Sarabet Chang Yuye

DBT flowchart

In 2022, I was in a relationship that regularly made me uncontrollably angry, in part due to being micro-surprised a lot. I wanted to control my undesired behavior instead of just avoiding the proximate trigger by breaking up, so I signed up for a dialectical behavior therapy group that came recommended by a friend.

I liked DBT for mysterious relationship anger, and I ended up taking the modules I found most helpful and rewriting them for my own use. I also wrote a few of my own. I put many of them into a flowchart, which I used regularly. The flowchart, and a description of all the skills referred to, are on this webpage.

I stopped using it after breaking up with the partner, but have come back to it in 2025 as a new parent, since sleep deprivation and a heavier workload made for worse emotional regulation.

What I like to do is go straight to the flowchart (on a permanent tab I have open on my phone) once I notice I’m more than mildly off balance emotionally.

The flowchart

Short term / urgent skills

STOP

The Pareto Principle (or 80/20 rule) says that 80% of outcomes  result from 20% of all causes (efforts) for any given event. Obviously this isn’t literally true, but it’s a good pointer to the observation that the majority of results come from a minority of inputs.

Stopping is a skill. Getting the hell out of the situation is a skill. Shutting the laptop and leaving the room to make yourself pancakes instead is a skill. For hot-headed people, it’s an 80/20 skill.

You know when to say “I need a timeout” or “let’s drop this, man” or to silently raise your palms out with a self-deprecating smile and let the silence unroll a little. You just don’t do it.

Let’s go through what it would be like to do it.

During a heated moment (activation 7+), it’s going to trickle through your mind that you probably need to stop. Normally at that point, you keep going. But this time you’re going to remember the term “stop skill”.

The moment you remember stopping is a skill, you have two frames of the situation: in the first one, the salient agents are yourself and the adversary you’re about to lash out against. There’s going to be a winner and a loser, and you want to be the winner. In the second one, the salient entities are the self that wants to barrel onwards and the self that can stop, take a time out, and untangle things later. There’s going to be a winner and a loser. You want to occupy that second frame, where the real battle is internal.

Technically, STOP is an acronym:

S: Stop. Literally freeze your body.

T: Take a step back. If possible, it should be physical – go to another room. If not, make it mental – close your eyes, and with each breath, navigate into a different imagined space, deeper or further away from the space you are in.

O: Observe. Notice your thoughts, feelings, and physical sensations. Observe the facts of the situation (not the interpretation).

P: Proceed mindfully.

Medium term / time sensitive skills

WHHS

“Willing hands, half smile” is a physical trick for getting your mind to stop resisting the ground facts of reality or the course of action you already know is best.

Hands: You flip your palms up into a receptive posture.

Smile: almost imperceptibly, relaxing your face, turning up the corners of your mouth.

Both of these are relatively subtle gestures can be done in public without garnering any notice.

Don’t Ruminate

A longer post on not ruminating. The quickest takeaway is an “overflowing your mental stack” trick where you think of 6-7 things in rapid succession (one item per sense is an easy prompt) with the final one being an idea of what to do next that is not ruminating. Immediately pivot to doing that thing.

Opposite Action

1/ What is the emotion you want to change?

2/ Describe your action urges. Are they appropriate for the situation? Don’t bullshit!

3/ If not, do the opposite.

Examples of emotions, their action urge, their opposite actions:

Anxiety – avoid or control – avoid avoiding (i.e. do the first step), formally give up, cope ahead

Anger – Lash out, criticize, attack – Gently avoid, take time out, be kind, deliberately have empathetic thoughts

Disgust – destroy, denounce – Take an interest in the stimulus with your senses, and lean in literally and mentally

Fear – avoid – Keep your eyes and ears open and focus on the feared event, take in information and explore, straight your back and keep a confident voice tone

Sadness – withdraw and isolate – Get active, do pleasant things, engage with environment, straighten back and keep an upbeat voice tone

Shame (you will be rejected if your characteristics are public) – Hide, conceal, avoid –Make public your behavior, repeat the behavior, do not apologize, forgive yourself

