T4: RESISTT Technique

RESISTT is a set of 7 techniques to help you deal with overwhelming emotions (Sheri Van Dijk covers this exercise in her book DBT Made Simple). When you have an experience of overwhelming emotions it's hard not to act on unproductive urges ranging from minor (e.g. overeating) to serious (e.g. self-harm). RESISTT helps you cope with unhealthy urges and not act on it.

RESISTT is a set of 7 techniques. When faced with an unhealthy urge, use the techniques that are appropriate and helpful in the situation.

Step One: Reframing the Situation

When you find yourself in a situation that seems inescapable, it's often very hard not to think in black-and-white terms. "My life is so bad right now,” or "I'll never get out of my depression,” or "I'll never stop feeling anxious when it comes to talking to people." This is characteristic for people who feel depressed and or anxious as well. Reframing the situation means changing your perspective of the situation - or finding a silver lining, finding the shades of grey between the white and the black. For every situation, you can objectively find arguments why the situation is not as definitive or "black and white" as it seems. This is not meant to invalidate your hardships, just to help you think in a more realistic way.

Step Two: Engaging in a Distracting Activity

This is where the list of distracting, pleasurable activities from the previous exercise will come in handy. Pick an activity that you will mindfully engage in, so that you will take your mind off the hot situation. Saying to yourself "Stop thinking about so-and-so" will just make you think more about that thing. Just like the old "Try not to think of a white polar bear for the next five minutes." saying. What are you thinking of now? Probably a white polar bear.

Step Three: Someone Else

Refocus your attention on somebody else. This is a great way to shift your attention to something other than the overwhelming emotions that you're feeling or the situation that triggers your urges. Maybe you can help out a friend with something, surprise your loved one or volunteer, or simply listen non-judgmentally when someone is telling you their story.

Think of some things you could do and make a list, so you have them at your disposal when you need them.

Step Four: Intense Sensations

When you're feeling painful emotions, it's often helpful to distract your mind with experiencing intense sensations that are not harmful for you. For example, you can take a cold or hot shower (or bath), hold an ice-cube in your hand, take a walk outside in the cold or hot weather, or sit outside in the hot sun. For example, the founder of DBT, Marsha Linehan, suggests that holding an ice-cube can replace self-harming behaviors or satisfy those urges. The main idea is to experience intense sensations that are safe.

Step Five: Shut it Out

Often, people find themselves in situations that contribute to their overwhelming emotions - you're having a heated argument with somebody or you start feeling very anxious while you're outside shopping. When possible, in these types of situations it is useful to leave the environment that is causing you distress, and go somewhere you would be more relaxed and mindful, somewhere you could take the appropriate steps to calm yourself. If you still find yourself dwelling on the negative situation, ask yourself whether this is a problem that you could solve right now. If it is - do that. If it's not possible to solve it right in the moment, visualize how you can put your problem in a box and put the box aside for the time being.

Think of situations that cause you to feel overwhelmed. Now think of what you could do in that situation to shut it out or put it in a box for later. Write down your plan.

Step Six: Neutral Thoughts

This can refer to anything that won't add to your distressing emotions. You can count to ten or count your breaths (just like we did in one of the mindfulness exercises before). You could observe the environment around you and notice the colors of the different objects. Perhaps remember your favorite song, and sing it. You could also repeat a phrase that seems helpful to you at the moment (e.g. "Right now, it is what it is, I accept everything.")

Step Seven: Take a Break

Taking a break will look different for everybody. Think of what your break would look like. Maybe you can inconsequentially put off some work or chores for tomorrow. Perhaps you could take a day off work for self-care. This is useful as long as it is not done too often - you wouldn't want to postpone things and create a new problematic situation for yourself.

Example

Situation: I'm having a quiet evening with my girlfriend when she starts making jokes about my outfit today. I feel very ridiculed and judged (my emotions rise very fast). I'm having an urge to chain-smoke a whole pack of cigarettes.

1. Reframing the situation: I immediately jumped to the conclusion that she's mocking me and making jokes to hurt me. But, I am aware that sometimes I am too sensitive about my appearance because I am a little insecure. I'm sure that if I asked her whether she was deliberately making fun of me, I'd find out that this is not the case.
2. Engaging in a distracting activity: I think that I can relax by playing some video games.
3. Someone else: Perhaps I can call my friend, see what he's up to and chat a little.
4. Intense sensations: It is November, so I'll go outside and walk in the cold weather for a while. I'm sure that this will clear my mind a little bit. Maybe if my friend doesn't have any plans, I can invite him as well.
5. Shut it out: I think that it would be best for me to just take a little time off and instead of getting extremely hurt and angry at my girlfriend and have a heated argument with her - I can explain to her that I need a little time for myself and take that walk that I was thinking about.
6. Think neutral thoughts: I do tend to think in black-and-white terms about my relationship when I feel hurt or rejected, so I will try to focus on a more neutral thoughts like: "It's okay, I accept this situation."
7. Take a break: I think that I will manage to stop myself from chain-smoking by doing the previous steps. I don't think that is necessary for me in this situation to take a break from my usual routine.

Practice using the RESISTT Technique using this worksheet.

DBT Distress Tolerance: RESISTT Technique

How can I better reframe the situation?

Usually, in an overwhelming situation with emotions that feel unbearable, people tend to think in black-and-white terms. Objectively though, a black-and-white thought is never really true - you could always find realistic arguments against thinking in that way. Be mindful that when we are very emotional, we tend to paint the way we think by those emotions. If you're having a hard time being kind to yourself, imagine you are talking to a friend. What would you say to them, to a person that you really care about?

Why trying not to think about something doesn't work?

If you actively try not to think about something, you are probably constantly reminding yourself of that thing. So, resisting the unwanted thoughts or emotions doesn't work in the direction that we want. That is why in a situation of distress, it is easier to just distract yourself with a pleasurable activity instead of beating yourself up for thinking or feeling a certain way. On the other hand, if you experience a more "quiet" form of depression and anxiety, you can try accepting those thoughts and emotions first, and then trying to find a solution.

Should I always use this technique when trying to manage urges?

In the Distress Tolerance module, we offer several exercises that will help you deal with an emotional crisis and help you prevent from engaging in a behavior that is not necessarily good for you. After becoming familiar with these techniques, you can choose which one you find the most suitable for you. Perhaps in a different situation you will want to try a different exercise.

If you have any behavioral health questions or concerns, please talk to your healthcare or mental health care provider. This article is supported by peer-reviewed research and information drawn from behavioral health societies and governmental agencies. However, it is not a substitute for professional behavioral health advice, diagnosis, or treatment.