Understanding Emotional Crisis
Emotional crises can come out of nowhere. Fast heart rate, dizzy mind, and everything is coming to a head. Emotional crisis challenge even the strongest of people. The strong people in our lives are totally afraid and hopeless when experiencing an emotional crisis. Dr. Marsha Linehan’s folks developed something called Dialectical Behavior Therapy (DBT) to help people who suffer from extremely high levels of emotional dysregulation.
DBT was created for those individuals that have Borderline Personality Disorder (BPD), who are often constantly thinking about suicide. BPD is not just “high end” emotional dysregulation. DBT is effective for most mental health symptoms. DBT teaches people to be mindful and “stay in the moment” emotionally while also developing healthier relationships and coping behaviors.
The RESISTT method is a piece of DBT’s Distress Tolerance module. Distress Tolerance teaches you how to deal with emotionally high-stakes experiences without relying on maladaptive behaviors. This module is meant to be used when the problems typically cannot be fixed and while sitting in this emotional intensity.
The Distress Tolerance Component of DBT
The Distress Tolerance component is essential to DBT because it teaches individuals to handle (or withstand) high-stakes emotional experiences and survive stress in tough situations without relying on maladaptive behavioral responses. The module is intended as a last resort when a person has faced a problem that cannot be solved immediately, or when they have high enough emotional intensity that they can’t think through other skills. The distress tolerance module is best summarized with the addition of, “tolerate pain in difficult situations-not change it.”
This module provides some of the most tangible and powerful tools and RESISTT is one of the most powerful. The RESISTT technique provides a powerful and actionable mental imagery mnemonic for surviving a crisis. It provides a concrete path to recognizing when we need to, “pause before reacting,” and prevent individuals from reacting impulsively in ways that can make difficult situations worse.
The Complete RESISTT Method
Step-by-Step Implementation Plan
Step 1: Reframe the Situation
Cognitive reframing addresses distorted thinking patterns that stimulate emotional crises. When you are in “fight or flight” mode, your thinking is binary. Reframing allows you to generate balanced perspectives.
Reframing Techniques:
- Push back on the initial assumptions you hold about the situation
- Ask yourself, “What would I tell a friend if they were experiencing this?”
- Look for “grey” in between the extremes
- Consider alternate explanations for the events/arguments
- Practice self-compassion in the voice you use when talking to yourself
Step 2: Participate in a Distracting Activity
A healthy distraction is a way to take a moment away from distressing thoughts. When the first step was taken, you felt very intense emotions that were evoked by thoughts. Taking the time to distract yourself represents a way to experience less emotional charge from happening again without avoiding or minimizing emotions.
Examples of healthy distractions:
- Play video games or puzzles
- Listen to music or podcasts
- Creative hobbies (art, writing, craft)
- Reading or watching interesting things
- Be mindfully engaged in the activity of choice.
Step 3: Someone Else (Seek Support)
Human connection is like an interruption to a negative rumination cycle and adds an outside perspective (i.e. seeks support strategies). This step interrupts the isolating nature of emotional distress.
Support-Seeking Options:
- Call a trusted friend or family member
- Volunteer or help someone else in need
- Engage in thoughtful acts of kindness
- Seek support groups or online groups
- Focus on someone else’s needs/difficulties for a period of time.
Step 4: Intense Sensations
Very intense physical sensations can disrupt or shift the emotional pain your brain is experiencing. This is especially valuable in self-harm urges that may be present, as it gives a different intense experience.
Safe Intense Sensation Options:
- Hold ice cubes in your hands or mouth
- Take very cold or very hot showers/baths
- Walk outside in very hot or very cold weather
- Squeeze stress balls or other exercise equipment
- Listen to very loud or aggressive music; taking care to keep it safe in your environment.
Step 5: Push Away (Shut It Off)
Taking temporary mental disengagement is the ability to put some mental distance between you and an overwhelming situation. It creates the needed space when you don’t have the resources to create a solution.
Helpful Push-Away Strategies:
- Imagine imaginary bricks building walls between you and the concern.
- Mentally ‘shelve’ the issue for you to return at a later time.
- Visualize an imaginary box to put the disturbing thoughts.
- Try simple thought stopping techniques.
- Imagine putting ‘boxes’ on top of overwhelming emotional states.
Step 6: Neutral Thoughts
Neutral thinking organizes you in the moment without adding layers of emotional reactivity. Engaging in mental exercises alleviates some of the ruminating patterns.
Neutral Thought Exercises:
- Count to 10 or count breaths.
- Look around and notice the color(s) in your immediate view.
- You could even repeat lyrics to songs or poems you had memorized.
- Use validation self-statements, such as: “This too will pass”.
- Try basic sensory awareness.
Step 7: Allow Yourself to Pause
Purposeful breaks are critical recovery time from the emotional intensity of this process. Your break should allow for genuine self-care and restoration, not avoidance.
Examples of Restorative Breaks:
- Take walks in calm, natural settings
- Engage in various gentle self-care tasks
- Mindfully postpone non-urgent tasks
- Create space that is peaceful for recovery
- Do something that authentically restores energy
The Evidence for RESISTT: Evidence-Based Effectiveness
Research shows that DBT is effective for many mental health conditions. Randomized control trials or RCTs show statistically significant and clinically important positive results for people who learn to use distress tolerance skills like RESISTT.
Research-Validated Benefits:
Self-Harm Reduction: Up to 50% reduction in self harming (compared to other treatments)
– PTSD Improvement: Decrease in trauma symptoms can be substantial with acceptance-based approaches
– Substance Use: Effective for reducing cravings and addictive behaviors.
– Eating Disorders: Is particularly effective for binge eating and bulimia.
– Depression / Anxiety: Observable improvement in emotional regulation and ability to not experience symptoms as intensely
DBT has been studied and found to be efficacious internationally in countries such as Australia, Canada, Denmark, Great Britain, the Netherlands and Norway. DBT has been validated in various populations globally which suggests that the principles of distress tolerance have universal applicability.
An Overview of Its Dialectical Basis
DBT’s philosophical roots are grounded in dialectic, where oppositional statements join together. The central dialectic in DBT is to find the balance between supporting the current reality and committing to change. RESISTT’s skills prioritize accepting the current situation and create the space to notice when transformation occurs.
This balance is effective in addressing the tendency for black-and-white thinking often seen in states of emotional dysregulation. It can enhance a person’s psychological flexibility, which is defined as their ability to adaptively respond to contexts instead of solely relying on one style of coping.
Clinical Applications of the RESISTT Skills and Considerations
The efficacy of RESISTT is highly dependent upon the quality of relationships developed between the client and therapist. The dialectic of DBT suggests a relational system where both client and therapist agree to invest in a collaborative way in building a life worth living for the client.
Behavioral Chain Analysis
Therapists and clients look at the chain of events that occurred prior to the dysfunctional behavior. They look for interventions made possible by RESISTT. They develop potential plans for how, in future contexts, the client may intervene in that sequence of events.
The Components of Therapeutic Process:
- Validate current client reality while creating change
- Establishing trust and safety in the therapeutic relationship
- Delivering perceived early gains to maintain engagement
- Managing resistance to establishing difficult skills
- Support clients through extreme emotional discomfort
Adaptive to Population
Although originally developed for individuals with Borderline Personality Disorder, RESISTT is suitable for many different populations and ages. It is particularly effective for people with impulsivity issues, anger issues, trauma responses, and problems with addictive behavior.
Common Implementation Challenges
Recognizing typical obstacles allows you to prepare for successful RESISTT implementation. Each challenge has evidence-based options that emerged from clinical practice.
Challenge 1: Allowing Distress to be Present Instead of Resisting it.
The strongest barrier is allowing distress to be without the additive burden of fighting it. Most people have extreme difficulty in learning to accept the discomfort in situations instead of fighting against it.
Challenge 2: Overcoming All-or-Nothing Thinking
When facing overwhelming situations, it is easy to slip into rigid “black-and-white” thinking. Thinking patterns like this make reframing complicated and does not allow for a neutral perspective-taking. The “Reframing” part of RESISTT specifically addresses these cognitive distortions.
Challenge 3: Experiencing the Distraction Paradox.
When you just tell yourself, “Don’t think about X” it often has the opposite effect of taking up time and attention. RESISTT urges the individual to mindfully and actively partake in alternative activities; not only does RESISTT suppress the form of thought passively.
Strategies to Overcome Common Barriers:
- Practice strategies during calm moments to create new neural pathways
- Assess and practice strategies in easier situations before higher stakes situations
- Combine more than one RESISTT strategy at a time when episodes are severe
- Work with therapists to modify resistance patterns
- Involve support systems and caregivers when using our strategies
More Than Crisis Survival: Building Resilience for the Long Term
Regular practice of RESISTT does much more than help us survive a crisis—it helps us build emotional resilience and emotional self-efficacy. Each time you practice it strengthens your neural pathways for adaptive coping, which can have cumulative benefits over time.
From Reacting to Responding
When you practice regularly, you will be moving from automatically reacting to emotional stimulus to being able to consciously choose how you respond to a situation. This movement from reaction to response gives us control and predictability to our emotional experiences.
Integration with Other DBT Modules
RESISTT operates within a well-rounded framework of DBT skills. Once distress tolerance helps create some emotional breathing room, the other modules dive into deeper issues and work towards building a fulfilling life.
Comprehensive DBT Integration:
Mindfulness: Observes emotions without passing judgment
Distress Tolerance: Navigates crisis moments safely
Emotion Regulation: Actively shifts unwanted feelings
Interpersonal Effectiveness: Fosters healthier relationships
The ultimate aim goes beyond just reducing symptoms; it’s about guiding individuals from a state of “quiet desperation” to experiencing “ordinary happiness and unhappiness,” where they can discover meaning and connection in their lives.
Conclusion:
The RESISTT method shines a light of hope during those tough times we all face. These seven techniques equip you with practical tools to handle emotional crises. With a bit of practice, they’ll become second nature to you.
Start by picking one or two techniques that resonate with you. Try them out when you’re feeling calm. Take your time to build your skills step by step. Keep in mind that emotional regulation is a journey, not just a destination. Crisis moments will still pop up—that’s just part of being human. But now, you have reliable strategies to help you navigate through them. You hold the power to decide how you respond to those emotional storms.
Your emotional well-being is important. These tools will be effective when you engage with them. So why not start today? Your future self will be grateful for the strides you take toward emotional mastery and resilience.
