Practice Your Own DBT Skills
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Practice Your Own DBT (Dialectical Behavior Therapy) Skills
By,
Meghan Dow DNP-PMHNP, CARN-AP
What is DBT? Think of it as “Diabolical Behavior Therapy.” Dialectics is the synthesis of opposites, and through understanding various contexts and seeking a workable balance- change is created. Derived from many aspects of Cognitive Behavioral Therapy (CBT), but refocusing on the emotion over the thought to drive the change. The behavioral component of the therapy is focused on development of skill based behaviors. So what can you do?
Mindfulness
Mindfulness is the act of consciously focusing the mind in the present moment, without judgement and without attachment to the moment. You’re choosing to pay attention to this moment without bias. We’re very often thinking about environmental distractions, this is the commitment to not doing this. The mindfulness component of DBT provides a context for exposure to and extinction of previously problematic emotional responses, improves emotional regulation by changing autonomic responses to emotions and changes the person’s relationship to their thoughts as just thoughts rather than truths and increases the individual’s ability to turn their attention to where they chose.
These activities can be ANYTHING that allows you to access this space. For me, this is progressive relaxation. Here are some online resources that list commonly utilized mindfulness activities, if you don’t have one you already use:
Measuring Mindfulness
It’s very important to measure, how are my mindfulness activities going, and how is the use of these activities helping my overall mindfulness. If it’s not working objectively, change it up! Here is well researched and validated tool to do this:
What is the WISE MIND?
When we talk of the Wise Mind with mindfulness in DBT, we’re aiming and can think of this as Walking the Middle Ground. We get here through a two-step process:
Step One: Observe and describe non-judgmentally and ONE-mindfully. Observe and become aware- feelings, thoughts, urges, physical sensations, behaviors, information from senses, environment around me, and the here and now, in this moment. One-mindfully describe without label or judgement. What are the facts, what is- not the “goods” or “bads” or independent perception. Pick the one thing to focus on and begin letting go of the distractions
Step Two: Participate Effectively. A what skills and a how skill. Make a mindful choice about what you are doing. Practice your skills until they are a part of you. Immerse yourself in the experience and presence. Focus on what the experience/situation requires. Remember your goals and what works. Play by the rules, don’t deter from your skills for a situation.
“You can’t wait to feel like it, you can’t wait to be motivated, you can’t wait to be happy and then DO STUFF, those are byproducts of doing them” Lane Pederson PsyD
What this means is that you can’t wait to practice skills until you need them. You wouldn’t play in an Allstar Game having never practiced or played in a regular season game. So practice, practice, practice, then evaluate effectiveness and change what is not working, expand skills that are!
Distress Tolerance
This skills portion is used to tolerate painful events, urges, and emotions when you cannot make things better right away. Ask yourself the following three questions: Am I able to solve the problem? Is now a good time to solve it? Am I in Wise Mind enough to solve it? If any answers are no, move to these skills:
1. Wise Mind ACCEPTS
Activities- what have you enjoyed in the past that you have maybe gotten away from? What are you willing to try? Now, this week, this month
Contributing- Get your eyes off yourself, rewards from achievement and altruism. This does not have to be organized volunteering, hold the door for someone else, listen to a friend, help out a loved one
Comparisons- Not to invalidate yourself, but look at others’ situations for more perspective on your own
Emotions- seek positive emotions, through prior producing experience
Pushing Away- conscious short term avoidance
Thoughts- refocus your thoughts, it’s hard to access two thoughts simultaneously so seek alternative thought and focus on that
Sensations- activate your senses
2. IMPROVE the moment
Imagery- what you are seeking
Meaning- finding an important reason why, why is doing this important?
Prayer
Relaxation
One thing at a time
Vacation- take a break
Encouragement
3. Self Soothe- use the Five Sense Grounding Technique: 5 things I can see, 4 things I can feel, 3 things I can hear, 2 things I can smell, 1 thing I can taste
4. Pros and Cons list- make a four quadrant pros/cons short-term/long-term list
5. Radical Acceptance- Pain + Rejecting Reality = Suffering. We remove the rejecting reality to eliminate the suffering, there is still pain you will experience. But this frees up your emotional ability to heal. True Acceptance is acceptance without negotiating a deal.
6. Willingness- Doing what is needed, dealing with reality, what am I willing to do given the situation?
Emotional Regulation
The goal of emotional regulation is to reduce emotional suffering, not to rid emotions. We need emotions for important functions in our lives. Emotional regulation skills help you to change emotions that you (not other people) want to change or to reduce the intensity of these emotions. Emotional regulation skills can also reduce your vulnerability to becoming extremely or painfully emotional and increase your emotional resilience. Emotional regulation starts with good self care. We can’t access skills, or be emotionally regulated when our needs are not being met. The following acronym helps with this:
Physical Health- what is the exercise I am getting? Could this be increased to better support my emotions? What is my diet like? Eating whole foods, less processed. Anti-inflammatory diets and Mediterranean diet have been proven to improve mood.
List resources and barriers- What resources are you using, what have you used? Then assess barriers to using these resources. For example, you used to meditate every morning and you haven’t meditated in two months. If is was working, what is the barrier to bringing it back into practice.
Eat three balanced meals- try to avoid foods with high sugar, and no nutritional value, foods that you don’t feel good after. Feel free to snack and make them healthy. We should all be eating to nourish our bodies!
Avoid mood altering drugs
Sleep between 7-10 hours a night
Exercise at least 20 minutes a day
Daily
We’re building positive experiences and this too helps shape behavior. Set goals, if not met take steps to meeting them and when you meet them set more. There is no limit to building a great life. We use the opposite to emotion action (O2E). A great example is with fears, the opposite to the emotion is jumping into the fear.
In emotional regulation we are focused on the undesired emotion’s opposite then do skill building to access the opposite emotion, in opposing the undesired emotion we less intensity or eliminate it all together.
Interpersonal Skills
Interpersonal skills help build new relationships, strengthen current relationships, and deal with conflict in relationships. This skills training is based on assertiveness training, about being fair to yourself and others. It is important to the development of self-respect and respect for others.
1. Self-respect effectiveness skill: FAST
Fair- be fair to self and others. Remember fair is not always equal.
Apologies- no unnecessary apologies, or apologies for beliefs, opinions, or being you
Stick to your values- know your values! And what is non-negotiable. Resolve value conflicts effectively
Truthful- avoid exaggerations, excuses and lies. Be accountable to yourself and others
2. Relationship effectiveness skill: GIVE
Genuine- be authentic and real, act from your true self. Be genuine in showing interest in others
Interest- make eye contact, show interest to be interested, allow reciprocity in relationships
Validate- Acknowledge what you heard without judging or fixing. Focus on the other person!
Easy Manner- use humor, smile and be easy going
DBT is a therapy of skill building. We strongly encourage you to work with a professional in developing these skills. And hope these practical implications help you on your journey!
References
Eeles, J. & Walker, DM. (2022). Mindfulness as taught in Dialectical Behaviour Therapy: A scoping review. Clinical Psychology & Psychotherapy, 29, 1843-1853. doi: 10.1002/cpp2764
Linehan, M. M. (2025) DBT Skills Training Handouts and Worksheets: Revised Edition. The Guilford Press.
Pederson, L. (2019) Dialectical Behavior Therapy (DBT) 4-Day Intensive Certification Training Course. [Conference Presentation].