Emotional Regulation Tips & Tools for ALPIMS
🧩 1. Understand What Dysregulates You Across ALPIMS Domains
| ALPIMS Domain | Common Emotional Triggers |
|---|---|
| Anxiety | Uncertainty, overwhelm, fast transitions, sensory overload |
| Laxity | Feeling unsupported (physically or emotionally), proprioceptive chaos |
| Pain | Exhaustion from flares, fear of reactivation, hopelessness |
| Immune (MCAS/POTS) | Sudden physiological shifts: flushing, heart rate spikes, itching, gut distress |
| Mood | Hormonal drops, burnout, disconnection, loss of joy |
| Sensory | Bright lights, noise, smells, texture — leading to meltdown or shutdown |
✅ First step: Track what dysregulates you, when, and how. Use a zone check-in: Green (calm), Yellow (edgy), Red (distress).
🧘 2. Body-First Regulation Strategies (Bottom-Up)
These are ideal when cognition is offline, and symptoms feel overwhelming.
| Tool | How to Use It |
|---|---|
| Weighted blanket or lap pad | Use during overwhelm or shutdown to reduce nervous system hyperarousal |
| Cold water on face or back of neck | Vagus nerve reset (especially for anxiety or MCAS flushes) |
| Deep pressure touch | Use compression garments, hugging a pillow, or body sock |
| Grounding via feet or gravity | Sit with feet flat on the floor, press into the chair, name what you feel |
| Movement-based calming | Rocking, bouncing on a therapy ball, swaying — especially good for ADHD or POTS |
| Breath pacing | 4–7–8 breath, hand over chest, or box breathing (4–4–4–4) if not too activating |
| Temperature regulation | Warm bath for pain or dissociation; cool washcloths for heat or MCAS spikes |
🧠 3. Cognitive + Narrative Tools (Top-Down)
When the brain is online, reframing and reflective practices can reduce emotional overwhelm.
| Tool | How to Use It |
|---|---|
| Internal dialogue mapping | Ask: “Is this fear, fatigue, flare, or fact?” |
| “Name it to tame it” | Labeling feelings can reduce amygdala activation (e.g. “This is grief,” “This is disappointment”) |
| Cognitive defusion (ACT) | “I’m noticing I’m having the thought that I’m failing.” |
| Daily journaling | Use structured prompts like “What helped me regulate today?” or “What felt too much?” |
| Thought-file sorting | Externalize worries (on paper or device), then sort: “urgent,” “later,” or “spiral” |
🌀 4. Zone-Based Regulation Menu
| Zone | Sensation | What to Try |
|---|---|---|
| 🟢 Green (Calm) | Steady, curious | Create art, engage socially, plan meals, gentle walks |
| 🟡 Yellow (Edge) | Wired, irritable, restless | Deep pressure, structured routine, body double, reduce noise |
| 🔴 Red (Overload) | Shut down, meltdown, despair | Sensory reset, lie down in dark room, weighted support, no verbal demands |
| ⚫ Crash | Numb, hopeless, “too much” | Safe stillness, hydration, check basic needs, soothing input (e.g. music, softness) |
✅ Keep a visual regulation menu to reference when dysregulated — reduce the need for decision-making.
🤲 5. Social and Relational Supports
| Support Type | Example |
|---|---|
| Co-regulation with a safe person | Gentle presence, touch (if wanted), regulated voice tone |
| Scripts for asking help | “I’m not okay. I don’t need fixing. Can you sit with me?” |
| Shared regulation tools | Listening to calming audio together, stretching, rocking chairs |
| Emotion-safe rituals | 5-min connection check-ins, shared grounding before appointments or transitions |
| Peer validation | ND or chronic illness peer groups (online or in person) for “me too” moments without pressure |
🛠 6. Daily Tools to Build Regulation Capacity
| Tool | Frequency | How It Helps |
|---|---|---|
| Low-spoon mindfulness (body scan, noticing breath) | 1–2x daily or as able | Increases interoceptive trust |
| Hydration + nutrition pacing | Every 2–3 hrs | Prevents emotional crashes from physical depletion |
| Movement snacks | 2–5 min every few hours | Supports circulation and vagal tone |
| Screen breaks + visual rest | 20–20–20 rule | Reduces cognitive overload and irritability |
| Sleep-safe environment | Daily wind-down | Stabilizes mood, reduces anxiety, supports immune repair |
💬 Affirming Phrases (Internal or External)
- “I’m allowed to feel what I feel — it’s information, not a verdict.”
- “This flare is hard, but it’s not forever.”
- “I can pause before I respond.”
- “I’m safe. I’ve done this before. I have tools.”
- “I don’t need to be perfect to be worthy.”
👥 Helpful Professional & Peer Supports
| Support | Role |
|---|---|
| Trauma- and ND-informed therapist | Teaches DBT, ACT, or parts work for emotional resilience |
| Occupational therapist (ND-, MCAS-aware) | Helps build regulation routines and environments |
| Peer coach or ND support worker | Models pacing, check-ins, and builds co-regulation systems |
| Body-based therapist (e.g., somatics, SE) | Supports bottom-up processing and emotion-body safety |
| Art or music therapist | Externalises emotional content through sensory-safe mediums |
Emotional Regulation with DBT for ALPIMS (with ZONES)
Practical, sensory-aware, neurodivergent-inclusive tools for anxiety, pain, overwhelm, and shutdown
🧭 DBT Basics (Adapted for ALPIMS)
“This is hard and I’m learning to handle it.”
“I want to be independent and I need help right now.”
ALPIMS conditions (MCAS, POTS, sensory overload, pain) amplify Emotion Mind. DBT helps access Wise Mind: the balanced place between Emotion and Reason.
Use Zone Awareness to identify your regulation state and choose tools accordingly.
🧘 DBT SKILLSET 1: TIPP — Emergency Regulation
Use in: 🔴 Red Zone (Overwhelm) / ⚫ Black Zone (Meltdown/Shutdown)
| Skill | ALPIMS-Friendly Use |
|---|---|
| T = Temperature | Splash cold water, apply ice to chest/back of neck — resets vagus nerve |
| I = Intense Exercise | Push wall, stomp feet, bounce — even in bed if upright is too much |
| P = Paced Breathing | 4–7–8 or hum slowly — engage parasympathetic nervous system |
| P = Paired Muscle Relaxation | Tense/release feet, hands, shoulders — grounding body safely |
🧠 Start with the body when words or logic aren’t accessible.
🧠 DBT SKILLSET 2: CHECK THE FACTS
Use in: 🟢 Green Zone (Regulated) / 🟡 Yellow Zone (Anxious or Shame Spiral)
| Step | Practice |
|---|---|
| Identify the emotion | “I feel ashamed / anxious / angry.” |
| Identify the event | “I had to cancel again.” |
| Challenge assumptions | “They think I’m lazy.” vs. “They might not even be thinking about this.” |
| Find the facts | “I cancelled to protect my health.” |
| Create a balanced thought | “My health limits don’t erase my value.” |
✅ Good for post-flare guilt, shame, or rejection sensitivity.
🧩 DBT SKILLSET 3: DISTRESS TOLERANCE — ACCEPTS
Use in: 🟡 Yellow Zone (Edgy/Anxious) or 🔴 Red Zone (Distressed)
| Letter | Skill | ALPIMS-Friendly Ideas |
|---|---|---|
| A | Activities | Gentle sorting, tapping app, music video loop |
| C | Contributing | Comment something kind, thank someone, small helpful act |
| C | Comparisons | “I’ve handled worse” or “This will pass too.” |
| E | Emotions (opposite) | Watch something silly or calming |
| P | Pushing away | Imagine placing the fear in a drawer for now |
| T | Thoughts | Distract: TV, puzzle, read quotes, stim playlist |
| S | Sensations | Deep pressure, warm tea, textured object, cold pack |
✅ Make a Distress Tolerance Box and label it: Use in Yellow + Red Zones
❤️ DBT SKILLSET 4: SELF-SOOTHING BY SENSES
Use in: 🔴 Red Zone (Overload) / ⚫ Black Zone (Shutdown)
| Sense | Examples |
|---|---|
| Sight | Soft lights, minimal visual clutter, calming colors |
| Sound | Deep instrumental music, brown noise, humming |
| Smell | Low-odor safe objects (e.g., cloth with a tolerable neutral scent) |
| Touch | Weighted blanket, fuzzy socks, pressure vest |
| Taste | Comfort food, cool water, electrolyte drink |
| Proprioception | Gentle rocking, chair swaying, stretching if able |
✅ Ideal for MCAS-related sensory distress, autistic burnout, or pain flares
📅 DBT SKILLSET 5: PLEASE — Daily Vulnerability Prevention
Use in: 🟢 Green Zone (Regulated Maintenance) / 🟡 Yellow (Early Crash Signs)
| Skill | ALPIMS-Friendly Support |
|---|---|
| P = Physical Illness | Take meds, pace activity, know your zones |
| L = Limit Substances | Reduce caffeine, histamine-rich foods, alcohol |
| E = Eat Regularly | Gentle meals every 3–4 hours, even when not hungry |
| A = Avoid Mood Vulnerability | Avoid doing too much on green days — leave capacity for recovery |
| S = Sleep Hygiene | Keep a safe sleep environment: blackout curtains, cooling, sensory calm |
| E = Exercise | Gentle movement snacks (even in bed): foot circles, arm raises, stretches |
✅ Use PLEASE to stabilize your baseline and reduce frequency of red/black zone drops.
