The Neurodivergent Friendly Workbook of DBT Skills [Autism + ADHD]

Overview

This workbook adapts Dialectical Behavior Therapy (DBT) specifically for autistic, ADHD, and neurodivergent individuals, recognizing that standard DBT often doesn’t account for sensory differences, meltdowns, alexithymia, and neurodivergent communication styles. Created by Sonny Jane Wise and informed by researchers like Dr. Marsha Linehan (DBT founder) and Dr. Dan Siegel (Window of Tolerance), it provides practical, accessible skills across everyday well-being, mindfulness, distress tolerance, emotional regulation, and sensory management. The workbook emphasizes choice, self-advocacy, and accommodations as central to healing rather than treating neurodivergence itself as the problem.

Core Concepts & Guidance

Everyday Well-Being, Supports, and Crisis Planning

Self-care forms the foundation of emotional regulation and requires attention across four interconnected domains.

Physical self-care includes medications, sleep hygiene, movement, hydration, and regular breaks. For neurodivergent individuals, consistency matters more than perfection—establishing routines around these basics prevents cascading dysregulation.

Emotional self-care involves setting boundaries, engaging in therapy or supportive relationships, expressing affection in ways that feel authentic, and dedicating time to special interests. Special interests aren’t frivolous distractions; they’re essential regulators and sources of meaning.

Social self-care means curating social media feeds, protecting alone time (which is restorative, not antisocial), and intentionally connecting with chosen people rather than obligatory socializing.

Sensory self-care requires proactive breaks, comfortable clothing (tags removed, seamless preferred), sunglasses and earplugs when needed, and permission to stim. This isn’t self-indulgence—it’s preventing sensory overload.

The Support and Accommodations Wheel helps identify needs across eight life areas: sleep, work/study, communication, daily living, sensory input, finances, eating/cooking, and relationships. Rate each on a 1–5 scale for current strength, impact on well-being, and level of support needed. This reveals where accommodations create the most relief.

A personal crisis plan should document: specific triggers and early warning signs (e.g., increased stimming, social withdrawal), three go-to distractions, safe contacts with their details and preferred communication methods, and a coping tools list. Keep it visible and shareable with trusted people.

Sensory-safe spaces function as regulation anchors. Designate a corner, closet, or tent. Layer in comforting lighting (warm white, soft blue, or purple), seating that feels grounding (beanbag, swing chair, or exercise ball), and items like fidgets, weighted blankets, earplugs, chewellery, and soothing music. This space becomes a reliable refuge.

Affirmations should be neurodivergent-specific rather than generic. Instead of “I am perfect as I am,” try “My sensory differences are real and valid, and they deserve to be accommodated” or, for rejection-sensitive dysphoria, “I decide what thoughts to reject and let pass.” These reframe neurodivergence as something to accommodate, not overcome.

Mindfulness for Neurodivergent Brains: Presence Without Visualization

Mindfulness in this context means present-moment awareness without judgment—not achieving a blank mind or visualization. For neurodivergent people, especially those with aphantasia (inability to visualize), traditional breath-only meditation often fails and feels discouraging.

Purpose: Mindfulness supports attention, identifies needs before crisis, aids decision-making, helps process criticism (especially important for rejection-sensitive dysphoria), and builds capacity for regulation.

When to use which skill depends on emotional intensity:

• Intensity 1–2 (calm/slight irritation): Use mindfulness for grounding and awareness.
• Intensity 3–6 (moderate frustration/anxiety): Use emotional regulation strategies.
• Intensity 7–10 (crisis/meltdown): Use distress tolerance (STOP, TIPP, diving reflex).

Wise mind—the overlap of logical mind and emotional mind—is accessible to everyone. It’s not mystical intuition; it’s the integration of what you know (facts, past experience) and what you feel (current needs, values). Engage it through mindfulness, curiosity (“What do I need right now?”), self-compassion, and checking in with your values.

Accessible mindfulness practices replace visualization:

• Use the environment: Name objects aloud, count patterns, or describe what you see/hear.
• Mindfully listen to music: Track individual instruments or lyrical layers.
• Anchor to breath sensations: Feel air on your hand as you breathe rather than counting breaths.
• Compare two objects: Notice texture, weight, temperature differences without judgment.
• Visual stimming: Trace patterns, words, or colors mindfully.
• Play-doh or clay exploration: Notice texture, resistance, temperature as you manipulate it.
• Mindful eating: Peel a mandarin slowly, notice the spray, smell, temperature, taste—this multi-sensory approach is particularly effective.
• Mindful stimming: Stim while paying attention to the sensation (fidget spinning, hand flapping, rocking) rather than suppressing it.
• Personal anchor object: Hold something weighted or textured with specific prompts: What are the corners like? Which surfaces are smooth? This tactile anchoring bypasses visualization entirely.
• Mindfulness with pets: Observe them, notice their textures and warmth, engage in an activity together (petting, playing, sitting nearby).

The principle: “There’s actually no right or wrong way to be mindful.” Use your senses, stims, and interests as entry points.

Distress Tolerance: Crisis Skills for High-Intensity States

Distress tolerance addresses emotional intensity levels 7–10—situations where regulating emotion through insight or reasoning is neurologically impossible. These skills buy time and physiological downshift.

The STOP skill is foundational:

• Stop: Step back, pause, create physical distance.
• Take a breath: Slow, intentional breathing (even one breath helps).
• Observe: Notice what’s happening without judgment or action.
• Proceed mindfully: Move forward with awareness rather than reactivity.

The mantra: “STOP, PAUSE, AND DON’T REACT.” This interrupts the automatic escalation.

The mammalian diving reflex is a rapid physiological downshift that slows heart rate and breathing through facial cold exposure. It’s one of the fastest biological de-escalation tools:

• Method 1: Submerge your face in ice-cold water (sink or bowl) for approximately 30 seconds while holding your breath. Focus the cold on your cheeks and above your eyebrows.
• Method 2: Apply a soft ice pack over your eyes, lean forward, and hold your breath for 20–30 seconds, then exhale slowly.

Critical safety note: If you have heart conditions, blood pressure issues, or cardiac concerns, consult a medical professional before using this technique. The physiological response can be intense.

TIPP skill combines four complementary approaches:

• Temperature: Ice pack or cold water as above (~30 seconds).
• Intense exercise: Short bursts of high-effort movement (jumping jacks, sprinting, stair climbing, or intense stimming like stim dancing). This rapidly metabolizes stress hormones.
• Paced breathing: Breathe in for a count of 4, hold for 4, exhale for 4 (adjust to 3/5/7 if needed). Paced breathing directly activates the parasympathetic nervous system.
• Paired muscle relaxation: Tense muscles on the inhale, relax on the exhale. This builds somatic awareness and discharge.

Meltdowns are involuntary, not tantrums. They result from cumulative sensory and emotional overwhelm and can present as shouting, crying, self-injury, shutdown (freezing), pacing, hyperventilation, or dissociation. Key distinction: meltdowns aren’t choices.

Meltdown prevention is far more effective than management:

• Learn your specific triggers and early warning signs (increasing stimming, withdrawal, repetitive speech, irritability).
• Maintain routines and sensory breaks before overload.
• Unmask when safe (stop suppressing stims, communication style).
• Use AAC (augmentative and alternative communication) or writing when overwhelmed.
• Have clear exit strategies (permission to leave meetings, known quiet spaces).
• Wear headphones or sunglasses as a signal and shield.
• Use deep pressure (weighted blankets, compression clothing).
• Plan in advance with a meltdown mapping worksheet: document triggers, early signs, what helps during (deep pressure, darkness, isolation vs. company), and what aids recovery (sensory processing, rest, low demands).

Create a tip sheet for loved ones: what’s helpful during a meltdown (quiet space, not forcing speech, respecting boundaries) and what’s harmful (forcing eye contact, punishment, dismissing the meltdown as choice or manipulation).

Sensory self-soothing across all modalities:

• Look: Nature imagery, preferred colors, visually calming environments.
• Sound: A curated calm playlist OR an “angry” playlist (depending on what matches and discharges your state).
• Taste: Warm tea, hard candy, preferred flavors.
• Smell: Candles, preferred scents, fragrance-free if hypersensitive.
• Touch: Warm bath, weighted blanket, petting a pet, firm pressure.

IMPROVE the moment (adapted from DBT for neurodivergent contexts):

• Intensity reduction: Dim lights, close curtains, create quiet.
• Movement and stimming: Honor the urge to move; stim dancing, pacing, fidgeting all discharge.
• Perspective: Ask others to turn off lights/close blinds if you can’t manage it; enforce boundaries.
• Recreational distraction: Shift to special interests, favorite shows, or games.
• Overtime (proprioceptive input): Weighted blanket, pillow, or deep pressure.
• Validation: Self-talk affirming that this state is real and temporary.
• Extrication if possible: Leave the triggering environment.

Emotional Regulation: Emotions As Information and Intentional Action

The role of emotions: Emotions aren’t problems to eliminate; they’re messengers. They communicate needs, motivate perception and action, provide information about threat or value, and influence which memories become salient. The statement “Emotions aren’t good or bad” is foundational. Anger isn’t bad; it signals a boundary violation. Sadness isn’t weakness; it reflects loss. Anxiety isn’t a flaw; it alerts to potential danger.

The emotional triangle shows how emotion, behavior, and body are interconnected:

• An emotion triggers urges to act in specific ways (anger urges confrontation; fear urges escape; sadness urges withdrawal).
• The emotion produces body changes (increased heart rate, muscle tension, digestion changes).
• The emotion activates specific thoughts and memories.

All three—emotion, urge, body sensation—are data for identification.

Emotional response sequence: Prompting event (internal or external) → interpretation and secondary emotion → body changes → expressions and behavioral urges. Many interventions happen at the interpretation stage (challenging unhelpful thoughts) or at the urge stage (choosing actions that fit facts and values rather than the raw urge).

Alexithymia (difficulty identifying and naming emotions) is common in Autism and ADHD. When standard emotion words don’t fit:

• Use sensation-based descriptors: “My chest is tight,” “My thoughts are racing,” “My body feels heavy.”
• Use activity-based descriptors: “I want to move/destroy/hide/talk.”
• Use emotion wheels or charts with more granular options.
• Use music and lyrics as emotional mirrors; often a song captures what words can’t.

Window of Tolerance (Dr. Dan Siegel) maps nervous system states:

• In the window: Calm, present, clear thinking, able to regulate and respond thoughtfully.
• Above the window (hyperarousal): fight-flight-freeze activation—anxiety, racing thoughts, restlessness, shaking, urge to escape.
• Below the window (hypoarousal): Shutdown state—numbness, dissociation, low energy, difficulty motivating, flattened affect.

Create personalized worksheets identifying your unique signs in each zone. This meta-awareness—knowing when you’re dysregulated and in which direction—makes regulation faster.

Check the facts (reframed to “Is it helpful?”) addresses situations where emotion and thought diverge from reality:

1. Identify the emotion and the action you’re urging toward.
2. Surface the interpretation, belief, or story driving it.
3. Ask: Does this response fit the actual facts? Will it meet my needs or cause harm?
4. If not helpful: Use regulation or distress-tolerance skills; challenge unhelpful thoughts with evidence and affirmations; choose an intentional action instead.