Guilt (your behavior violates your moral code) – Repair transgression, apologize, make public the behavior and commit to not doing it again – Don’t repair, make public, do not apologize

Jealousy (someone is about to take something that is yours) – take away their access – let go of controlling others’ actions, share the things and people you have

Envy (someone has what you want but don’t have) – destroy or steal what they have – count your blessings

Check the Facts

You probably already kind of know when you’re having an intense reaction that is unreasonable. You know you’re having “the wrong emotion”, but knowing that doesn’t help, because what are you supposed to do about that?

Sometimes you can change the wrong emotion by backtracking and examining the interpretation that underlies it.

(The diagram below show emotions changing as you spread out your interpretations over a wider distribution.)

1/ Write down the event (the collection of literal facts of what happened). You might need multiple tries to pare it down to just the literal facts. Look for judgments or extremes that might creep in.

2/ Then write down what your interpretations are about those facts.

3/ List as many other interpretations (or alternative outcomes, if the strong emotion is about a future possibility) as you can. Get creative, throw in a couple of weird or silly ones.

4/ If appropriate, ask the relevant people if their interpretation is correct, or relay the facts (but not your interpretation) to a friend and ask for their input, or post your prediction to a prediction market.

5/ Set a timer for 3 minutes and do Effective Rethinking where you cycle through all your interpretations. On each (slow) inhale you verbalize each interpretation in your mind; on the exhale, you think “that might be true”.

Effecting Rethinking

DEAR MAN, GIVE, FAST

These are scripts for communicating with others.

DEAR MAN is an acronym for the script you use to communicate your state and ask for something from others. GIVE is an add-on that tells you what stance you take if you value the relationship. FAST is an add-on that tells you what stance you take if you value self-respect.

1/ Consider which you most care about: your objective, the relationship, or your self respect

2/ Consider whether it’s appropriate to make the ask. Are they obligated?

3/ Consider when the best time would be to make the ask.

4/ Write the DEAR script, adding GIVE or FAST elements as necessary depending on your answers in 1.

DEAR MAN:

  • Describe the situation that you want to hash out with the other person. Facts only. You want to establish an uncontroversisal common understanding of reality before proceeding to negotiate your interpretations and desires.
  • Express your opinions and feelings about it.
  • Ask for the thing you want, or decline their (implicit or explicit) ask.
  • Reward them by explaining the benefit to them if they go along with your plan.
  • Do all this
    • Mindfully
    • Appearing calm
    • and willing to negotiate. You do want to hear their opinion.**

GIVE

  • Gentle: no attacks, threats, judgment, moralizing. Be patient if they want to talk another time
  • Interested: listen to their point of view, face them, don’t interrupt
  • Validating: see the world from their point of view, say “let me make sure I understand you” and repeat your understanding, acknowledge their feelings, avoid problem-solving mode harder than you normally would.
  • Easy manner: smile, be a little humorous, adopt a chill body posture

FAST

  • Fair: be fair to yourself and the other person (i.e. GIVE to both parties)
  • Apologize: only once or twice if needed, and do not apologize if it is not warranted
  • Stick to your values
    • Mine are to be: instrumentally rational, non-coercive, regulated, decisive, open-minded
  • Truthful – be honest. Do not exaggerate or minimize your difficulties

Radical Acceptance

Often, a nontrivial portion of intense emotion or distress comes from resisting reality where a stressor exists, rather than the stressor itself. Or, more bluntly, you might be miserable because you’re low-key throwing a tantrum and it would be good to stop.

Cues that we are in a state of futile resistance:

  • “It shouldn’t be this way”
  • “He should be able to do this himself”
  • Trying to fix every situation and grabbing control

What has to be accepted?

