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From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission 
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details).eMotion re Gulation Handout 23  
managing e xtreme e motions
Follow these suggestions when emotional arousal is very hiGh —so extreme that your ability to 
use your skills breaks down.
First, observe and describe that you are at your Skill S Break DoWn poin T:
Your distress is extreme.
You are overwhelmed.
You cannot focus your mind on anything but the emotion itself.
Your mind shuts down; your brain stops processing information.
You cannot solve problems or use complicated skills.
now check the facts. Are you really “falling apart” at this level of distress?
If no, u Se your Skill S.
If yes, go to Step 1: You are at your Skill S Break DoWn poin T.
Step 1. Use crisis survival skills to bring down your arousal:
(See Distress Tolerance Handouts 6–9a.)
••TIP your body chemistry.
••DISTRACT  yourself from the emotional events.
••SELF- SOOTHE  through the five senses.
••IMPROVE  the moment you are in.
Step 2. Return to mindfulness of current emotions.
(See Emotion Regulation Handout 22.)
Step 3. Try other emotion regulation skills (if needed).