Reproducible Materials: DBT® Skills Training Manual, Second Edition

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General Skills: Orientation and Analyzing Behavior

General Handouts

Orientation Handouts

General Handout 1: Goals of Skills Training

General Handout 1a: Options for Solving Any Problem

General Handout 2: Overview—Introduction to Skills Training

General Handout 3: Guidelines for Skills Training

General Handout 4: Skills Training Assumptions

General Handout 5: Biosocial Theory

Handouts for Analyzing Behavior

General Handout 6: Overview—Analyzing Behavior

General Handout 7: Chain Analysis

General Handout 7a: Chain Analysis, Step by Step

General Handout 8: Missing-Links Analysis

Mindfulness Skills

Mindfulness Handouts

Handouts for Goals and Denitions

Mindfulness Handout 1: Goals of Mindfulness Practice

Mindfulness Handout 1a: Mindfulness Denitions

Handouts for Core Mindfulness Skills

Mindfulness Handout 2: Overview—Core Mindfulness Skills

Mindfulness Handout 3: Wise Mind—States of Mind

Mindfulness Handout 3a: Ideas for Practicing Wise Mind

Mindfulness Handout 4: Taking Hold of Your Mind—“What” Skills

Mindfulness Handout 4a: Ideas for Practicing Observing

Mindfulness Handout 4b: Ideas for Practicing Describing

Mindfulness Handout 4c: Ideas for Practicing Participating

Mindfulness Handout 5: Taking Hold of Your Mind—“How” Skills

Mindfulness Handout 5a: Ideas for Practicing Nonjudgmentalness

Mindfulness Handout 5b: Ideas for Practicing One- Mindfulness

Mindfulness Handout 5c: Ideas for Practicing Effectiveness

Handouts for Other Perspectives onMindfulness Skills

Mindfulness Handout 6: Overview—Other Perspectives on Mindfulness

Mindfulness Handout 7: Goals of Mindfulness Practice—A Spiritual Perspective

Mindfulness Handout 7a: Wise Mind from a Spiritual Perspective

iii

CONTENTS

Mindfulness Handout 8: Practicing Loving Kindness to Increase

LoveandCompassion

Mindfulness Handout 9: Skillful Means—Balancing Doing Mind andBeing Mind

Mindfulness Handout 9a: Ideas for Practicing Balancing Doing Mind andBeing

Mind

Mindfulness Handout 10: Walking the Middle Path—Finding the Synthesis

between Opposites

Interpersonal Effectiveness Skills

Interpersonal EffectivenessHandouts

Handouts for Goals and Factors ThatInterfere

Interpersonal Effectiveness Handout 1: Goals of Interpersonal Effectiveness

Interpersonal Effectiveness Handout 2: Factors in the Way ofInterpersonal

Effectiveness

Interpersonal Effectiveness Handout 2a: Myths in the Way ofInterpersonal

Effectiveness

Handouts for Obtaining ObjectivesSkillfully

Interpersonal Effectiveness Handout 3: Overview—ObtainingObjectivesSkillfully

Interpersonal Effectiveness Handout 4: Clarifying Goals inInterpersonal

Situations

Interpersonal Effectiveness Handout 5: Guidelines for Objectives Effectiveness—

GettingWhat You Want

Interpersonal Effectiveness Handout 5a: Applying DEAR MAN Skills toaDifcult

CurrentInteraction

Interpersonal Effectiveness Handout 6: Guidelines forRelationship

Effectiveness—Keepingthe Relationship

Interpersonal Effectiveness Handout 6a: Expanding the V in GIVE—Levels of

Validation

Interpersonal Effectiveness Handout 7: Guidelines for Self- Respect

Effectiveness—KeepingRespect for Yourself (FAST)

Interpersonal Effectiveness Handout 8: Evaluating Options forWhether or How

Intensely to Ask for Something or Say No

Interpersonal Effectiveness Handout 9: Troubleshooting—WhenWhat You Are

Doing Isn’t Working

Handouts for Building Relationships and Ending Destructive Ones

Interpersonal Effectiveness Handout 10: Overview—BuildingRelationships and

Ending Destructive Ones

Interpersonal Effectiveness Handout 11: Finding and Getting People toLike You

Interpersonal Effectiveness Handout 11a: Identifying Skills to Find People and Get

