Acute Crisis
For moments of acute escalation, high pressure or immediate need for stabilization.
- 22
- entries
- 4
- roles
- 9
- Clusters
What this is about
DBT situates acute crises as moments when the prefrontal cortex becomes largely unavailable and the emotional brain takes over. This distinguishes it from high tension, where there is still some cognitive access — in an acute crisis, even familiar skills feel unreachable. The relevant skill categories are crisis survival (TIP, ACCEPTS, distraction) and self-soothing, not reflection or planning.
The primary error is attempting emotion regulation or interpersonal problem-solving while the nervous system is still dysregulated — cognitive skills will fail at this activation level. A second common mistake is expecting a quick resolution; crises often have a slow descent phase. Skills that work on the body (temperature, breathing, physical movement) remain accessible even when cognitive resources are absent.
What happens in the body
Body reactions, typical impulses in an exceptional state, and escalation course as orientation for first stabilizing steps.
- Body in exceptional stateSevere heart palpitations, shortness of breath, numbness or dissociation, tingling in the limbs, trembling or freezing, near panic in the body
- Typical impulsesAct immediately or run away, take control or give up completely, call someone or isolate yourself completely, want to prevent harm
- Escalation courseCrises usually escalate very quickly. Cognitive resources are hardly available. Important: physical regulation first before any reflection. Decay often takes longer than the peak.
First entry (2)
The most direct first step for this situation.
STOP Skill
If before any further analysis, communication or regulation, the reflexive further reaction must first be stopped.
Also in: Emotion Regulation · Interpersonal Effectiveness
TIP Skills
When what is needed is not primary understanding or talking, but rather quick, body-oriented crisis regulation.
Also in: Emotion Regulation
Orient (4)
Helps frame the situation and gain an overview.
Is This Self-Soothing or Improving the Moment?
When sensory-physical calming and broader IMPROVE strategies easily blur together.
Also in: Distress Tolerance
What Helps Now Versus Long Term?
When a distinction must be made as to whether a skill should be effective now or whether it will only have a long-term effect through repeated practice.
Also in: Distress Tolerance · Emotion Regulation
Which Skill Helps Me First?
If, before choosing a specific skill, you first need orientation about the appropriate basic direction.
Also in: Distress Tolerance · Emotion Regulation · Interpersonal Effectiveness
Wise Mind
When, before the next step, an inner orientation is needed that takes both feelings and reason seriously.
Also in: Distress Tolerance · Emotion Regulation · Interpersonal Effectiveness
Apply (7)
Concrete exercises and skills for the situation.
STOP: Proceed Mindfully
When, after stopping and distancing yourself, it is no longer necessary to simply inhibit yourself, but to continue to act carefully.
Also in: Emotion Regulation · Mindfulness
Physiological Coping Skills
When the body has to be downregulated first before other skills can even be accessed again.
Also in: Emotion Regulation
STOP: Take a Step Back
When it is not necessary to intervene immediately, but rather to gain a small distance so that you do not continue to act reflexively.
TIP: Intense Exercise
When high tension not only calms you down, it should first be physically reduced so that other skills can take action.
Also in: Emotion Regulation
TIP: Paced Breathing
When acute tension requires immediate, close-to-the-body and discreet regulation.
Also in: Emotion Regulation
TIP: Paired Muscle Relaxation
When physical alertness needs to be specifically regulated via muscle and tension levels.
Also in: Emotion Regulation
TIP: Temperature
When the TIP skills need to be regulated particularly quickly via the body and not via language or cognition.
Also in: Emotion Regulation
Stabilize (9)
Supports calming and regulation in the situation.
STOP: Stop
When differentiated further thinking is not yet possible and the blind pursuit must first be stopped.
Also in: Emotion Regulation
REST Strategy
When complete withdrawal is not necessary, but a conscious interruption is needed before further skills or decisions are made.
Also in: Mindfulness · Emotion Regulation
Improving the Moment
If the secondary overload of the moment should be reduced so that perseverance, thinking and later skill use become possible again.
Also in: Mindfulness · Emotion Regulation
STOP: Observe
When a short observation step is needed between stopping and moving on to reassess the situation.
Also in: Emotion Regulation · Mindfulness
Community Reinforcement
When sustainable change depends on the environment supporting behavior instead of constantly undermining it.
Also in: Interpersonal Effectiveness · Emotion Regulation
Cue-Controlled Relaxation
When not only general relaxation is needed, but also the fastest possible, trained approach to calming down in stressful situations.
Also in: Emotion Regulation
Dialectical Abstinence
When abstinence or change goals require clear determination and a flexible return to the course.
Also in: Emotion Regulation
Safe-Place Visualization
When, in times of stress or fear, a quickly accessible inner counter-image to threats and excessive demands needs to be created.
Also in: Emotion Regulation
Self-Soothing
When reassurance, body regulation or a non-punitive form of self-care are needed before problem solving, emotion regulation or interpersonal skills.
Also in: Mindfulness · Emotion Regulation