What a Bad Flu Taught Me (Again) About Emotional Resilience —The PLEASE Skills

I've spent over two decades helping people understand the connection between their bodies and their emotions. I've taught it in therapy sessions, written about it, and am building an entire platform around it. And yet, it took a nasty bout of the flu to remind me just how powerful that connection really is.

A week ago, I got hit with one of those flus that flattens you completely. Fever, aches, the kind of exhaustion where even reaching for the remote feels like a triathlon. But the part that caught my attention, both as a mother and as a psychologist, was what happened to my emotions.

I was totally unpleasant. My patience with my kids, which on a good day I'd give a solid B+, dropped to a D–. Every small request felt like an unreasonable demand. A spilled drink at dinner sent a wave of irritation through me that was wildly disproportionate to the event. I had what I can only describe as a hair trigger, and my kids were understandably confused by it. They didn't do anything differently. I was the variable that changed.

Here's what was interesting, though. Even in the thick of feeling terrible, the psychologist part of my brain was quietly taking notes. I noticed that being physically ill had made me emotionally brittle in a way that was textbook. And I also noticed two things working in my favor: I wasn't drinking any alcohol (because who wants a glass of wine when they can barely keep down toast?), and I was sleeping significantly more than usual. Those two incidental shifts were acting as a buffer, softening what could have been an even rougher emotional experience.

This is exactly the principle behind DBT's PLEASE skills.

The Body-Mind Connection Isn't Just a Wellness Cliché

Before I walk you through the skill itself, I want to be clear about something. When I talk about the body influencing the mind, I'm not offering vague self-care advice. There is a robust and growing body of research demonstrating that physiological states directly affect emotional regulation. When your body is out of balance, whether through illness, sleep deprivation, poor nutrition, or substance use, your threshold for emotional reactivity drops. You become more vulnerable to "emotion mind," a state where feelings drive your behavior and decision-making without the tempering influence of rational thought.

Think of it this way. Your emotion regulation system has a capacity, like a battery. When your body is well-rested, nourished, and healthy, that battery is fully charged. You can absorb the stresses of daily life without completely draining your reserves. But when your body is rundown, the battery is already half-drained. That spilled drink? On a full charge, it's nothing. On a depleted battery, it's the thing that sends you over the edge.

PLEASE: A Framework You Can Actually Use

In DBT, we use the acronym PLEASE to help people remember the foundational behaviors that protect emotional resilience. Letters represents a domain of physical self-care that has direct implications for how you feel and how you cope.

P

L: Treat PhysicaL Illness

This one obviously hit home for me during my bout of the flu. Being sick lowers your resistance to negative emotions, no question. The healthier you can keep yourself, the more capacity you have to regulate your feelings.

Now, I know this sounds simple, but for many people, treating physical illness is anything but straightforward. Some of my patients avoid doctor's appointments because of weight stigma, anxiety, past medical trauma, financial barriers, or simply the difficulty of making and keeping an appointment when life is overwhelming. If you recognize yourself in any of that, you're not alone. Acknowledging barriers is the first step toward problem-solving.

During the flu, I had to accept that I was sick and adjust my expectations accordingly. I couldn't power through and pretend my body wasn't affecting my mind. Acceptance didn't make the irritability disappear, but it helped me contextualize it. I could say to myself, "You're not a terrible mother. You're sick, and your emotional bandwidth is compromised." That reframe matters.

E: Balance Eating

This one is particularly close to my heart, given that eating disorders are my area of specialization. Balanced eating means consuming the amounts and kinds of food that help you feel good, not too much and not too little. Both overeating and dietary restriction increase vulnerability to emotion mind.

The research on this is compelling. Studies on restrained eaters (people on self-imposed diets) consistently show that restricting food intake leads not only to binge eating episodes but also to increased emotionality, dysphoria, preoccupation with food, and difficulty concentrating. In other words, when you undereat, emotion regulation suffers in measurable ways.