Them toLike You

Interpersonal Effectiveness Handout 12: Mindfulness of Others

Interpersonal Effectiveness Handout 12a: Identifying Mindfulness ofOthers

Interpersonal Effectiveness Handout 13: Ending Relationships

Interpersonal Effectiveness Handout 13a: Identifying How toEndRelationships

Handouts for Walking the Middle Path

Interpersonal Effectiveness Handout 14: Overview—Walking theMiddle Path

Interpersonal Effectiveness Handout 15: Dialectics

Interpersonal Effectiveness Handout 16: How to Think and Act Dialectically

Interpersonal Effectiveness Handout 16a: Examples of Opposite Sides That Can

Both Be True

Interpersonal Effectiveness Handout 16b: Important Opposites toBalance

Interpersonal Effectiveness Handout 16c: Identifying Dialectics

Interpersonal Effectiveness Handout 17: Validation

Interpersonal Effectiveness Handout 18: A “How To” Guide toValidation

Interpersonal Effectiveness Handout 18a: Identifying Validation

Interpersonal Effectiveness Handout 19: Recovering from Invalidation

Interpersonal Effectiveness Handout 19a: Identifying Self- Validation

Interpersonal Effectiveness Handout 20: Strategies forIncreasing theProbability

ofBehaviors You Want

Interpersonal Effectiveness Handout 21: Strategies for Decreasing or Stopping

UnwantedBehaviors

Interpersonal Effectiveness Handout 22: Tips for Using Behavior Change

StrategiesEffectively

Interpersonal Effectiveness Handout 22a: Identifying Effective Behavior Change

Strategies

Emotion RegulationSkills

Emotion RegulationHandouts

Emotion Regulation Handout 1: Goals of Emotion Regulation

Handouts for Understanding andNaming Emotions

Emotion Regulation Handout 2: Overview—

Understanding andNaming Emotions

Emotion Regulation Handout 3: What Emotions Do for You

Emotion Regulation Handout 4: What Makes It Hard to Regulate YourEmotions

Emotion Regulation Handout 4a: Myths about Emotions

Emotion Regulation Handout 5: Model for Describing Emotions

Emotion Regulation Handout 6: Ways to Describe Emotions

Handouts for Changing EmotionalResponses

Emotion Regulation Handout 7: Overview—Changing Emotional Responses

Emotion Regulation Handout 8: Check the Facts

Emotion Regulation Handout 8a: Examples of Emotions That Fit theFacts

Emotion Regulation Handout 9: Opposite Action andProblemSolving—

DecidingWhich to Use

Emotion Regulation Handout 10: Opposite Action

Emotion Regulation Handout 11: Figuring Out Opposite Actions

Emotion Regulation Handout 12: Problem Solving

Emotion Regulation Handout 13: Reviewing Opposite Action andProblem Solving

Handouts for Reducing Vulnerability toEmotion Mind

Emotion Regulation Handout 14: Overview—Reducing Vulnerability

toEmotionMind: Building a Life Worth Living

Emotion Regulation Handout 15: Accumulating Positive Emotions—

Short Term

Emotion Regulation Handout 16: Pleasant Events List

Emotion Regulation Handout 17: Accumulating Positive Emotions—

Long Term

Emotion Regulation Handout 18: Values and Priorities List

Emotion Regulation Handout 19: Build Mastery and Cope Ahead

Emotion Regulation Handout 20: Taking Care of Your Mind by Taking Care of

Your Body

Emotion Regulation Handout 20a: Nightmare Protocol, StepbyStep—

WhenNightmares Keep You from Sleeping

Emotion Regulation Handout 20b: Sleep Hygiene Protocol

Handouts for Managing Really Difcult Emotions

Emotion Regulation Handout 21: Overview—Managing Really Difcult Emotions

Emotion Regulation Handout 22: Mindfulness of Current Emotions—Letting Go

of Emotional Suffering

Emotion Regulation Handout 23: Managing Extreme Emotions

Emotion Regulation Handout 24: Troubleshooting Emotion RegulationSkills—

WhenWhat You Are Doing Isn’t Working

Emotion Regulation Handout 25: Review of Skills forEmotionRegulation

Distress Tolerance Skills

Distress Tolerance Handouts

Distress Tolerance Handout 1: Goals of Distress Tolerance

Handouts for Crisis Survival Skills

Distress Tolerance Handout 2: Overview—Crisis Survival Skills

Distress Tolerance Handout 3: When to Use Crisis Survival Skills

Distress Tolerance Handout 4: The STOP Skill

Distress Tolerance Handout 5: Pros and Cons

Distress Tolerance Handout 6: TIP Skills—Changing Your Body Chemistry

Distress Tolerance Handout 6a: Using Cold Water, Step by Step

Distress Tolerance Handout 6b: Paired Muscle Relaxation, Step by Step

Distress Tolerance Handout 6c: Effective Rethinking and Paired Relaxation, Step

by Step

Distress Tolerance Handout 7: Distracting

Distress Tolerance Handout 8: Self- Soothing

Distress Tolerance Handout 8a: Body Scan Meditation Step by Step

Distress Tolerance Handout 9: Improving the Moment

Distress Tolerance Handout 9a: Sensory Awareness, Step by Step

Handouts for Reality AcceptanceSkills

Distress Tolerance Handout 10: Overview—Reality Acceptance Skills

Distress Tolerance Handout 11: Radical Acceptance

Distress Tolerance Handout 11a: Radical Acceptance—Factors That Interfere

Distress Tolerance Handout 11b: Practicing Radical Acceptance Step byStep

Distress Tolerance Handout 12: Turning the Mind

Distress Tolerance Handout 13: Willingness

Distress Tolerance Handout 14: Half- Smiling and Willing Hands

Distress Tolerance Handout 14a: Practicing Half- Smiling andWillingHands

Distress Tolerance Handout 15: Mindfulness of Current Thoughts

Distress Tolerance Handout 15a: Practicing Mindfulness of Thoughts

Handouts for Skills When the Crisis IsAddiction

Distress Tolerance Handout 16: Overview—When the Crisis IsAddiction

Distress Tolerance Handout 16a: Common Addictions

Distress Tolerance Handout 17: Dialectical Abstinence

Distress Tolerance Handout 17a: Planning for Dialectical Abstinence

Distress Tolerance Handout 18: Clear Mind

Distress Tolerance Handout 18a: Behavior Patterns Characteristic ofAddict Mind

and of Clean Mind

Distress Tolerance Handout 19: Community Reinforcement

Distress Tolerance Handout 20: Burning Bridges and Building NewOnes

Distress Tolerance Handout 21: Alternate Rebellion andAdaptiveDenial

vii

General Handouts

Orientation Handouts

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



General Handout 1

(General Worksheet 1; p. 27 )

Goals of Skills Training

GENERAL GOAL

To learn how to change your own behaviors, emotions, and thoughts

that are linked to problems in living and are causing misery and distress.

SPECIFIC GOALS

Behaviors to Decrease:

 Mindlessness; emptiness; being out of touch with self and others; judgmentalness.

 Interpersonal conﬂict and stress; loneliness.

 Absence of ﬂexibility; difﬁculties with change.

 Up-and-down and extreme emotions; mood- dependent behavior; difﬁculties in regulating

emotions.

 Impulsive behaviors; acting without thinking; difﬁculties accepting reality as it is; willfulness;

addiction.

Skills to Increase:

 Mindfulness skills.

 Interpersonal effectiveness skills.

 Emotion regulation skills.

 Distress tolerance skills.

PERSONAL GOALS

Behaviors to Decrease:

Skills to Increase:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



General Handout 1a

Options for Solving Any Problem

When life presents you with problems, what are your options?

1. SOLVE THE PROBLEM

Change the situation . . . or avoid, leave, or get out of the situation for good.

2. FEEL BETTER ABOUT THE PROBLEM

Change (or regulate) your emotional response to the problem.

3. TOLERATE THE PROBLEM

Accept and tolerate both the problem and your response to the problem.

4. STAY MISERABLE

Or possibly make it worse!

1. TO PROBLEM-SOLVE:

Use interpersonal effectiveness skills

Walking the Middle Path (from interpersonal effectiveness skills)

Use problem- solving skills (from emotion regulation skills)

2. TO FEEL BETTER ABOUT THE PROBLEM:

Use emotion regulation skills

3. TO TOLERATE THE PROBLEM:

Use distress tolerance and mindfulness skills

4. TO STAY MISERABLE:

Use no skills!

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

General Handout 2

Overview:

Introduction to Skills Training

GUIDELINES FOR SKILLS TRAINING

SKILLS TRAINING ASSUMPTIONS

BIOSOCIAL THEORY

OF EMOTIONAL AND

BEHAVIORAL DYSREGULATION

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



General Handout 3

Guidelines for Skills Training

1. Participants who drop out of skills training are

not

out of skills training.

a. The only way out is to miss four scheduled sessions of skills training in a row.

2. Participants who join the skills training group support each other and:

a. Keep names of other participants and information obtained during sessions conﬁdential.

b. Come to each group session on time and stay until the end.

c. Make every effort to practice skills between sessions.

d. Validate each other, avoid judging each other, and assume the best about each other.

e. Give helpful, noncritical feedback when asked.

f. Are willing to accept help from a person they ask or call for help.

3. Participants who join the skills training group:

a. Call ahead of time if they are going to be late or miss a session.

4. Participants do not tempt others to engage in problem behaviors and:

a. Do not come to sessions under the inﬂuence of drugs or alcohol.

b. If drugs or alcohol have already been used, come to sessions acting and appearing clean

and sober.

c. Do not discuss, inside or outside sessions, current or past problem behaviors that could be

contagious to others.

5. Participants do not form conﬁdential relationships with each other outside of skills

training sessions and:

a. Do not start a sexual or a private relationship that cannot be discussed in group.

b. Are not partners in risky behaviors, crime, or drug use.

Other guidelines for this group/notes:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



General Handout 4

Skills Training Assumptions

An assumption is a belief that cannot be proved,

but we agree to abide by it anyway.

1. People are doing the best they can.

All people at any given point in time are doing the best they can.

2. People want to improve.

The common characteristic of all people is that they want to improve their lives and be happy.

3. People need to do better, try harder, and be more motivated to change.*

The fact that people are doing the best they can, and want to do even better, does not mean

that these things are enough to solve the problem.

4. People may not have caused all of our own problems, but they have to solve them

anyway.**

People have to change their own behavioral responses and alter their environment for their life

to change.

5. New behavior has to be learned in all relevant contexts.

New behavioral skills have to be practiced in the situations where the skills are needed, not just

in the situation where the skills are ﬁrst learned.

6. All behaviors (actions, thoughts, emotions) are caused.

There is always a cause or set of causes for our actions, thoughts, and emotions, even if we do

not know what the causes are.

7. Figuring out and changing the causes of behavior work better than judging and blaming.

Judging and blaming are easier, but if we want to create change in the world, we have to

change the chains of events that cause unwanted behaviors and events.

*But trying harder and being more motivated may not be needed if progress is steady and at a realistic rate of improvement.

**Parents and caregivers must assist children in this task.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

General Handout 5 (p. 1 of 2)

Biosocial Theory

Why do I have so much trouble controlling

my emotions and my actions?

Emotional vulnerability is BIOLOGICAL:

It’s simply how some people are born.

 They are more

sensitive

to emotional stimuli; they can detect subtle

emotional information in the environment that others don’t even notice.

 They experience emotions

much more often

than others.

 Their emotions seem to hit for no reason, from

out of the blue.

 They have more

intense

emotions.

 Their emotions hit like a

ton of bricks

 And their emotions are

long- lasting

Impulsivity also has a BIOLOGICAL basis:

Regulating action is harder for some than for others.

 They ﬁnd it

very hard to restrain

impulsive behaviors.

 Often, without thinking, they do things that

get them in trouble.

 Sometimes their

behavior

seems to

come out of nowhere.

 They ﬁnd it very

hard to be effective

 Their moods get in the way of

organizing

to achieve their goals.

 They

cannot control

behaviors linked to their moods.

(

continued on next page

)

General Handout 5 (p. 2 of 2)

An invalidating SOCIAL environment

can make it very hard to regulate emotions.

 An invalidating environment doesn’t seem to understand your emotions.

 It tells you your emotions are

invalid, weird, wrong,

bad

 It often

ignores

your emotional reactions and does nothing to help you.

 It may say things like “Don’t be such a baby!” “Quit your blubbering.” “Quit

being such a chicken and just solve the problem.” or “Normal people don’t

get this frustrated.”

 People who invalidate are OFTEN DOING THE BEST THEY CAN.

 They

may not know

how to validate or how important it is to validate, or

they

may be afraid

that if they validate your emotions, you will get more

emotional, not less.

 They

may be under high stress

or time pressure, or they may have too

few resources themselves.

 There may be just a

poor ﬁt

between you and your social environment:

You may be a tulip in a rose garden.

An ineffective SOCIAL environment

is a big problem when you want

to learn to regulate emotions and actions.

 Your environment may

reinforce out-of- control emotions and actions.

 If people give in when you get out of control, it will be hard for you to get in

control.

 If others command you to change, but don’t coach you on how to do this,

it will be hard to keep on trying to change.

It’s the TRANSACTIONS that count

between the person and the social environment.

 Biology and the social environment inﬂuence the person.

 The person reciprocates and inﬂuences his or her social environment.

 The social environment reciprocates and inﬂuences the person.

 And so on and on and on.

Handouts for Analyzing Behavior

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

General Handout 6

(General Worksheets 2, 3; pp. 31, 38 )

Overview:

Analyzing Behavior

To ﬁgure out its causes

and plan for problem solving.

