Created by Marsha Linehan, Dialectical Behavioral Therapy (DBT) is a relatively new model for psychotherapy. It is beneficial for people who struggle to manage overwhelming emotions, those who struggle with impulsivity and/or urges to harm themselves, and the mental health disorders associated with persistent struggles in these categories.
In addition to a trusting relationship between a therapist and client, a big part of DBT is skills-building. Learning about, committing to memory, planning, and practicing specific ways of responding to an internal or an external crisis are key skills.
Many people find this therapy model helpful, and the specific, actionable steps DBT offers appeals to many people.
According to Marsha Linehan, DBT includes both “change skills” and “acceptance skills.”
- 💪🏽 Change skills are tools that can be learned. These skills could be strategies for handling conflict and specific behaviors to use as an alternative to self-harm or other problematic responses to emotional pain.
- 🙏🏽 Acceptance skills are specific ways we can live into the adage about changing what we have the power to change and accepting what we can’t change. DBT acceptance skills combine elements of time-tested Buddhist meditation with the cutting-edge science of Neuropsychological research on the power of mindfulness to help brains cope.
DBT Worksheets, Binders, and Resources
DBT can be considered a resource-heavy therapy model. Many approaches to psychotherapy (like psychodynamic therapy) emphasize the healing capacity of therapeutic relationships and emotional presence in the here-and-now. Other models, like CBT, can incorporate- or even heavily rely on- worksheets and homework.
Dialectical Behavioral Therapy, when done in compliance with DBT therapist training, utilizes all of these therapeutic tools:
- The healing power of relationships,
- Attention to the emotional experience of the here-and-now, and
- Learning and Skills building– facilitated through diary cards, worksheets, and/or written homework.
These three aspects combine to help develop the following elements in DBT participants:
- 👩🏼🤝👩🏾 improved interpersonal skills (to build the kind of relationships that support long-term well-being),
- 🥴 mindfulness distress tolerance (i.e., being able to get Very Upset without behaving in ways that harm ourselves or others), and
- 🌈 emotional regulation. (More on emotional regulation here, but essentially it’s the ability to return to baseline well-being after being pushed beyond our capacity to handle it).
DBT Homework Help
Many clients struggle with the homework aspect of DBT therapy. Linehan‘s research at the University of Washington demonstrates the importance of diary cards and handouts as a part of effective DBT. However, actually completing written assignments can be where many participants struggle to stay on track.
A good DBT therapist can help people understand and work with the internal and external reasons they may struggle to finish diary cards or homework on time. Yet, for some highly reactive people, failure to complete assignments may contribute to dropping out of therapy due to feeling guilty about not finishing. Or, they may be triggered into a shame response for not meeting the goal.
An Alternative: Approachable DBT Worksheets & Materials
I believe that some resources used in Mental Health treatment are unnecessarily cold, clinical, or technical. These hard-to-relate-to resources may risk pushing people away instead of inviting them to engage in both a healing relationship with their therapist and with information that could help their recovery. My work seeks to offer resources like worksheets, visuals, and handouts that bridge this gap.
Too often, homework, worksheets, or handouts used by a clinician to help a client actually have the opposite effect. Instead of helping a client understand that information and use it to inform healthier thoughts, choices, and behaviors, clinical worksheets can make it harder for some people to move toward their recovery and their mental health goals.
Sometimes, therapeutic worksheets can feel cold and impersonal, triggering feelings of rejection, isolation, or hopelessness. Clinical worksheets may often look like academic homework, which can be difficult for those with educational trauma or shame around performance. Even people deeply committed to their DBT treatment may struggle with how clinical diary cards and DBT worksheets might make them feel sicker.
My DBT printable resources are different. I consciously designed them to integrate the fundamental concepts and package them in an approachable, non-clinical, non-threatening way. These DBT-inspired worksheets can make diary cards, homework printables, and skills-practicing as easy and fun as activity books, bullet journaling, or filling out a relationship quiz in a teen magazine!
DBT WORKSHEETS & RESOURCES
Click a worksheet below to jump directly to the download, or keep reading to learn more about these resources.
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DBT Bingo Card for Skills Tracking
Designed to “gamify” regular attendance and real-life practicing of DBT Skills, the DBT bingo card can be used as a handout or as a digital file that can be completed by loading the page on a tablet.
For printed DBT bingo cards, participants can use sharpies, stickers, or even old fashion bingo chips to make their way to a “winning” bingo card. Download now or read on to learn more about how to use this DBT skills tracking resource.
For more information on the allowed uses that each of these license types include, click here.
Brief Descriptions of the DBT Skills Featured:
Awareness, Acceptance, Action: This is an acronym that describes the process of mindful change – becoming aware of your situation/thoughts/feelings (without judgment), accepting the nature of the situation/your thoughts/feelings, and finding a way to create change (take action) where it is needed.
Dear Man: Learning and using the Dear Man skills can help us grow our ability to communicate and function in healthy relationships. Dear Man is an acronym that stands for:
- Describe – explain what is happening in the immediate moment.
- Express – state feelings about your current experience.
- Assert – clearly ask for or state what is needed.
- Reinforce – explain what will happen if what is needed is attained/not attained.
- Mindful – focus on the goal (what is needed).
- Appear – be confident, maintain good eye contact and bodily/physical conduct.
- Negotiate – be open to give/get.
Radical Acceptance: This refers to accepting what is and letting go of what we can’t control.
Tried Grounding with Senses: This refers to using one’s senses (taste, touch, sight, sound, and smell) to soothe ourselves when we are upset.
Vitals: the Vitals DBT skills can help us in achieving personal goals, in our personal and professional lives. Vitals stands for:
- Validate your feelings
- Imagine yourself doing it peacefully and productively
- Take small steps – break it down into manageable pieces
- Applaud yourself – notice and celebrate your efforts
- Lighten the load – remember how this is benefitting you
- Sweeten the pot – reward your efforts by giving yourself something during or after that you enjoy
Mindfulness: This refers to a practice of awareness and acceptance of what is occurring in the present. (Check out more resources on mindfulness)
Recognizing & Naming Emotion: This refers to being aware of and able to identify emotions in the body that you may be experiencing. (Refer to my Emotion-Sensation Feeling Wheel or articles on Emotional Regulation for more information on how practicing recognizing, expressing, and naming emotions are part of mental health recovery for many people)
Master(y): When we do things we are good at- or practice until we improve at something hard- it feels good! Getting better, stronger, faster, more skilled, etc. at something we care about creates positive changes in the brain that can help in other areas of our lives, too. Doing activities or tasks that make us feel competent and in control can be a practice that helps other aspects of DBT be more effective.
MindfulnessSkills: The mindfulness “what” skills describe what to be mindful of in the present – to observe, describe, and participate.
GIVE: Give is a DBT skill acronym that can help us to maintain healthy relationships. Give stands for:
- Gentle – use appropriate language
- Interested – be an active, involved listener
- Validate – show sympathy, empathy, and concern
- Easy manner – be calm and relaxed in conversation
Opposite to Emotion Action: This is a skill that involves learning to recognize when our automatic response would be unhelpful and intentionally choosing the opposite of what our initial urge draws us to do. (Example: you want to isolate, but instead, you reach out to a friend, or you want to retaliate against someone who was inconsiderate, but instead, you pause and describe how their actions made you feel).
TIPP: The TIPP acronym is a distress tolerance skill meant to be used when emotions are overwhelming. The aspects of the DBT TIPP skill can help alleviate acute distress, like a surge of anxiety or uncontrollable tears. TIPP stands for:
- Temperature: This skill involves “tipping” the body’s temperature in the other direction, typically with cold water splashed on a face.
- Intense exercise: Getting a heart rate up for a few minutes (ideally, about 20 minutes, but any amount can help).
- Progressive muscle relaxation. Tensing and then relaxing muscles can be more effective than focusing on relaxation alone.
- Though not original to Linehan’s DBT, some sources add Paced Breathing: regulating our breath to help signal our brains that all is well.
I’m Doing My Best: An encouraging mantra to tell yourself. When it’s hard to say kind things to ourselves organically, having a few mantras to return to can help manage stress, gain a sense of control, and soothe.
ABC’s: This is a skill-set that encourages self-care, ABC stands for:
- Accumulate positive emotions by doing things you enjoy.
- Build mastery by doing things you enjoy.
- Cope ahead – have a plan in place for how you’ll cope successfully when faced with a challenge (refer to my Crisis Plan printable for putting a plan in place).
Fact-Checking: Before reacting to powerful emotions, “check the facts.” Tune in to your feelings, assess the situation, and determine if what you think and feel is appropriately matched to the situation. Using this skill can make healthier decisions that consider more than just how we feel in the moment- and these thoughtful, more reasoned responses can help preserve and strengthen our important relationships.
ACCEPTS: The ACCEPTS acronym is a skill employed to temporarily distract from negative emotions. It stands for:
- Activities – find/do an activity you enjoy
- Contribute – help someone else or a community
- Comparisons – reflect on the difference between the self now versus a self in a previous (worse) state
- Emotions – employ an opposite emotion (humor/happiness)
- Pushing away – put the current emotions aside for a moment
- Thoughts – think about something else
- Sensations – do something that brings an intense feeling
Explained A Skill to Someone: Studying and practicing DBT skills works. However, learning is often enhanced and becomes more integrated into our own brains when we explain or teach something to someone else. To scratch off this DBT bingo square, teach a son or daughter about using TIP when they are upset, or explain to a friend why Radical Acceptance works to reduce stress.
Pro’s & Con’s: This refers to pausing and thinking through the positive and negative factors in tolerating/not tolerating distress.
4 Problem-Solving Options: There are four realistic solutions to solving any problem:
- Solve the problem: change or leave the situation
- Feel better about the problem: regulate emotions
- Tolerate the problem: accept/tolerate the problem and your response to it
- Stay miserable: don’t make any changes
PLEASE: PLEASE is a DBT skill that helps remind us to take care of the basics. When we’re feeling especially agitated, despondent, or reactive, taking the time to check in and provide care for our bodies in the following areas can sometimes provide some immediate relief:
- PhysicaL illness – Get good physical care, take prescribed medication, and seek treatment for untreated issues.
- Eating – Eat diverse, nourishing foods, and mindfully reject diet culture messaging to avoid associating food and shame.
- Altering drugs – Avoid mood-altering substances and only take prescribed drugs in the prescribed amounts.
- Sleep – Try to get at least 7 hours of sleep to support physical and mental health.
- Exercise – Move your body. If a full workout feels overwhelming, try just going outdoors for a bit (research indicates it can help).
Mindfulness How Skills: The mindfulness “how” skills describe how one should be mindful: non-judgmentally, one-mindfully, and effectively.
Stop: This is another DBT distress tolerance skill-set, STOP stands for:
- Take a step back
- Observe what’s going on
- Proceed mindfully
Behavior Chain Analysis: This phrase is a complicated way of saying, “Study how your choices impact the responses you get.” Most of us navigate life and relationships by relying mostly on behavior patterns rather than thoughtfully considering every action. For those of us who experienced modeling of dysfunctional behaviors, we may have adopted behavior patterns that work against us. Taking time to study our choices and what happens as a result can help us recognize patterns we’d like to change and begin that work.
FAST: This is a set of skills that can help us to have stronger, more satisfying relationships- and also feel better about ourselves- who doesn’t want that!? FAST stands for:
- Fair – be fair to yourself and others.
- Apologies – when you apologize, be sincere, but don’t apologize more than once.
- Stick to value – stay true to what you believe.
- Truthful – be honest.
IMPROVE: The IMPROVE acronym is a group of skills that can help calm ourselves (or a student, child, client, or customer) when we are feeling very upset. Learn IMPORVE skills to walk through the following:
- Imagery – imagine a calming mental image
- Meaning – find purpose in what is being felt
- Prayer – take a moment to pray or chant a mantra
- Relaxation – use relaxation techniques
- One thing at a time – focus on what is in the present moment
- Vacation – take a break (even 5 minutes can help you respond better to a situation)
- Encouragement – be your own cheerleader
In a dialectical approach, the presence of one thought or feeling doesn’t mean that we cannot also validate and affirm a conflicting or opposite thought. DBT, and specifically dialectical thinking, can help us make space for complexities within the world, our relationships, and within our own internal experiences. As illustrated below, Marsha Linehan lectures on how, in dialectical thinking, one color plus the opposite color doesn’t have to equal a color blend- it can create a pattern or tapestry.
Frequently Asked Questions about DBT
What happens in DBT therapy?
DBT is a therapy model that combines 1:1 treatment with an empathic therapist with classes on specific skills for problem-solving and mindful presence for ourselves and others. Together, these two aspects help improve emotional regulation (i.e., our ability to stay calm in stressful situations or return to calm after being upset) and reduce patterns of behavior, emotion, thinking, and relating (interpersonally) that aren’t actually helpful.
By giving participants skills to increase the quality and satisfaction of personal relationships, DBT can help build support systems that support long-term recovery. DBT approaches treatment through individual therapy, group skills training, a consultation team, and regular phone coaching.
What makes DBT different from other therapies?
For participants, DBT will probably feel different from other therapies because, in addition to one-on-one therapy with a therapist, you’ll also be attending a learning-focused group. You’ll also have access to your therapist (or a therapist they collaborate with), whom you can contact by phone for support on tough days.
In terms of theory, dialectical behavior therapy (DBT) is an adaptation of cognitive behavioral therapy (CBT) that allows for acceptance-based techniques and dialectics (i.e., for multiple perspectives and approaches to be taken in addressing issues).
What is the GIVE skill in DBT?
The GIVE skill-set helps to build and maintain healthy interpersonal relationships, from intimate/close relationships to coworkers. Click here to learn what the DBT acronym GIVE stands for.
What is DBT therapy good for?
It is a form of therapy that is considered helpful for more complex disorders.
What is DEAR MAN in DBT?
Dear Man is a skill-set that can help us grow our ability to communicate and function in healthy relationships. This DBT acronym is one of the original DBT concepts created by Marsha Linehan, who is the original creator of DBT. Click here to learn what the DBT acronym DEAR MAN stands for.