Act Intentionally (replacing the traditional DBT “Opposite Action”):

• Rather than doing the opposite of an urge, choose an action that fits the facts and your values.
• Example: Anger urges confrontation and yelling. If confrontation would harm your relationship and yelling won’t solve the problem, choosing to walk away and then use TIPP is intentional action—it’s not suppressing anger; it’s responding wisely.
• Use emotion-based action menus:
  • Anger: Tear magazines, listen to intense music, throw soft items, journal forcefully.
  • Sadness: Look at meaningful photos, call a warmline, spend time with a safe person, eat favorite safe foods.
  • Anxiety: Wrap in a blanket, review a reality-check list, use TIPP, work a puzzle.

Managing Sensory Needs: Profiles, Overload, and Toolkit Building

The eight senses—sight, sound, touch, smell, taste, vestibular (balance/motion), proprioception (body/spatial awareness), and interoception (internal body cues)—are the sensory foundation of well-being.

Hypersensitivity (sensory input feels too intense) and strategies:

• Visual: Lights too bright → lamps instead of overhead lighting, sunglasses, decluttered or nature-rich spaces.
• Sound: Background noise overwhelming → noise-cancelling headphones, earplugs, quiet designated areas.
• Touch: Tags, seams, brushing unbearable → remove tags, wear seamless clothing, prefer firm rather than light touch.
• Smell: Scents overpowering → fragrance-free products, ventilation, avoid heavy perfumes.
• Taste: Textures or strong flavors overwhelming → safe/preferred foods, chewellery for oral sensory processing needs.
• Vestibular: Motion sickness or dizziness → reduce ride length, prefer front seat, break movements into smaller segments.
• Proprioception: Difficulty judging body position or force → use grippy tools, beanbags for grounding, seated work.
• Interoception: Heightened internal cues (aware of every heartbeat, digestion, breath) → scripts for what’s normal, visual reminders for eating/hydration, frequent regulation breaks.

Hyposensitivity (sensory input feels insufficient) and strategies:

• Seeks loud or intense input, strong pressure, and movement.
• Management: Multiple light sources for visual richness, open shelving for visibility, bright visual instructions, weighted or textured pens, movement furniture (chair swing, exercise ball, trampoline), sensory diet with frequent breaks, crunchy snacks, chewables, tight hugs or weighted blankets, regular sensory check-ins, easy-access hydration and quick snacks.

Sensory overload happens when multiple sensory inputs exceed capacity:

• Signs: irritability, restlessness, increased stimming, freezing, headaches, exhaustion, feeling that “everything is too fast.”
• Response: Reduce or remove contributing sensory inputs (lights, sounds, crowds). Build awareness by completing a sensory processing profile worksheet to identify which inputs affect you most and when.

Sensory toolkit for quick regulation—keep accessible with simple instructions:

• Visual: Fairy lights, glitter jar, kaleidoscope, bubbles.
• Sound: Noise-cancelling headphones, white noise machine, cat purring sounds, audiobooks.
• Touch: Weighted blanket, slime, play-doh, stress balls, soft toys, bubble wrap.
• Smell: Scented lotion, aromatherapy pillow, calming spray, scratch-and-sniff cards.

Practical Strategies & Techniques

Building Your Personal Crisis Plan

A crisis plan isn’t fatalistic; it’s preparation that prevents harm and speeds recovery. Document in writing or record as audio (whatever format you’ll actually use):

1. Identify triggers: List situations, times, social contexts, sensory conditions, or thoughts that reliably escalate your distress.
2. Name early warning signs: Before crisis, what shifts? Increased stimming, social withdrawal, repetitive speech, physical tension, dissociation, or emotional numbness?
3. Create a distraction list: Three to five activities that interrupt the spiral (special interests, sensory processing input, physical movement, creative tasks).
4. Identify safe contacts: Include name, number, and preferred communication method (text vs. call) for each.
5. List your coping tools: STOP, TIPP temperature, ice pack location, weighted blanket, noise-cancelling headphones, etc.
6. Plan recovery: What does your body and nervous system need after crisis? Darkness, rest, alone time, food, gentle movement?

Share this plan with trusted people and update it as you learn more about yourself.