Chain Analysis

is for when you engage in ineffective behavior.

A chain analysis examines the chain of events that leads to

ineffective behaviors, as well as the consequences of those

behaviors that may be making it hard to change them. It also

helps you ﬁgure out how to repair the damage.

Missing-Links Analysis

is for when you fail to engage in effective behaviors.

A missing-links analysis helps you identify what got in the way of

doing things you needed or hoped to do, things you agreed to do,

or things others expected you to do. It also helps you problem-

solve for the future.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

General Handout 7

(General Worksheets 2, 2a; pp. 31, 35 )

Chain Analysis

TO UNDERSTAND BEHAVIOR, DO A CHAIN ANALYSIS.

Step 1: Describe the PROBLEM BEHAVIOR.

Step 2: Describe the PROMPTING EVENT that started the chain of events leading to the problem

behavior.

Step 3: Describe the factors happening before the event that made you VULNERABLE to starting

down the chain of events toward the problem behavior.

Step 4: Describe in excruciating detail the CHAIN OF EVENTS that led to the problem behavior.

Step 5: Describe the CONSEQUENCES of the problem behavior.

To change behavior:

Step 6: Describe SKILLFUL behaviors to replace problem links in the chain of events.

Step 7: Develop PREVENTION PLANS to reduce vulnerability to stressful events.

Step 8: REPAIR important or signiﬁcant consequences of the problem behavior.

VULNERABILITY

PROMPTING EVENT

LINKS

CONSEQUENCES

PROBLEM BEHAVIOR

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

General Handout 7a (p. 1 of 2)

(General Worksheets 2, 2a; pp. 31, 35 )

Chain Analysis, Step by Step

1. Describe the speciﬁc PROBLEM BEHAVIOR (overeating or overdrinking, yelling at your

kids, throwing a chair, having an overwhelming emotional outburst, dissociating, not coming or

coming late to skills training, putting off or refusing to do skills practice, etc.).

A. Be very speciﬁc and detailed. No vague terms.

B. Identify exactly what you did, said, thought, or felt (if feelings are the targeted problem

behavior). Identify what you did not do.

C. Describe the intensity of the behavior and other characteristics of the behavior that are

important.

D. Describe the problem behavior in enough detail that an actor in a play or movie could

recreate the behavior exactly.

E. If the behavior is something you did not do, ask yourself whether (a) you did not know you

needed to do it (it did not get into short-term memory); (b) you forgot it and later it never

came into your mind to do it (it did not get into long-term memory); (c) you put it off when

you did think of it; (d) you refused to do it when you thought of it; or (e) you were willful and

rejected doing it, or some other behavior, thoughts, or emotions interfered with doing it. If (a)

or (b) is the case, skip from here to Step 6 below (working on solutions). Otherwise, keep

going from here.

2. Describe the speciﬁc PROMPTING EVENT that started the whole chain of behavior. Begin

with the environmental event that started the chain. Always begin with some event in your

environment, even if it doesn’t seem to you that the environmental event “caused” the problem

behavior. Otherwise, we could ask about any behavior, thought, feeling, or experience, “What

prompted that?” Possible questions to help you get at this are:

A. What exact event precipitated the start of the chain reaction?

B. When did the sequence of events that led to the problem behavior begin? When did the

problem start?

C. What was going on right before the thought of or impulse for the problem behavior occurred?

D. What were you doing/thinking/feeling/imagining at that time?

E. Why did the problem behavior happen on that day instead of the day before?

3. Describe speciﬁc VULNERABILITY FACTORS happening before the prompting event.

What factors or events made you more vulnerable to reacting to the prompting event with a

problematic chain? Areas to examine are:

A. Physical illness; unbalanced eating or sleeping; injury.

B. Use of drugs or alcohol; misuse of prescription drugs.

C. Stressful events in the environment (either positive or negative).

D. Intense emotions, such as sadness, anger, fear, loneliness.

E. Previous behaviors of your own that you found stressful coming into your mind.

(

continued on next page

)

General Handout 7a (p. 2 of 2)

4. Describe in excruciating detail the CHAIN OF EVENTS that led to the problem behavior.

Imagine that your problem behavior is chained to the precipitating event in the environment.

How long is the chain? Where does it go? What are the links? Write out all links in the chain of

events, no matter how small. Be very speciﬁc, as if you are writing a script for a play. Links in

the chain can be:

A. Actions or things you do.

B. Body sensations or feelings.

C. Cognitions (i.e., beliefs, expectations, or thoughts).

D. Events in the environment or things others do.

E. Feelings and emotions that you experience.

What exact thought (or belief), feeling, or action followed the prompting event? What thought,

feeling, or action followed that? What next? What next? And so forth.

• Look at each link in the chain after you write it. Was there another thought, feeling, or action

that could have occurred? Could someone else have thought, felt, or acted differently at that

point? If so, explain how that speciﬁc thought, feeling, or action came to be.

• For each link in the chain, ask whether there is a smaller link you could describe.

5. Describe the CONSEQUENCES of this behavior. Be speciﬁc. (How did other people react

immediately and later? How did you feel immediately following the behavior? Later? What effect

did the behavior have on you and your environment?)

6. Describe in detail at each point where you could have used a

skillful

behavior to head off the

problem behavior. What key links were most important in leading to the problem behavior? (In

other words, if you had eliminated these behaviors, the problem behavior probably would not

have happened.)

A. Go back to the chain of behaviors following the prompting event. Circle each link where, if

you had done something different, you would have avoided the problem behavior.

B. What could you have done differently at each link in the chain of events to avoid the problem

behavior? What coping behaviors or skillful behaviors could you have used?

7. Describe in detail a PREVENTION STRATEGY for how you could have kept the chain from

starting by reducing your vulnerability to the chain.

8. Describe what you are going to do to REPAIR important or signiﬁcant consequences of the

problem behavior.

A. Analyze: What did you really harm? What was the negative consequence you can repair?

B. Look at the harm or distress you actually caused others, and the harm or distress you

caused yourself. Repair what you damaged. (Don’t bring ﬂowers to repair a window you

broke: ﬁx the window! Repair a betrayal of trust by being very trustworthy long enough to ﬁt

the betrayal, rather than trying to ﬁx it with love letters and constant apologies. Repair failure

by succeeding, not by berating yourself.)

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

General Handout 8

(General Worksheet 3; p. 38 )

Missing-Links Analysis

Ask the following questions to understand how and why

effective behavior that is needed or expected did not occur.

1. Did you know what effective behavior was needed or expected (what skills

homework was given, what skills to use, etc.)?

IF NO to Question 1, ask what got in the way of knowing what was needed or expected.

Ideas might include not paying attention, unclear instructions, never getting the instructions

in the ﬁrst place, becoming too overwhelmed and couldn’t process the information, and so

on.

PROBLEM-SOLVE what got in the way. For example, you might work on paying

attention, ask for clariﬁcation when you don’t understand instructions, call others, look

up information, and so on.

2. IF YES to Question 1, ask were you willing to do the needed or expected effective

behavior?

IF NO to Question 2, ask what got in the way of willingness to do effective behaviors.

Ideas might include willfulness, feeling inadequate, or feeling demoralized.

PROBLEM-SOLVE what got in the way of willingness. For example, you might practice

radical acceptance, do pros and cons, practice opposite action, and so on.

3. IF YES to Question 2, ask did the thought of doing the needed or expected effective

behavior ever enter your mind?

IF NO to Question 3,

PROBLEM-SOLVE how to get the thought of doing effective behaviors into your mind.

For example, you might put it on your calendar, set your alarm to go off, put your skills

notebook next to your bed, practice coping ahead with difﬁcult situations (see Emotion

Regulation Handout 19), and so on.

4. IF YES to Question 3, ask what got in the way of doing the needed or expected

effective behavior right away? Ideas might include putting it off, continuing to

procrastinate, not being in the mood, forgetting how to do what was needed, thinking that

no one would care anyway (or no one would ﬁnd out), and so on.

PROBLEM-SOLVE what got in the way. For example, you might set a reward for doing

what is expected, practice opposite action, do pros and cons, and so on.

Mindfulness Handouts

Handouts for Goals and Denitions

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



Mindfulness Handout 1

(Mindfulness Worksheet 1; p. 77 )

Goals of Mindfulness Practice

REDUCE SUFFERING AND INCREASE HAPPINESS

 Reduce pain, tension, and stress.

 Other:

INCREASE CONTROL OF YOUR MIND

 Stop letting your mind be in control of you.

 Other:

EXPERIENCE REALITY AS IT IS

 Live life with your eyes wide open.

 Experience the reality of your . . .

• connection to the universe.

• essential “goodness.”

• essential validity.

 Other:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

Mindfulness Handout 1a

Mindfulness Deﬁnitions

WHAT IS MINDFULNESS?

• Intentionally living with awareness in the present moment.

(Waking up from automatic or rote behaviors to participate and be present to our own lives.)

• Without judging or rejecting the moment.

