Take a Breather! It’s a Critical Life Skill for Bipolar Disorder.

Fortunately, my second (and under all of my power, my last) suicide attempt did not succeed. But it did land me in a psychiatric ward, which felt like a prison with a less appealing library.

When I was released from my mental health hold, it was part of a deal in which I agreed to attend a partial hospitalization program every day. They used a therapeutic method that has gained more influence with every study: Dialectical Behavior Therapy (DBT). I got so much benefit from it that I voluntarily joined a nine-week intensive class on DBT at my local hospital after the partial program ended.

My nine weeks spent intensively learning DBT were worth every minute and now I want to share what I learned with you. I am not a therapist and I’m only sharing my own experience; yes, with the hope that it will be helpful to you but not with any knowledge of your particular situation and needs.

My therapist calls DBT the combination of Cognitive Behavioral Therapy and Zen Buddhism. Don’t click away if you’re not a Buddhist: there is no religion in DBT. But some threads of Buddhism, such as Zen, look more like sciences of mind than like religions. Its creator, Marsha Linehan, is a Zen Buddhist Master, a title she earned during her own search for freedom from mental illness.

Dr. Linehan is also a well-respected and frequently cited researcher on Borderline Personality Disorder and DBT’s applications to Bipolar Disorder and many other mental illnesses.

DBT is a collection of life skills that you learn one at a time. The skills are categorized into four modules: Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance. Although Dr. Linehan presents them in that order, I want to share a skill with you from the last of the four modules, the module that helps you stand it when you feel like you can’t: Distress Tolerance.

STOP is both the name of the skill and a handy tool for remembering it. The STOP skill is one that makes all of the others work because it gives you the breathing room you need in between having a thought or an impulse and acting on it.

The S stands for the word Stop. Stop whatever you’re doing. “Don’t move a muscle. Your emotions may try to make you act without thinking.” (FN) This is especially true for people with Bipolar Disorder, who have higher rates of impulsivity even when they are not in a mood episode.

Stopping is the step that makes the other three steps work. When you stop, you get a moment, however small, to think about what you were on a course to do. You get a moment to think about whether that impulse is your best option.

T is for Take a Step Back. Take a step far enough back that you get some perspective.  The further back, the better. “Take a break… Do not let your feelings make you act impulsively.” (FN)

Then Observe (the O): see what you’re feeling, what you have an impulse to do with or because of that feeling, and whether that’s a good idea. Take as long as you need – or as long as you can stand when the impulse is strong! – to consider your next move. Consider both what’s going on inside of you and what’s going on outside of you. You can make things a lot better or a lot worse for yourself with your very next action.

Finally, Proceed Mindfully (the P). Once you’ve taken a look at where you are and decided what action is truly in your best interests, proceed to take that action… mindfully. What “mindfully” here means for me is remember why you decided to act this way as you are acting. If your action doesn’t lead to what you expected or hoped, you will more quickly notice and be able to change course.

Have you tried the STOP skill? Before reading this or after? Did it help? Sometimes, like any skill, DBT skills take practice. If at first you don’t succeed, try, try again! I look forward to hearing how it worked (or didn’t work) for you in the comments.

(FN) Distress Tolerance Handout 4, DBT Skills Training Handouts and Worksheets, Second Edition by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan.