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• Sep 5, 2023

5 Fantastic DBT Worksheets, Games, & Ideas with Prompts

Updated: Apr 3

Download PDF activities for your DBT sessions, homework, and skills groups.

Can you ever have enough DBT (dialectical behavioral therapy) worksheets and other activities? After all, DBT is a therapy built upon effective, memorable skills to cope with overwhelming emotions. DBT leaders are always looking for new and effective ways to teach them .

Formal DBT includes both individual sessions and skills groups each week. It's offered for teens and adults, and youth groups include parents as well. However more and more therapists are also providing DBT-informed therapy, incorporating some elements of the popular treatment into everyday therapy.

Whether you're a DBT therapist, an eclectic counselor, or a person seeking new skills, here are some DBT worksheets and other activities to help you teach or learn important concepts.

Dear MAN Worksheet

Wise Mind Worksheet

Radical Acceptance Worksheet

The Greatest DBT Board Game on Earth

DBT Prompts Jenga Stickers and Dice

Skip to the Giant Activity Bundle

1. DBT DEARMAN Skill Worksheet

DEARMAN is a beloved DBT skill that helps you learn how to ask for something in an effective way. Many people struggle with not asking for what they want, or the opposite – becoming threatening or aggressive when they’re upset.

The DEARMAN skill provides an outline of how to ask what you want in a calm and assertive way. It’s important not to let others walk all over your boundaries.

It’s also important to ask for what you need in a clear and calm way. Here’s a list of what the acronym stands for.

D escribe the situation or request

E xpress your thoughts and feelings about it

A ssert what you need kindly but firmly

R einforce that this issue is important

M indfully stay calm and aware in the moment

A ppear confident and believe in yourself

N egotiate by compromising if needed

Start with outlining the request or problem. Here are some example topics to use DEARMAN for:

Request a raise at work

Ask your roommate to stop playing loud music in the morning

Talk to a friend who keeps violating your boundaries

Ask your significant other to help more around the house

Request an extension on a school assignment

Ask that your landlord take care of a problem in your apartment

When you talk to the other person, be clear with yourself and with them what you want. Be willing to compromise somewhat (that’s what the negotiate phase is for). But, don’t give away what you really need in the situation.

Spell out the problem, situation, or request clearly so that there’s no confusion about it.

During the express phase, you might express your feelings about what’s going on. For example, you might say to a roommate, “I’ve been feeling overwhelmed and frustrated lately having to take care of all the cleaning myself.”

If you’re in a professional setting, perhaps it’s more like, “I’ve taken on more and more responsibilities and I feel my contribution should be recognized.”

If you’re asking a friend to give you some space, you could say, “I really enjoy spending time with you and I want to keep doing that. But I feel pressured and ignored when you keep asking me after I’ve said no to something you want to do.”

Being assertive is all about being firm but calm. You don’t give in, but you also don’t get aggressive. And you definitely don’t get loud, pushy, or violent.

Here are some example phrases that might show assertiveness.

I’m not okay with you pressuring me to do this activity. This can’t happen again.

I’ve made this business more and more money over the past few years, and I believe my request for a raise should be considered.

I’m not going to continue to do your half of the chores. Since we agreed to split the responsibilities, I’d like you to keep up your side of it.

Reinforce is all about not backing down. While there can be some room for compromise, your request shouldn’t be dismissed outright. A response of, “Oh yeah, I’ll get to that sometime,” may reflect that the other person didn’t hear you or isn’t taking you seriously.

Return to your assertive stance and make it clear, without getting loud or inappropriate, that you are serious.

Staying mindful is an internal process. It’s not something you express to the other person. But it can help you keep the situation in perspective. Plus, it can help you deal with any anxiety , which is normal when you’re asking for something important to you.

Ways to stay mindful include slowing your breathing, learning medication, and using grounding techniques .

Appear Confident

Appearing confident is really just a reflection of feeling confident. You have a right to ask for what you need and want. You might not always get it, but many people feel better simply because they stood up for themselves.

Physical signs of confidence include standing up straight, holding your head up, and not slinking off when you aren’t taken seriously at first. Internally, you can self-coach. Think, “I’m doing what’s right,” or “It’s perfectly normal and okay to set a boundary.”

Finally, be willing to compromise if needed. But don’t give in entirely. Maybe your roommate says they hate doing dishes, so you agree to trade them for cleaning the bathroom. Create a clear plan for how the chores will be done, and what you should both do if they start slipping again.

If you’re dealing with a more serious issue such as a friend pressuring you to do something you aren’t comfortable with, negotiating may not be appropriate. Instead, it’s your job to stand your ground going forward. In most cases if you’re firm the pressuring will stop.

However, if someone is abusing, threatening or coercing you it goes beyond DEARMAN. Ask for help from a person of authority or a therapist to help.

The DEARMAN worksheet provides an outline to practice with. It’s obviously not as simple as a 1-2-3 process, but thinking about your request ahead of time can make all the difference.

The worksheet also has a poster-type page you can put up or take a picture of. Plus, it has a form you can use to organize your thoughts and share with the other person if appropriate.

2. Wise Mind Worksheet

Wise mind is another popular DBT skill that crosses many areas of therapy and self-help. You might think of it as part Buddhist mindfulness and part practical decision making. The idea goes like this.

Part of our brain is instinctual. It’s sometimes called the lizard brain, because it’s all about immediate reactions. You might respond in fear or in impulse.

If you want a piece of candy you take it, no questions ask. See a new car you like? Why not buy it on the spot! Want to go on a date that’s obviously not a good idea. The heck with it.

We sometimes need this part of our brain to overcome fears, ruts, or anxieties. And we need it – it’s the part of us that survives and has fun in the world.

However, if lizard brain is in control all of the time, life tends to take on more stress than fun. You’ll face the consequences of constant rash decisions.

On the other hand, we have the responsible brain. Think of this as your parents at their strictest , or the mean teacher you had in kindergarten. Get your work done! No play before dinner! Arriving on time is arriving late.

We need this part of our brain to stay out of jail, out of trouble with the IRS, and in our boss’s good graces. But if it’s in control all of the time life may become stifling and overwhelming.

Now, there’s wise mind. Wise mind knows that the lizard brain and responsible brain are an important part of self. Their needs are valid, and should be taken into account. But it operates in a calmer, wiser place, in the middle.

Wise mind might say it’s okay to blow off homework for one night, but you’ll need to make up for it the next. It might calm lizard brain when it’s about to tell someone off, instead setting firm but peaceful boundaries.

It doesn’t forget responsible mind either. Paying bills on time and having a savings account makes more room for lizard brain to have fun. The whole idea is to find the balance in the calm, somewhat Zenfull center.

Your wise mind would be the first to tell you that no one is perfect at this. There may always be a shifting or counterbalancing act to keep things roughly even. But in the most important and difficult decisions, it’s the one you want running the show.

3. Radical Acceptance Worksheet

Finally we have radical acceptance. This one doesn’t work as well in acronym or homework form. That’s because it’s less about reasoning and more about … you know … acceptance.

Radical acceptance is when you finally let go of a relationship that’s not worth it. When you say to the he** with it when your dream vacation is falling apart. When you accept yourself as you are, with full love and without reservation.

Sometimes you need to stay in problem-solving mode, reframing a situation or using your new DEARMAN skill. At other times there’s no amount of reasoning, trying to fix things, or saying sorry that’s going to change the situation.

That’s when it’s time for radical acceptance. It’s saying to yourself, “This is how it is. There’s nothing more I can do about it. Life goes on.”

Understandably, it can feel invalidating. It’s definitely not something you want to say to someone else. And often it’s inappropriate to say to yourself too. For many it’s a last resort, to use when you’ve been spinning your wheels so long that it’s making you miserable.

In those moments, radical acceptance can be liberating, healing, and just the step you need to move on with a happier life.

Radical acceptance isn’t exactly something you can do homework on. It’s more a state of mind or a spiritual experience in the moment. But it can help to reflect on the idea and consider for areas of your life that just aren’t worth it.

4. The Greatest DBT Board Game on Earth

I’m honored to offer the Greatest DBT Board Game on Earth. That might sound like an arrogant title, but since it’s the only DBT board game I know of, I’m radically accepting it as is.

The board game is really a way to make discussing and reviewing DBT a lighter experience. It’s complete with prompts covering the four key areas of DBT, including:

Mindfulness

Interpersonal Effectiveness

Distress Tolerance

Emotional Regulation

You might notice that it overlaps with the worksheets above. You can travel the board which is set in a carnival theme, complete with a mindfulness tent and emotional roller coaster. Discuss scenarios where you might use skills, or review the skills themselves.

There’s also a beta telelehealth version available, so you can play the DBT game remotely. It’s set up to offer a more realistic feel to playing a real board game, rather than a watered down version. Check it out to see what you think!

Play to complete as many discussion points as you can, or simply as a fun way to make DBT group more interactive.

5. DBT Jenga and Dice Prompts

Looking for something more tactile? Our DBT Jenga stickers and printable DBT dice offer prompts as well.

You can make up your own game, such as naming a problem and then rolling the dice until an appropriate skill comes up to help with it.

Or, use pre-made scenarios on the dice and see if you can match them with skills. Roll one dice with a problem described and another with a list of skills.

It can be a bit of a creative challenge if two prompts don’t easily go together. How do you use DEARMAN to cope with a headache, for example? Maybe you can’t but it could be pretty interesting to try!

It might seem silly, but at the least it will help you clarify what skills work well in specific situations, and what may not do the trick.

The Jenga stickers also include scenarios focused on the four areas mentioned of mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. Discuss and practice skills within each core area of DBT.

These game options are easy and light. And if you don’t want to deal with actual dice or Jenga, just cut out the prompts and put them in a little box or bag. Draw and discuss the topic or skill that comes up.

All five worksheets and activities are available in the DBT Activity Kit. Or, you can purchase them as part of the Giant Therapy Activity Bundle , full of dozens of games, worksheets and activities that overlap with DBT.

DBT Skills Training Manual, Second Edition, by Marsha M. Linehan, 2014, available on Amazon.

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How to Use the Four Options of DBT to Solve a Problem

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Have you ever come up against a situation in your life that seemed impossible? One that overwhelmed you, no matter how many ways you tried to solve it?

Life sometimes presents each of us with what seems to be an impossible situation. When we feel overwhelmed, many of us become paralyzed with indecision, our minds reeling as we consider and then reject one possible solution after another. What a conundrum! By taking a step back and utilizing a problem-solving method, we can uncover options in any situation.

DBT (Dialectical Behavior Therapy), a form of cognitive-behavioral therapy developed by Marsha Linehan in the late 1980s, aims to help individuals identify and regulate intense emotions, improve interpersonal relationships, and develop coping strategies to manage distressing situations. DBT offers four basic options for handling any challenge: solving the problem, finding ways to feel better about the problem, learning to accept the problem or situation, or staying miserable. When a situation seems overwhelming, this basic framework can help us explore our challenges with curiosity, compassion, and wisdom, increasing our chances of a successful outcome.

