35 DBT Interventions & Resources for Your

Therapy Sessions

Dialectical Behaviour Therapy (DBT) is not your average therapy session; it’s like
a toolbox filled with colourful tools to tame the unruliest of emotions and turn
stress into confetti.

With your clients, you’ll explore the art of mindfulness, allowing them to surf the
waves of thoughts without wiping out. Learn the secret dance of distress
tolerance and shimmy your way through tough situations without breaking a
sweat.

But wait, there’s more! Emotion regulation is a secret superpower. Say goodbye
to emotional chaos and hello to emotional peace. With the skill of interpersonal
effectiveness, your clients will learn to navigate through sticky conversations and
build connections that would make a social butterfly jealous!

In this article, we’ll journey through the transformative world of DBT

interventions, where thoughts become allies and your clients become empowered
to make positive changes in their lives.

This Article Contains

• The Meaning of DBT

• Useful DBT Interventions
• Creative DBT Group Activities
• 4 Other DBT Tools
 • 5 Recommended DBT Workbooks
• DBT Apps & Videos
• PositivePsychology.com’s DBT Resources
• A Take-Home Message

The Meaning of DBT

Dialectical Behavior Therapy (DBT) is a type of psychotherapy that psychologist

Marsha M. Linehan originally developed in the 1980s (Linehan, 1993). It was
initially designed to treat individuals with borderline personality disorder (BPD),
but it has since been found effective in treating a range of other mental health
conditions, including depression, anxiety, eating disorders, substance abuse, and
post-traumatic stress disorder (Chapman, 2006; Bohus et al., 2020).

Linehan noticed an important key to these hard-to-reach clients. She found they
engaged in what she called dichotomous thinking. Also known as “splitting,” this
is the tendency to see the world in black-and-white terms; things are either all
good or all bad (Dimeff & Linehan, 2001).

The crucial problem with this type of thinking is that it gives rise to powerful
emotions, which then can lead to impulsive and maladaptive behaviors. For
example, a person might not agree with something their boss decided, but rather
than taking the time to think through potential solutions, a person with this
thinking style may decide their boss is evil and quit on the spot.

The opposite of this type of thinking is dialectical, or seeing things from multiple
perspectives. Linehan discovered that this was a valuable tool for clients to learn
and understand. Psychological flexibility is critical for overcoming depression and
anxiety.

Linehan also stated that the clinician also needed to embrace a dialectic. In DBT,
this involves finding a balance between accepting and validating the client as they
are, while also encouraging and supporting the need for change and personal
growth (Dimeff & Linehan, 2001).

Useful DBT Interventions

Although DBT was created for and is

primarily used with clients that have
borderline personality disorder,
suicidal ideation, or self-harm, it has
been shown to be very beneficial for
other illnesses as well.
This section will detail some of the best DBT tools for depression and anxiety.

For depression

Dialectical Behaviour Therapy (DBT) can effectively treat depression, particularly

when combined with other evidence-based therapies (Webb et al., 2016). While
DBT as a complete protocol is beneficial, certain tools help with symptoms of
depression specifically.

Mindfulness practices are a cornerstone of DBT and be beneficial in reducing

symptoms of depression (Hofmann & Gómez, 2017). Mindfulness exercises can
help individuals become more aware of their emotions and thoughts, reducing
rumination and negative thinking patterns associated with depression.

DBT practitioners often use behavioural activation techniques to help individuals

with depression engage in activities that bring pleasure and a sense of
accomplishment. Encouraging clients to take part in positive experiences can
counteract the withdrawal and inactivity often associated with depression (Webb
et al., 2016).

Encouraging clients to practice radical acceptance of their current circumstances

and emotions can be helpful, particularly in managing depressive symptoms.
Acceptance can foster a more compassionate approach toward oneself and
reduce self-criticism, which is common in depression.

For borderline personality disorder

DBT was originally created to treat borderline personality disorder. People with
BPD often show signs of dichotomous thinking, self-harm, and difficulty
maintaining healthy relationships (Kliem et al. 2010).

The DBT tools designed to treat these patterns include mindfulness, distress
tolerance, and emotion regulation (Lenz et al., 2016). Each of these includes a set
of tools that provide the client with specific practices designed to reduce harmful
thoughts and impulsive and destructive actions, and improve closeness and
intimacy in relationships (Chapman, 2006).

For anxiety

DBT has also proven to be useful in reducing anxiety. Tools that individuals might
find especially beneficial for anxious symptoms are distress tolerance, emotion
regulation, and coping ahead (Hofmann & Gómez, 2017).

Using distress tolerance skills, such as splashing cold water on your face or
engaging in intense exercise, can provide quick relief from intense anxiety and
often relief from panic attacks.
 DBT also encourages engaging in comforting activities, like taking a warm bath or
using relaxation techniques, that can calm your nervous system during moments
of distress.