The Stop-and-Tipp Sequence for Crisis Moments

When intensity reaches 7–10:

1. STOP: Step back physically. Create space between you and the trigger. Take one intentional breath.
2. Choose a TIPP element:
   • Temperature: Face-cold water or ice pack over eyes (20–30 seconds, holding breath).
   • Intense exercise: 30 seconds of maximal effort (sprint, jump, stim dance).
   • Paced breathing: 4-4-4 or 3-5-7 counts.
   • Paired relaxation: Tense-inhale, relax-exhale.
3. After 1–2 minutes of TIPP: Your nervous system should have downshifted enough for the next skill (distress tolerance or emotional regulation).

This is not about “feeling better” immediately; it’s about buying time and accessing your thinking brain.

Meltdown Prevention and Response Planning

Create a meltdown mapping worksheet:

• My Meltdown Triggers: [List specific stressors—social demands, sensory overload, transitions, etc.]
• My Early Signs: [Increased stimming, withdrawal, irritability, physical tension, etc.]
• What Helps During a Meltdown: [Quiet space, isolation, deep pressure, no demands, specific sensory processing input, etc.]
• What Doesn’t Help: [Forced eye contact, talking about feelings, punishment, demands, etc.]
• Recovery Needs: [Time alone, sensory processing input, sleep, low demands, etc.]

Share a tip sheet for supporters: “During my meltdown, please: give me space, reduce sensory processing input (lights, sounds, voices), don’t demand explanations or apologies, let me stim. Don’t: force engagement, punish me, treat this as a choice.”

Mindfulness Practices for Non-Visualizers

Try one of these anchors for a 2–5 minute grounding session:

• Mandarin mindfulness: Peel slowly, notice the oil spray, smell, temperature. Separate segments deliberately. Notice texture and taste. This engages multiple senses.
• Compare-two-objects: Hold a smooth and a textured item. Alternate between them. Notice weight, temperature, how each feels against your skin.
• Stim dancing: Put on music and move intentionally, paying attention to your body rather than suppressing the movement.
• Anchor object ritual: Hold a special object. Notice its weight, corners, textures, temperature. Let your hands explore it fully.
• Listening drill: Pick a song and track one instrument or vocal layer for the full duration. This focuses attention and prevents spiraling.

Sensory Toolkit Setup

Designate a small space or box with items for each sense:

• Place within arm’s reach during dysregulation.
• Include simple instructions (e.g., “Hold ice pack over eyes for 30 seconds”).
• Rotate items occasionally to prevent habituation.
• If hyposensitive, include more intense options (louder music, stronger scents, more pressure).

Key Takeaways

1. Emotions are valid messengers; behavior choices determine outcomes: Feeling anger at injustice is legitimate. Choosing to walk away and later address it calmly respects both the emotion and your values. The goal isn’t to eliminate emotions but to act intentionally despite them.

   • Example: You feel rejected at work and the urge is to quit immediately. Recognizing the rejection-sensitive dysphoria, you pause (STOP), use TIPP to de-escalate, then decide whether quitting serves you or whether staying with a boundary is the intentional choice.

2. Match skill intensity to emotional state for fastest relief: Talking through feelings when intensity is 9/10 is neurologically impossible. De-escalate first with TIPP or the diving reflex, then access insight.

   • Example: During a meltdown, forcing yourself to “talk about your feelings” fails. Instead, use deep pressure, reduce sensory processing input, and rest. Recovery and reflection come after.

3. Sensory processing accommodation is not indulgence; it’s the foundation of regulation: You don’t overcome sensory processing needs; you meet them proactively.

   • Example: For a hyper-sound-sensitive day, pre-pack earplugs, choose lower-noise seating, and plan movement breaks. For hypo days, schedule time with a mini-trampoline and fidget tools.

4. Wise mind—the integration of logic and emotion—is accessible through curiosity, not meditation mastery: Ask “What do I need right now?” and listen to both your thoughts and your gut. This bypasses the frustration of traditional mindfulness.

