Panic List

Panic List for Distress Tolerance

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These suggestions are meant as alternates to Self-Injury in times of dire crisis and overwhelming urges. They are what I call 'Intermediate coping strategies,' designed to help you move into a less emotionally volatile state. They are NOT DBT skills!

The source of this material is from many people with BPD sharing what has worked for them. This is a compilation of their answers.

These suggestions for dealing with panic are not a replacement for the Distress Tolerance skills. They are about being effective in the moment - which means doing what it takes to be safe. Believe it or not, even the ones that sound stupid usually help a little, and the best skill of all is to wait 15 min, and then ask yourself if you can wait 15 more, and so on. If 15 min is a long time for you, try 5. The point is, self-injury urges usually hit and you want to do it "right now". If you can wait, then maybe you don't have to do it at all. Emotions come to us in waves. The longer you wait, the more likely the urgent need will dissipate. As you go along in life without self-injuring, one day you will think about doing it and a little voice says, "Ouch! That would hurt! That's not going to make me feel better." Self-injury can be addictive but over time, with practice, you'll find other ways to tolerate distress and it will become more manageable.

Distress tolerance options for when you feel angry, frustrated, restless
* Try something physical and violent, something not directed at a living thing:
  • Slash an empty plastic soda bottle or a piece of heavy cardboard or an old shirt or sock.
  • Make a soft cloth doll to represent the things you are angry at. Cut and tear it instead of yourself.
  • Flatten aluminum cans for recycling, seeing how fast you can go.
  • Hit a punching bag.
  • Use a pillow to hit a wall, pillow-fight style.
  • Rip up an old newspaper or phone book.
  • On a sketch or photo of yourself, mark in red ink what you want to do. Cut and tear the picture.
  • Make Play-Doh or Sculpey or other clay models and cut or smash them.
  • Throw ice into the bathtub or against a brick wall hard enough to shatter it.
  • Break sticks.
  • Sometimes these things work even better if you rant at the thing you are cutting/tearing/hitting. You could start out slowly, explaining why you are hurt and angry, but you might end up swearing and crying and yelling. It helps a lot to vent like that.
  • Crank up the music and dance.
  • Clean your room (or your whole house).
  • Go for a walk/jog/run.
  • Stomp around in heavy shoes.
  • Play handball or tennis.
  • Play an intense computer game.
  • Distress tolerance options for when you feel sad, melancholy, depressed, unhappy
  • Do something slow and soothing, like taking a hot bath with bath oil or bubbles.
  • Curl up under a comforter with hot cocoa and a good book.
  • Baby yourself somehow. Do whatever makes you feel taken care of and comforted.
  • Light sweet-smelling incense.
  • Listen to soothing music.
  • Smooth nice body lotion onto the parts of yourself you want to hurt.
  • Call a friend and just talk about things that you like.
  • Make a tray of special treats and tuck yourself into bed with it and watch TV or read.
  • Visit a friend.
  • Play a friendly, easy computer game.
  • Make a list of the things you are grateful for. Start with the easy things. Thich Naht Hahn suggests you begin with "I'm grateful for my non-toothache." Then go wild. "I'm thankful that I can walk" or whatever is appropriate to you.

  • Distress tolerance options for when you feel overwhelmed or obsessed with negative thoughts.

  • Watch a funny movie.
  • Watch a cartoon movie.
  • Watch children's programs.
  • Watch educational programs.
  • Watch programs about nature.
  • Avoid watching violent television.
  • continued. . .
    Distress tolerance options for when you feel craving sensation, feeling depersonalized, dissociating, feeling unreal
  • Do something that creates a sharp physical sensation:
  • Squeeze ice hard (this really hurts). (Note: putting ice on a spot you want to burn gives you a strong painful sensation and leaves a red mark afterward, kind of like burning would.)
  • Put a finger into a frozen food (like ice cream) for a minute.
  • Bite into a hot pepper or chew a piece of ginger root.
  • Rub liniment under your nose.
  • Slap a tabletop hard.
  • Snap your wrist with a rubber band.
  • Take a cold bath.
  • Stomp your feet on the ground.
  • Focus on how it feels to breathe. Notice the way your chest and stomach move with each breath.
  • Claim your breath and body parts, like "this is my hand, this is my nose." Touch those parts and notice how they feel as if you'd never touched them before.
  • Cover your arms with a layer of Elmer's glue and let it dry (or dry it with a hairdryer if you are impatient). Slowly, gradually pick the glue off your skin.
  • Distress tolerance options for when you feel wanting focus
  • Do a task (a computer game like tetris or minesweeper, writing a computer program, needlework, etc.) that is exacting and requires focus and concentration.
  • Try to balance an egg on it's short side.
  • Eat or drink something you really like, but do it slowly and notice every sensation - taste, texture, aroma, etc.
  • Memorize a poem or prayer.
  • NOTE: Some people report that being online while dissociating increases their sense of unreality; be cautious about logging on to the internet in a state like this until you know how it affects you.
  • Eat a raisin mindfully. Pick it up, noticing how it feels in your hand. Look at it carefully; see the asymmetries and think about the changes the grape went through. Roll the raisin in your fingers and notice the texture; try to describe it. Bring the raisin up to your mouth, paying attention to how it feels to move your hand that way. Smell the raisin; what does it remind you of? How does a raisin smell? Notice that you're beginning to salivate, and see how that feels. Open your mouth and put the raisin in, taking time to think about how the raisin feels to your tongue. Chew slowly, noticing how the texture and even the taste of the raisin change as you chew it. Are there little seeds or stems? How is the inside different from the outside? Finally, swallow.
  • Choose an object in the room. Examine it carefully and then write as detailed a description of it as you can. Include everything: size, weight, texture, shape, color, possible uses, feel, etc.
  • Choose a random object, like a paper clip, and try to list 30 different uses for it.
  • Pick a specific subject and research it on the web. Don't go off in any direction except your specific research.
  • If you still have the urges for self-injury, try answering these questions in a journal.
  • Why do I feel I need to hurt myself? What has brought me to this point?
  • Have I been here before? What did I do to deal with it? How did I feel then?
  • What I have done to ease this discomfort so far? What else can I do that won't hurt me?
  • How do I feel right now?
  • How will I feel tomorrow morning if I hurt myself?
  • Can I avoid this stressor, or deal with it better in the future?
  • Do I need to hurt myself?

  • If you can't get your mind from remembering traumatic events or feel like you are in a flashback, try changing perspectives.

  • Write about your situation as if you were another person or a piece of furniture or a pet looking at it from a distance.
  • Write letters to people who you'd like to say something to. Be bold. Don't hold back. Then rip it up or dissolve it in water. Journal about your experience.
  • Find an old photo of yourself and make up a completely new fictional story about what is happening in the picture. Write a story where the subject is empowered.
  • Write your life story as if you had the happiest, most unique life in the world. It doesn't have to be fiction, use real examples but pretend you see it from a different point of view. Leave out all the bad stuff. The more trauma you leave out, the funnier the story starts to seem.
  • In your mind, play out your life worries as cartoon characters. Make the characters ridiculous and give them silly voices.
  • Read a children's story or any other story that's not too complex out loud as if you were a storyteller.
  • Color in a coloring book.
  • Draw pictures with heavy crayons or oil pastels that allow you to distort and mesh the picture by smudging it with your fingers.
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