What is STOPP?
STOPP is a five-step skill used in some CBT programs: Stop, Take a breath, Observe, Pull back (put the situation in perspective), and Practice what works. DBT is a structured outpatient treatment developed by Dr Marsha Linehan for the treatment of borderline personality disorder (BPD) and is based on cognitive-behavioral principles. DBT was originally developed in the 1980s by Marsha Linehan, a psychologist at the University of Washington. Although initially intended to help chronically suicidal individuals diagnosed with borderline personality disorder (BPD), DBT has since been adapted for and used to effectively treat a number of other psychological problems.
The activity walks through each step: pausing before acting, taking a slow breath to settle the nervous system, noticing thoughts and physical sensations without judgment, stepping back to see the situation from a wider angle, and then choosing an action that aligns with your values and longer-term goals.
How therapists use it
Introduce STOPP when a client notices they're reacting strongly to a situation and wants to create space between the trigger and their response. Have them work through the five steps during the session, then assign it as a between-sessions practice. Its aim is damage prevention, getting through the hottest moments without the impulsive act you'd regret. Start with low-stress moments to build familiarity, then deploy it when emotions spike.
Who it's for
Cognitive-behavioral therapy (CBT) is a first-line, empirically supported intervention for anxiety disorders. The STOP technique is a natural fit for anxiety, where the urge that most needs interrupting is escape. Stopping before you flee a feared situation, breathing through the spike, observing that anxiety is a wave that rises and falls, and proceeding toward rather than away from what matters is, in miniature, the logic of exposure-based treatment. Distress tolerance skills are effective for a wide range of mental health conditions, including anxiety, depression, PTSD, and eating disorders. STOPP works best for clients who can tolerate sitting with discomfort briefly and who benefit from structure. It is less suited to clients in acute crisis who need immediate safety planning.
What clients see
The client reads through each step of STOPP, then practices the technique by pausing, breathing, observing their internal and external experience, widening their perspective, and deciding on their next action. They can return to the activity whenever they notice a strong emotional reaction.
Modality fit
CBT uses behavioral techniques to interrupt automatic reactions and create space for choice. STOPP applies this by pausing before action, observing thoughts and sensations, and choosing a response aligned with values rather than impulse.
DBT teaches STOP within the distress tolerance module, but each of its steps, pausing, breathing, observing, and proceeding with awareness, is an applied mindfulness skill. STOPP is a crisis survival strategy that helps clients tolerate distress without worsening the situation through impulsive action.
Common questions
When should I assign STOPP to a client?
The STOP technique is a natural fit for anxiety, where the urge that most needs interrupting is escape. It also works for any moment when a client notices a strong emotional reaction and wants to pause before responding. Assign it early so the client can practice in lower-stress moments before using it during actual emotional spikes.
How is STOPP different from just taking a deep breath?
Both versions build the same pause; STOPP makes the perspective-taking step explicit. The full sequence—pausing, breathing, observing, pulling back, and proceeding—creates a structured pathway from reaction to choice, rather than a single calming technique.
Is STOPP enough for panic disorder?
For panic specifically, STOP can help in the moment, but repeated panic attacks usually warrant more than an in-the-moment tool: CBT for panic disorder directly retrains the fear of panic sensations themselves, which is what keeps the cycle going.
What does the client do with STOPP between sessions?
The client practices the full sequence in planned, low-stress moments to build familiarity, then uses it when they notice a strong emotional reaction. Regular practice makes the steps more automatic during actual emotional spikes.