When you are in distress, the important thing is to whatever is effective for you so that you are not a danger to yourself or others. The DBT skills are good, healthy ways to be effective. But I have found some other things particular to myself, that are useful especially when I'm feeling rebellious or willful about using skills. Sometimes, I just can't think clearly enough to use the skills. These are behaviors that I have found to be effective - keep me safe - but not what you would want to think of as a skill. That's why I call them "intermediate." These strategies may not apply to you. But maybe they'll give you some ideas so you can look deep into yourself and find your own intermediate strategies.

1. Emotion Immersion - This is about staying with the emotion of grief or sadness or self anger or whatever it is and accepting it to the point of making it a part of me. It's a kind of "ferocious" approach of radical acceptance only making it part of my identity as much as my desire for knowledge is a part of me or even as much as my arm or my feelings of hunger are a part of me. In so doing, I stop running away from it. I find that when I run away, I don't do it consciously, I just keep building up a state of anxiety until I'm about to explode and when I finally sit down to confront it, I realize I'm just depressed. If I create it as part of my identity, I'm not surprised by its presence. I can say, "oh yeah, there's that aspect of me again." In learning to live with it, I stop being afraid of it and often, because I'm "choosing" to let it envelop me, it will pass. The reality is, if I'm aware of the depression and don't fight it, I really can't maintain it for long, extended periods of time. Negative emotions seem to love themselves but it takes a lot of energy to sit with a guttural negative emotion. My body will naturally surf the feeling, moving in and out. When I'm in, I can say, "this really, really sucks. I validate for myself that this is really and truly crappy." Although it seems like it would be scary to do this because I might think that if I accept it so thoroughly I'll be trapped in it, but it's quite the opposite. Whereas when I'm running away from it trying to ignore and deny the presence of the feeling, it builds up and gets out of proportion. It leads to "all or nothing" thinking. "I'm always like this. Nobody will ever love me."

2. Planning a "depression time" - Sometimes I have to appear "up" at certain times and it's not appropriate to express my feelings or sometimes my depression is about feeling anxious about the past or future. I can then assign myself a more effective time to experience the emotion. For instance, when I'm with my therapist. Or I might schedule into my day a 10-minute time to get really worried and anxious. When the feeling arises again in a less appropriate time, I can say to myself, "Oh, I already felt anxious about that or I'm scheduled to feel anxious about that at such and such time."

3. Hiding, playing, comforting, throwing a tantrum - This is about giving myself permission to express my feelings in an uninhibited childlike way. When I feel very small and insignificant, I might curl up in a corner in the closet and shut the door and pout until I get bored with it. I might make a fort near my bed and take in some dolls and stuffed animals and hug them and rock myself. Maybe I'll get out some crayons or finger paints and scribble on paper making a real mess and expressing myself with colors like red and black or even draw pictures of blood and guts. Or I can be childlike and pretend I have no cares and color in a coloring book, skip, hop, sing or play with cars and trucks or Barbie dolls complete with making the appropriate squealing noises or male and female speech when the dolls are conversing (I have a little toy box for such things). I could also get on the floor and kick and yell and throw pillows and punch the couch. These things can be very freeing and cathartic.

4. Riding the wave by spinning off the worst case scenario - When I realize I'm depressed because I'm afraid of something like maybe my mother will get angry with me, I imagine it happening. I might see her get angry and yell and then slap me and then pick up a sword and challenge me to a dual. The farther I go with it, the more I immerse in it and finally exhaust the emotion and realize how silly it would be. When Chris uses EMDR with me, I often replay the scenario I'm afraid of and then turn all the players involved (including myself) into cartoon characters. It has a different feel when for instance, I saw my old landlord as the guy in "The Mask" with Jim Carrey. He was so silly with his eyes bugging out. Although, not for everyone, when I was suicidal, I would pretend to tell everyone off and then I'd hate myself really, really bad. I'd yell at myself for everything wrong with me and I'd plan all the different ways I could kill myself. I would allow myself to believe it. In so doing, it would dispel the energy and I'd get too tired to REALLY play it out. Having played it out in my mind, it seemed less important and requiring way too much energy. However, I did this after many years of therapy and in the beginning I'm not sure it would have been helpful.

5. Dissociation - I'm not talking about an identity disorder. Rather I separate myself from the situation as if I'm looking down at it all from above. This is especially helpful when I'm feeling triggered and in a state of panic or high anxiety or in a stressful social encounters. First, I might raise my shields like in Star Trek and in my mind's eye see the other person's words or actions glancing off the shield and bouncing back to the person. I sort of watch it from above and see that the outflow of the hurtful words that the other person is speaking is emotional poison. I might feel sorry for that person that they are so full of this poison. The idea is that I'm separated from it. I might even see myself in the situation and coach myself like a loving parent coaching their child. "See there how upset you are. THAT you is feeling pain and hurt and needs to be comforted." I try to act as if I'm years into the future looking back on what is happening and noticing how wise I am about it now. As someone with PTSD and history of extreme circumstances, this can be a way to help me through flashbacks or remembering in an obsessive way.

6. Spaceship control - This is sort of like a "safe place" visualization only more high tech. I imagine myself in a spaceship designed specially for me so that no one else can get in. There's a movie screen there that I can use to watch a past situation or a possible future one. I sit back and analyze the movie with a compassionate mind. I might even try to reedit the movie differently. There is also a "holodeck" in my ship. I can bring people into the holodeck that I might want to discuss my issues with - like Jesus or Buddha, or I might play out a scene, but I have the absolute control to say, "Computer, end program" and then everything disappears and I see that I'm really alone in the holodeck. I can also bring comforting things into the holodeck like maybe the ocean with super blue water and crashing waves and just hang out there for a while. I might invite Big Bird or Mr. Rogers to come in and make me feel good. But nobody gets in without my permission.

It's all rather imaginative and strange at the same time. But these things have helped me to survive and improve my quality of life, which seems to me to be the ultimate goal.