🧠 DBT “STOP” Skill
Use in: 🟡 Yellow (Conflict/Burnout) or 🔴 Red (Meltdown Impulse)
| Step | Practice |
|---|---|
| S = Stop | Freeze — don’t act on the emotion yet |
| T = Take a step back | Pause, breathe, drink water, sit or lie down |
| O = Observe | Notice what’s happening inside and around you |
| P = Proceed mindfully | Choose your next step gently — don’t rush |
✅ Use STOP when you feel an urge to quit, lash out, collapse, or dissociate.
🔄 Zone Summary: When to Use Which Skill
| Zone | Emotional State | Best DBT Tools |
|---|---|---|
| 🟢 Green | Calm, aware | Wise Mind, Build Mastery, PLEASE, Check the Facts |
| 🟡 Yellow | Edgy, restless, anxious | STOP, ACCEPTS, Opposite Action, Check the Facts |
| 🔴 Red | Overwhelmed, panicked, distressed | TIPP, Self-Soothe, STOP, ACCEPTS |
| ⚫ Black | Shut down, hopeless, no energy | Radical Acceptance, Willing Hands, Self-Soothe by Senses, co-regulation |
🧑🤝🧑 Who Can Help
| Role | What They Support |
|---|---|
| DBT therapist (ND/ALPIMS-aware) | Adapts skillsets to energy, cognition, pacing |
| OT (ND- and MCAS-aware) | Builds sensory regulation stations at home |
| Support worker (NDIS) | Co-regulation, food prep, activity pacing, tool practice |
| Family/friend | Uses zone-checking phrases and sensory tools supportively |
| Peer groups | Validation, scripting, shared pacing strategies |
WJust let me know what would best support your needs right now.
🧭 Support Roles with Zones, Pros, and Cons (ALPIMS-Aligned)
| Support | Role | Best Zones | Pros | Cons |
|---|---|---|---|---|
| Trauma- and ND-informed therapist | Teaches DBT, ACT, or parts work for emotional resilience | 🟢 Green (skill-building) 🟡 Yellow (processing with support) 🔴 Red (only if regulated/co-regulated) | ✅ Builds emotion regulation and self-trust ✅ Supports grief, identity, medical trauma ✅ Validates neurodivergent and ALPIMS experience | ❌ Not all therapists are fully ALPIMS-literate ❌ Talk therapy can overwhelm in red/black zones ❌ May unintentionally pathologize symptoms |
| Occupational therapist (ND-, MCAS-aware) | Helps build regulation routines and environments | 🟢 Green (daily life design) 🟡 Yellow (sensory or task support) 🔴 Red (if trained in sensory retreat support) | ✅ Practical strategies for pacing, routine, sensory calm ✅ Can liaise with NDIS or medical teams ✅ Builds scaffolding for sustainable energy use | ❌ Some OTs prioritize function over comfort ❌ May overlook emotional readiness or trauma triggers ❌ Variable knowledge of MCAS, fatigue, or mood needs |
| Peer coach or ND support worker | Models pacing, check-ins, and builds co-regulation systems | 🟢 Green (goal planning) 🟡 Yellow (motivation, emotional buffering) 🔴 Red (co-regulation, safety check-ins) ⚫ Black (quiet presence, task support) | ✅ Lived experience = real empathy and practical tools ✅ Can help implement DBT tools informally ✅ Often less formal and more flexible | ❌ Scope may be limited (not a therapist) ❌ Relies heavily on good fit ❌ May need training in MCAS/trauma pacing |
| Body-based therapist (e.g., somatics, SE) | Supports bottom-up processing and emotion-body safety | 🟢 Green (body reconnect) 🟡 Yellow (calm embodiment) 🔴 Red (only if highly trained in trauma response) | ✅ Builds interoceptive awareness and grounding ✅ Trauma-informed methods may reduce emotional flooding ✅ Complements nervous system regulation work | ❌ Not always available or funded ❌ Sessions may trigger flare or dissociation if rushed ❌ MCAS reactions or sensory mismatch risk |