Checking the facts is one powerful tool for emotion regulation. Evaluating the
validity of anxious thoughts and challenging cognitive distortions can help you
gain a more balanced perspective.

DBT therapists teach clients how to “cope ahead.” Planning and practicing coping
strategies for future anxiety-provoking situations can increase feelings of
preparedness and decrease anxiety levels. The PLEASE skill teaches clients to take
care of their physical health through healthy mindful eating, regular exercise, and
sufficient sleep, all of which can contribute to reduced anxiety levels.

Creative DBT Group Activities

A critical component of DBT is group therapy. Working in a group helps to

enhance engagement, encourages skill practice, and provides a unique way to
explore emotions and coping strategies.

Here are 10 creative DBT group activities:

1. Emotion collage Ask group members to create collages using images, colours, and
words that represent their emotions or feelings. They can share their collages
with the group and discuss the emotions depicted and potential coping skills.
2. Emotion theatre In small groups, have participants act out various emotions and
practice using opposite actions to handle the feelings effectively.
3. Coping skill charades: Play charades using coping skills as the actions to be
guessed. This activity reinforces coping techniques in a fun and interactive way.
4. Emotion bingo Play a modified version of bingo using emotions instead of
numbers. Participants can share personal experiences related to the emotions
called out.
5. Gratitude journaling Have participants decorate and maintain gratitude journals,
where they regularly write down things they are thankful for.
6. Skill demonstration Encourage group members to demonstrate a specific DBT
skill of their choice and discuss its effectiveness in managing emotions.
7. Emotion artifacts Bring in various objects or artifacts that represent different
emotions. Participants can select an object and share how it relates to their
emotional experiences.
8. Coping skill sculpture Provide craft supplies like modelling clay and ask
participants to create sculptures that represent their favourite coping skills.
9. Role-play scenarios Divide participants into pairs and assign different scenarios
that require the use of DBT skills. They can role-play and then discuss the
outcomes.
10. Inspirational posters Create posters with DBT quotes, mindfulness quotes, or
affirmations to display in the group room, serving as a source of inspiration.

Remember to tailor the activities to the needs and preferences of the group
members and encourage open discussion and sharing throughout each activity.
The goal is to make learning and practicing DBT tools engaging, enjoyable, and
meaningful.

4 Other DBT Tools

Other DBT tools not yet mentioned

include the STOP skill, the IMPROVE
skill, and opposite action. There are
also interpersonal awareness
techniques that help with improving
communication.

Read on for clarification of each and worksheets to help with implementation.

The STOP skill is an emotion regulation technique that is designed to help with
impulse control. The skill comprises the following sequence: stop, take a step
back, observe, and proceed mindfully.

The IMPROVE skill is a distress tolerance technique. It is an acronym that stands

for “imagery, meaning, prayer, relaxation, one thing at a time, vacation, and
encouragement.” The IMPROVE skill is designed to help individuals cope with
intense emotions and distressing situations in a healthier and more constructive
way.

Opposite action is also an emotion regulation technique that teaches the client to
try doing the opposite of what their emotion is urging them to do. For example,
shame may be an emotion that causes us to hide. The opposite action would be to
stick around, make eye contact, and show confidence.

DBT has many useful techniques to help with interpersonal effectiveness. One
such tool is DEAR MAN. This tool helps when someone is struggling to have a
difficult conversation. Using the tool to outline exactly what you would like to say
is helpful. The acronym stands for:

• Describe the problem.

• Express your feelings.
• Assert what you’d like.
 • Reinforce how it would benefit the other person.
• Mindfully be aware of your impact on the other person.
• Appear confident.
• Negotiate and be willing to compromise.

5 Recommended DBT Workbooks

Workbooks are a common tool used in DBT. As clients are learning many new
skills, it can be helpful to have them available to practice outside of sessions.
Listed below are some of the best workbooks currently available.

1. The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises for
Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and
Distress Tolerance – Matthew McKay, Jeffrey C. Wood, and Jeffrey Brantley
This is a DBT workbook with a high recommendation and that is
very commonly used by therapists.

This thorough workbook introduces the four key skills of DBT:

distress tolerance, mindfulness, emotion regulation, and
interpersonal effectiveness.

The workbook introduces these concepts in an introductory way, giving step-by-

step instructions and practice, and works the reader up to more advanced
practices.While DBT was originally created for borderline personality disorder, it
has been shown to be effective in treating many other mental health challenges.

2. DBT Workbook for Adult ADHD and Anxiety: A Practical Guide With Dialectical
Behavior Techniques and Coping Skills to Overcome a Scattered Brain, Improve
Focus, and Achieve Optimal Mental Performance – Janet Willow

For individuals with attention deficit hyperactivity disorder

(ADHD), DBT can offer some support.

