ALPIMS • SKILLS & SUPPORT
DBT-informed skills for daily life
Understand what is happening, support your needs and choose one manageable next step.
Living with overlapping physical, sensory and emotional needs can be demanding. Adapted DBT skills may offer practical support alongside healthcare, rest, pacing and a more tolerable environment.
Choose a starting point Explore the six domainsThis is a proposed DBT-informed approach, not a diagnostic tool or a validated ALPIMS treatment programme. Skills on a website are different from a full course of DBT with a trained clinician.
Recognition and change can go together
“My experience and limits deserve recognition. With appropriate support, I can explore changes that make life safer, easier or more meaningful.”
A change might be asking for help, reducing a demand, adapting the environment or getting medical care. It can also involve learning a new way to respond to distress or communicate a need.
What is DBT?
Dialectical behaviour therapy combines acceptance with change. It teaches four main areas of skills:
- Mindfulness: notice the present moment with less judgement.
- Distress tolerance: get through a difficult moment without adding further harm.
- Emotion regulation: understand emotions and support the conditions that make them more manageable.
- Interpersonal effectiveness: communicate needs, protect boundaries and support relationships.
You do not need to use every skill. The useful question is: “Does this fit my needs and capacity right now?”
How does this relate to stress, energy, autonomic and immune needs?
These systems can interact, but emotional regulation, autonomic function, energy regulation and immune function are different processes. An improvement in one does not prove that the others have been treated.
For ALPIMS, the proposed role of DBT skills is to help with distress, decisions, communication and coping. Supporting sleep, regular nourishment, care routines and manageable demands may also make daily life easier.
DBT is not established as a treatment that corrects POTS, MCAS, connective tissue differences or ME/CFS. Physical symptoms need appropriate assessment even when anxiety or trauma is also present.
Start with what you need
You can open just one section. There is no need to work through the whole page.
My body feels unwell or my energy is low
Begin with bodily support. Consider your care plan, rest, regular food, prescribed treatment or help with a task.
If you experience post-exertional malaise (PEM), protect your energy limits. Thinking, social contact and skills practice can also use energy.
A useful sentence: “I do not have to solve everything now. What needs attention first?”
Bodily needs, rest & pacing • Coming soonEverything feels too much
Reduce the incoming load. If possible, move to a tolerable setting, pause conversation or ask someone to take over a demand.
Try one short grounding option that suits you: look at a familiar object, notice a comfortable contact point or listen to a tolerable sound. Quiet is also an option.
A useful request: “Please give me fewer words and a little time.”
Sensory overload & recovery • Coming soonMy emotions are intense
Pause before solving. Name the feeling if you can, make the situation safer and delay non-urgent decisions.
You might say: “This is painful. I can take care of this moment before deciding what to do next.”
Once the intensity settles, consider what the emotion is signalling: a need, a loss, a boundary, a reminder of the past or several things together.
Gentle distress tolerance • Coming soonI need help or a boundary
Make one clear request. Describe the situation, say what you need and keep the request manageable.
For example: “I am getting overloaded. Could we pause and talk for ten minutes tomorrow?”
Supporters can respond: “I hear you. Would quiet, practical help or company be most useful?”
Communication skills work best when everyone practises listening, consent and respectful responses.
Communication & boundaries • Coming soonA gentle way to use the model
- Notice: What is happening in my body, feelings and surroundings?
- Validate: What makes this understandable?
- Support: What needs attention first?
- Choose: Would one small skill or practical change help?
- Review: Did it help, and was there a later cost?
“I am not sure” is a valid answer. You can begin with comfort and support while the cause remains uncertain.
Example: dizziness and distress during a conversation
A person becomes dizzy while standing during a difficult conversation. Their heart races and they feel frightened.
They sit or lie down as appropriate, follow their existing medical plan and pause the conversation. Later, they use a communication skill to explain what happened and arrange a shorter discussion.
Bodily support and emotional support can both be useful. Neither the fear nor an improvement after resting establishes the diagnosis.
How skills may fit the ALPIMS domains
These are possible support roles, not claims that DBT treats all the conditions listed.
A • Anxiety & Autonomic
Examples: anxiety and panic, POTS/dysautonomia, Raynaud’s phenomenon and erythromelalgia.
Possible support: cope with fear, pause during distress, communicate bodily needs and plan for difficult situations.
Keep in mind: dizziness, palpitations and breathlessness should not automatically be attributed to anxiety. Follow condition-specific care.
L • Laxity / Connective Tissue
Examples: hypermobility spectrum disorders, EDS where diagnosed, joint instability and musculoskeletal pain.
Possible support: ask for assistance, communicate limits and cope with frustration or uncertainty.
Keep in mind: acceptance can include aids, adaptations and appropriate rehabilitation. DBT does not correct connective tissue differences.
P • Pain / Bodily Sensitivity
Examples: migraine, fibromyalgia, TMJ/bruxism, IBS, painful bladder, vulvodynia, small-fibre neuropathy and severe period pain.
Possible support: manage distress during flares, reduce self-blame and communicate pain and care needs.
Keep in mind: accepting that pain is present does not mean accepting inadequate care. Protection and rest should not automatically be labelled avoidance.
I • Immune / Inflammatory
Examples: MCAS, asthma, allergies, allergic rhinitis, coeliac disease and inflammatory bowel disease where diagnosed.
Possible support: cope with unpredictable symptoms, organise care and explain environmental or dietary needs.
Keep in mind: skills do not replace prescribed treatment, emergency plans or medically necessary avoidance.
M • Mood / Mental Health
Examples: depression, anxiety, PTSD and complex PTSD.
Possible support: identify emotions, tolerate difficult moments, practise validation and improve communication.
Keep in mind: trauma-focused treatment may be needed. Specialist DBT-PTSD is a clinical programme that includes trauma treatment; it is different from using general DBT skills.
S • Sensory / Neurodevelopmental
Examples: autism, ADHD, sensory-processing differences, misophonia, hyperacusis, visual snow syndrome and tinnitus.
Possible support: recognise overload, use concrete choices, request sensory protection and communicate in accessible ways.
Keep in mind: skills should work alongside accommodations. They should not require masking, forced sensory exposure or staying in an intolerable setting.
Conditions and needs across several domains
ME/CFS, post-viral illness, FND, sleep apnoea, vocal cord dysfunction, vasomotor rhinitis, hormonal transitions and nutrient deficiencies may add different care needs.
DBT-informed skills may help someone cope with the impact of illness and access support. Each condition still needs appropriate assessment and treatment.
Shared symptoms do not prove a shared cause. Medical conditions, neurodevelopmental differences and trauma-related difficulties can coexist.
Adapt the skill to the person
Foundational care • adapting PLEASE and ABC
DBT’s PLEASE skills address bodily factors that can increase emotional vulnerability: illness care, eating, substances, sleep and exercise. ABC skills encourage positive experiences, manageable achievements and preparation for difficult situations.
For ALPIMS, use regular nourishment, appropriate healthcare, realistic sleep support and movement only as medically appropriate and tolerated. With PEM, pacing and recovery take priority over activity targets.
A positive experience can be very small. An achievement might be asking for help or stopping before overload. Preparing ahead might mean arranging a quiet room or an exit option.
Adapted ABC PLEASE • Coming soonMindfulness and distress tolerance • keep options gentle
Offer brief, eyes-open or externally focused practices. Body scans, breath focus and muscle exercises can be uncomfortable for some people and should be optional.
Standard TIPP skills include temperature change, intense exercise, paced breathing and paired muscle relaxation. They need individual consideration when physical illness is present.
Do not make intense exercise, cold immersion or breath-holding default suggestions. Ask a clinician about suitability where relevant, and stop a practice that worsens symptoms.
Gentle mindfulness & distress tolerance • Coming soonCheck the facts and opposite action • include bodily facts
Checking the facts includes illness, sensory exposure, actual safety, energy limits and the behaviour of other people. It should not become a way to dismiss bodily symptoms or someone’s experience.
Opposite action can help with some emotional urges when the emotion does not fit the facts, or acting on the urge would be ineffective. It is not a general instruction to push through symptoms.
Resting during PEM, protecting an unstable joint or leaving harmful sensory input may be appropriate actions.
Checking the facts & choosing an action • Coming soonAcceptance and relationships • support goes both ways
Acceptance means recognising the reality of this moment. It does not mean approving of mistreatment, abandoning boundaries or giving up on better care.
Family members and supporters can practise validation, clear agreements, co-regulation and repair. The person with the lowest capacity should not carry all the work of making an interaction succeed.
Acceptance, boundaries & relationship support • Coming soonWhat progress might look like
Earlier support
Recognising a need sooner, resting earlier or asking for help before overload builds.
More workable moments
Clearer requests, less conflict or one decision that fits today’s capacity.
Progress does not have to mean fewer physical symptoms or doing more. The model should be reviewed if it increases exhaustion, shame or symptom flares.
Explore related support
Bodily symptoms, anxiety & trauma overlap DBT skills adapted for ALPIMS • Coming soon Foundational care: ABC PLEASE • Coming soon Distress and sensory overload • Coming soon Communication and boundaries • Coming soonEvidence and further reading
The complete ALPIMS adaptation described here has not been tested as a treatment programme. Evidence for a particular DBT programme or population cannot establish benefit for all ALPIMS conditions.
- Healthdirect Australia: dialectical behaviour therapy — introduction to acceptance, change and DBT skills.
- Bemmouna and colleagues, 2025: DBT for emotion dysregulation in autistic adults — a trial of 63 autistic adults without intellectual disability who also experienced self-harm and/or suicidal behaviours.
- Bohus and colleagues, 2020: DBT-PTSD compared with cognitive processing therapy — specialist treatment for complex presentations of childhood-abuse-related PTSD.
- NICE NG206: ME/CFS care and energy management — supports individually managed energy limits and advises against fixed activity increases.