Do I really need a DBT Crisis Kit?

Do I really need a DBT Crisis Kit?

So a little known fact about me is that I’ve always had a bit of a fascination with Mount Everest. To be clear, I have no desire to actually climb Mount Everest, but for some reason I’ve always had a deep interest in the mountain and the people who do chose to take it on. This interest has led me over the years to read a lot of books and watch a lot of movies and documentaries on the subject, and I’ve become a bit of an armchair expert on it. It’s how I’ve come to know a fair amount about the best route to take to summit the mountain, and what happens to the brain and body of a climber at extreme altitude. Interestingly enough, it now serves as a powerful metaphor when I am teaching skills groups on Distress Tolerance and the importance of having a Crisis Kit.

Generally, climbers tackle the daunting task of reaching the summit of Mount Everest in a series of stages; they ascend and descend among a series of camps set up at different altitudes on the mountain until they make the final push to the summit through what’s called “the death zone” above the highest camp. This extremely dangerous stretch between the highest camp and the summit earned this moniker because, at that altitude, climbers are literally dying until they descend due to the lack of oxygen in the thin air. Human beings just weren’t made to survive at that altitude. Even the most experienced climbers struggle at this point; there are numerous accounts of skilled mountaineers making “rookie” mistakes and even becoming delusional because their thinking becomes so scrambled and remains so until they descend to a lower altitude. In fact, when disaster happens on Mount Everest, it is generally in that “death zone” and often happen because climbers know how to get up the mountain, but don’t have the energy left to get back down.

The thing is, this is exactly what happens to all of us when we are at the summit of emotional intensity. Whether an emotion is wanted or unwanted, in its highest intensity it impacts our ability to think clearly, assess risks appropriately, and make sound decisions. It is when emotions are running hot that our clients engage in problem behaviors in an effort to bring relief to the suffering triggered by emotional pain. Just like the climbers on Everest, our thinking becomes scrambled when emotions hit their peak and the only way to begin to think clearly again is to come down off the summit, emotionally speaking. This is really where the Crisis Kit comes in, and why it is such an essential tool for Distress Tolerance. Simply stated, a Crisis Kit is a tool box that we prepare before emotional crises hit, and is used to help utilize skills like Distraction and Self-Soothing.

Inevitably, when I am teaching these skills in group, a group member always brings up the question of how this is really going to help them. In some groups, it’s phrased in a gentle way, but every now and then it’s closer to “So you’re telling me that taking a hot shower, doing a crossword puzzle and lighting a scented candle are going to solve my life’s problems?”. Absolutely not! In fact, to do so would be ineffective at best and invalidating at worst; the very things we are trying to avoid with our clients. These skills are not meant to be for complex problem-solving; they are meant to be for problem-behavior avoiding. None of us can do our best thinking or decision making when we’re experiencing off the chart emotions, no matter how well-versed in DBT we may be.

Knowing that life will at times present us with situations that put as at the peak of the emotional mountain, we need to prepare ahead of time by making a Crisis Kit. When we’re feeling generally emotionally-regulated, we can each probably think of all kinds of different things to do if things get tough; the same way that climbers know theoretically what to do when faced with challenges at the summit but struggle in their ability when faced with the reality of it. Every skill in DBT works in conjunction with each other, like a jigsaw puzzle for emotional dysregulation. We need each skill, each piece, to complete the puzzle. While Crisis Kits aren’t going to provide the solutions to the long-term complex problems that many of our clients face in their lives, they are absolutely essential in helping people at their peak of their emotions come safely down from the summit.