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DBT Adult Crisis Plan IntlFillable

The document outlines a crisis plan with sections on observing warning signs of a crisis, goals and activities to help get through a crisis, distraction strategies, self-soothing techniques, additional skills to practice, using temperature, intense exercise, paced breathing and paired muscle relaxation to change body chemistry, reducing risk in one's environment, contacts for help and distraction, and additional crisis resources.

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366 views1 page

DBT Adult Crisis Plan IntlFillable

The document outlines a crisis plan with sections on observing warning signs of a crisis, goals and activities to help get through a crisis, distraction strategies, self-soothing techniques, additional skills to practice, using temperature, intense exercise, paced breathing and paired muscle relaxation to change body chemistry, reducing risk in one's environment, contacts for help and distraction, and additional crisis resources.

Uploaded by

al436796
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DBT Crisis Plan Last Updated:________________________

Observing Warning Signs:


What are the signs that a crisis may be developing? What body sensations (pit in stomach, heart racing, flushed), specific emotions
(sadness, shame, anger), situations (argument with a loved one) etc. should I look out for (e.g., common links on the chain)?

My Life Worth Living Goals: Crisis Survival Skills!


What goals (short AND long term) can I for when ineffective urges show up
stay mindful of to help me through this
crisis effectively (even when it’s painful)? My Go-To Distract Strategies Favorite Ways to Self-Soothe
Activities Hearing

Contribution Smell

Comparison Taste

Emotions Vision

Pushing Away Touch/Movement


Extra Skills:
What are some other skills I can practice? Thoughts Other Crisis Skills to Consider
Sensations Pros/Cons IMPROVE
(DT Handout #5) (DT Handout #9)

Using TIP Skills to Change Body Chemistry


See Distress Tolerance HO #6 for add’l instructions. Do not use T and I if you have heart issues.
Temperature: Place bowl of ice water between your knees, take a deep breath and
plunge your face in. Hold for at least 15 sec. Repeat as needed.
Intense Exercise: Do jumping jacks, squats, sprint etc. until you can’t anymore.
Paced Breathing: Breathe into your belly. Slow your breathing. Extend the length
of your exhale (ex. Inhale for count of 5, exhale for count of 7)
Paired Muscle Relaxation: see DT Handout #6 for instructions
Things I Can Do to Reduce Risk in My Environment

People I Can Contact for Distraction or for Help


Name: Phone:
Name: Phone:
Name Phone:
Clinician Name: Phone:
Urgent Care Address: Phone:
Suicide Prevention Lifeline:
Check out the DBT-RU playlist of skills videos if you need help practicing! youtube.com/dbtru
© Ruork & Rizvi, 2021
Modeled After Brown & Stanley, 2008

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