While DBT is not a cure for ADHD, it can provide individuals with
skills that can reduce anxiety, increase positive coping skills, and
help change maladaptive thoughts and behaviours.

This workbook applies DBT skills to the unique challenges experienced by adults
with ADHD.

3. DBT Workbook for PTSD: Proven Psychological Techniques for Managing Trauma
& Emotional Healing with Dialectical Behavior Therapy – Barrett Huang
 Similarly, individuals with post-traumatic stress disorder (PTSD)
can also benefit from many of the skills taught by DBT. PTSD can
cause nightmares, insomnia, panic attacks, and negative thought
processes. This workbook provides exercises, routines, and
worksheets that can help reduce some of these symptoms.

4. Depressed & Anxious: The Dialectical Behavior Therapy Workbook for

Overcoming Depression & Anxiety – Thomas Marra

For those who experience depression and anxiety, learning DBT

techniques can offer some relief. The workbook Depressed &
Anxious teaches individuals how to identify the thoughts that
underlie depression and anxiety. The workbook offers
mindfulness techniques that help provide support for those who
feel their emotions are overwhelming and have lost motivation or
meaning in their lives.

5. The Neurodivergent Friendly Workbook of DBT Skills – Sonny Jane Wise

Individuals with neurodivergent brains, such as those with autism,

ADHD, or high sensitivity to environmental stimuli, may find that
DBT skills do not feel accessible.

This book, written by Sonny Jane Wise, is a workbook created

specifically for those who experience autistic characteristics such
as stimming, meltdowns, and sensory sensitivities.

The author has personal experience and has created a workbook that addresses
the unique needs of this population.

DBT Apps & Videos

DBT Coach

DBT Coach is a comprehensive and popular app for learning DBT techniques and
maintaining practice.

This app provides video lessons and animations to help users remember their
skills. There are over 100 exercises, and the app allows users to track their
progress.
This app also can connect clinicians and clients. Clinicians can sign up to track
their client’s progress and respond in real time. Clients can share their diary cards
where they list what skills they are learning and practicing.

DBT Diary Card and Skills Coach

DBT Diary Card and Skills Coach was created by a clinical

psychologist trained directly by Marsha Linehan.

This app provides diary cards, an important component of

DBT practice, skills practice, a behavior tracker, and
coaching.

DBT Travel Guide

DBT Travel Guide is an app created for folks with BPD. The
user interface is simple and easy to use.

This app offers hundreds of skill practices and an option for

a diary card. The behavioral chain analysis is one
component that is well liked by subscribers.

Marsha Linehan, creator of DBT, has a series of 27 short videos (two to three
minutes each) that break down the process of DBT and review each of the skills in
detail. In the excerpt below, she discusses how she came to develop DBT.
PositivePsychology.com’s DBT Resources

We have a wide selection of resources that pertain to DBT therapy, and you might
enjoy setting out with this selection of recommended articles.

Recommended reading

To learn more about DBT and find our specialized materials:

20 DBT Worksheets and Dialectical Behavior Therapy Skills.

Distress tolerance is a crucial part of DBT skills training. Our What Are Distress
Tolerance Skills? article focuses on this important aspect and also provides great
tools.

Want to become trained as a DBT practitioner? Then we have the answer for you
in this How-to Train in DBT article, which includes everything you need.
Useful tools

Radical acceptance is an important distress tolerance skill that is taught in DBT.

This skill helps individuals learn to accept reality as it is, rather than how they
wish it could be. This tool provides a client with step-by-step instructions to
arrive at acceptance.

Emotional intelligence is the ability to understand the emotions that you are
feeling and how they might be affecting behaviour. This tool helps clients begin
the process by naming and describing emotions.

Becoming skilled at interpersonal effectiveness requires practising

communication skills. This communication tool will help clients practice
introducing themselves and a partner or friend to a group and reflect on how it
felt and what they could improve.

Mindfulness is also a very important component of DBT. If you’re looking for more
science-based ways to help others enjoy the benefits of mindfulness, check out
this collection of 17 validated mindfulness tools for practitioners. Use them to help
others reduce stress and create positive shifts in their mental, physical, and
emotional health.

A Take-Home Message

DBT offers a treasure trove of evidence-based coping skills to empower

individuals on their journey to emotional well-being.

The magic of DBT lies in its ability to transform distress into growth, emotional
chaos into harmony, and turbulent relationships into meaningful connections. As
clinicians and clients delve into this therapeutic adventure, they discover the
power of self-awareness, the art of effective communication, and the strength to
embrace emotions without judgment.

With DBT as their compass, individuals chart a course toward a life filled with
authentic empowerment, balance, and the joy of writing their narrative.

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