| Art or music therapist | Externalises emotional content through sensory-safe mediums | 🟢 Green (creative integration) 🟡 Yellow (non-verbal emotional processing) 🔴 Red (low-demand formats can help regulate) | ✅ Accessible for non-verbal processing ✅ Supports neurodivergent communication ✅ Can help externalize trauma without over-talking | ❌ Sensory sensitivity may require adaptation ❌ Availability limited in some areas ❌ May not be trauma-trained or MCAS-aware |
Support Options for Emotional Regulation in ALPIMS (with DBT Integration)
Including Pros, Cons, and Suitability by Zone (Green, Yellow, Red, Black)
🧑⚕️ 1. DBT Therapist (Chronic Illness + Neurodivergence Aware)
| Role | Teaches DBT skills adapted to your energy, sensory profile, cognitive load, and chronic illness needs. Helps process emotional reactivity and rebuild distress tolerance. |
|---|
| Pros | Cons |
|---|---|
| ✅ Highly skilled in emotion regulation tools | |
| ✅ Can offer structure, validation, and trauma-sensitive adaptation | |
| ✅ Can guide you through intense zones (e.g. Red → Yellow safely) | |
| ✅ Ideal for unpacking shame, fear, avoidance | ❌ Expensive without funding |
| ❌ Energy needed for regular sessions | |
| ❌ Quality varies — some may not understand ALPIMS or MCAS | |
| ❌ Not all therapists are ND-affirming |
Zone Fit: 🟢 Green (skill-building), 🟡 Yellow (processing triggers), 🔴 Red (prevention work), ⚫ Black (recovery planning, not during)
🧩 2. Occupational Therapist (OT – Sensory / Pacing / Emotional Support)
| Role | Helps you create sensory regulation environments, pacing plans, and practical supports for nervous system overload. Can integrate DBT into routines or life skills. |
| Pros | Cons |
|---|---|
| ✅ Often covered by NDIS or CDMP | |
| ✅ Can help build visual plans, routines, and regulate sensory load | |
| ✅ Understands environmental and physical adaptations | |
| ✅ Practical — not just talk-based | ❌ Not all OTs are DBT-trained |
| ❌ May need to advocate for ALPIMS-specific needs | |
| ❌ May prioritize functional tasks over emotional work |
Zone Fit: 🟢 Green (routine building), 🟡 Yellow (sensory pacing), 🔴 Red (space setup), ⚫ Black (comfort zone support)
🧑🤝🧑 3. Support Worker (NDIS-Funded or Privately Hired)
| Role | Assists with daily tasks (e.g., cooking, cleaning, emotional check-ins, pacing reminders). Some may help with co-regulation and DBT skill rehearsal. |
| Pros | Cons |
|---|---|
| ✅ Can reduce executive load and daily overwhelm | |
| ✅ Can be trained to support sensory needs and regulation routines | |
| ✅ Helps with fatigue, shutdown recovery, sensory support | |
| ✅ Flexible support model | ❌ Quality and skill level vary |
| ❌ Emotional co-regulation depends on personality fit | |
| ❌ Requires onboarding/training in DBT and ALPIMS specifics | |
| ❌ May be inconsistent due to staffing |
Zone Fit: 🟢 Green (build skill routines), 🟡 Yellow (support emotional pacing), 🔴 Red (physical help), ⚫ Black (nonverbal help, presence)
🧑🎓 4. Peer Coach or DBT Mentor (ND-aware, lived experience-based)
| Role | Someone who uses DBT personally and helps you integrate skills. May be a peer support worker, ND coach, or community DBT facilitator. |
| Pros | Cons |
|---|---|
| ✅ Shared lived experience | |
| ✅ Low-pressure, non-clinical | |
| ✅ Validating, real-world strategies | |
| ✅ May support flexible, drop-in scheduling | ❌ Not formally trained or trauma-informed in all cases |
| ❌ Might need to set boundaries around triggering topics | |