(Noticing consequences, discerning helpfulness and harmfulness—but letting go of evaluating,

avoiding, suppressing, or blocking the present moment.)

• Without attachment to the moment.

(Attending to the experience of each new moment, rather than ignoring the present by clinging

to the past or grabbing for the future.)

WHAT ARE MINDFULNESS SKILLS?

• Mindfulness skills are the speciﬁc behaviors to practice that, when put together, make up

mindfulness.

WHAT IS MINDFULNESS PRACTICE?

• Mindfulness and mindfulness skills can be practiced at any time, anywhere, while doing

anything. Intentionally paying attention to the moment, without judging it or holding on to it, is all

that is needed.

• Meditation is practicing mindfulness and mindfulness skills while sitting, standing, or lying

quietly for a predetermined period of time. When meditating, we focus the mind (for example,

we focus on body sensations, emotions, thoughts, or our breath), or we open the mind (paying

attention to whatever comes into our awareness). There are many forms of meditation that differ

mostly by whether we are opening the mind or focusing the mind—and, if focusing, depending

on what is the focus of our attention.

• Contemplative prayer (such as Christian centering prayer, the rosary, Jewish Shema, Islamic

Suﬁ practice, or Hindu raja yoga) is a spiritual mindfulness practice.

• Mindfulness movement also has many forms. Examples include yoga, martial arts (such as

Qigong, tai chi, akido, and karate), and spiritual dancing. Hiking, horseback riding, and walking

can also be ways to practice mindfulness.

Handouts for Core Mindfulness Skills

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

Mindfulness Handout 2

(Mindfulness Worksheets 2–2c, 3; pp. 78–83 )

Overview:

Core Mindfulness Skills

WISE MIND:

STATES OF MIND

“WHAT” SKILLS

(what you do when practicing mindfulness):

Observing, Describing, Participating

“HOW” SKILLS

(how you practice when practicing mindfulness):

Nonjudgmentally, One- Mindfully, Effectively

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



Mindfulness Handout 3

(Mindfulness Worksheet 3; p. 83 )

Wise Mind:

States of Mind

EMOTION

MIND

REASONABLE

MIND

WISE

MIND

Reasonable Mind Is:

Cool

Rational

Task-Focused

When in reasonable mind,

you are ruled by facts, reason,

logic, and pragmatics. Values

and feelings are not important.

Emotion Mind Is:

Hot

Mood-Dependent

Emotion-Focused

When in emotion mind,

you are ruled by your

moods, feelings, and urges

to do or say things. Facts,

reason, and logic are not

important.

Wise Mind Is:

The wisdom within

each person

Seeing the value of

both reason and

emotion

Bringing left brain and

right brain together

The middle path

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

Mindfulness Handout 3a (p. 1 of 2)

(Mindfulness Worksheet 3; p. 83 )

Ideas for Practicing Wise Mind

The mindfulness skills often require a lot of practice. As with any new skill, it is important to ﬁrst

practice when you don’t need the skill. If you practice in easier situations, the skill will become

automatic, and you will have the skill when you need it. Practice with your eyes closed and with

your eyes open.

1.  Stone flake on the lake. Imagine that you are by a clear blue lake on a beautiful sunny day.

Then imagine that you are a small flake of stone, flat and light. Imagine that you have been

tossed out onto the lake and are now gently, slowly, floating through the calm, clear blue

water to the lake’s smooth, sandy bottom.

• Notice what you see, what you feel as you ﬂoat down, perhaps in slow circles, ﬂoating

toward the bottom. As you reach the bottom of the lake, settle your attention there within

yourself.

• Notice the serenity of the lake; become aware of the calmness and quiet deep within.

• As you reach the center of your self, settle your attention there.

2. Walking down the spiral stairs. Imagine that within you is a spiral staircase, winding down

to your very center. Starting at the top walk very slowly down the staircase, going deeper

and deeper within yourself.

• Notice the sensations. Rest by sitting on a step, or turn on lights on the way down if you

wish. Do not force yourself further than you want to go. Notice the quiet. As you reach the

center of your self, settle your attention there— perhaps in your gut or your abdomen.

3. Breathing “Wise” in, “Mind” out. Breathing in, say to yourself, “Wise”; breathing out, say

“Mind.”

• Focus your entire attention on the word “wise,” then, focus it again entirely on the word

“mind.”

• Continue until you sense that you have settled into Wise Mind.

4. Asking Wise Mind a question. Breathing in, silently ask Wise Mind a question.

• Breathing out, listen for the answer.

• Listen, but do not give yourself the answer. Do not tell yourself the answer; listen for it.

• Continue asking on each in- breath for some time. If no answer comes, try again another

time.

(

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)

Mindfulness Handout 3a (p. 2 of 2)

5. Asking is this Wise Mind? Breathing in, ask yourself, “Is this (action, thought, plan, etc.)

Wise Mind?”

• Breathing out, listen for the answer.

• Listen, but do not give yourself the answer. Do not tell yourself the answer; listen for it.

• Continue asking on each in- breath for some time. If no answer comes, try again another

time.

6. Attending to your breath coming in and out, let your attention settle into your center.

• Breathing in completely, notice and follow the sensations of your breath coming in.

• Let your attention settle into your center, at the bottom of your breath, at your solar

plexus—or

• Let your attention settle in the center of your forehead, your “third eye,” at the top of your

breath.

• Keeping your attention at your center, exhale, breathing normally, maintaining attention.

• Settle into Wise Mind.

7. Expanding awareness. Breathing in, focus your awareness on your center.

• Breathing out, stay aware of your center, but expand awareness to the space you are in

now.

• Continue on in the moment.

8. Dropping into the pauses between inhaling and exhaling.

• Breathing in, notice the pause after inhaling (top of breath).

• Breathing out, notice the pause after exhaling (bottom of breath).

• At each pause, let yourself “fall into” the center space within the pause.

9. Other Wise Mind practice ideas:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



Mindfulness Handout 4

(Mindfulness Worksheets 2–2c, 4–4b; pp. 78–82, 84–87 )

Taking Hold of Your Mind: “What” Skills

OBSERVE

 Notice your body sensations (coming through your eyes, ears, nose, skin, and tongue).

 Pay attention on purpose, to the present moment.

 Control your attention, but not what you see. Push away nothing. Cling to nothing.

 Practice wordless watching: Watch thoughts come into your mind and let them slip right by

like clouds in the sky. Notice each feeling, rising and falling, like waves in the ocean.

 Observe both inside and outside yourself.

DESCRIBE

 Put words on the experience. When a feeling or thought arises, or you do something,

acknowledge it. For example, say in your mind, “Sadness has just enveloped me,” or “Stomach

muscles tightening,“ or “A thought ‘I can’t do this’ has come into my mind.”

 Label what you observe. Put a name on your feelings. Label a thought as just a thought, a

feeling as just a feeling, an action as just an action.

 Unglue your interpretations and opinions from the facts. Describe the “who, what, when,

and where” that you observe. Just the facts.

 Remember, If you can’t observe it through your senses, you can’t describe it.

PARTICIPATE

 Throw yourself completely into activities of the current moment. Do not separate yourself

from what is going on in the moment (dancing, cleaning, talking to a friend, feeling happy or

feeling sad).

 Become one with whatever you are doing, completely forgetting yourself. Throw your

attention to the moment.

 Act intuitively from Wise Mind. Do just what is needed in each situation—a skillful dancer on

the dance ﬂoor, one with the music and your partner, neither willful nor sitting on your hands.

 Go with the ﬂow. Respond with spontaneity.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

Mindfulness Handout 4a (p. 1 of 4)

(Mindfulness Worksheets 2–2c, 4–4b; pp. 78–82, 84–87 )

Ideas for Practicing Observing

BY COMING BACK TO YOUR SENSES

Remember: Observing is bringing your mind back to the sensations of your body and mind.

Observe with your eyes:

1. Lie on the ground and watch the clouds in the sky.

2. Walking slowly, stopping somewhere with a view, notice flowers, trees, and nature itself.

3. Sit outside. Watch who and what go by in front of you, without following them with your

head or your eyes.

4. Notice the facial expression and movements of another person. Refrain from labeling the

person’s emotions, thoughts, or interests.

5. Notice just the eyes, lips, or hands of another person (or just one feature of an animal).

6. Pick up a leaf, a flower, or a pebble. Look at it closely, trying to see each detail.

7. Find something beautiful to look at, and spend a few minutes contemplating it.

8. Other:

Observe sounds:

9. Stop for a moment and just listen. Listen to the texture and shape of the sounds around

you. Listen to the silences between the sounds.

10. If someone is talking, listen to the pitch of the voice, to the smoothness or roughness of the

sounds, to the clarity or the mumbling of the speech, to the pauses between the words.

11. Listen to music, observing each note as it comes and the spaces between the notes. Try

breathing the sounds into your body and letting them flow out again on your out breath.

12. Other:

Observe smells around you:

13. Breathing in, notice any smells around you. Bring something close to your nose, and notice

the smells. Take it away, and then notice the smells again. Do they linger?