Define the Problem

The first step is to define the problem. We start by stating the problem to ourselves the way we might as a reporter or a detective: Just the facts, ma’am! Who, what, where, when, and why. For instance, “I’m tired of living with my partner’s personality and habits, and I can’t decide if I should stay or move out.”

Choice 1: Solve the problem/make a change.

Once we have defined the problem, we evaluate the problem honestly: Is this a situation that is in my power to change or influence? If so, it is certainly worthwhile to try to make changes. We may not be able to change our partner, for instance, but we can change the way we communicate with our partner, and we may be able to negotiate a solution together.

Having defined the problem, we then need to consider possibilities for changing our situation. Brainstorming is one tried-and-true way to generate possible solutions to any given problem. We might start by taking a sheet of paper and writing down ideas, from the most practical to the seemingly ridiculous. When we review the list, we will probably find a few “gems”!

Once we have chosen a possible solution, the next step is to try it out. For instance, perhaps we have decided to talk to our partner about an annoying habit using an assertive communication technique. Having clarified our goal (what we would like to see change), we approach our partner to discuss our concerns. We may be able to work together to create this change, or at least achieve a compromise that is acceptable to both of us.

An important part of implementing a solution for change is to constantly evaluate the outcome. Is it working? If not, is there something we can tweak that would make a difference?

Choice 2: Find ways to feel better about the situation by changing our perception of the situation.

Sometimes we are not able to change a situation to our liking, or we may not currently be willing to take the steps we need to make a change. Assuming we are not in an unsafe situation, the next possible option is to change our point of view. Here we are trying to get through a challenging situation, at the very least without making it worse, and possibly using it to grow inner strengths. For instance, we can use a difficult situation to develop a specific quality, such as understanding, wisdom, or compassion. In some traditions, this is expressed as using challenges as “fertilizer” for personal or spiritual growth. Or we might consciously and deliberately use the challenge to develop skills, such as interpersonal skills, emotion regulation skills, etc. (for example, seeing a challenging interpersonal situation as an opportunity to practice assertiveness skills). In the case of an uncooperative partner, we may choose to use our interactions to learn something about ourselves, or to practice humility. Perhaps we don’t always have the right solution or perfect perspective!

Choice 3: Learn to accept the problem by practicing Radical Acceptance.

If we have no practical way to solve a problem, or if we are not yet willing to make a change, another approach we can try is to practice radical acceptance. Radical acceptance is based on the idea that it is often our resistance to a painful situation that causes extra or unnecessary suffering. You can think of this as a formula:

Pain x Resistance = Suffering

Practicing nonresistance in this case can decrease suffering because we are not constantly in an emotional struggle with reality. For instance, if our partner has a personality trait we find frustrating, we accept that his personality is unlikely to change. We may say to ourselves, “It’s true that I deeply wish my partner would change, but he has not, and possibly never will change.” We are practicing radical acceptance at two levels here: We are deeply acknowledging our own heartfelt desires without judgment, and we are accepting the truth of the situation with our partner. We acknowledge completely and with great self-kindness that we do not like the situation, without pouring unnecessary self-blame ourselves. It is natural to want to be happy! It is natural to want things that are not likely to occur, so radical acceptance can also help us to generate self-compassion.

Radical acceptance also helps to counteract self-compassion’s close cousin, self-pity. In the face of difficult challenges, it is easy to get caught up in a “woe is me” attitude. We may ask ourselves, “Why do these things always happen to me? This is so unfair!” Radical acceptance instead recognizes that life brings to each of us its share of both joys and sorrows. Practicing acceptance of this basic fact can bring a sense of equanimity and balance, freeing our energy to be applied wisely and creatively.

But by no means is radical acceptance an act of helplessness! Radical acceptance does not necessarily mean that we condone a situation. It does not mean tolerating abuse. With radical acceptance, we look at our situation with a clear-eyed, nonjudgmental attitude and simply acknowledge that it is our current reality. As psychologist and mindfulness instructor Tara Brach, PhD, author of the book Radical Acceptance, describes it, we can acknowledge the situation by saying to ourselves, “Yes, this, too.” This, too, is a part of our current reality. It is what it is, at least for now.

Choice 4: Stay Miserable

If we cannot or are not yet ready to make a change, are not ready to consider changing our perception, and can’t quite yet accept a situation, we may be realistically left with just feeling miserable. And that’s okay…if we don’t use it as an excuse to beat ourselves up! There is nothing to keep us from exploring the first three options, but the crucial piece here is awareness. As we stay miserable, we notice and honestly evaluate: How does it feel? Does our situation stay the same or possibly get worse? How does it impact our thinking? What does it mean for our actions? We simply stay aware and just keep noticing what it is like to stay miserable.

Putting the Four Options into practice.

Now that you have learned about the Four Options, you are ready to put this information into action! Choose a problem or challenging situation that is present in your life and run it through the above options. It might be helpful to start with a smaller, less emotionally charged challenge the first time you try out this approach. In a sense, this approach is a “no lose” approach. Every time you utilize this process, you will learn something new. Make it your own! Armed with the Four Options, you never need to feel completely lost. You will always have a “road map” to making sense of your life’s challenges.

Anxiety & Stress

Overcoming Revenge Bedtime Procrastination for Better Mental Health

Rewiring Your Mind: Techniques to Challenge and Replace Negative Thoughts

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Links to external resources.

Psychology Tools makes every effort to check external links and review their content. However, we are not responsible for the quality or content of external links and cannot guarantee that these links will work all of the time.

• Scale (Long Form) Download Primary Link Archived Link
• Scale (Short Form) Download Primary Link Archived Link
• Scoring Download Primary Link Archived Link
• Scale Download Primary Link Archived Link
• Reference Bohus, M., Limberger, M. F., Frank, U., Chapman, A. L., Kühler, T., & Stieglitz, R.-D. (2007). Psychometric properties of the Borderline Symptom List (BSL). Psychopathology, 40(2), 126–132. https://doi.org/10.1159/000098493

Case Conceptualization / Case Formulation

• DBT Case Formulation Format | Comtois Download Archived Link

Guides and workbooks

• DBT Part 1 Download Archived Link
• DBT Part 2: Behavioral skills Download Archived Link
• DBT Part 3: Core Mindfulness Download Archived Link
• Self-validation skills for use in DBT group skills training | Fruzetti | 2013 Download Primary Link Archived Link

Information Handouts

• DBT skills training pros & cons worksheet Download Primary Link Archived Link
• DEAR MAN GIVE FAST handout & worksheet Download Primary Link Archived Link
• DBT behavior chain & solution analysis worksheet (fillable) Download Primary Link Archived Link
• DBT target behavior chain analysis worksheet archive.org Download Primary Link
• Working with primary and secondary emotions worksheet and handout Download Primary Link Archived Link
• Opposite action handout & worksheet Download Primary Link Archived Link
• Check the facts handout & worksheet Download Primary Link Archived Link
• Emotion myths worksheet Download Primary Link Archived Link
• Distress tolerance worksheet Download Primary Link Archived Link
• Guided mindfulness script for practicing mindfulness to emotion Download Primary Link Archived Link
• DBT multi-purpose pros & cons worksheet Download Primary Link Archived Link
• Reality acceptance skills overview Download Primary Link Archived Link
• 6 levels of validation handout & worksheets | Rachel Gill | 2013 Download Primary Link Archived Link
• States of mind handout Download Primary Link
• DBT skills quick reference sheet Download Primary Link Archived Link

Information (Professional)

• Nightmare protocol | Lineman Download Primary Link Archived Link

Presentations

• The chain analysis in dialectical behavior therapy | Henry Schmidt III | 2012 Download Primary Link Archived Link

Treatment Guide

• Dialectical Behaviour Therapy: Skills Handbook | Fulton State Hospital | 2004 Download Primary Link Archived Link
• Turning Point: Dialectical Behavior Therapy Program (DBT) – Youth & Coaches Workbook Download Archived Link
• Modified DBT group therapy manual for working with adolsecents experiencing substance misuse | Mission Australia Download Archived Link
• Mindfulness Download Primary Link Archived Link
• Distress Tolerance Download Primary Link Archived Link
• Emotion Regulation Download Primary Link Archived Link
• Interpersonal Effectiveness Download Primary Link Archived Link
• Miscellaneous Download Primary Link Archived Link

Recommended Reading

• Valentine, S. E., Bankoff, S. M., Poulin, R. M., Reidler, E. B., & Pantalone, D. W. (2015). The use of dialectical behavior therapy skills training as stand‐alone treatment: A systematic review of the treatment outcome literature.Journal of Clinical Psychology,71(1), 1-20. Download Primary Link Archived Link
• Palmer, R. L. (2002). Dialectical behaviour therapy for borderline personality disorder. Advances in Psychiatric Treatment, 8, 10-16 Download Primary Link
• Linehan, M. M., & Wilks, C. R. (2015). The course and evolution of dialectical behavior therapy.American journal of psychotherapy,69(2), 97-110. Download Primary Link Archived Link

What Is Dialectical Behavior Therapy?

The purpose of dbt.

Linehan (2015a, 2015b) describes the purpose or functions of DBT as:

• to enhance an individual’s capability by increasing skillful behavior;
• to improve and maintain the client’s motivation to change and to engage with treatment;
• to ensure that generalization of change occurs through treatment;
• to enhance a therapist’s motivation to deliver effective treatment;
• to assist the individual in restructuring or changing her environment in ways that support and maintain progress and movement toward goals.

DBT Skills Training

DBT teaches a balance of ‘acceptance skills’ and ‘change skills.’ These include:

• Mindfulness skills  (acceptance) including core mindfulness skills (nonjudgmental observation) and more complex mindfulness practice (wise mind, loving kindness, balancing ‘doing’ and ‘being’).
• Distress tolerance skills  (acceptance) including crisis survival skills, reality acceptance skills, and distress tolerance skills related to addiction.
• Emotion regulation skills  (change) including recognizing emotions, changing emotional responses (including cognitive restructuring), and reducing vulnerability to the emotional mind.
• Interpersonal effectiveness skills  (change) including objectives, relationship, and self-respect effectiveness skills.

Treatment Strategies in DBT

Treatment strategies in DBT include:

• Dialectical strategies  in which attention is paid toward balancing acceptance and change. Techniques include the use of metaphor and paradox, cognitive challenging, and restructuring.
• Core strategies  include problem solving and validation. Problem solving involves analysis and acceptance of a problem followed by an attempt to generate, evaluate, and implement adaptive solutions. Chain analysis is frequently used to analyze problem behaviors in the context of chains of actions, emotions, physiological responses, and cognitions. Skillful (wise) responses are generated and practiced.
• Communication strategies  are closely attended to in DBT. DBT therapists balance reciprocal communication that responds to the client’s agenda with an irreverent communication style intended to promote insight and change.
• Case management strategies  are used in DBT to guide the therapist’s interactions, including regular supervision and consultation on the grounds that complex clients should not be treated/‘held’ by a sole clinician.
• Linehan, M. M. (1993). Cognitive–behavioral therapy of borderline personality disorder . New York: Guilford Press.
• Linehan, M. M. (2015a). DBT skills training handouts and worksheets (2nd ed.). New York: Guilford Press.
• Linehan, M. M. (2015b). DBT skills training manual (2nd ed.). New York: Guilford Press.
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20 DBT Worksheets and Dialectical Behavior Therapy Skills

If you’re as lost as I was when I first heard the term, then you’ve come to the right place. In this piece, you will learn what DBT is, how it works, and some of the most useful and applicable components of treatment.

Whether you are someone who is thinking about participating in Dialectical Behavior Therapy, a therapist who is looking for DBT worksheets to use with clients, or just a curious individual, read on to learn more about it.

Mindfulness is critical to DBT. Before you read on, we thought you might like to download our three Mindfulness Exercises for free . These science-based, comprehensive exercises will not only help you cultivate a sense of inner peace throughout your daily life but will also give you the tools to enhance the mindfulness of your clients, students or employees.

This Article Contains:

• What is Dialectical Behavior Therapy? A Definition
• About the Founder by Marsha Linehan

DBT vs. CBT: How Do They Differ?

4 essential dbt skills & techniques to master.

• 4 DBT Worksheets, Handout and Manuals (PDF)

What Is The Diary Card All About?

The 4 best books on dbt, treatment methods based on dbt and emotion regulation, certification possibilities & courses.

• What is DBT’s Role in Mindfulness?

A Take-Home Message

What is dialectical behavior therapy a definition..

Dialectical Behavior Therapy (DBT) is a type of cognitive-behavioral therapy that focuses on the psychosocial aspects of therapy, emphasizing the importance of a collaborative relationship, support for the client, and the development of skills for dealing with highly emotional situations (Psych Central, 2016).

DBT was created for the treatment of individuals struggling with suicidal thoughts but has matured into a treatment for a range of other conditions that involve dysfunctional emotional regulation. It is currently considered the “gold standard” for borderline personality disorder and has even been applied to the treatment of substance abuse and eating disorders (Linehan Institute, n.d.).

DBT is generally characterized by its two main components:

• Individual weekly therapy sessions;
• Weekly group therapy sessions.

Individual Weekly Therapy Sessions

These individual sessions are an opportunity for the therapist and client to address the issues and solutions that came up over the last week, with special attention paid to self-destructive or potentially self-harmful behaviors. These behaviors are targeted not only because they are inherently worrisome, but also because they can seriously disrupt the treatment process and undermine treatment goals.

Clients and therapists work as a team in these individual sessions, with the focus on learning and improving social and coping skills . They may also discuss more general issues relevant to improving the client’s quality of life, or more specific issues like post-traumatic stress disorder .

Weekly Group Therapy Sessions

These sessions are usually scheduled for two and a half hours and generally focus on developing skills from one of four skill areas:

• Interpersonal effectiveness ;
• Distress tolerance/reality acceptance skills;
• Emotion regulation;
• Mindfulness skills.

Skill Modules

These four skill modules cover a wide range of useful skills that can be applied in daily life:

1. Interpersonal Effectiveness Module

The skills in this module are related to interacting with others, especially in difficult or potentially damaging situations.

These skills are intended to help clients function effectively when trying to change something (e.g., making a request) or in trying to resist changes (e.g., refusing a request). The intention is to aid the client in meeting their goals in each situation while avoiding any damage to the relationship or to the client’s self-respect (Psych Central, 2016).

2. Distress Tolerance Module

This module includes skills that are extremely important yet often overlooked: skills relating to accepting, tolerating, and learning from suffering.

Many other mental health treatment regimens focus on avoiding pain, changing difficult situations, or walking away from circumstances that cause suffering, but the distress tolerance skills taught through Dialectical Behavior Therapy focus on dealing with the pain and suffering that is inevitable to the human condition.

The distress tolerance module is split into four crisis survival strategies:

• Distracting;
• Self-soothing;
• Improving the moment;
• Thinking of pros and cons.

In addition, there are many skills that relate to accepting and tolerating the current situation, like radical acceptance and willingness vs. willfulness.

3. Emotion Regulation Module

Many clients who participate in DBT are struggling with personality or mood disorders and can benefit immensely from emotion regulation skills.

Some of these skills that can help clients deal with their  emotions include:

• Identifying and labeling emotions;
• Identifying obstacles to changing emotions;
• Reducing vulnerability to “emotion mind;”
• Increasing positive emotional events;
• Increasing mindfulness to current emotions;
• Taking the opposite action;
• Applying distress tolerance techniques (Psych Central, 2016).

4. Mindfulness Module

Readers of this blog are likely already aware of the numerous mindfulness-related skills that can benefit them in their daily life.

These skills include “what” skills or skills that answer the question “What do I do to practice core mindfulness skills?” like observing, describing, and participating. There are also “how” skills or skills that answer the question “How do I practice core mindfulness skills?”, like non-judgment and practicing “One-mindfully” effectively.

Many of these mindfulness skills feed into skills from the other modules; for example, the nonjudgment encouraged in mindfulness is also encouraged in distress tolerance, and the observing and describing skills can be helpful in identifying and labeling emotions.

About the Founder Marsha Linehan

Dialectical Behavior Therapy was developed by Dr. Marsha Linehan.

She is a Professor of Psychology and adjunct Professor of Psychiatry and Behavioral Sciences at the University of Washington and Director of the Behavioral Research and Therapy Clinics, a research consortium that explores treatments for severely disordered and suicidal individuals (The Linehan Institute, n.d.).

Dr. Linehan is dedicated to promoting effective and accessible resources for the treatment of individuals who are struggling.

Dr. Linehan founded Behavioral Tech LLC, an institute focused on developing and sharing treatment tools for DBT training, consultation, and treatment. Behavioral Tech Research, Inc., was also established by Dr. Linehan in an effort to incorporate online and mobile technology into the successful practice of DBT.

Dr. Linehan approaches her scientific research and development from a perspective that is relatively uncommon in the sciences: one based in spirituality. She has trained with a number of spiritual leaders and influential thinkers, including a Zen master.

This may help explain her affinity for mindfulness, which grew to prominence through a collaboration of traditional Buddhist philosophy and the modern scientific paradigm (The Linehan Institute, n.d.).

Of course, DBT is a type of CBT, so similarities are understandable. But DBT also has distinct features that set it apart from most CBT approaches.

DBT, like CBT, focuses on helping people address their dysfunctional thinking and behavior through modification of their thought patterns and, through changing their thoughts, their behavior as well. However, CBT is usually confined to a limited period of time and is often applied with one or two specific goals in mind.

On the other hand, DBT narrows the focus to psychosocial aspects of daily life. Many people have trouble with their thought and behavior patterns, but these issues are often at their most disruptive in the context of relationships with others. DBT was created to approach treatment from this angle, one that is often incorporated in general CBT but is not typically the main focus (Grohol, 2016).

This emphasis on relating to others is what explains the DBT-specific treatment component of group therapy sessions. The benefits of additional therapy to the treatment of severe emotion regulation dysfunction are clear, but it’s the group aspect that really helps explain its importance.

Adding group dynamics to the learning setting offers clients an opportunity to practice relational skills in a safe and supportive environment, a practice that has been shown to be extremely effective.

DBT also differs from general CBT in the use of clients’ history. Both incorporate the past in striving for a healthier future, but this discussion is not a focus of the therapy in DBT as it often is in CBT (Grohol, 2016). The perspective of DBT is that one can learn from their past, but that problems are inevitably rooted in current thoughts and behaviors, and the present is where these will be addressed.

We won’t go into all of them in detail, but these are the main skills and techniques applied in DBT.

Interpersonal Effective Skills

1) objectiveness effectiveness “dear man” skills.

• Appear confident;

2) Relationship Effectiveness “GIVE” Skills

• Interested;
• Easy manner.

3) Self-Respect Effectiveness “FAST” Skills

• Apologies / no apologies;
• Stick to value;

Distress Tolerance Skills

1) crisis survival “accepts” skills.

• Activities;
• Contributing;
• Comparisons;
• Pushing away;
• Sensations.

2) Self-Soothing Skills

3) improve the moment “improve” skills.

• Relaxation;
• One thing at a time;
• Encouragement.

4) Pros and Cons / Accepting Reality Skills

• Willingness;
• Turning your mind;
• Radical acceptance.

Download 3 Free Mindfulness Exercises (PDF)

These detailed, science-based exercises will help you or your clients enjoy the benefits of mindfulness and create positive shifts in their mental, physical, and emotional health.

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Emotion Regulation Skills

1) reducing vulnerability skills.

• Treat physical illness;
• Altering drugs (only those prescribed by a doctor);

2) Build Mastery Skills

• Build positive experiences;
• Be mindful of current emotion;
• Opposite to emotion action.

Mindfulness Skills

1) “what” skills.

• Participate.

2) “How” skills

• Non-judgmentally;
• One-mindfully;
• Effectively (Dietz, 2012).

As you can see, acronyms are front and center in DBT treatment, in part because it makes remembering these skills in important moments easier.

You may also notice that many of these skills are generally considered effective skills , rather than specific skills for specific problems. While Dialectical Behavior Therapy focuses on the treatment of severely distressed individuals, the means of working towards these goals are not mystical or mysterious. The methods of furthering treatment are grounded in common sense and the straightforward practice of skills.

In fact, these skills are so generally applicable that many of them have practical applications for everyone.

Mindfulness

Mindfulness is such a simple and beneficial practice that it’s hard to sum up the potential positive impacts in one section, let alone one article (but we gave it a shot anyway – see our piece on the benefits of mindfulness ).

“Mindfulness can be described as simply living your life in the present instead of being stuck in the past or the future. Practicing mindfulness helps us become more aware of our thought patterns, our emotions, and how our thoughts and feelings affect our reactions to events” (Tartakovsky, 2015A).

If your mind has you jumping on the thought train (i.e., one thought leads to another, which often leads to a “should” thought, which can lead to judgment), try to detach yourself from the thought by telling yourself about the thought you are having (e.g., “There’s a thought about the errand I need to run after work”).

This can help you refocus on your current practice and remind yourself that you have thoughts, but you are not your thoughts (Tartakovsky, 2015A).

If you’re interested in learning more about how to practice mindfulness, check out our post on mindfulness exercises and techniques .

Reality Acceptance

Accepting reality is an effective antidote for a common problem in our society: struggling against the pain and suffering that is inherent to life as a human. DBT and Acceptance and Commitment Therapy (ACT) have this in common – both teach that accepting our reality, including the unpleasant aspects of it, is the only way to thrive.

This skill can be harder to practice and build than it seems since there are all sorts of sneaky ways we find to deny the reality of our situation.

These examples from Psych Central can shed some light on when we fight reality and how we can stop this tendency:

• You need to rush home, but you’re catching every red light. Instead of getting frustrated, you take a deep breath and tell yourself: “ It is what it is. I’ll get home when I get there .”
• You need to fill up your car, but gas prices have skyrocketed. Again, you breathe deeply, and say to yourself: “ There’s nothing I can do about it. I need gas. Getting angry isn’t going to help. ”
• You have to walk to work because your car is in the shop. It’s not far, but it’s pouring. You take a deep breath and say: “ It’s just rain. I’ll bring a towel, and I’ll dry off when I get to work ” (Tartakovsky, 2015A).

