Quick answer: A DBT crisis plan is a short, written sequence of skills and actions you will use when distress gets too high to think clearly. It works best as a skills ladder: the fastest, most physical skills at the top for moments above roughly 70% distress, and slower, thinking-based skills further down for when you are coming back to baseline. The plan also names your warning signs, the people you will contact and the point at which you get urgent help. Its value is that it removes decisions from the moment when decisions are hardest.
What is a DBT crisis plan?
A DBT crisis plan is not a safety plan in the clinical sense, though the two overlap. A safety plan is usually built around suicidal crisis and includes means restriction and emergency contacts. A DBT crisis plan is broader: it is your personal order of operations for any moment when emotion is driving and reasoning is not.
DBT assumes that skills are not equally available at every level of distress. Paced breathing is hard to start at 95%. A cold shower is difficult to think of when you are calm but very effective when you are not. Most people learn a long list of skills and then, in the moment, use whichever one they happen to remember. The crisis plan replaces memory with a sequence.
Why isn’t a list of skills a plan?
A list tells you what exists. A plan tells you what to do next. The difference matters because high distress narrows attention, slows working memory and makes complex decisions feel impossible. Under that load, “choose a skill” is a decision, and decisions are exactly what you cannot make.
A plan also settles the question of order. Many people try a cognitive skill first, find they cannot concentrate, conclude that DBT does not work for them, and give up. If the plan says “TIPP first, then a distraction, then reappraisal when I am under 50%”, the failure is no longer personal. It is a sequencing error, and sequencing errors are fixable.
What should a DBT crisis plan include?
At minimum, six things:
- Warning signs. The early signals that you are heading somewhere difficult: clenching your jaw, checking your phone repeatedly, a particular thought (“everyone is against me”), withdrawing, skipping meals, a specific tension in your chest.
- Triggers and vulnerability factors. The situations and conditions that reliably make things harder, so you can act before the wave rather than inside it.
- Two zones of skills. What you will do above roughly 70% distress, and what you will do below it.
- One or two people. Who you will contact, with a sentence on what you will say. “Text Sam: ‘I’m spiralling, can you talk?’” is more useful than “reach out”.
- What not to do. The behaviours that reliably make it worse: drinking, driving, texting the person you always regret texting, reading the argument again. Write them down, because they are also the behaviours that will feel most appealing.
- The escalation point. The signs that this has moved beyond self-management, and what you will do then: call your clinician, call a crisis line, go to A&E, tell someone in the house.
Keep the whole thing to one page. If it needs a table of contents, you will not read it at 2am.
What is a skills ladder?
A skills ladder is a visual way of arranging DBT skills by intensity. At the top are the skills that work when you are most activated. At the bottom are the skills you use once the peak has passed, to settle and make sense of what happened. You work down the ladder as you come down.
Bifocal’s Skills Ladder adds a single, very useful rule: place the fastest, most physical skills above the 70% line and calmer skills below it. The number is not a measurement device; it is a shared reference point. “This is a 70% moment, so I start at the top” is a sentence you can act on. “How bad is this, really?” is not.
The ladder is drawn as rungs, with the threshold shown between the two zones, and you can reorder skills by dragging so the order matches what actually works for you. You can add skills from the DBT library or create your own custom entries with a name, icon and colour for anything your therapist has taught you that is not in the app.
How do you build a skills ladder step by step?
- Name the top of the ladder. What does your most acute state look like? Not “very upset”, but what you notice: pacing, shouting, self-harm urges, numbness, the sense that you cannot stay in your body.
- Fill the top zone with fast, physical skills. These are the ones that change your body state quickly. Aim for two to four, in the order you would try them.
- Draw the 70% line. Everything you would not be able to think your way into at high intensity belongs above it.
- Fill the bottom zone with thinking and relating skills. Self-soothing, mindfulness of the moment, checking the facts, opposite action, DEAR MAN when the issue involves someone else.
- Add a bottom rung for repair and learning. Once you are calm: a chain analysis, a note in your journal, a message to your therapist, or simply recording what happened.
- Test it on a medium day. Use the ladder at 50% and 60% before you need it at 90%. You are learning the route, not just drawing it.
- Review it after every use. Which rung did you actually reach for? Which one helped? Which one is on the ladder because it sounds good but does nothing? Replace it.
Two or three rungs at the top is usually enough. A ladder with fifteen entries is a list again, and lists are what we are trying to avoid.
Which skills belong above the 70% line?
The distress tolerance skills that act on the body or interrupt the spiral:
- TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation). The temperature step is the fastest route down for many people. The full explanation is in the guide to TIPP.
- STOP (Stop, Take a step back, Observe, Proceed mindfully) when the risk is that you are about to act.
- Intense exercise for a short burst: stairs, fast walking, press-ups.
- Paced breathing with a long exhale, if you can use it at that level.
- Distraction with ACCEPTS, especially activities and sensations that occupy attention completely.
- Pros and cons of acting on the urge, written in advance and read rather than generated.
- Radical acceptance of the immediate fact, in one sentence, when the distress is about something that has already happened.
Put these in the order you would actually use them. If cold water works first for you, it goes first. If it does not, it should not be at the top simply because it appears first in a book.
Which skills belong below the 70% line?
Once the peak passes, the goal changes from surviving to settling and making sense:
- Self-soothing through the five senses.
