DBT skills: getting through a crisis moment (TIPP, STOP, radical acceptance)

When emotions are overwhelming, it’s hard to remember or use the coping skills you know. Some programs call this the “red zone”. Crisis skills are built for exactly this moment.

Crisis survival skills

• ACCEPTS: healthy distraction
• IMPROVE the moment
• Pros and cons
• Self-soothe with the five senses
• STOP
• TIPP

Acceptance skills

• Half-smiling and willing hands
• Radical acceptance
• Willingness

Crisis skills are for getting through minutes or hours. Once the wave passes, other DBT skills, like checking the facts or problem solving, help with the cause. See DBT skills: emotion regulation.

Don’t do or say anything. Notice the strong feeling or urge, and remember you are still in charge of what you do next.

Step away from the situation, even for a minute. Take a breath or a break. Be gentle with yourself: it’s hard to figure things out on the spot.

Use your mindfulness skills. Notice your thoughts, feelings and the facts of the situation without jumping to conclusions. What are your options?

Think about your goals, your feelings and the other person’s. Ask wise mind, “What can I do right now so I don’t make this worse?”

Changing the temperature of your face with very cold water is a classic TIPP skill.

Ways to try it

• Hold a cool pack or a bag of frozen peas wrapped in a cloth to your face
• Hold a cold drink can against your cheeks
• Splash very cold water on your face

Intense aerobic exercise, aimed at raising your heart rate, can help use up the energy that strong emotion creates.

Ideas

• A fast walk around the block
• Dancing hard to two songs
• Jumping jacks or running on the spot
• Running up and down the stairs

Paced breathing is one of the TIPP skills.

1. Breathe in gently through your nose for a count of about 4
2. Breathe out slowly for a count of about 6
3. Keep going for a minute or two
4. If counting makes you anxious, just make the out-breath a little longer

This skill pairs relaxing your muscles with breathing out. Some programs teach it as progressive muscle relaxation.

1. Breathe in and gently tense one muscle group, like your fists
2. Hold for a few seconds
3. Breathe out and let the tension go, perhaps thinking “relax”
4. Move through shoulders, face, legs and feet

• A puzzle, game or crossword
• Cleaning one drawer
• Cooking something simple
• Watching a favourite show

• Send a thank-you message
• Help a neighbour
• Make a cup of tea for someone at home

Compare with a time you coped with something hard, or how far you have come. Skip this one if comparing makes you feel worse or guilty.

• A funny video or comedy show
• Uplifting music
• Looking at photos of a happy day

Imagine putting the worry in a box and setting it aside until a set time. You can come back to it when you are calmer.

• Count backwards from 100 by sevens
• Name an animal for each letter of the alphabet
• Read a few pages of a book
• Recite song lyrics you know by heart

• A hot shower or a cold drink
• Holding an ice cube
• Smelling something strong, like mint or coffee
• Squeezing a stress ball

Self-soothing with the five senses is a DBT distress tolerance skill.

• Hearing: calming music, rain sounds, a familiar voice
• Sight: a candle, the sky, photos you love
• Smell: lotion, fresh air, a favourite scent
• Taste: warm tea, a piece of fruit, eaten slowly
• Touch: a soft blanket, a pet, a warm bath

• I – Imagery: picture a safe, calm place
• M – Meaning: look for any meaning or purpose in the pain
• P – Prayer: pray, or connect with something bigger than you, if that fits your beliefs
• R – Relaxation: loosen your muscles, breathe slowly
• O – One thing in the moment: focus only on what you are doing right now
• V – Vacation: take a short break from worrying
• E – Encouragement: talk to yourself kindly, like “I can get through this”

• Pros of acting on the urge
• Cons of acting on the urge
• Pros of resisting the urge
• Cons of resisting the urge

Look at short-term and long-term effects. Many urges feel good for a few minutes and cost a lot later.

Write your pros and cons for a common urge on your phone or a card. In the red zone, reading it is easier than thinking it through from scratch.

• It isn’t approving of what happened
• It isn’t giving up on change you can make
• It isn’t pretending you’re fine
• It never means staying somewhere unsafe

You can accept that something happened and still act to protect yourself or change your situation. Acceptance often makes that action clearer.

Acceptance rarely happens once. You may need to “turn your mind” back toward acceptance many times a day. Mind turning is one of the acceptance skills taught in DBT groups.

Willingness means being ready to take part fully in life, staying open and flexible. Willfulness is refusing to act when action is needed, or fighting solutions that could help.

Half-smiling means relaxing your face, neck and shoulders and allowing a gentle half-smile. It’s a message to yourself, not to others.

Willing hands means unclenching your hands, palms up, fingers relaxed. Clenched fists go with fighting reality; open hands go with acceptance.

In a 2025 study of 92 young adults, people who used radical acceptance on a distressing personal memory saw their upset fully return to baseline. Those who used a different DBT skill, checking the facts, did not. It was one session with healthy volunteers, so more research is needed.

In DBT, skills are taught with homework so you practise them during the week, not just in crisis.

Try paced breathing on a calm evening, or STOP during a small annoyance. Then it’s familiar when a big moment comes.

List three skills, two people you can reach out to and the 988 number. See Building your coping plan for a fuller plan.

• “I’m here. We can get through the next few minutes together.”
• “That sounds really painful. It makes sense you’re upset.”
• “Would cold water or a walk help right now?”
• “Do you want to try one of your skills together?”

• “Calm down.”
• “You’re being dramatic.”
• Arguing about the facts while emotions are high
• Taking over or making decisions for them, unless safety is at risk

If you’re worried someone may be thinking about suicide, stay with them if you can, and call or text 988 together. If a life is in danger, call 911. See Helping someone who may be suicidal.

Call or text 988 or chat online if you’re in emotional distress, thinking about suicide, or worried about someone. It is free, confidential and open 24/7. If a life is in danger, call 911.

If you’re struggling with urges to hurt yourself, see Coping with urges to self-harm and If you’re having suicidal thoughts. You can call or text 988 any time.

Find A Helpline lists free, confidential helplines by country, by phone, text or chat.