The part-humorous, part-helpful Tumblr blog “ Shit Borderlines Do ” provides some steps towards practicing this skill in the moment:

• Observe that you are fighting the reality of your situation. Acknowledge that you are reacting to something that you cannot change;
• Remind yourself what the reality is, even if it’s difficult or upsetting;
• Consider the causes of the current reality and incorporate the skill of non-judgment to remind yourself that this is a random occurrence set in motion by a million other factors that are outside of your control;
• Accept this reality with your whole being, or your mind, body, and spirit. Pay attention to the bodily signs of fighting reality (e.g., posture, “fight-or-flight” response) as well as the spiritual signs (you may “know” that this is real, but you don’t “feel” like it’s real).

These steps are by no means exhaustive or required to accept reality, but they can be helpful in the moment.

Radical Acceptance

Dialectical Behavior Therapy’s radical acceptance technique can help in these situations.

Radical acceptance is simply acknowledging the reality of your circumstances instead of fighting it by thinking “ This shouldn’t be happening ” or “ This isn’t fair. ”

It can be difficult to accept pain, but fighting the reality of your pain only creates more pain, and this pain is optional. Instead of fighting pain, radical acceptance offers a way to accept it and address it.

In the words of psychotherapist Sheri Van Dijk:

“If you don’t like something, you first have to accept that it is the way it is before you can try to [change] it. If you’re not accepting something, you’ll be so busy fighting that reality that you don’t have the energy to put towards trying to change it” (Tartakovsky, 2015).

This explanation shows us that not only can radical acceptance help us accept the reality of things that we cannot change, it can also help us to realize what can be changed.

Non-judgmental Stance

Being non-judgmental means that you avoid assigning value to events and feelings.

Instead of facing a difficult situation and thinking “ This is awful ,” practicing non-judgment allows us to take a step back and realize that the value judgments we make are based on facts (the facts of what is happening) and the emotions we are feeling in reaction (Tartakovsky, 2015B).

For example, you may be stuck in accident-related traffic and thinking “People are such idiots.” If you make an effort to be nonjudgmental, this may translate to “ I’m stuck at a standstill in traffic because of an accident up ahead. This makes me frustrated and upset. ”

When you break a judgment down into a fact and your emotional reaction, you not only reduce the emotion(s) you are feeling, you can also be empowered to think about ways to solve the problem and make healthy decisions.

Say you are thinking about how selfish your significant other is being right now. Instead of stopping at “ My partner is so selfish ,” practicing non-judgment may lead to articulating the issue (“ My partner is not helping me with this problem, and that makes me angry and disappointed ”) and finding a way to solve it (“ This is not a wise use of my time and energy. I will talk to my partner about how his/her unwillingness to help me with this problem makes me feel, and try to negotiate a solution with him/her ”).

Handling emotional situations in this manner can not only help you reduce your emotional reaction and find smart solutions to problems, it can also improve your self-esteem and self-respect when you handle the issue in a way that makes you proud of yourself (Tartakovsky, 2015B).

4 DBT Worksheets, Handout, and Manuals (PDF)

This is where Dialectical Behavior Therapy worksheets, handouts, and manuals can prove to be extremely effective tools in building your skills and improving your ability to accept your situation, deal with difficulty, and solve problems.

We’ll go over some of the most popular and effective ones below.

DBT Interpersonal Effectiveness Skills

This handout lists and describes the interpersonal effectiveness skills we outlined earlier, and also provides useful tips to put these skills into practice.

For example, the section on objective effectiveness (the DEAR MAN skills) lists the following tips:

• Use clear and concrete terms to describe what you want;
• Don’t say: “Could you please clean?”;
• Do say: “Could you do the dishes before going to bed?”
• Let others know how a situation makes you feel by clearly expressing your feelings;
• Don’t expect others to read your mind;
• Try using this line: “I feel ___ because ___.”
• Don’t beat around the bush—say what you need to say;
• Don’t say: “Oh, well, I don’t know if I can cook tonight or not;”
• Do say: “I won’t be able to cook because I’m working late.”
• Reward people who respond well, and reinforce why your desired outcome is positive;
• This can be as simple as a smile and a “thank you.”
• Don’t forget the objective of the interaction;
• It can be easy to get sidetracked into harmful arguments and lose focus.
• Consider your posture, tone, eye contact, and body language.
• No one can have everything they want out of an interaction all the time;
• Be open to negotiation;
• Do say: “If you wash the dishes, I’ll put them away.”

The Wise Mind

It is a balance between the two minds and is characterized by the ability to recognize and respect your feelings, but also respond to them in a rational manner .

The worksheet offers space to describe an experience that you have had with each of these three “minds” to further your understanding of the minds and how they have come into play in your life.

Function of Emotion Worksheet

The Function of Emotion Regulation  worksheet helps you to identify the function of an emotional reaction you have had over the last week.

The worksheet moves through the following questions and steps:

• What was the prompting event?
• What was your interpretation?
• What was the emotion and intensity (0-100)?

Use the following to identify the function(s) of the emotion:

• Did the emotion communicate something to others or influence their behavior? If so, describe;
• Did the emotion organize or motivate you to do something? If so, describe;
• Did the emotion give you information, color your perception, or lead you to any conclusions? If so, describe.

These questions aid the individual in making the connections between a galvanizing event and the reaction s/he had to the event, as well as understanding how the emotional reaction impacts the self and others.

DBT Skills Training Manual: Second Edition

For a resource that can help you apply general DBT treatment, check out this manual from Dr. Linehan herself. It’s not free, but it is an extremely valuable resource for applying DBT with your clients.

This manual is separated into two parts: the first describes DBT and provides instructions on how to set up a treatment program and manage the problems that can arise, while the second gives detailed notes on teaching each DBT skill.

Check out the manual, buying options, and reviews from some very satisfied readers here .

According to dbtselfhelp.com :

“You use the card to track your urges, moods, how you did or did not use DBT Skills, your feelings, and whatever else is helpful to you. You bring these cards with you to your DBT therapist every week to help you look for behavior patterns and triggers that occur in your life. Such information is invaluable to help you to help yourself live a life worth living.”

There are many possible layouts for a diary card (see here , here , and here ), but they generally contain the same fields:

• Day/date of urge or behavior;
• Emotions felt;
• Actions taken or skills used (or not used);
• Triggers for the urges.

The diary card may also include space for a general rating for the day and any medications or substances used (legal or illegal).

The client is encouraged to fill out this card regularly and faithfully. While it is important that the client does so, they should know that no one is going to score them or judge them based on their diary card. It is not an assignment to be completed and graded, but a way for them to track their experience and evaluate their progression through DBT treatment and, hopefully, self-improvement.

Diary Card App

As with most problems or issues, technology is making an impact on how people keep diary cards.

If you hate to waste paper, don’t like getting ink on your hands, or just get tired of writing, there’s a diary card app that you can use instead.

Check out the app created by a licensed clinical psychologist here .

If you’re interested in learning more about Dialectical Behavior Therapy, as a client, therapist, or just a curious person, there are several books available.

Listed below are some of the most popular and highly reviewed books on DBT out there, and they’re all available for purchase on Amazon.com:

1. The Dialectical Behavior Therapy Skills Workbook – Matthew McKay, Jeffrey C. Wood, and Jeffrey Brantley

It walks the reader through descriptions of DBT and how it can help, introductory exercises, and more advanced skill chapters. This can be an excellent resource for any individual considering DBT or for therapists to recommend to their clients.

Available on Amazon .

2. DBT Made Simple: A Step-by-Step Guide to Dialectical Behavior Therapy – Sheri Van Dijk

It includes a section on the theory and research behind DBT and how it grew from traditional CBT approaches, as well as strategies for working with clients, an explanation of the four skill modules, and several handouts, case examples, and some sample therapy dialogue.

3. The Mindfulness Solution for Intense Emotions: Take Control of Borderline Personality Disorder with DBT – Cedar R. Koons and Marsha M. Linehan

It teaches readers about the seven powerful skills related to mindfulness and emotion regulation that can help people cope with a borderline personality disorder (BPD), post-traumatic stress disorder (PTSD), severe depression, and other emotion regulation problems.

4. Calming the Emotional Storm: Using Dialectical Behavior Therapy Skills to Manage Your Emotions and Balance Your Life – Sheri Van Dijk

With a rating of over 4.5 out of 5 stars from nearly 50 customers, it sounds like the description is accurate.

These books are an excellent start to learning about DBT and applying the skills in your clients’ lives, but if you’re looking for even more, visit this website to learn about other helpful books.

• Understanding one’s emotions;
• Reducing emotional vulnerability;
• Decreasing emotional suffering (Bray, 2013B).

There are several ways to work toward these goals.

One of the websites we mentioned earlier, dbtselfhelp.com , offers an outline of how to build emotion regulation skills:

Interpreting Emotions

We all have emotions, but there is a theory that there are only a few basic emotions while the rest is interpretation and evaluation.

You can work on your skills related to interpreting emotions by completing a writing challenge described here .

Describing Emotions

Emotions involve action urges, prompts to perform certain behaviors. These urges are not part of the emotion but can feel like they are. There is often a prompting event, followed by interpretation, body changes in response to the emotions, and action urges.

This can lead to an effective or dysfunctional expression of emotions, which can have a wide range of consequences. To work on describing emotions, try to describe the qualities of your emotions and pay attention to things that may interfere, like secondary emotions that spring from the original emotion.

Follow this link for more information on describing emotions.

Function of Emotions

Emotions have three major functions in DBT:

• They communicate to and influence others;
• They organize and motivate action, and;
• They can be self-validating.

You can learn about the function of emotions by answering questions like “What are some examples of situations where your expressions of emotion were misread?” and “Can you think of some times when you misread the emotions of someone else?”

See this page for more information.

Reducing Vulnerability

We are all vulnerable to negative emotions, but we can build our skills related to reducing vulnerability. You can keep track of the factors that affect your physical and mental wellbeing, like your diet, any mood-altering drugs, sleep, and exercise.

Refer to these skills in the emotion regulation module for more information.

Paying Attention to Positives

Increasing positive emotions can be an effective method for dealing with difficult emotions. To build this skill, focus on the positive experiences you have throughout the day (short-term experiences) and the bigger, more impactful ones (long-term experiences).

Focus on building and maintaining positive relationships, and give mindfulness a try to savor positive experiences.

Letting Go of Painful Emotions

On the flipside of savoring the positive, letting go of the negative also has a place in emotion regulation. While accepting that pain happens is healthy, dwelling on negative emotions is dysfunctional.

Practice observing your emotions, describing and accepting them but not allowing yourself to be overwhelmed by them.

See this page for more information on letting go.

Opposite to Emotion Action

This technique is used to change painful emotions that are harmful rather than helpful. It is not about suppressing our emotions, but accepting the emotion and using it to take a different action.

To practice this technique, list some examples of when you have acted opposite to your current emotion. Describe a situation in which it is not appropriate to act opposite to your emotion to help you learn about the difference between each situation.

Check out this handout for more information.