14. When eating, notice the aroma of the food; when cooking, notice the aroma of the spices or

other ingredients; when bathing, smell the soap or shampoo; when walking outside, notice

the aroma of the air; when near flowers, bend down and “smell the roses.”

15. Other:

Observe taste and the act of eating:

16. Putting something in your mouth, pay attention to the taste. Keep it in your mouth, and

notice all the taste sensations.

17. Lick a lollipop or something else. Notice just the sensation of taste.

18. Eat a meal, or even a part of a meal, paying attention to the taste of each mouthful.

19. Other:

Observe urges to do something:

When you are feeling an urge to do something impulsive,

20. “Urge-surf” by imagining that your urges are a surfboard and you are standing on the

board, riding the waves.

21. Notice any urge to avoid someone or something.

22. Scan your entire body, and notice the sensations. Where in the body is the urge?

23. When you are chewing your food, notice when you have the urge to swallow.

24. Other:

(

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Mindfulness Handout 4a (p. 2 of 4)

Observe sensations of touch on your skin:

25. Stroke your upper lip with your fingernail.

• Stop stroking, and notice how long it takes before you can’t sense your upper lip at all.

26. When walking, notice the sensations of walking—your feet hitting the ground and rising up

and down. Sometimes walk very slowly and notice. Sometimes walk very fast and notice.

27. When sitting, notice your thighs on the chair. Notice the curve of your knees and your back.

28. Pay attention to anything touching you.

• Try to feel your feet in your shoes, your body touching your clothes.

• Feel your arms touching a chair.

• Notice the sensations of your hands.

29. Touch something—the wall, a fabric, a table top, a pet, a piece of fruit, a person.

• Notice the texture of what you feel, notice the sensations on your skin.

• Try it again with another part of your body.

• Notice the sensations again.

30. Focus your attention on the sensations in your chest, your stomach, or your shoulders.

31. Focus your attention on the place in your body where you feel tight or tense.

32. Focus your attention on the space between your eyes.

33. Other:

Observe your breath: Breathe evenly and gently, focusing your attention on:

34. The movement of your stomach.

• As you begin to breathe in, allow your belly to rise in order to bring air into the lower half

of your lungs.

• As the upper halves of your lungs begin to ﬁll with air, your chest begins to rise.

• As you breathe out, notice your belly, then notice your chest. Don’t tire yourself.

35. The pauses in your breathing.

• As you breathe in, notice the brief pause when your lungs have ﬁlled with air.

• As you breathe out, notice the brief pause when you have expelled all the air.

36. The sensations in your nose as you breathe in and as you breathe out.

• As you breathe, close your mouth and breathe in through your nose, noticing the

sensations traveling up and down your nostrils.

37. Your breath while walking slowly. Breathe normally.

• Determine the length of your breath—the exhalation and the inhalation—by the number

of your footsteps. Continue for a few minutes.

• Begin to lengthen your exhalation by one step. Do not force a longer inhalation. Let it be

natural.

• Watch your inhalation carefully to see whether there is a desire to lengthen it. Now

lengthen the exhalation by one more footstep.

• Watch to see whether the inhalation also lengthens by one step or not.

• Only lengthen the inhalation when you feel that it will be comfortable.

• After 20 breaths, return your breath to normal.

38. Your breath while listening to a piece of music.

• Breathe long, light, and even breaths.

• Follow your breath; be master of it, while remaining aware of the movement and

sentiments of the music.

• Do not get lost in the music, but continue to be master of your breath and yourself.

39. Your breath while listening to a friend’s words and your own replies. Continue as with music.

40. Other:

(

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)

Mindfulness Handout 4a (p. 3 of 4)

Observe thoughts coming in and out of your mind:

41. Notice thoughts as they come into your mind.

• Ask, “Where do thoughts come from?”

• Then watch them to see if you can see where they come into your mind.

42. As you notice thoughts in your mind, notice the pauses between each thought.

43. Imagine that your mind is the sky and that thoughts are clouds.

• Notice each thought-cloud as it drifts by, letting it drift in and out of your mind.

• Imagine thoughts as leaves on water ﬂowing down a stream, as boats drifting by on the

lake, or as train cars rolling by you.

44. When worries go round and round in your mind, move your attention to the sensations

in your body (those most intense right now). Then, keeping your attention on your body

sensations, notice how long it takes for the worries to ooze away.

45. Step back from your mind, as if you are on top of a mountain and your mind is just a

boulder down below.

• Gaze at your mind, watching what thoughts come up when you are watching it.

• Come back into your mind before you stop.

46. Watch for the first two thoughts that come into your mind.

47. Other:

Imagine that your mind is a:

48. Conveyor belt, and that thoughts and feelings are coming down the belt.

• Put each thought or feeling in a box, and then put it on the conveyor belt and let it go by.

49. Conveyor belt, and that you are sorting thoughts and feelings as they come down the belt.

• Label the types of thoughts or feelings coming by (e.g., worry thoughts, thoughts about

my past, thoughts about my mother, planning-what-to-do thoughts, angry feeling, sad

feelings).

• Put them in boxes nearby for another time.

50. River, and that thoughts and feelings are boats going down the river.

• Imagine sitting on the grass, watching the boats go by.

• Describe or label each boat as it goes by.

• Try not to jump on the boat.

51. Railroad track, and that thoughts and feelings are train cars going by.

• Describe or label each as it goes by. Try not to jump on the train.

52. Other:

Observe by expanding awareness:

53. Breathing in, notice your breath. Then, keeping your breath in your awareness, on the

next breath notice your hands. Then, keeping both in your awareness, on the next breath

expand your awareness to sounds.

• Continue holding all three in awareness at the same time.

• Practice this awareness of threes at other times, selecting other things to be aware of.

54. Keeping your focus on what you are currently doing, gently expand your awareness to

include the space around you.

55. Go hug a tree, and feel the sensations of the embrace.

• Attend to the embrace of the sheets and blankets or comforters around you as you lie in

bed.

• Do this when you feel lonely and want to be loved or to love.

56. Other:

(

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)

Mindfulness Handout 4a (p. 4 of 4)

Open your mind to your senses:

57. Practice walking with your senses as wide open as you can make them.

• Notice what you hear, see, and feel.

• Notice what you feel when shifting your weight between each step.

• Notice your body experience as you turn.

58. For one mouthful in a meal, pause with a spoonful or forkful of food.

• Look at what you are going to eat, smell it, and listen to it. Then, when you are ready, put

it in your mouth.

• Note the taste, texture, temperature, and even the sound your teeth make in chewing your

mouthful slowly.

• Note the changes in its taste, texture, temperature, and sound as you chew it to

completion.

59. Focus your mind on paying attention to each sensation that comes into your mind.

• Attend to sensations of sight, smell, touch, hearing, and taste, or to the thoughts

generated by your brain.

• Notice sensations as they arise, and notice them as they fall away.

• Let your mind focus on each sensation as it arises.

• Notice each sensation with curiosity, allowing it to be. Examine the uniqueness of each

sensation.

60. Be here. Be in the present now.

• Take a moment to notice every sense you are aware of.

• To yourself, make a statement, about each sense: “I feel the chair; the chair feels me.”

“I hear the heater; the heater hears me.” “I see the wall; the wall sees me.” “I hear a

stomach growl; it hears me.”

61. When a feeling arises within you, notice it—saying, for example, “A feeling of sadness is

arising within me.”

62. When a thought arises within you, notice it—saying, for example, “The thought ‘It is hot in

here’ is arising within me.”

63. Take just a moment of your time, and practice “nothing-to-do” mind.

• Let yourself become completely aware of your present experience, noticing sensations

and the space around you.

64. Find a small object, one you can hold in your hand. Place it in front of you on a table or in

your lap. Observe it closely—first not moving it, and then picking it up and turning it over

and around, gazing at it from different angles and in different lights. Just notice shapes,

colors, sizes, and other characteristics that are visible.

• Then change your focus to your ﬁngers and hands touching the object. Notice the

sensations of touching the object; notice the texture, temperature, and feel of the object.

• Put the object down. Close your eyes, and inhale and exhale deeply and slowly.

• Then, with beginner’s mind, open your eyes. With new vision, once again notice the

object. With beginner’s mind, open to feeling new textures and sensations, explore the

object with your ﬁngers and hands.

• Put down the object, and once again focus your mind on inhaling and exhaling once.

65. Other:

Mindfulness Handout 4b

(Mindfulness Worksheets 2–2c, 4–4b; pp. 78–82, 84–87 )

Ideas for Practicing Describing

Practice describing what you see outside of yourself:

1. Lie on the ground and watch the clouds in the sky. Find and describe cloud patterns that

you see.

2. Sit on a bench on a busy street or at a park. Describe one thing about each person who

walks by you.

3. Find things in nature—a leaf, a drop of water, a pet or other animal. Describe each thing in

as much detail as you can.

