Dialectical Behavior Therapy DBT technique- a Non-addictive Benzodiazepine

Drugs, Rock ‘n’ Roll, & an 80’s Video

I want a new drug
one that won’t spill
one that don’t cost too much
or come in a pill…

one that won’t make me sick
one that won’t make me crash my car
or make me feel three feet thick…
-Huey Lewis & The News . “I want a new drug.”

Dialectical Behavior Therapy (DBT) technique

Don’t we all Huey.

Anxiety and anger problems are both very common in therapy offices (Lachmund, 2005). Insomnia plagues us in this age of longer work hours, Red Bull, Blackberries, and decreased physical activity. But many pharmaceutical interventions for anger, anxiety, and insomnia come with devastating side effects.

For example, Benzodiazepines (Xanax, Klonopin, Valium, etc.) are incredibly effective in the short-term for reducing physiological arousal. But the risk of addiction, paradoxical excitation, and depression, is cause for serious concern by consumers and prescribers alike.

So, the next time you or a client can’t calm down or go to sleep, could you try something that isn’t in the medicine cabinet?

What about shoving your face in a sink full of ice-cold water? Sound as soporific as warm milk? Maybe not, but sleep specialists know that cooler temperatures are typically a good idea in the bedroom. One reason vigorous exercise isn’t recommended hours prior to bedtime is due to the increase in body temperature. But, there may be more to a cold water face plunge than Huey Luis or most of us thought.

French Ducks & Ectoplasm

In 1879, a French physiologist, Paul Bert reported that he had observed a duck survive under water for approximately 20 minutes. Charles Richet, the man who later coined the term “ectoplasm”


and went on to win a Nobel Prize, was then one of his students. After hearing his mentor’s description, he went on to design an experiment to further clarify what had been observed, and established that ducks could hold their breaths longer underwater than above. He proposed that bradycardia was at least one mechanism responsible.

This was some of the earliest scientific work conducted on the diving reflex. The diving reflex can be triggered in reptiles, birds, and mammals (including humans). When the animal’s face gets wet, and the breath is held, oxygen is conserved by slowing the heart, peripheral vasoconstriction, and increasing (at least the ratio) blood supply to vital organs. Obvious evolutionary advantages of this reflex are clear. But what about a client who can’t sleep and wakes with nocturnal rumination?

Diving Reflex’s Practical Implications

Last year I heard Marsha Linehan and a colleague share a story of a physician audience member who introduced them to the concept of the diving reflex.

Many of their patients had used cold water on their faces to calm down. The diving reflex explained why these techniques had been working for their clients. Since learning of the reflex, they had become more confident in the strategy, nicknamed it a “non-pharmacological Benzo,” and may be including it in their upcoming version of the Dialectical Behavior Therapy (DBT) skills workbook. Tolerance and addiction aren’t side effects any clinician should expect from the “non-pharmacological Benzo,” but anyone planning to use it needs to consult his/her physician first (heart problems may be at least one contraindication).

But for those with medical clearance, here are the steps:

Non-pharmacological Benzo Strategy

  1. Pour water in an appropriate sized bowl
  2. Place ice cubes in the water
  3. Inhale and exhale 3 times
  4. Plunge your face into the cold water, hold your breath for as long as you can, without inducing a panic response
  5. Pull your head up

Any approximation of the exercise can be experimented with.  If your coworkers might view you as odd for shoving your face into an ice bucket before a board meeting, even holding a cold soda can to your forehead might have some benefit. But the ideal conditions appear to be about 38 degree Fahrenheit water, bending forward as if diving, and bringing the water up to the temple line. With those recommendations in mind, there may be great variation.

So with medical clearance, experimenting with the parameters is probably a good idea to find what is most effective for you. There appears to be some anecdotal evidence that improvements in the efficacy of the technique may occur with practice according to Dialectical Behavior Therapy (DBT) practitioners. Even more interesting, classical conditioning may even aid in the process as the technique becomes ritualized. So that bradycardia may even occur before your face hits the water.

If you or your clients have already used this or a similar technique, or if you try it, we would love to hear how it goes.  Especially if you find ways to make it more effective- let us know your experience.


Lachmund, E., DiGiuseppe, R., & Fuller, J. R.  (2005).  Clinicians’ diagnosis of a case with anger problems. Journal of Psychiatric Research, 39(4), 439-447.

[title size=”2″ content_align=”left” style_type=”double solid” ]Dialectical Behavior Therapy (DBT) Skills Group[/title]

[fontawesome icon=”fa-file-text-o” circle=”no” size=”medium” iconcolor=”#000000″ ] Contact Dr. Fuller if you’re interested in joining the Dialectical Behavior Therapy (DBT) Skills Group

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