What is Dialectical Behavior Therapy for adolescents (DBT)? – UC San Francisco

Dialectical Behavior Therapy is a recognized treatment that is well supported by the evidence. There are many ways to learn about applying DBT, but getting certified is a great option. There are courses and online DBT training for both individuals interested in practicing DBT and for therapists and other mental health professionals who wish to apply DBT in their work.

For Therapists and Other Mental Health Professionals

Dr. Linehan’s Behavioral Tech Research Institute provides information on Dialectical Behavior Therapy certification for therapists. The certification is available through the DBT-Linehan Board of Certification and requires the following:

• A graduate degree in a mental health-related field from a regionally accredited institution of higher education;
• A mental health practitioner license;
• A minimum of 40 didactic training hours specific to DBT Clinical experience with DBT (at least three clients);
• DBT team experiences (at least 12 months of preparation and current participation on a DBT team);
• DBT skills knowledge/experience;
• You must have read the Skills Training Manual for Treating Borderline Personality Disorder by Marsha Linehan, completed all the homework assignments in the manual, and taught or participated in all modules of skill training;
• Successful pass of exam based on the Cognitive-Behavioral Treatment of Borderline Personality Disorder by Marsha Linehan;
• Letter of recommendation from your team leader;
• Work product demonstration (videotapes of three consecutive live therapy sessions);
• Mindfulness experience (at least one of the following: a mindfulness retreat, formal practice community participation, formally a student of a recognized Zen/contemplative teacher, or at least one formal training in mindfulness).

You can also become certified through the Dialectical Behavior Therapy National Certification and Accreditation Association (DBTNCAA). This allows you to list a specialized certification in DBT when you apply to Health Care Providers and HMO networks.

What is DBT’s Role in Mindfulness?

While DBT and mindfulness are not synonymous, they are certainly linked.

DBT is a therapy based on identifying, describing, and modifying thoughts and feelings. Mindfulness has clear applicability in this therapy, through its ability to help practitioners to become more aware of their feelings, thoughts, impulses, and behaviors (Bray, 2013A).

One description of the benefit of mindfulness in Dialectical Behavior Therapy is that it provides the individual with the ability to take control of the mind instead of having the mind control the individual.

Practicing mindfulness helps the individual in DBT to direct their attention to observing, describing, and participating in a nonjudgmental way, which enhances the individual’s skills and leads to improved ability to focus on the positive, let go of the negative, and regulate emotions.

As we’ve said before, mindfulness is an extremely useful skill for individuals dealing with difficult emotions or situations, but it can be an even more effective tool for people struggling with a diagnosis.

Top 17 Exercises for Mindfulness & Meditation

Use these 17 Mindfulness & Meditation Exercises [PDF] to help others build life-changing habits and enhance their wellbeing with the physical and psychological benefits of mindfulness.

Created by Experts. 100% Science-based.

The intention of this piece was to provide an overview of Dialectical Behavior Therapy and outline the skills and tools that can help you or your clients to address emotion regulation issues. I hope it has met this goal, and that you know much more about Dialectical Behavior Therapy than you did when you started!

I hope you also keep in mind that the skills involved in DBT are applicable for those that are not suffering from a diagnosed mental health issue as well. Skills like mindfulness, focusing on the positive, letting go of the negative, and accepting the reality of your situation have clear benefits for everyone, not just those who are in the midst of suffering.

Have you tried DBT? Have you applied DBT with your clients? As always, please let us know about your experiences in the comments.

Thanks for reading!

We hope you enjoyed reading this article. Don’t forget to download our three Mindfulness Exercises for free .

• Bray, S. (2013A). Core mindfulness in Dialectical Behavior Therapy. GoodTherapy. Retrieved from http://www.goodtherapy.org/blog/core-mindfulness-dialectical-behavior-therapy-0215134
• Bray, S. (2013B). Emotion regulation in Dialectical Behavior Therapy. GoodTherapy. Retrieved from www.goodtherapy.org/blog/emotion-regulation-dialectical-behavior-therapy-dbt-0318135
• Dietz, L. (2012). DBT skills list. DBT Self Help. Retrieved from www.dbtselfhelp.com/html/dbt_skills_list.html
• Grohol, J. (2016). What’s the difference Between CBT and DBT?  Psych Central. Retrieved from https://psychcentral.com/lib/whats-the-difference-between-cbt-and-dbt/ Linehan Institute
• Psych Central. (2016). An overview of Dialectical Behavior Therapy. Psych Central. Retrieved from https://psychcentral.com/lib/an-overview-of-dialectical-behavior-therapy/
• Tartakovsky, M. (2015A). 3 DBT skills everyone can benefit from. Psych Central. Retrieved from https://psychcentral.com/blog/archives/2015/08/28/3-dbt-skills-everyone-can-benefit-from/
• Tartakovsky, M. (2015B). What it really means to practice radical acceptance. Psych Central. Retrieved from https://psychcentral.com/blog/archives/2015/10/04/what-it-really-means-to-practice-radical-acceptance/
• The Linehan Institute. (n.d.).  Linehan Institute. Retrieved from http://www.linehaninstitute.org/about-Linehan.php

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Article feedback

What our readers think.

I appreciate you giving this information. In our online treatment, dialectical behavioral therapy is used. It works incredibly well for depression, substance abuse, and borderline personality disorder. Even the most serious cases respond very well to DBT, and we treat a wide range of clients.

I’ve been looking for this info!!! DBT saved my life and I believe EVERYONE could benefit from it. The reason I’ve been searching is for my boys. I never meant to pass that part of me to any of my children but I see it in them. I’m trying for them to avoid the wrong roads I took. I barely escaped the darkness. I couldn’t bare to see them in that place. So ty!! I can’t say it enough.

I have recently completed a DBT group therapy course which I found extremely helpful in managing my BPD and PTSD.

I would love to teach these skills to others worldwide, is it a requirement that you have a certain level of certification to teach cbt/dbt and if so what qualifications are required to go on to teach these skills to others online?

I believe I have enough personal experience, understanding and now knowledge of the skills and mental illness, but am confused on the law of teaching these skills without official certification, or even if that’s a must?

Please help

That’s great your experience was so helpful for you! To teach CBT and DBT skills to support people with mental illnesses, you need to become a licensed therapist or psychologist. This requires that you complete a master’s qualification. You can learn more about the process in our dedicated blog post: https://positivepsychology.com/how-to-become-a-therapist/

Hope this helps!

– Nicole | Community Manager

I have the same question. I work in mental health as a life coach and yoga instructior. I do not want to teach the program. My intention is to use the “My life Vision” worksheet and the wise mind model. What is the legal implications? I would sight the source while being clear on my role and title. The client would be provided resources for a licensed therapist.

This is outstanding!!!!!!

Just curious, you mention in the section – Working with Primary and Secondary Emotions While – “this webpage” but then there is no link to the webpage the article is referencing. I am wondering if you would direct me to the webpage please for further reference. As well, in the following paragraph on Emotion Regulation, again you mention “this worksheet” but don’t link a worksheet. Are you able to reference these for follow-up, please and thank you?

Hi Heather,

Thank you so much for being so observant and bringing this to our attention.

These links went to other websites, which may have restructured their content and caused dead links on our side. I have unfortunately not been able to trace the original worksheets discussed, but have amended our copy to prevent any further confusion.

Apologies for not being able to help you further.

Regards, Annelé

I wish DBT was more available in standard mental health services. In the UK, it’s thin on the ground.

BPD is prolific and causes so much suffering. Yet still much ignorance and stigma remains.

I hate the way so many blame and shame such lonely and fragile people.

We want love, but are terrified of our vulnerability being abused. I wish I could’ve got this treatment. My partners would not have had to put up with so much, maybe.

Damaged people damage people.

Thank you for sharing your thoughts on the availability of Dialectical Behavior Therapy (DBT) and the challenges faced by individuals with Borderline Personality Disorder (BPD). It is indeed disheartening to hear that access to this valuable treatment is limited in the UK and that stigma continues to surround BPD.

The importance of raising awareness about mental health conditions and advocating for better access to evidence-based treatments, such as DBT, cannot be overstated. It is essential to create a more understanding and compassionate society that supports individuals with mental health challenges instead of perpetuating shame and blame.

I encourage you to check out Psychology Today! It has a great directory you can use to find therapists in your local area. Usually, the therapists provide a summary in their profile with their areas of expertise and types of issues they are used to working with.

Please know that your voice matters and your experiences can contribute to raising awareness, challenging stigmas, and ultimately improving mental health care for those who need it most.

Warm regards, Julia | Community Manager

I have been waiting a very long time for DBT therapy for diagnosed Borderline Personality Disorder, being unable to work for 20 months now. I have finally been assigned a place but am unable to purchase DBT Skills Training Handouts and Worksheets Second Edition. Seeking help from so many places, I can’t even find a Microsoft Word version of the worksheets that I can complete online in order to participate in the group therapy. As a result, I cannot have the therapy I desperately need. I know this is a long shot, but does anyone have a version in Word (or Open.Office) that they can send to me?? Otherwise, I will continue to suffer as the NHS has taken so long to help me with a condition I have had for decades, together with my depression and anxiety. Thanking you in advance.

I’m sorry to hear you’ve had so much trouble receiving support. Please let me know which specific worksheet(s) you are trying to open, and I will let you know the best way to do so with free software.

Thank you for providing this information.

This sums up the group therapy session I have just graduated from! Modalities were based from Marsha’s core theories; it is alot of skills to practice.

Courtney, everything you wrote on this page IS TRUE, well written for any level audience. Well done.

Radical Acceptance, and Emotional identification is THE HARDEST part of BPD and DBT. I find it hard now to identify why I am in an “emotional crisis”, since I want to “Name it, to Tame it”. I really can’t identify why I become so deeply emotional (rage, crying, worthless…) but the emotions are EXTREME. I can’t identify what I was so emotional about, why I became so emotional in the first place ONCE I GET CAUGHT IN “THE DARK HOLE” as my husband refers to my “emotional crises”.

Just thought I would share my own personal experience; FYI I am an ongoing work in progress. Still have many ups and downs; however I can reflect on these events (usually AFTER the fact, but LIVE AND LEARN).

Super frustrting that it says “We hope you enjoyed reading this article. Don’t forget to download our 3 Mindfulness Exercises for free.” but you enter your information and then it tells you it cost $27.00. Why the false advertising…why say free just to get another person email to spam?

My apologies! Please try visiting this link to access the free downloads. The three exercises are definitely free! But if there’s a link in the text that tries to point you toward a paid resources, please let us know where it is so we can correct this 🙂

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DBT: Dialectical Behavior Therapy

Overview of DBT

Dialectical Behavior Therapy (DBT) is a structured therapy that focuses on teaching four core skills (mindfulness, acceptance & distress tolerance, emotional regulation, and interpersonal effectiveness) to help you create a good life for yourself. You work on those skills through a series of lessons and then start applying them to your life.

This free guide has approximately 40 short DBT lessons. Each lesson includes a short video and then an exercise with an accompanying worksheet. Many readers use them between sessions with their therapist or you can use them as a self-study course to do on your own. Many readers use these at-home exercises in conjunction with a therapist and many readers use them as a self-study guide.