  • Facts about the present
  • Limitations on the future (real limitations, not crazy pessimistic shit you know on some level you’re cooking up on purpose)
  • That the thing that is difficult had deterministic causes
  • That a whole can be still worth it even if a part of it is bad

1/ Observe that you are questioning or fighting reality

2/ Cognitive acceptance: remind yourself that reality is what it is. Imagine a spacetime loaf and move around it, looking at the fact that the present time slice is what it is, and that previous time slices produced it in a suspiciously deterministic fashion. Notice that this loaf holds everything – every good thing that has happened to you, every bad thing, every work of art, every person you admire and care for, every joke and book. The thing you are resisting is woven in alongside everything else.

3/ Physical acceptance: assume willing hands half smile while holding this spacetime loaf in your mind, and then imagine throwing yourself into the spacetime loaf. You are physically jumping into the reality, from an observer position to a participant stance.

4/ Allow disappointment, sadness, and grief to arise within you, and give yourself the reassurance, validation, or condolences that is appropriate.

5/ Practice opposite action: list what you’d do if you accepted the facts, and then do them.

One Mindful Participation

One-mindful

  • Rivet yourself to the now. Do one thing at a time. When you are eating, eat. When you are worrying, worry. When you are planning, plan.
  • A busy mind is a lazy mind.
  • If you find you are doing two things at once, stop. Go back to doing one thing at a time.

Participation

  • Participate with awareness of connection to the universe
  • Focus on whether your body touches an object, and consider what the object does for you
  • Consider the walls in the room that keep out the wind and rain
  • Do exactly what is needed

Long term

Accumulate Positive Experience

You should

  • Do things that make you feel good
  • Ideally at times where it’s appropriate to do those things
  • And really pay attention as you do them. Don’t mentally wander off during a good meal.

Below are suggestions. If you know this is the right time to accumulate positive experience, do not just read these and wander away to your unsatisfying existence again. Pick one either from your own list or the below, and do it even if you don’t feel like it.

  • Watching a movie, a good one that came recommended by someone you trust
  • Or a book, same deal
  • Eating something good
  • Fantasizing sexually, taking the time to imagine something new and interesting about it
  • Shopping
  • Thinking about a friend’s good qualities, really taking the time to revisit the memories
  • Thinking about your own good qualities and life highlights
  • Going online and leaving cheerful, helpful comments on various posts
  • Taking a warm bath
  • Metta meditation, prayer, or conversation with an ideal parent figure

Build Mastery

This often means, clean your fucking room.

Some large percentage of modern misery comes from the fact that you aren’t doing the thing you should be doing. There are almost certainly multiple stressful things you should formally give up on so they stop taking up space in your brain (have you taken a good hard look at whether the tax return that’s making you mildly suicidal is worth filing?), and multiple essential things that are going to be done within 15 minutes if you just sit down and do them, and multiple things that are long heroic slogs.

As soon as I think “I’m getting depressed,” I go through my to-do list and identify all the things I’ve really been dreading and force myself to do them one after another. After a day or two of slogging through, I tend to feel much better. Doing this, I haven’t had any major depressive episodes in 2-3 years, which is a huge departure from my base rate of “several per year, verging on constant.”

I think the trick is strongly self-signaling I’ll do whatever’s needed to avoid depression. The cost is lower than you’d think; IME doing anything when I’m depressed feels awful, so doing dreadful stuff feels only a bit worse than otherwise neutral stuff.

– Cate Hall, https://twitter.com/catehall/status/1743415458429276434

1/ Set a 1 hour timer (or 30m or 10m, depending on how overwhelmed you are)

2/ Start writing down the stuff crowding in your head. You’re definitely going to generate more than you can do in the hour. It’s fine.

3/ Once your head feels reasonably empty, start processing the most important items. If it’s a task where you’ll need context to pick it up later, write down that context as you go in a text file.

4/ When the timer goes off, stop. If you have context your future self will need to continue the task, send yourself an email.

Cope Ahead

When there is a recurring problem scenario in your life, you can generate an alternative action plan that’s better than your normal reaction, and simulate acting in that alternative way. The more you practice acting differently in your imagination, the likelier it is that you can act on it beforehand.

1/ Scenario: who does what? Says what, exactly?