- Mindfulness of current emotion: noticing the feeling without acting on it.
- Check the facts and opposite action from emotion regulation.
- DEAR MAN, GIVE and FAST if the situation involves another person and you want to return to it. The DEAR MAN guide covers the scripts.
- Radical acceptance for the part of the situation you cannot change.
- Wise Mind for the decision that follows.
- Cope Ahead for a similar situation coming up.
The bottom of the ladder is also where learning happens. A line in a journal, a short chain analysis, or a note about which skill you used first is what turns one difficult evening into a slightly better plan.
What does a crisis plan look like on one page?
| Section | Your entry |
|---|---|
| Early warning signs | Jaw tightens, rereading messages, “nobody helps me” thought, skipping lunch |
| Vulnerability factors | Under six hours’ sleep, alcohol the night before, unresolved argument |
| Above 70%: first moves | Cold water on face, walk fast for ten minutes, STOP, paced breathing |
| Above 70%: if still rising | Text Sam, put phone in another room, pros and cons card |
| Below 70% | Shower, self-soothing with music, check the facts, journal |
| People | Sam (text “spiralling, can you talk?”), therapist (voicemail okay) |
| Not helpful | Drinking, re-reading the thread, messaging my ex, driving |
| Escalation | If I have thoughts of ending my life, call a crisis line or go to A&E; tell someone in the house |
Write it once, print it or pin it, and keep a copy on your phone. The version in your head is not the version you will have access to at 90%.
How do you rehearse a plan before you need it?
A plan you have never used is a hypothesis. The rehearsal is what turns it into a route.
- Walk it at low intensity. Next time you are irritated rather than overwhelmed, open the ladder and use the bottom rungs. You are practising the mechanics: opening the app, finding the skill, doing the steps.
- Use Cope Ahead for an event you can see coming. A family dinner, a performance review, a medical appointment. Write out the scenario, the skills you will use and what you will do if the first one fails. Bifocal includes a Cope Ahead Thoughts journal entry type for this.
- Decide the awkward parts in advance. What exactly will you text? What will you say if someone asks why you are leaving? Rehearsing the sentence is more useful than rehearsing the intention.
- Time the top rungs. Does the cold water actually bring you down, and how long does it take? Realistic expectations stop you abandoning a skill after ninety seconds.
- Debrief after use. Three questions: what did I try, what helped, what will I change? One line each is enough.
How do you build a crisis plan in Bifocal?
Bifocal’s Skills Ladder is the spine of that plan. You add skills from the library or create custom ones, drag them into the order that works for you, and the 70% line separates the high-distress zone from the calmer zone. Because it is a visual ladder rather than a list, the next rung is obvious even when thinking is slow.
The rest of the plan lives alongside it. The diary card tracks the emotions, urges and skills that tell you whether the plan is working. Stress Diary entries record tension across the day, which is how you learn that your 70% moments cluster at a particular time. The journal holds Cope Ahead notes and reflections after a hard evening. And a Chain Analysis after a target behaviour shows which rung you missed and why.
Everything works offline. There is no account, your entries stay on your iPhone or in your own private iCloud, and usage analytics are opt-in and off by default. If you want a copy on paper for the fridge, Bifocal can export a PDF report of your records.
When should you get urgent help?
A crisis plan is for distress you can manage with skills. It is not a substitute for emergency care. Get urgent help if you are at immediate risk of harming yourself or someone else, if you have taken an overdose or injured yourself, or if you cannot keep yourself safe.
In England, you can call 111 and select the mental health option, call Samaritans on 116 123, or go to your nearest A&E. In the US, call or text 988. Elsewhere, use your local emergency number or crisis line. If you are supporting someone else, stay with them and help them make the call rather than leaving them alone with a plan.
A good crisis plan includes this escalation point explicitly, because “I’ll know when it’s bad enough” is not a plan. Decide now what the signal is and who you will tell.
Frequently asked questions
What is a DBT crisis plan?
A short written plan for high-distress moments. It lists your warning signs, the skills you will use above and below roughly 70% distress, the people you will contact and the point at which you get urgent help.
What is a skills ladder in DBT?
A way of ordering skills by intensity. The fastest, most physical skills sit above the 70% line and calmer, thinking-based skills sit below it, so you work down the ladder as you come down.
How many skills should be on the ladder?
Two to four in the high-distress zone and three to five below it is plenty. The ladder is a sequence, not a library, and too many options recreates the problem it is meant to solve.
Should TIPP be at the top of the ladder?
For many people, yes. TIPP changes your body state quickly, which is what the top of the ladder is for. If cold water or intense exercise reliably brings you down, put it first and use it early rather than as a last resort.
How often should I update my crisis plan?
Review it after every use, and set a longer review every few months. Skills that helped a year ago may no longer fit, and new triggers appear. A plan that has not changed in two years is probably out of date.
Can I use a crisis plan for panic attacks?
Yes. A panic attack is exactly the kind of moment where a sequence beats a decision. Put paced breathing, cold water and grounding at the top, and leave the cognitive work for afterwards, when your body has settled.
Does a crisis plan replace therapy?
No. It is a tool you build inside or alongside therapy. If you are not in treatment and your distress is frequent or severe, a crisis plan is a support, not a substitute for professional care.