4. Describe as accurately as you can what a person has just said to you. Check to see if you

are correct.

5. Describe a person’s face when the person seems angry, afraid, or sad. Notice and describe

the shape, movement, and placement of the forehead, eyebrows, and eyes; the lips and

mouth; the cheeks; and so on.

6. Describe what a person has done or is doing now. Be very specific. Avoid describing

intentions or outcomes of the behavior that you do not directly observe. Avoid judgmental

language.

7. Other:

Practice describing thoughts and feelings:

8. Describe your feelings as they arise within you: “A feeling of anger is arising within me.”

9. Describe your thoughts when you feel a strong emotion: “I feel X, and my thoughts are Y.”

10. Describe your feelings after someone else does or says something: “When you do X, I feel

Y.”

11. Describe thoughts, feelings, and what you observed others do: “When you do X, I feel Y,

and my thoughts are Z.” “When X occurs, I feel Y, and my thoughts are Z.”

12. Describe as many of your thoughts as you can while feeling a strong emotion.

13. Other:

Practice describing your breathing:

14. Each time you inhale and exhale, as you inhale, be aware that “I am inhaling, 1.” When you

exhale, be aware that “I am exhaling, 1.” Remember to breathe from the stomach. When

beginning the second inhalation, be aware that “I am inhaling, 2.” And, slowly exhaling, be

aware that “I am exhaling, 2.” Continue on up through 10. After you have reached 10, return

to 1. Whenever you lose count, return to 1.

15. Begin to inhale gently and normally (from the stomach), describing in your mind that “I

am inhaling normally.” Exhale in awareness, “I am exhaling normally.” Continue for three

breaths. On the fourth breath, extend the inhalation, describing in your mind that “I am

breathing in a long inhalation.” Exhale in awareness, “I am breathing out a long exhalation.”

Continue for three breaths.

16. Follow the entrance and exit of air. Say to yourself, “I am inhaling and following the

inhalation from its beginning to its end. I am exhaling and following the exhalation from its

beginning to its end.”

17. Other:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

Mindfulness Handout 4c

(Mindfulness Worksheets 2–2c, 4–4b; pp. 78–82, 84–87 )

Ideas for Practicing Participating

Participate with awareness of connection to the universe:

1. Focus your attention on where your body touches an object (floor or ground, air molecules,

a chair or armrest, your bed sheets and covers, your clothes, etc.). Try to see all the ways

you are connected to and accepted by that object. Consider the function of that object with

relation to you. That is, consider what the object does for you. Consider its kindness in

doing that. Experience the sensation of touching the object, and focus your entire attention

on that kindness until a sense of being connected or loved or cared for arises in your heart.

Examples: Focus your attention on your feet touching the ground. Consider the kindness of

the ground holding you up, providing a path for you to get to other things, not letting you fall

away from everything else. Focus your attention on your body touching the chair you sit in.

Consider how the chair accepts you totally, holds you up, supports your back, and keeps

you from falling down on the floor. Focus your attention on the sheets and covers on your

bed. Consider the touch of the sheets and covers holding you, surrounding and keeping

you warm and comfortable. Consider the walls in the room. They keep out the wind and the

cold and the rain. Think of how the walls are connected to you via the floor and the air in the

room. Experience your connection to the walls that provide you with a secure place to do

things. Go hug a tree. Think of how you and the tree are connected. Life is in you and in the

tree and both of you are warmed by the sun, held by the air and supported by the earth. Try

and experience the tree loving you by providing something to lean on, or by shading you.

2. Dance to music.

3. Sing along with music you are listening to.

4. Sing in the shower.

5. Sing and dance while watching TV.

6. Jump out of bed and dance, or sing before getting dressed.

7. Go to a church that sings, and join in the singing.

8. Play karaoke with friends or at a karaoke club or bar.

9. Throw yourself into what another person is saying.

10. Go running, focusing only on running.

11. Play a sport and throw yourself into playing.

12. Become the count of the breath, becoming only “one” when you count 1, becoming only

“two” when you count 2, and so on.

13. Become a word as you slowly say the word over and over and over.

14. Take a class in improvisational acting.

15. Take a dance class.

16. Other:

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

Mindfulness Handout 5

(Mindfulness Worksheets 2–2c, 5–5c; pp. 79–82, 88–93 )

Taking Hold of Your Mind: “How” Skills

NONJUDGMENTALLY

 See, but don’t evaluate as good or bad. Just the facts.

 Accept each moment like a blanket spread out on the lawn, accepting both the rain and the

sun and each leaf that falls upon it.

 Acknowledge the difference between the helpful and the harmful, the safe and the dangerous,

but don’t judge them.

 Acknowledge your values, your wishes, your emotional reactions, but don’t judge them.

 When you ﬁnd yourself judging, don’t judge your judging.

ONE- MINDFULLY

 Rivet yourself to now. Be completely present to this one moment.

 Do one thing at a time. Notice the desire to be half- present, to be somewhere else, to go

somewhere else in your mind, to do something else, to multitask—and then come back to one

thing at a time.

• When you are eating, eat.

• When you are walking, walk.

• When you are worrying, worry.

• When you are planning, plan.

• When you are remembering, remember.

 Let go of distractions. If other actions, or other thoughts, or strong feelings distract you, go

back to what you are doing—again, and again, and again.

 Concentrate your mind. If you ﬁnd you are doing two things at once, stop—go back to one

thing at a time (the opposite of multitasking!).

EFFECTIVELY

 Be mindful of your goals in the situation, and do what is necessary to achieve them.

 Focus on what works. (Don’t let emotion mind get in the way of being effective.)

 Play by the rules.

 Act as skillfully as you can. Do what is needed for the situation you are in—not the situation

you wish you were in; not the one that is fair; not the one that is more comfortable.

 Let go of willfulness and sitting on your hands.

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Mindfulness Handout 5a

(Mindfulness Worksheets 2–2c, 5–5c; pp. 79–82, 88–93 )

Ideas for Practicing Nonjudgmentalness

Leaving out comparisons, judgments, and assumptions:

1. Practice observing judgmental thoughts and statements, saying in your mind,

“A judgmental thought arose in my mind.”

2. Count judgmental thoughts and statements (by moving objects or pieces of paper from

one pocket to another, by clicking a sports counter, or by marking a piece of paper).

3. Replace judgmental thoughts and statements with nonjudgmental thoughts and statements.

Tips for replacing judgment by stating the facts:

1. Describe the facts of the event or situation—only what is observed with your senses.

2. Describe the consequences of the event. Keep to the facts.

3. Describe your own feelings in response to the facts (remember, emotions are not

judgments).

4. Observe your judgmental facial expressions, postures, and voice tones (including

voice tones in your head).

5. Change judgmental expressions, postures, and voice tones.

6. Tell someone what you did today nonjudgmentally, or about an event that occurred. Stay

very concrete; only relate what you observed directly.

7. Write out a nonjudgmental description of an event that prompted an emotion.

8. Write out a nonjudgmental blow-by-blow account of a particularly important episode in your

day. Describe both what happened in your environment and what your thoughts, feelings,

and actions were. Leave out any analysis of why something happened, or why you thought,

felt, or acted as you did. Stick to the facts that you observed.

9. Imagine a person you are angry with. Bring to mind what the person has done that has

caused so much anger. Try to become that person, seeing life from that person’s point

of view. Imagine that person’s feelings, thoughts, fears, hopes, and wishes. Imagine that

person’s history and what has happened in his or her history. Imagine understanding that

person.

10. When judgmental, practice half- smiling and/or willing hands. (See Distress Tolerance

Handout 14: Half- Smiling and Willing Hands.)

11. Other:

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Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

Mindfulness Handout 5b

(Mindfulness Worksheets 2–2c, 5–5c; pp. 79–82, 88–93 )

Ideas for Practicing One- Mindfulness

1. Awareness while making tea or coffee. Prepare a pot of tea or coffee to serve a guest or

to drink by yourself. Do each movement slowly, in awareness. Do not let one detail of your

movements go by without being aware of it. Know that your hand lifts the pot by its handle.

Know that you are pouring the fragrant, warm tea or coffee into the cup. Follow each step

in awareness. Breathe gently and more deeply than usual. Take hold of your breath if your

mind strays.

2. Awareness while washing the dishes. Wash the dishes consciously, as though each bowl

is an object of contemplation. Consider each bowl sacred. Follow your breath to prevent your

mind from straying. Do not try to hurry to get the job over with. Consider washing the dishes

the most important thing in life.

3. Awareness while hand- washing clothes. Do not wash too many clothes at one time.

Select only three or four articles of clothing. Find the most comfortable position to sit or

stand, so as to prevent a backache. Scrub the clothes consciously. Hold your attention on

every movement of your hands and arms. Pay attention to the soap and water. When you

have ﬁnished scrubbing and rinsing, your mind and body will feel as clean and fresh as your

clothes. Remember to maintain a half-smile and take hold of your breath whenever your

mind wanders.