DBT is a type of cognitive behavioral therapy (CBT) . CBT focuses on helping people change unhelpful thought patterns. DBT takes those CBT ideas or challenging unhelpful thought patterns, but also adds additional elements like mindfulness, acceptance and distress tolerance, and interpersonal skills to give you more tools for dealing with hard situations. Dialectical (the D is DBT) meets opposites, and comes from the idea of combining two of those ideas - change and acceptance.

DBT Core Skills

Mindfulness

Distress Tolerance

Emotion Regulation

Interpersonal Effectiveness

How does dbt work.

The skills focus on four core skills, and for each skill there are around 10 lessons to help you develop that skill.  Clients usually start with Mindfulness to increase their general awareness of your thoughts and emotions.  Then focus on the skills that will provide the most benefit.

Each lesson is structured with a learning component that takes around 5 minutes to complete. Then there is an accompanying exercise and worksheet that will take you around 10 minutes to complete.  You repeat the exercises that you find useful a few times a week until you feel like you have got what you need out of the lesson.

DBT skills training is often done in groups and is accompanied by individual treatment and coaching from a therapist.  In a clinical setting learning all the skills typically takes six months.

DBT is premised on the idea that many problems are based on a skill deficit, and that by giving clients better skills they can live a happier and more productive life.

For example, instead of coping with stress caused by a difficult boss with self-injury, substance abuse, or anxiety, the client learns to reduce the stress and be more tolerant of the stress. You may for example learn mindfulness techniques to make you more aware of triggers and your response.  Distress tolerance and acceptance techniques could help you with self-soothing techniques or radical acceptance.  Emotional regulation can help you balance emotional urges with their opposites.  And interpersonal effectiveness skills might help you be more assertive with your boss, set boundaries or find another job.

What is DBT Used For?

DBT was originally developed for Borderline Personality Disorder, but its use has now widened to a wide range of conditions including:

• Anxiety & Depression: DBT helps you become aware of the negative thought  patterns and change them. It also helps you focus more on the positive activity that keeps you healthy.
• Substance Abuse: DBT helps you reduce cravings, avoid situations that lend themselves to substance abuse, and find better ways to manage stress.
• Self-Harm: DBT provides specific techniques to manage self-harm impulses and avoid unhealthy behavior.
• Attention Deficit Hyperactivity Disorder (ADHD): DBT skills help you improve impulse control and develop life organizational skills.
• Borderline Personality Disorder (BPD): DBT helps moderate excessive emotions and be more tolerant of high stress levels and other triggers. It also helps with addressing associated behaviors like problem relationships, self-harming behavior, and impulsivity.
• Eating Disorders: DBT helps with bulimia and binge-eating by developing distress tolerance and emotional regulation skills.
• Post-Traumatic Stress Disorder (PTSD): DBT has been found useful in processing traumatic events and providing grounding techniques to reduce the severity of PTSD symptoms.
• Anger Management: DBT helps you recognize  triggers and provides tools to reduce emotion without aggressive behavior.

Benefits and Effectiveness of DBT

DBT has become one of the most studied forms of therapy and has picked up popularity among therapists as evidence of its clinical effectiveness has continued to accumulate. There have been 15 significant trials of DBT to date. The evidence shows effectiveness in reducing self-harm, more treatment adherence, less time in treatment, fewer serious episodes, and patients have reported feeling better.

Frequently Asked Questions

What is dbt used for.

Dialectical behavior therapy (DBT) is a type of psychotherapy originally developed to treat borderline personality disorder (BPD). However, its effectiveness extends far beyond that. DBT can be used to treat a variety of mental health conditions, including:

• Anxiety disorders
• Eating disorders
• Post-traumatic stress disorder (PTSD)
• Substance abuse
• Bipolar disorder

What are the benefits of DBT therapy?

The benefits of DBT are numerous and far-reaching. Here are just a few:

• Reduced emotional distress
• Improved interpersonal effectiveness
• Increased distress tolerance
• Better emotion regulation skills
• Enhanced mindfulness
• Reduced suicidal thoughts and behaviors
• Greater sense of self-acceptance and self-compassion

What is the difference between DBT and CBT?

Both DBT and cognitive behavioral therapy (CBT) are effective forms of therapy, but they have key differences:

• Focus: DBT focuses on accepting and validating emotions, while CBT aims to change negative thoughts and behaviors.
• Structure: DBT often uses group therapy with specific skills training modules, while CBT is typically individual therapy with a more flexible approach.
• Suitability: DBT is often preferred for people who struggle with intense emotions and find traditional CBT challenging.

What is the role of a psychologist in DBT, and how often are sessions held?

Can dbt be used in group therapy, how much does dbt therapy cost, is dbt effective for treating bpd, in what order should dbt skills be learned.

While there's a recommended sequence, the order can be adapted to individual needs:

• Mindfulness: This forms the foundation of DBT, teaching you to observe your thoughts and feelings without judgment.
• Distress tolerance: Learn healthy ways to cope with intense emotions and urges without resorting to self-harm or other destructive behaviors.
• Emotion regulation: Develop skills to manage difficult emotions like anger, sadness, and fear in a healthy way.
• Interpersonal effectiveness: Build stronger, more fulfilling relationships by learning assertive communication and conflict resolution skills.

Who created DBT?

How long does a session of dbt therapy last in the psychiatric clinic, are there self-help workbooks available for learning dbt skills for free, when should i use dbt videos, and when is it necessary to contact a psychologist or doctor.

DBT videos can be a valuable resource for learning and practicing skills, especially when used alongside our free workbooks. However, if you're struggling with a mental health condition or find it difficult to manage your emotions on your own, seeking professional help from a qualified DBT therapist is crucial. They can provide personalized guidance, support, and ensure you're using the skills effectively.

• The Linehan Institute Behavioral Tech. What is dialectical behavior therapy (DBT)? What is dialectical behavior therapy (DBT)? -->.
• Behavioral Tech. How DBT helps How DBT helps -->.
• Behavioral Tech. DBT: An Evidence-Based Treatment DBT: An Evidence-Based Treatment -->.
• Pasieczny, N., & Connor, J. (2011). The effectiveness of dialectical behavior therapy in routine public mental health settings: an Australian controlled trial. Behavior Research and therapy, 49(1), 4-10.
• Robins CJ, Chapman AL (2004). Dialectical behavior therapy: Current status, recent developments, and future directions. J Personal Disord (Pubmed), 2004;18:73–9.
• Dimeff, L., & Linehan, M. M. (2001) Dialectical behavior therapy in a nutshell. The California Psychologist, 34(3), 10-13

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DBT’s options for solving ANY problem

As San Francisco DBT therapists, we work with people who want help managing emotions and relationships.

We see all sorts of problems that result in all kinds of pain.

Even though there are as many different problems as there are human beings, there are really only four solutions to solve any problem, regardless of what the problem is.

What, you may wonder? Isn’t solving problems complicated? Yes and no. The details of how we go about solving any problem may be complex and take time, but our options are quite finite.

The 4 DBT problem-solving options*

Solve the problem.

Change or leave the situation.

Feel Better about the Problem

Regulate the emotions that the problem elicits.

Tolerate the Problem

Accept and tolerate the problem, as well as your response to it.

Stay Miserable

Don’t make any changes.

Let’s look at each of the 4 DBT problem-solving options in more depth:

With any problem situation, you can figure out if there is a way to change the situation, avoid the situation or leave the situation.

Example: Let’s take the problem of feeling lonely and isolated.

You could solve the problem by changing the situation to meet new people and form friendships. You could join social groups or volunteer for a cause where you will interact with others. You could initiate conversations with co-workers or neighbors, or try to re-connect with old friends you lost touch with.

Feel better about the problem

You can decide not to change the actual problematic situation, but to change your emotions in reaction to it.

Example: You could feel better about being lonely by reassuring yourself that being lonely does not mean you are unlikable or unlovable. And by reminding yourself that making new friends isn’t easy.

You could find ways to get more enjoyment out of the time you spend on your own, by making sure you still do things that you want to do even if you’re alone. Like going to see a movie or checking out a new restaurant – even if you do these things by yourself.

Tolerate the problem

If you can’t solve the problem, and you can’t feel better about the problem, you can still ease some of the emotional suffering that the problem brings up.

Example : If you can’t do things to build new friendships or feel better about being alone, you can respond to the problem by accepting and tolerating both the problem and your response to it.

Maybe your work schedule, home responsibilities or a disability means you can’t solve the problem by going out and joining a group to meet new people.

You may not be successful in your attempts to feel better about being alone, despite your use of skills.

But you can reduce your suffering by using the Distress Tolerance skill of Radical Acceptance . Radical acceptance doesn’t equal approval of the situation, but radical acceptance means you stop fighting reality .

No one can avoid pain, but resisting pain creates suffering and suffering is optional .

Stay Miserable:

You could choose to stay miserable. Or, you could also do things that will make the problem even worse.

To choose this option, don’t use any skills!

Solving your problems

So there you have it – the four DBT problem-solving options. Depending on the nature of your problem, you may choose a different option for different situations. Of course, it’s totally up to you. The important thing is that you take the time to think about and acknowledge how you’re dealing with the problem.

A DBT skills group will teach you the necessary skills to solve problems, feel better about problems and tolerate problems.

Contact us to see how therapy can help you. We offer individual and group DBT as well as couples counseling . Our offices are located in the Castro district of San Francisco.

* Adapted from the DBT Skills Training Handouts and Worksheets, Marsha Linehan Guildford Press 2015

15 DBT Activities & Exercises to do with your Clients in Therapy

Marsha Linehan pioneered Dialectical Behavioral Therapy ( DBT ) in the late 1970s, aiming to address the complex mental health challenges faced by women, often involving multiple concerns such as suicidal risk. DBT encompasses various components, including individual therapy, skills group therapy sessions, and weekly team consultations. A typical DBT treatment plan can span from six months to a year. Discover below 15 DBT activities and exercises that can be incorporated into therapy sessions with your clients.

DBT Worksheets Bundle (Editable, Fillable, Printable PDFs)

CBT Worksheets Bundle (Editable, Fillable, Printable PDFs)

See all of our DBT Worksheets

Effective DBT treatment includes 5 characteristics (Chapman, A.L., 2006). Chapman identified the following characteristics:

• Enhancing the client’s capabilities- This can include dialectical behavior therapy exercises focusing on emotion regulation skills, mindfulness practices, improving interpersonal effectiveness, and learning distress tolerance skills
• Generalizing goals that can apply to day-to-day life- This can include skills training and homework to ensure that the skills covered in sessions can improve your client’s quality of life.
• Improving client motivation and reducing the presence of dysfunctional behaviors- This can be addressed in individual sessions and self-monitoring activities, such as diary cards.
• Using structure to avoid reinforcing negative behaviors
• Providing therapists with support, validation, continued training, and skills building to promote effective counseling- DBT is often used with clients who have a history of trauma and significant impairment from their mental health concerns. It is important to make sure that Counselors and Therapists are receiving the support they need so that they can provide effective therapeutic interventions.