This doesn't mean you need to eat perfectly, of course. It means paying attention to how food affects your emotional state. Some foods genuinely help you feel calm or energized. Routine and consistency for when and how you eat is especially stabilizing for people who are prone to mood fluctuations. The goal is never perfection. It's awareness and balance.

A: Avoid Mood-Altering Substances

Here's where my flu offered an unintentional experiment. Because I was so sick, I didn't drink any alcohol whatsoever for over a week. And while I can't isolate that one variable from everything else that was happening, it certainly buffered my emotional state when I was otherwise vulnerable.

Alcohol and other substances alter mood by definition. That's precisely why people use them. But they also lower your resilience to negative emotions and compromise your ability to regulate your responses. This doesn't have to be an all-or-nothing message. The DBT framework encourages moderation, or abstinence if that's what works for you. The key insight is recognizing that substances are not emotionally neutral. Using them before high-stakes situations, whether that's a job interview, a difficult conversation, or a stressful parenting evening, can meaningfully impair your emotional and behavioral control.

S: Balance Sleep

If I had to pick the single most underappreciated factor in emotion regulation, it would be sleep. The research linking sleep deprivation to emotional difficulties is extensive and growing. Insufficient sleep doesn't just make you tired. It reduces activity in the prefrontal cortex (the brain region responsible for executive function and impulse control) while simultaneously increasing reactivity in the amygdala (your brain's threat-detection center). The result is a nervous system that is primed to overreact and under-equipped to course correct.

During my illness, I slept far more than I typically do. And even though I was physically miserable, that extra sleep was doing real protective work for my emotional state. Most adults need between seven and nine hours per night, and consistency matters as much as quantity. A regular sleep schedule helps regulate your circadian rhythm, which in turn supports mood stability.

For many of the patients I work with, sleep is one of the first things to deteriorate when stress and emotions escalate. Poor sleep worsens emotionality, creating a vicious cycle. If this resonates with you, prioritizing sleep hygiene isn't indulgent. It's foundational.

E: Get Exercise

Consistent aerobic exercise functions as an antidepressant. That's not an exaggeration or a motivational slogan. It's what the evidence shows. Regular physical activity increases serotonin and norepinephrine availability, promotes neuroplasticity, and reduces cortisol levels. Beyond the neurochemistry, building an exercise routine also creates a sense of mastery, the experience of doing something difficult and following through, which is itself a bolster to positive emotionality.

We recommend aiming for some form of exercise* five to seven days per week, building up to about twenty minutes per session. That might sound like a lot, but it doesn't have to be intense. A brisk walk counts. The consistency matters more than the intensity.

*Follow your team’s recommendation first and foremost. If you struggle with excessive exercise, anorexia, OCD, muscle dysmorphia…Ignore the ‘E’ in PLEASE!

What the Flu Really Taught Me… (Other than, “Don’t forget to get vaccinated next year!”)

Lying on the couch, too sick to do much of anything, I was living proof of what I teach patients all the time. My body was compromised, and my emotions followed. I was irritable, reactive, and short-tempered in ways that had nothing to do with my children's behavior and everything to do with my physiological state.

However, I also saw the PLEASE skills working in real time. The extra sleep and the absence of alcohol were quietly doing their jobs, keeping me from falling further into emotional dysregulation than I otherwise could have.

The PLEASE skills aren’t glamorous. But they are foundational to our wellbeing. You can practice distress tolerance and mindfulness and interpersonal effectiveness 'til the cows come home, but if your body is depleted, you're fighting an uphill battle.

So here's my invitation. Before you try to think your way out of emotional difficulty, check in with your body. Are you sick and pushing through? Are you eating in a way that supports your mind and body? Are you skipping meals or relying on snack foods only? Are you using substances that are undermining your emotional stability? Are you sleeping enough, and consistently? Are you joyfully moving your body?

When your health and wellness behaviors are compromised, you are more vulnerable to negative emotions and emotion mind. The PLEASE skills can help you increase emotional resilience.

Linehan, M. M. (2015). DBT® skills training manual (2^nd ed.). The Guilford Press.