4. Awareness while cleaning house. Divide your work into stages: straightening things and

putting away books, scrubbing the toilet, scrubbing the bathroom, sweeping the ﬂoors, and

dusting. Allow a good length of time for each task. Move slowly, three times more slowly

than usual. Focus your attention fully on each task. For example, while placing a book on

the shelf, look at the book; be aware of what book it is; know that you are in the process

of placing it on the shelf; and know that you intend to put it in that speciﬁc place. Know

that your hand reaches for the book and picks it up. Avoid any abrupt or harsh movement.

Maintain awareness of the breath, especially when your thoughts wander.

5. Awareness while taking a slow- motion bath. Allow yourself 30–45 minutes to take a

bath. Don’t hurry for even a second. From the moment you prepare the bath water to the

moment you put on clean clothes, let every motion be light and slow. Be attentive of every

movement. Place your attention on every part of your body, without discrimination or fear. Be

aware of each stream of water on your body. By the time you’ve ﬁnished, your mind will feel

as peaceful and light as your body. Follow your breath. Think of yourself as being in a clean

and fragrant lotus pond in the summer.

6. Awareness with meditation. Sit comfortably on the ﬂoor with your back straight, on the

ﬂoor or in a chair with both feet touching the ﬂoor. Close your eyes all the way, or open them

slightly and gaze at something near. With each breath, say to yourself, quietly and gently,

the word “One.” As you inhale, say the word “One.” As you exhale, say the word “One,”

calmly and slowly. Try to collect your whole mind and put it into this one word. When your

mind strays, return gently to saying “One.” If you start wanting to move, try not to move. Just

gently observe wanting to move. Continue practicing a little past wanting to stop. Just gently

observe wanting to stop.

7. Other:

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Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

Mindfulness Handout 5c

(Mindfulness Worksheets 2–2c, 5–5c; pp. 79–82, 88–93 )

Ideas for Practicing Effectiveness

1. Observe when you begin to get angry or hostile with someone. Ask yourself, “Is this

effective?”

2. Observe yourself when you start wanting to be “right” instead of effective. Give up being

“right” and switch to trying to be effective.

3. Notice willfulness in yourself. Ask yourself, “Is this effective?”

4. Drop willfulness, and practice acting effectively instead. Notice the difference.

5. When feeling angry or hostile or like you're about to do something ineffective, practice willing

hands.

6. Other:

Handouts for Other Perspectives

onMindfulness Skills

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Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

Mindfulness Handout 6

(Mindfulness Worksheets 6–10b; pp. 97–108 )

Overview:

Other Perspectives on Mindfulness

MINDFULNESS PRACTICE:

A Spiritual Perspective

SKILLFUL MEANS:

Taking hold of your everyday life by

balancing Doing Mind and Being Mind

WISE MIND:

Walking the Middle Path

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Mindfulness Handout 7

(Mindfulness Worksheet 1; p. 77 )

Goals of Mindfulness Practice:

A Spiritual Perspective

TO EXPERIENCE:

 Ultimate reality as it is which leads to a sense of inner spaciousness and awareness of

intimate wholeness with the entire universe, the transcendence of boundaries, and the

ground of our being.

 Other:

TO GROW IN WISDOM:

 Of the heart and of action.

 Other:

TO EXPERIENCE FREEDOM:

 By letting go of attachments to the demands of your own desires, cravings, and intense

emotions, and radically accepting reality as it is.

 Other:

TO INCREASE LOVE AND COMPASSION:

 Toward yourself.

 Toward others.

 Other:

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Mindfulness Handout 7a

Wise Mind from a Spiritual Perspective

Wise Mind as . . .

Contemplative practice

Mindfulness

Meditation

Contemplative prayer

Contemplative action

Centering prayer

Thoughts, attitudes, and actions designed to

help us express or experience connection to:

• The sacred, the divine within,

the transcendent.

• God, the Great Spirit, the Absolute,

Elohim, the nameless one, Brahma, Allah,

Parvardigar.

• Ultimate reality, the totality, the source, our

essential nature, our true self, the core of

our being, the ground of being.

• No self, emptiness.

Wise Mind experience

from a spiritual perspective

Experience where a deeper layer of

reality rises to consciousness. A reality

that has always been there but has been

misperceived. An experience of expansion of

consciousness; the experience of unity and

oneness within the sacred.

Wise Mind

from the perspective of mysticism

(seven characteristics

of mystical experiences)

1. Direct experience: Experience without

words of ultimate reality.

2. Experience of unity: Awareness of

oneness and of no distance between

oneself, reality, and all other beings.

3. Without words: Experience of reality

that cannot be grasped and can only be

described with metaphors and stories.

4. Certain: During the experience, certainty

of the experience is total, undeniable,

clear.

5. Practical: Experience that is concretely

beneﬁcial to one’s life and well-being.

6. Integrative: Experience that establishes

harmony of love, compassion, mercy,

kindness; quieting of extreme emotions.

7. Sapiential: Experience that leads to

wisdom, enhances capacity for intuitive

knowledge.

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Mindfulness Handout 8

(Mindfulness Worksheet 6; p. 97 )

Practicing Loving Kindness to Increase

Love and Compassion

WHAT IS LOVING KINDNESS?

Loving kindness is a mindfulness practice designed to increase love and compas-

sion ﬁrst for ourselves and then for our loved ones, for friends, for those we are

angry with, for difﬁcult people, for enemies, and then for all beings.

Loving kindness can protect us from developing and holding on to judgmentalness,

ill will, and hostile feelings toward ourselves and others.

PRACTICING LOVING KINDNESS

Practicing loving kindness is like saying a prayer for yourself or someone

else. As when you are asking or praying for something for yourself or others, you

actively send loving and kind wishes, and recite in your mind words and phrases that

express good will toward yourself and others.

LOVING KINDNESS INSTRUCTIONS

1. Choose a person to send loving kindness toward. Do not select a person you

do not want to relate to with kindness and compassion. Start with yourself, or, if

this is too difﬁcult, with a person you already love.

2. Sitting, standing, or lying down, begin by breathing slowly and deeply. Opening

the palms of your hands, gently bring the person to mind.

3. Radiate loving kindness by reciting a set of warm wishes, such as “May I be

happy,” “May I be at peace,” “May I be healthy,” “May I be safe,” or another

set of positive wishes of your own. Repeat the script slowly, and focus on

the meaning of each word as you say it in your mind. (If you have distracting

thoughts, just notice them as they come and go and gently bring your mind

back to your script.) Continue until you feel yourself immersed in loving

kindness.

4. Gradually work yourself up through loved ones, friends, those you are angry

with, difﬁcult people, enemies, and ﬁnally all beings. For example, use a script

such as “May John be happy,” “May John be at peace,” and so on (or “John,

may you be happy,” “May you be at peace,” and so on), as you concentrate on

radiating loving kindness to John.

5. Practice each day, starting with yourself and then moving to others.

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Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

Mindfulness Handout 9

(Mindfulness Worksheets 7, 8, 9; pp. 98–104 )

Skillful Means:

Balancing Doing Mind and Being Mind

Note. The terms “doing mind,” “being mind,” and “nothing-to-do mind” were ﬁrst used by Jon Kabat-Zinn in Full Catastrophe Living (1990, 2013).

BEING

MIND

DOING

MIND

WISE

MIND

Doing Mind Is:

• Discriminating Mind

• Ambitious Mind

• Goal-Oriented

When in doing mind,

you view your thoughts

as facts about the world.

You are focused on

problem solving and

achieving goals.

Being Mind Is:

• Curious Mind

• Nothing-to-Do Mind

• Present-Oriented

When in being mind, you

view your thoughts as

sensations of the mind.

You are focused on the

uniqueness of each

moment, letting go of

focusing on goals.

Wise Mind Is:

• A balance of doing

and being

• The middle path

When in Wise Mind, you:

Use skillful means.

Let go of having to achieve

goals—and throw your

entire self into working

toward these same goals.

Enhance awareness while

engaging in activities.

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Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

Mindfulness Handout 9a (p. 1 of 2)

(Mindfulness Worksheets 7, 8, 9; pp. 98–104 )

Ideas for Practicing Balancing

Doing Mind and Being Mind

The mindfulness skills require a lot of practice. The practice ideas below are to help you act

skillfully in everyday life, bringing together doing activities of everyday life with being mind.

1. Wise Mind reading. To increase your desire for mindfulness, find readings or quotations

that have the effect of making you actually want to practice mindfulness in your everyday

life. Put these quotations at strategic spots in your life (e.g., near the coffee maker), and then

while you are waiting for other things, read the inspirational messages.

2. Wise Mind reminders. Set an alarm at home, at work, or (if possible) on your cell phone or

watch to go off randomly or at set times. Use the alarm as a reminder to be mindful of your

current activities. (See www.mindfulnessdc.org/bell/index.html or a similar Internet site for a

free mindfulness clock to download onto your computer.) Set up automatic text messages

or Twitter messages to remind yourself. Write out mindfulness quotations that you like, and

tape them in strategic places where you will see them as reminders to practice mindfulness.