Dialectical Behavioral Therapy (DBT) is a specialized form of cognitive-behavioral therapy that is particularly well-suited for individuals who experience emotional dysregulation, self-destructive behaviors, and difficulty managing intense emotions. There are several compelling reasons why DBT may be chosen as a preferred treatment option:

• Effective for Emotion Regulation : DBT is specifically designed to help individuals better understand, tolerate, and regulate their emotions. It provides practical skills for managing intense emotional states, which is particularly valuable for conditions like borderline personality disorder (BPD).
• Evidence-Based : DBT is backed by substantial research and clinical evidence supporting its effectiveness for a range of conditions, including BPD, self-harm, suicidal ideation, substance use disorders, and eating disorders.
• Comprehensive Approach : DBT offers a comprehensive approach to therapy, encompassing individual therapy sessions, group skills training, phone coaching between sessions, and therapist consultation teams. This multifaceted approach provides ongoing support and skill-building opportunities.
• Mindfulness Emphasis : DBT incorporates mindfulness techniques, which help individuals stay grounded in the present moment, reduce reactivity to emotions, and make healthier choices in challenging situations.
• Dialectical Thinking : DBT introduces dialectical thinking, which encourages individuals to find a balance between seemingly opposing ideas or perspectives. This can lead to more adaptive problem-solving and decision-making.
• Suicide Prevention : DBT includes a strong focus on suicide prevention. It equips individuals with skills to reduce self-destructive behaviors and suicidal thoughts and provides a safety net through phone coaching with therapists.
• Acceptance and Change : DBT emphasizes the importance of both acceptance and change. Clients learn to accept themselves and their current circumstances while also working toward positive changes in their lives.
• Customized Treatment : DBT is highly adaptable and can be tailored to address a wide range of mental health issues, making it suitable for clients with complex and comorbid conditions.
• Enhanced Interpersonal Skills : DBT includes modules on interpersonal effectiveness, helping individuals improve their communication and relationships with others.
• Long-Term Benefits : Research indicates that DBT can lead to long-lasting improvements in emotional well-being and overall functioning, even after the completion of therapy.
• Empowerment : DBT empowers individuals to take control of their lives and make informed choices that align with their values and goals.
• Holistic Approach : DBT recognizes the interconnectedness of thoughts, emotions, behaviors, and relationships and addresses these aspects in a holistic manner.

While DBT is highly effective for many individuals, it is important to note that therapy is a personal journey, and the choice of DBT or another therapeutic approach should be based on the individual’s unique needs and preferences, as well as the expertise of the therapist. DBT may be particularly beneficial for those who struggle with emotional dysregulation and self-destructive behaviors. Keep reading to learn 15 DBT activities and exercises you can do with your clients.

What Conditions Can DBT Treat?

While DBT has been widely accepted as an effective treatment for borderline personality disorder, research has shown that DBT is an effective treatment for a variety of other mental health concerns. Mental health concerns that can benefit from DBT include:

• Eating Disorders, including binge eating disorder
• Post-traumatic stress disorder
• Suicidal behaviors

List of DBT Activities and Exercises to do With Your Clients

Dialectical behavior therapy activities can be an effective way to introduce various skills to your client, and encourage them to use the skills they learn outside of sessions.

Examples of DBT exercises that you can incorporate into your individual or group session include:

• The GIVE skill is an additional interpersonal effectiveness skill that can help your client improve their communication. You can use a recent conversation that your client feels could have gone better and see where they could make changes based on the GIVE skill. Allow time to explore any situations where your client was able to apply this skill outside of the session. Our GIVE Skill worksheet can help your clients with this skill.
• Introduce your client to the How Skill. This skill encourages your client to not judge the situation as “bad” or “good” or have a “right” or “wrong” response. Clients are encouraged to be present at the moment, and not to worry about how the future would be impacted. Lastly, the client should be encouraged to do what works, without worrying if it is “right”. Encourage your client to focus on their desired outcome. Allow for time to follow up regarding their ability to use the How Skill outside of the session.
• Spend time exploring the use of our senses. Bring a leaf into the session and ask your client to describe the leaf using their senses for a full five minutes. Normalize that if their mind wanders, accept that it happened and come back to the leaf. After the five minutes, process their experience. Based on their engagement in the exercise, provide them with feedback about how they can further engage their senses in mindfulness exercises.
• Introduce your client to the acronym TIPP. This is a distress tolerance skill that can help them cope with distressing or overwhelming emotions at the moment. Allow for time to follow up about their ability to utilize this distress tolerance skill in later sessions. Our TIPP Skill Worksheet can help your clients with this skill.
• Introduce your client to radical acceptance statements and discuss how they can be used to cope with distress. Use a recent challenge of theirs to explore how radical acceptance statements can be applied. Encourage your client to try using these statements when they become distressed and be aware of how they impact their level of distress.
• Introduce your client to the idea of meditation, and explore their current understanding of what meditation entails. Clients may not have a full, or correct, understanding of meditation and what to expect. You can discuss different forms of meditations including guided imagery and progressive muscle relaxation. Be mindful of your client’s mental health before introducing mindfulness- individuals with trauma may not benefit from the use of meditations. Follow up with your client about their ability to engage in a mindfulness practice outside of the session and how it impacted them.
• Boundaries are a vital part of healthy relationships . Spend time exploring components of healthy boundaries and ask your client to identify a relationship that they feel could benefit from new or enforced boundaries. Roleplaying can be an effective tool that allows clients to practice difficult conversations and situations they may experience regarding healthy boundaries. Follow up regarding their ability to improve the boundaries they choose to work on.
• Spend time talking about the role that self-talk can have on our well-being. Explore your client’s self-talk, and explore changes that they could make to show themselves more kindness, compassion , and encouragement than they may be doing at this time. Encourage them to be mindful of their self-talk outside of the session, and notice how they feel when they make positive shifts to it.
• Introduce your client to the concept of a thought challenge. Using a recent challenge, they have experienced, walk them through the process of a thought challenge, taking your time to ensure that they understand the steps. Encourage your client to practice thought challenges outside of the session and use a thought challenge worksheet to document their experience to review in their next session.
• Talk with your client about self-soothing skills that use their five senses. This can help your client incorporate mindfulness into their coping skills . Providing your client with a worksheet, such as the DBT self sooth worksheet one available at TherapyByPro, can serve as a reference for your client outside of the session. Allow for time to follow up about your client’s ability to use their self-soothing skills and evaluate their effectiveness in later sessions.
• While in session, ask your client to eat a raisin (or another similar food item) which requires your client to stay focused on the present moment. Ask them to explore the raisin using their five senses. When the exercise is complete, ask them if their mind was wandering, and how they felt throughout the exercise. This can help reinforce the benefits of being in the present moment.
• Introduce your client to the three states of mind that we have; the emotional mind, the logical mind, and the wise mind. The wise mind uses both, our emotional and logical mind, and adds in our intuition. In the session, work through a recent session by looking at the three minds, and the way the challenge unfolded. Encourage your client to try and use their wise mind when they experience challenges outside of the session. Some clients may benefit from having a Wise Mind worksheet template, like the one available at TherapyByPro, to serve as a guide.
• Introduce your client to the ABC PLEASE skill. This skill focuses on taking care of ourselves which can decrease our chances of struggling with an emotional crisis. When you introduce these skills, evaluate your client’s current behaviors regarding the actions discussed, and how they think they could improve their current behaviors. Allow for time to follow up on their applied changes in a later session. Check out our ABC PLEASE worksheet .
• Introduce your client to the DEARMAN skill. This skill would be beneficial for individuals who can benefit from focusing on their interpersonal effectiveness, and improving their communication patterns. Use a recent challenge to walk through the skill as an example in the session. If your client would benefit from having a handout to walk them through the skill, TherapyByPro offers a thorough DEARMAN Assertive Communication worksheet. Allow time to follow up with your client’s ability to practice this skill outside of the session.
• Spend time engaging in a body scan exercise. You can begin with their toes, and work your way up to the top of their head. Ask the client to be aware of how their clothes feel, what their body is touching, how their clothes feel, if they feel warm, etc. When the body scan is complete, allow time to process their experience. Ask your client what they learned about their body at that moment that they were unaware of before. As an example, maybe they noticed that they were holding tension in their shoulders or jaw that they were unaware of before. Explore how their physical sensations relate to their emotions and thoughts.

Final Thoughts on Selecting DBT Activities for Your Clients

Thank you for reading this resource on 15 DBT Activities and Exercises to do with your Clients in Therapy. With the proper training and experience, DBT activities can be an effective treatment for clients who are living with a range of mental health concerns. There are many aspects of DBT that can be applied to individuals with an array of mental health concerns and challenges. Being able to tailor DBT exercises to your individual client, or group of clients can help you provide a customized approach to your work.

If you are able to practice using these skills yourself, you would likely be able to improve the way that you introduce, explore, and talk about the DBT exercises you share. This can include breathing exercises and meditations. Supervision can be a wonderful time to explore your experiences with DBT skills and to practice your approach to introducing skills in sessions. 

TherapyPatron.com helps mental health professionals better serve their clients. Our (editable, fillable, printable PDF) therapy worksheets can help you streamline your practice, effectively deliver different types of therapy, and support your clients be the best version of themselves.

• Chapman, A.L. (2006). Dialectical behavior therapy: Current indications and unique elements.
• Psychiatry,3 (9), 62-68. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963469/

Author: Kayla VanGuilder, MA, LCMHC

Kayla is a Mental Health Counselor who earned her degree from Niagara University in Lewiston, New York. She has provided psychotherapy in a residential treatment program and an outpatient addiction treatment facility in New York as well as an inpatient addiction rehab in Ontario, Canada. She has experience working with individuals living with a variety of mental health concerns including depression, anxiety, bipolar disorder, borderline personality disorder, and trauma.

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40 DBT Activities and Interventions for Therapy

A trusted name in recovery.

Dialectical behavior therapy (DBT) is an evidence-based talk therapy approach designed to help individuals manage their emotions, improve relationships, and create a more balanced life. Originally developed to treat borderline personality disorder, DBT has since been adapted for various mental health conditions. Implementing DBT activities, particularly in group settings, can be highly beneficial for individuals.

Rockland Recovery Behavioral Health teaches DBT skills to our clients at our Sharon, MA, treatment center. Engaging in our DBT programs in Massachusetts provides support to individuals seeking to overcome mental health challenges and improve their overall well-being. Call 855.520.0531 to get started.

The Purpose of DBT Activities

DBT activities encompass a range of exercises and practices aimed at teaching individuals skills in four key areas—mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. By engaging in these activities, individuals can learn to cope with challenging situations, regulate their emotions, and improve their relationships.

DBT Activities for Groups to Practice Skills

Conducting DBT activities for groups allows individuals to practice their skills in a social context, fostering support and mutual learning.

Mindfulness Activities

Mindfulness activities aim to help individuals gain awareness of their thoughts and feelings while also promoting acceptance and non-judgment.