   • Example: Logically, you should attend the party. Emotionally, you’re drained. Wise mind: attend for 45 minutes, then leave. Logic + emotion honored.

5. Alexithymia is managed by bypassing words: When emotion names don’t fit, use sensations, activities, or music as mirrors.

   • Example: Instead of “I’m sad,” notice “My body is heavy and I want to hide.” Or play a song that captures your state.

6. Meltdowns are involuntary crises, not choices or manipulation: Prevention (reducing cumulative triggers) and recovery (rest, low demands) matter far more than “managing” the meltdown itself.

   • Example: Recognizing that Friday meltdowns follow five days of masking and sensory processing input, you add Thursday evening recovery time. Meltdowns decrease.

7. Distress tolerance (STOP, TIPP, diving reflex) is for survival, not healing: These skills don’t solve problems; they create space to think and choose. Use them for crisis, then address root causes.

   • Example: The diving reflex stops the urge to harm during a crisis. Later, you address the trigger (lack of breaks, overstimulation).

8. Window of Tolerance awareness—knowing whether you’re hyperaroused or hypoaroused—makes regulation twice as fast: Different strategies work in different zones.

   • Example: If hyperaroused (racing thoughts, anxiety), movement and paced breathing help. If hypoaroused (numb, dissociated), intense sensory processing input or movement is needed; calm breathing may worsen it.

9. Sensory processing profiles aren’t static; they vary by day and context: You can be hypersensitive to sound one day and hyposensitive the next. Flexibility trumps rigid protocols.

   • Example: Monday might require sunglasses and quiet; Tuesday might need intense music and movement. Check in with yourself regularly.

10. Self-advocacy is a skill: Naming your needs (“I need quiet,” “I need to stim,” “I need to leave”) and ensuring they’re met is not selfish—it’s essential regulation.

    • Example: Saying “I’m overwhelmed and need 15 minutes alone” prevents escalation and models self-care for others.

11. Special interests are not distractions from “real” work; they’re powerful regulation and meaning sources: Protecting time for them is self-care, not procrastination.

    • Example: Spending an hour on your special interest isn’t lost productivity; it restores nervous system capacity for other demands.

12. Neurodivergent-specific affirmations reframe accommodation as self-respect: “My sensory processing differences are real and valid, and they deserve to be accommodated” is more grounding than generic affirmations.

    • Example: When criticized for needing quiet or accommodations, your affirmation reminds you that these aren’t flaws—they’re facts to work with.

Memorable Quotes & Notable Statements

• “Emotions aren’t good or bad.” — Central to emotional regulation. Anger, sadness, and anxiety all carry information and motivation. The goal is to understand and respond wisely, not eliminate them.

• “STOP, PAUSE, AND DON’T REACT.” — The foundational crisis mantra. It interrupts automatic escalation and creates space for choice.

• “We all have our own wise mind.” — Affirms that the integration of logic and emotion is not a mystical gift but an accessible capacity within you.

• “There’s actually no right or wrong way to be mindful.” — Removes the pressure to visualize or breathe “correctly,” opening mindfulness to sensory processing-focused, stim-based, and non-traditional approaches.

• “My sensory processing differences are real and valid, and they deserve to be accommodated.” — Neurodivergent-specific affirmation reframing accommodations as self-respect rather than indulgence.

• “I decide what thoughts to reject and let pass.” — RSD-specific affirmation addressing rejection-sensitive dysphoria by reclaiming agency over which narratives you internalize.

• “Meltdowns are involuntary, not tantrums.” — Critical distinction preventing self-blame and shame. Meltdowns result from cumulative overwhelm, not character flaws.

• “Emotions are messengers.” — Reframes emotions as information sources rather than problems, shifting the goal from elimination to understanding.

• “Window of Tolerance awareness makes regulation twice as fast.” — Knowing whether you’re hyperaroused or hypoaroused lets you choose strategies that actually fit your current state.