How to manage overwhelming emotions

What helps when emotions feel overwhelming?

In the moment, what helps most is anything that lowers the intensity enough for you to choose what to do next: slowing your breathing, changing your body temperature, moving your body, or grounding yourself in your surroundings. Over time, what helps is understanding your emotions better, reducing what makes you vulnerable to them, and learning to act on them deliberately rather than on impulse.

Both halves of that answer come from dialectical behavior therapy. Cleveland Clinic describes DBT as a type of talk therapy based on cognitive behavioral therapy and specially adapted for people who experience emotions very intensely. It was developed by the American psychologist Marsha Linehan.

Where these skills come from

DBT is best known as a treatment for people at high risk of suicide and for borderline personality disorder, and it has since been used for other conditions in which people struggle to manage intense emotions. Cleveland Clinic lists depression, anxiety, post-traumatic stress disorder, substance use and some eating disorders among them.

The "dialectical" in the name refers to holding two things together, especially acceptance and change. The Behavioral Tech Institute, which trains clinicians in DBT, explains that DBT adds acceptance strategies, including validation, to the change strategies of CBT, because too much focus on change can leave people feeling that their suffering is not being taken seriously.

A 2015 randomized trial led by Linehan and published in JAMA Psychiatry compared versions of DBT with and without the skills training component. Versions that included skills training did better on some outcomes, including self-harm, which supports the idea that the skills themselves carry some of the benefit.

The four DBT skill areas

The Behavioral Tech Institute summarizes the four groups of skills taught in DBT like this.

• Mindfulness: being fully aware and present in this one moment.
• Distress tolerance: how to tolerate pain in difficult situations, not change it.
• Emotion regulation: how to change emotions that you want to change.
• Interpersonal effectiveness: how to ask for what you want and say no while keeping your self-respect and your relationships.

Getting through the peak: distress tolerance

Distress tolerance is about the crisis moment, when the goal is simply not to make things worse. Ideas drawn from it that many people find useful on their own include the following. They are adapted here for general reading, not taken from Linehan's manual.

• Pause before acting. Notice the urge, stop, take a breath, and step back before you send the message, slam the door or reach for a drink.
• Change your body chemistry. Cold water on your face, a few minutes of brisk movement, or slow breathing with a long exhale can bring physical arousal down. See calming your body when stress hits. If you have a heart condition or other health problem, check with your doctor before using cold water or hard exercise this way.
• Distract on purpose. Choose an activity that fully occupies your attention for a while, knowing you will come back to the problem when you are steadier.
• Soothe your senses. Something warm to hold, music, a familiar smell, being outside.
• Accept what cannot be changed right now. Fighting reality adds suffering on top of pain; acknowledging it does not mean approving of it.

Changing emotions over time: emotion regulation

Emotion regulation skills work further upstream. They start with naming what you feel as precisely as you can. "Bad" is hard to work with; "embarrassed and worried I let my team down" is easier. Naming an emotion often lowers its intensity a little.

Next is checking whether the emotion fits the facts. Fear fits when there is real danger; it is less useful when it is responding to a memory or a worst case. When an emotion does not fit, DBT teaches a skill called opposite action: doing the opposite of what the emotion urges. If shame tells you to hide, you stay in the conversation. If anxiety tells you to avoid, you approach in small steps.

Emotion regulation also means reducing vulnerability: sleep, food, exercise, managing illness, and doing some things each day that give you a sense of enjoyment or competence. Exhausted, hungry people have shorter fuses. Always busy and exhausted explores that link.

When self-help is not enough

If you often feel flooded by emotion, act on urges you later regret, or have harmed yourself, it is worth seeking professional help rather than relying on a page like this. Full DBT is a structured treatment that typically combines individual therapy with group skills training, and it is delivered by clinicians trained in the model.

Laura Bass works with adults in Charlotte, North Carolina, on coping skills for stress and strong emotions, through individual counseling. If you are looking specifically for a comprehensive DBT program, ask any clinician you are considering about their training in it; Cleveland Clinic suggests asking whether they provide comprehensive DBT or a modification.

If you are thinking about harming yourself or feel unable to stay safe, call or text 988 for the 988 Suicide & Crisis Lifeline. In an emergency, call 911.

Common questions