• Mindful breathing – Focusing on the breath, noticing sensations, and gently redirecting attention when the mind wanders
• 5-4-3-2-1 sensory awareness – Identify five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste
• Body scan meditation – Bring awareness to different parts of the body, noticing sensations without judgment
• Walking meditation – Mindfully walk, paying attention to each step and the sensation underfoot
• Guided imagery – Using pre-recorded scenarios to immerse the group in a calming environment
• Mindful eating – Paying attention to the tastes, textures, and sensations of eating

As one of the cornerstones of DBT, mindfulness presents an opportunity to check in with yourself and practice being present in the moment.

Distress Tolerance Activities

Distress tolerance activities focus on building skills to manage intense emotions and difficult situations without resorting to harmful or impulsive behaviors.

• Pro-con list – Analyze the pros and cons of tolerating distress versus not tolerating it
• TIPP skills – TIPP stands for Teach Temperature, Intense Exercise, Paced Breathing, and Paired Muscle Relaxation
• Safe-place visualization – Visualize a peaceful place to calm the mind.
• Distract with wise mind ACCEPTS – ACCEPTS stands for Activities, Contributing, Comparisons, Emotions, Pushing Away, Thoughts, and Sensations
• Self-soothe – Use the five senses to find comforting activities
• STOP Skill – STOP stands for Stop, Take a step back, Observe, and Proceed Mindfully
• Assertiveness training – Role-playing to practice assertive communication
• DEAR MAN – DEAR MAN stands for Describe, Express, Assert, Reinforce, Mindful, Appear Confident, and Negotiate
• FAST – FAST stands for Be Fair, no Apologies, Stick to values, and be Truthful
• GIVE – GIVE stands for Gentle, Interested, Validate, and Easy Manner
• Boundary setting – Discuss and practice establishing healthy boundaries
• Validation practice – Recognize and validate others’ feelings and experiences

These activities further underscore the commitment to providing a comprehensive and dynamic therapeutic experience.

Therapeutic DBT Group Activities

Having explored some engaging activities that integrate the principles of DBT into the recovery process, let’s delve into additional exercises that further encapsulate the essence of this therapeutic approach. These DBT group activities are designed not only to reinforce the skills learned but also to foster a sense of camaraderie and mutual support among participants.

General DBT Skills Group-Focused Practices

Some therapy sessions will employ activities that focus on general skill-building.

• Group sharing – Share personal experiences in a supportive environment
• DBT Jeopardy! – A fun game to test knowledge of DBT concepts
• Collage creation – Use magazines and art supplies to create a visual representation of personal journeys
• Skills feedback – Provide constructive feedback on peers’ use of skills
• Mindful listening – Practice active and present listening
• Group problem solving – Address interpersonal conflicts and dilemmas using DBT techniques

Therapists may use these and other exercises to keep sessions dynamic, engaging, and informative. These activities also reinforce the skills learned in individual therapy sessions, helping individuals internalize DBT principles.

Emotion Regulation Activities

Regulating emotions is one of the primary goals of DBT. These activities help individuals identify and manage intense emotions.

• Identify emotions – Discuss various emotions, how they feel, and how they manifest
• Pleasant activities list – Compile a list of activities that evoke positive emotions.
• Opposite action – Learn to act opposite to the emotion you’re feeling
• Mood tracking – Keep a daily log of emotional highs and lows
• Build mastery – Engage in activities that foster a sense of achievement
• Reduce vulnerability to emotion-mind – Focus on physical illness, balance eating, avoid mood-altering drugs, balance sleep, get exercise, and build mastery

After building an understanding of different emotions and their triggers, these activities help individuals learn to regulate their emotional responses.

Skills Integration and Practice

Practicing skills in real-life situations is vital to the success of DBT. These activities provide opportunities for individuals to put their skills into practice.

• Role-playing – Enact real-life scenarios to practice using DBT skills
• Homework review – Reflect on DBT practice assignments from the previous week
• Skills generalization – Discuss how skills can be applied in various life situations
• Crisis planning – Identify triggers and create a plan to navigate them
• Behavior chain analysis – Identify events leading up to problematic behaviors and explore alternatives
• Gratitude journaling – Keep a daily log of things you’re grateful for

Through these activities, individuals can gain confidence in their ability to use DBT skills effectively and successfully navigate challenging situations.

Emphasizing Wellness

No holistic therapy course is complete without a focus on the body and spirit. Incorporating activities that encourage wellness can pave the way for an overall enhanced experience.

• Yoga and mindfulness – Gentle yoga poses combined with mindfulness practices
• Nature walks – Combine physical activity with mindfulness in a natural setting
• Guided relaxation – Use audio prompts to lead the group in relaxation techniques
• Music and mindfulness – Listen to calming music, focusing on different instruments and rhythms

DBT-skills programming is a transformative tool in the therapeutic arsenal of Rockland Recovery Behavioral Health. These group activities help foster community, provide direct skill application, and assist clients on their journey to mental wellness. We believe that through active participation, support, and consistent practice, anyone can harness the power of DBT to improve their life.

Call Rockland Recovery Behavioral Health Now

We recognize the transformative power of DBT in addressing a range of emotional and behavioral challenges. Our dedicated team of professionals has honed a comprehensive range of interventions tailored to the unique needs of each individual. Call us at 855.520.0531 or contact us online to find the right way forward for a better future.

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4 Strategies for Resolving Problems with Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) is an evidence-based treatment initially developed for individuals with Borderline Personality Disorder but has since been adapted for various mental health conditions. DBT focuses on teaching practical skills to help individuals manage their emotions, navigate interpersonal relationships, and develop healthier coping mechanisms. These skills can be applied in everyday life to resolve various problems involving personal conflicts, emotional distress, or decision-making. In this article, we explore four DBT skills that can be utilized to address and resolve problems effectively.

Mindfulness

Mindfulness is a core component of DBT that emphasizes being fully present and aware of one's thoughts, emotions, and sensations without judgment. By cultivating mindfulness, individuals can develop greater self-awareness, enabling them to recognize the underlying issues contributing to a problem and respond more effectively.

To use mindfulness to resolve a problem, begin by taking a moment to pause and observe your thoughts and feelings about the situation. Pay attention to any physical sensations, emotions, or thought patterns that arise. This non-judgmental observation can help you identify unhelpful thoughts or emotions that may exacerbate the issue and provide insight into potential solutions.

Once you have developed a greater understanding of the problem through mindfulness, use this awareness to inform your decision-making process. Consider your options with a clear, focused mind, and weigh the pros and cons of each potential solution. You can make more informed and thoughtful choices by approaching the problem with mindfulness.

Emotion Regulation

Emotion regulation is a DBT skill that focuses on understanding and managing one's emotions healthily and adaptively. By learning to regulate emotions, individuals can prevent emotional reactions from escalating and causing further problems.

To use emotion regulation in problem-solving:

• Begin by identifying the emotions you are experiencing concerning the issue.
• Acknowledge these emotions without judgment, and consider how they may influence your perception of the problem.
• If intense emotions cloud your judgment, use self-soothing techniques, such as deep breathing or visualization, to help calm your emotional state.

Once you have achieved a calmer emotional state, assess the situation objectively and consider possible solutions. Remember that emotions can serve as valuable signals but should not dictate your decision-making process. By regulating your emotions, you can approach the problem with clarity and make more rational choices.

Distress Tolerance

Distress tolerance is a DBT skill that helps individuals build resilience and cope with challenging situations without resorting to unhealthy or destructive behaviors. By learning to tolerate distress, individuals can navigate problems more effectively and avoid exacerbating the situation.

To apply distress tolerance to problem-solving, first acknowledge the discomfort and distress associated with the situation. Remind yourself that it is natural to experience discomfort when facing a problem, and avoiding or suppressing these feelings may only prolong the issue.

Next, implement healthy coping strategies to manage the distress, such as engaging in self-care activities, seeking support from loved ones, or practicing mindfulness. By tolerating the distress, you can prevent it from overwhelming you and maintain the mental and emotional capacity to address the problem effectively.

Interpersonal Effectiveness

Interpersonal effectiveness is a DBT skill that builds and maintains healthy relationships through assertiveness, empathy, and effective communication. This skill can be beneficial when resolving problems that involve other people, such as conflicts or disagreements.

To use interpersonal effectiveness in problem-solving:

• Start by clarifying your goals and priorities in the situation.
• Consider the desired outcome and any potential consequences for the relationship.
• Strive for a balance between asserting your needs and respecting the needs of others.

Next, practice active listening and empathic communication to understand the other person's perspective. This understanding can foster a collaborative approach to resolving the problem and create a more open and supportive environment for problem-solving.

Finally, assert your needs and opinions respectfully, using clear and concise language. Be open to feedback and be willing to compromise when appropriate. By employing interpersonal effectiveness skills, you can work together to find a mutually satisfactory resolution and strengthen the relationship.

Final Thoughts

Dialectical Behavior Therapy offers valuable skills that can be applied to a wide range of problems and challenges in daily life. By harnessing the power of mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness, individuals can effectively address and resolve problems healthily and adaptively.

These DBT skills help individuals navigate difficult situations and contribute to their overall emotional well-being and personal growth. By incorporating these strategies into everyday life, individuals can develop greater resilience, stronger relationships, and a more balanced approach to problem-solving.

Grouport Offers Online DBT Skills Groups

If you're looking for an online group therapy session to practice dialectical behavior therapy, the  Grouport DBT series  by Grouport Therapy is the perfect solution. Our 12-week program equips participants with new skills to replace negative behaviors and emotions that can cause daily life and relationship issues.

Our group meets once a week at a scheduled time, and you'll receive access to session links via email after enrolling and paying for the program. By joining  our DBT skills group , you can improve relationships, manage anxiety, and reduce emotional suffering, regaining hope for the future.

Don't hesitate to take the first step towards a better life. Our next session is waiting for you.  Join our Grouport DBT series  today and start improving your mental health alongside a supportive group of individuals.

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Opposite Action Skill

All emotions activate us to respond and the type of activation is biologically wired. The Opposite Action Skill allows us to choose to respond opposite from what our biological response would activate us to do. They get us ready to act. Here are some examples:

• Thirst: tells us that we need to hydrate. It activates us to drink water.
• Hunger: tells us that we need to give our body fuel. It activates us to eat.
• Fatigue: tells us that we need rest. It activates us to sleep.

Switch it Up

The 3 emotions listed above are helpful for our survival; but those that follow require thought before we act and opposite action may be helpful.

• Anger gets us ready to attack/ It activates us to attack or defend. Opposite show kindness/concern or walk away.
• Shame gets us ready to hide. It activates us isolate. Opposite raise your head up, give eye contact, shoulders back.
• Fear gets us ready to run or hide. It activates us to escape danger. Opposite go towards, stay involved in it, build courage.
• Depression gets us ready to be inactive. It activates us to avoid contact. Opposite get active.
• Disgust gets us ready to reject or distance ourselves. It activates us to avoid. Opposite push through and get through situation.
• Guilt gets us ready to repair violations. It activates us to seek forgiveness. Opposite apologize and mean what we say.
• 1 If we want an emotion to stick around or increase, continue to do the action as above.
• 2 If we want an emotion to go away or become less uncomfortable, do the opposite action.
• 3 If we want this skill to work, we must use opposite action all the way and believe that it will work.

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