you are helpless or that you cannot try to change things in the future.
• It is an acknowledgment: You simply stop wasting energy fighting the facts of what has already happened.

Fighting reality only turns pain into long-term suffering. When you acknowledge the facts—even the terrible ones—you free up the mental energy needed to actually figure out what to do next

300

Your partner forgets to do the dishes 

You might think "They never help, I always have to do everything"

What cognitive distortion is at play?

Overgenerealization 

400

You assume your friend is ignoring you as you have reached out to them and they are taking awhile to reply. 

What emotion regulation skill can be helpful when we find ourselfs emotionally assuming? 

Check the facts

500

What two cognitive distortion are at play in this Scenario: "My partner has been quiet all evening. I know they're upset with me"

Mind reading and Personalization