2/ What do I usually do?

3/ Alternate action: what am I going to do and say?

4/ Rehearse – set a 3 minute timer and physically rehearse (repeat if necessary) until timer goes off.

5/ If it’s really important, set a calendar reminder for tomorrow, 3 days from now, and 7 days from now to do it again.

Not in the flowchart

Decisiveness

I consider this a subskill of Building Mastery.

This one seems like an odd duck of a “therapy skill”, but I’ve found that a lot of problems I have are exacerbated because I push decisions of various sizes off because I don’t feel confident I can make the right call. I think “I’m too tired” or “I notice I’m anxious about it and I should wait for when I’m not anxious (when?)”. I don’t think most people struggle with this very hard – the following practice is for people who do.

Don’t agonize over decisions. You are stupid and slow and need to radically accept that your decisions will be made in a stupid and slow state. (Also, roughly speaking, the more you agonize the likelier it is the choice doesn’t matter – you wouldn’t be agonizing if the expected utilities of both choices weren’t so close.

1/ Accept that the decision will be made in a suboptimal state. Expect a high-ish probability of regret, and go ahead.

2/ Make a pros/cons list and attach dollar amounts to each one. (If the choices branch due to uncertainty, make a decision tree.) Try to do this in writing if you can. After listing dollar amounts, if the pros/cons are obvious, then don’t go further. Do the thing the numbers say.

3/ If it’s not obvious based on numbers, use an overarching strategy. Is there an overall life framework this choice fits into, like “don’t do social things you’re not enthused about” or “do things that are totally new to you” or “be more generous”?

Don’t generate one framework per choice that favors that choice – hold the question in mind and wait for the framework to come to you.

Taking Criticism

Is not part of normal DBT, but I found myself writing a module on it when I made a handbook for myself.

Mindfulness of current emotion

Ideally, when you have an emotion that is causing you suffering, you want to have the ability to

  • Neither reject the emotion, nor amplify it (no pushing or pulling)
  • Step back and observe the mental and physical sensations of the emotion
  • Observe when the emotion leaves
  • Retain awareness that you have felt differently at other times
  • Not act on the emotion
  • Have an attitude of cool respect towards the emotion

When you do each of the following exercises, mark it as tried, and optionally jot down some notes.

  • Closed eyes and scanned body for first physical sensation. Then scanned for first thought/emotion. Shuttle back and forth.
  • Neither pushed the emotion away nor pulled
  • Observed how many seconds it took the emotion to fade out
  • Had the attitude of being willing to have the unwelcome emotion
  • Noticed an emotion-driven urge without acting on it
  • Reminded myself of 1 time you felt the opposite way, and 1 time you felt an orthogonal way
  • Held a gentlemanly attitude of respect and patience towards the emotion
  • Imagined the emotion as being a wave crashing against your body as you stood in waist-deep water (you’ll sway but you won’t fall)

Dialectical thinking

The core of DBT. We need interpretations to label and understand reality. But we have to unglue ourselves from one interpretation. The quality of being glued to one interpretation is a common source of strong unpleasant emotions and unproductive action.

Some dialectical things:

  • Radical responsibility vs radical helplessness
  • That makes no sense to me vs that makes sense to them
  • It’s their fault and they should die vs you need to level up
  • People may not have caused their problems and they have to solve them anyway
  • I can be angry at myself while also liking myself
  • I can try to increase energy levels and accept that I’m at baseline a very tired person
  • I can chill about my partner while also expecting him to mess up
  • My emotions are understandable & my emotions need to be controlled

For a while, to practice dialectical thinking, I wore an unaccustomed piece of jewelry that had three stones arranged in a triangle. Whenever I noticed a thought that felt ‘extreme’, like it wanted to extinguish dissonant evidence or emotion, I’d think it again and then chain two additional thoughts, while touching each stone jewelry:

[initial thought] and [opposing valid perspective] and [secret third way of thinking about it]

“She really messed up with the chores, and the chore system was confusing, and this is all at most a medium sized deal.”