| ❌ May not suit all emotional depths or diagnoses |
Zone Fit: 🟢 Green (daily check-ins), 🟡 Yellow (re-regulation via co-scripting), 🔴 Red (supportive distraction), ⚫ Black (gentle presence)
👨👩👧 5. Family Member / Friend (When Safe + Trained)
| Role | Can help with co-regulation, pacing reminders, sensory support, and DBT tools like STOP, Wise Mind, or self-soothing by senses. Best when boundaries and needs are clear. |
| Pros | Cons |
|---|---|
| ✅ Familiarity and emotional safety | |
| ✅ Can offer real-time support | |
| ✅ Good for gentle check-ins, grounding activities, reducing isolation | ❌ May trigger emotions if not regulated themselves |
| ❌ Risk of over-functioning or burnout | |
| ❌ Can lead to role confusion (parentification, fixing) | |
| ❌ Needs mutual understanding of zones and pacing |
Zone Fit: 🟢 Green (co-reflection), 🟡 Yellow (emotion check-in), 🔴 Red (sit quietly, offer water), ⚫ Black (presence, not pressure)
💬 6. Group DBT / Peer Support (Online or In-Person)
| Role | Offers space to practice and normalize DBT skills, learn pacing tips from others, and build emotional resilience in community. Ideal if tailored for ND or chronic illness. |
| Pros | Cons |
|---|---|
| ✅ Normalizes emotion cycles | |
| ✅ Cost-effective | |
| ✅ Teaches pacing and alternative tools | |
| ✅ Can be affirming, validating | ❌ Not all groups are inclusive or trauma-safe |
| ❌ May be overstimulating for sensory-sensitive individuals | |
| ❌ May require social energy not always available | |
| ❌ Not suitable for active flare states or shutdowns |
Zone Fit: 🟢 Green (learning new tools), 🟡 Yellow (reflection), 🔴/⚫ (not ideal — can trigger unless very gentle)
🪑 7. Self-Guided Tools (Journals, Apps, Visuals, DBT Worksheets)
| Role | Used at your own pace to reinforce DBT skills — especially useful in pacing zones or post-flare recovery. |
| Pros | Cons |
|---|---|
| ✅ Zero pressure | |
| ✅ Repeatable anytime | |
| ✅ Easy to adapt to energy levels | |
| ✅ Ideal for self-paced learning and Green Zone reflection | ❌ Can be hard to access in Red/Black Zones without support |
| ❌ May require visual/reading tolerance | |
| ❌ Not all resources are ND- or ALPIMS-aware | |
| ❌ No live feedback or co-regulation |
Zone Fit: 🟢 Green (journaling, planning), 🟡 Yellow (short worksheets, visual STOP), 🔴 Red (flashcard reminders), ⚫ Black (gentle symbols or cue cards only)
🔄 Summary Table: Supports, Zones, and Usefulness
| Support Type | Green | Yellow | Red | Black | Notes |
|---|---|---|---|---|---|
| DBT Therapist | ✅ Skill building | ✅ Trigger processing | ☑️ Crisis plan prep | ❌ Active session not ideal in crash | Best when long-term relationship is built |
| OT | ✅ Routine, sensory map | ✅ Pacing plans | ✅ Home support | ☑️ Recovery zone planning | Ask for ND + MCAS experience |
| Support Worker | ✅ Daily tasks, reminders | ✅ Emotion-safe routines | ✅ Sensory care, practical aid | ✅ Quiet presence | Needs clear onboarding |
| Peer Coach | ✅ Validation, goals | ✅ Co-regulation | ☑️ Distraction | ✅ Gentle check-in | Informal but relatable |
| Family/Friend | ✅ Connection time | ✅ Ask + Listen support | ✅ Sit beside, hydrate | ☑️ Comforting presence | Needs boundaries and scripting |
| Group DBT | ✅ Skill learning | ✅ Peer check-in | ❌ Often overstimulating | ❌ Not crash-safe | Choose ND-friendly options |
| Self-Guided | ✅ Journals, trackers | ✅ Worksheets, visual maps | ☑️ Flashcards, brief prompts | ☑️ Symbol cues, soothing visuals | Combine with pacing tools |