3. Wise Mind in the routine of daily life. Choose one routine activity in your daily life (such

as brushing your teeth, getting dressed, making coffee or tea, working on a task). Make a

deliberate effort to bring moment-to- moment awareness to that activity.

4. “Just this one moment” Wise Mind. When you begin to feel overwhelmed or frazzled, say,

“Just this one moment, just this one task,” to remind yourself that your only requirement at

the moment is to do one thing in the moment—wash one dish, take one step, move one set

of muscles. In this moment, let the next moment go until you get there.

(

continued on next page

)

Note. Exercises 3 and 4 are from Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for depression:

other exercises are adapted from Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain,

Mindfulness Handout 9a (p. 2 of 2)

5. Wise Mind awareness of events. Notice events in your everyday life (both pleasant and

unpleasant), even if they are only very small (such as warm water on your hands when

washing, the taste of something you eat, the feel of wind on your face, the fact that your car

is running out of gas or that you are tired).

6. Wise Mind awareness of what needs to be done. When relaxing after a hard day’s work

or at a break during the day, stay aware of what needs to be done and focus on doing what

is needed.

7. Wise Mind willingness. Practice willingness to do what is needed when you are asked, or

when you see that something needs to be done. Do what is needed with a balance of being

and doing, focusing the mind, immersing yourself in the task.

8. Three-minute WISE MIND: Slowing down “doing mind” in your everyday life

• Bring yourself into the present moment by adopting a “wide-awake” posture, and then, in

Wise Mind, ask, “What is my experience right now? What thoughts and images are going

through my mind?” Notice them as mental events, as neural ﬁring in your brain. Next ask,

“What are my feelings and sensations in my body?” Notice these as they come into your

awareness. Then say, “OK, this is how it is right now.”

• Settle into Wise Mind and focus your entire attention on your breath as it goes in and

as it goes out, one breath after another. Gather yourself all together, and focus on the

movements of your chest and abdomen, the rise and fall of your breath, moment by

moment, breath by breath as best you can. Let your breath become an anchor to bring

you into the present moment.

• Once you have gathered yourself to some extent, allow your awareness to expand. As

well as being aware of the breath, include also a sense of the body as a whole, your

posture, your facial expression, your hands. Follow the breath as if your whole body is

breathing. When you are ready, step back into your activities, acting from Wise Mind of

your whole body in the present moment.

9. Other Wise Mind practice ideas:

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Mindfulness Handout 10

(Mindfulness Worksheets 10, 10a, 10b ; pp. 10 5–108 )

Walking the Middle Path:

Finding the Synthesis between Opposites

Reasonable

mind

Emotion

mind

Both regulate actions and make decisions based on reason,

And

take into account values and experience even strong emotions as they come and go.

Doing

mind

Nothing-to-do

mind

Both do what is needed in the moment (including reviewing the past or planning for the future),

And

experience fully the uniqueness of each moment in the moment.

Intense desire

for change

of the moment

Radical

acceptance

of the moment

Both allow yourself to have an intense desire to have something else than what is now,

And

be willing to radically accept what you have in your life in the present moment.

Self- denial Self- indulgence

Both practice moderation,

And

satisfy the senses.

Other:

Interpersonal

EffectivenessHandouts

Handouts for Goals and Factors

ThatInterfere

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



interpersonal effectiveness Handout 1

(Interpersonal Effectiveness Worksheet 1; p. 167 )

Goals of Interpersonal Effectiveness

BE SKILLFUL IN GETTING WHAT YOU WANT

AND NEED FROM OTHERS

 Get others to do things you would like them to do.

 Get others to take your opinions seriously.

 Say no to unwanted requests effectively.

 Other:

BUILD RELATIONSHIPS

AND END DESTRUCTIVE ONES

 Strengthen current relationships.

 Don’t let hurts and problems build up.

 Use relationship skills to head off problems.

 Repair relationships when needed.

 Resolve conﬂicts before they get overwhelming.

 Find and build new relationships.

 End hopeless relationships.

 Other:

WALK THE MIDDLE PATH

 Create and maintain balance in relationships.

 Balance acceptance and change in relationships.

 Other:

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Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



interpersonal effectiveness Handout 2

Factors in the Way of Interpersonal Effectiveness

 YOU DON’T HAVE THE INTERPERSONAL SKILLS YOU NEED

YOU DON’T KNOW WHAT YOU WANT

 You have the skills, but can’t decide what you really want from the other person.

 You can’t ﬁgure out how to balance your needs versus the other person’s needs:

 Asking for too much versus not asking for anything.

 Saying no to everything versus giving in to everything.

YOUR EMOTIONS ARE GETTING IN THE WAY

 You have the skills, but emotions (anger, pride, contempt, fear, shame, guilt)

control what you do.

YOU FORGET YOUR LONG-TERM GOALS FOR SHORT-TERM GOALS

 You put your immediate urges and wants ahead of your long-term goals. The

future vanishes from your mind.

OTHER PEOPLE ARE GETTING IN YOUR WAY

 You have the skills but other people get in the way.

 Other people are more powerful than you.

 Other people may be threatened or may not like you if you get what you want.

 Other people may not do what you want unless you sacriﬁce your self- respect, at

least a little.

YOUR THOUGHTS AND BELIEFS ARE GETTING IN THE WAY

 Worries about negative consequences if you ask for what you want or say no to

someone’s request get in the way of acting effectively.

 Beliefs that you don’t deserve what you want stop you in your tracks.

 Beliefs that others don’t deserve what they want make you ineffective.

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Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 2a

(Interpersonal Effectiveness Worksheet 2; p. 168 )

Myths in the Way of Interpersonal Effectiveness

Myths in the Way of Objectives Effectiveness

 1. I don’t deserve to get what I want or need.

 2. If I make a request, this will show that I am a very weak person.

 3. I have to know whether a person is going to say yes before I make a request.

 4. If I ask for something or say no, I can’t stand it if someone gets upset with me.

 5. If they say no, it will kill me.

 6. Making requests is a really pushy (bad, self- centered, selﬁsh, etc.) thing to do.

 7. Saying no to a request is always a selﬁsh thing to do.

 8. I should be willing to sacriﬁce my own needs for others.

 9. I must be really inadequate if I can’t ﬁx this myself.

 10. Obviously, the problem is just in my head. If I would just think differently I wouldn’t have to

bother everybody else.

 11. If I don’t have what I want or need, it doesn’t make any difference; I don’t care really.

 12. Skillfulness is a sign of weakness.

Other myth:

Myths in the Way of Relationship and Self- Respect Effectiveness

 13. I shouldn’t have to ask (say no); they should know what I want (and do it).

 14. They should have known that their behavior would hurt my feelings; I shouldn’t have to tell

them.

 15. I shouldn’t have to negotiate or work at getting what I want.

 16. Other people should be willing to do more for my needs.

 17. Other people should like, approve of, and support me.

 18. They don’t deserve my being skillful or treating them well.

 19. Getting what I want when I want it is most important.

 20. I shouldn’t be fair, kind, courteous, or respectful if others are not so toward me.

 21. Revenge will feel so good; it will be worth any negative consequences.

 22. Only wimps have values.

 23. Everybody lies.

 24. Getting what I want is more important than how I get it; the ends really do justify the means.

Other myth:

Handouts for Obtaining

ObjectivesSkillfully

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 3

Overview:

Obtaining Objectives Skillfully

CLARIFYING PRIORITIES

How important is:

Getting what you want/obtaining your goal?

Keeping the relationship?

Maintaining your self- respect?

OBJECTIVES EFFECTIVENESS: DEAR MAN

Be effective in asserting your rights and wishes.

RELATIONSHIP EFFECTIVENESS: GIVE

Act in such a way that you maintain positive relationships and that

others feel good about themselves and about you.

SELF- RESPECT EFFECTIVENESS: FAST

Act in such a way that you keep your self- respect.

FACTORS TO CONSIDER

Decide how ﬁrm or intense you want to be in asking

for something or saying no.

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Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



interpersonal effectiveness Handout 4

(Interpersonal Effectiveness Worksheet 3 ; p. 173 )

Clarifying Goals in Interpersonal Situations

OBJECTIVES EFFECTIVENESS: Getting What You Want from Another Person

• Obtaining your legitimate rights.

• Getting another person to do something you want that person to do.

• Saying no to an unwanted or unreasonable request.

• Resolving an interpersonal conﬂict.

• Getting your opinion or point of view taken seriously.

Questions

1. What speciﬁc

results or changes

do I want from this interaction?

2. What do I have to do to get the results? What will work?

RELATIONSHIP EFFECTIVENESS: Keeping and Improving the Relationship

• Acting in such a way that the other person keeps liking and respecting you.

• Balancing immediate goals with the good of the long-term relationship.

• Maintaining relationships that matter to you.

Questions

1. How do I want the

other person to feel about me

after the interaction is over (whether or

not I get the results or changes I want)?

2. What do I have to do to get (or keep) this relationship?

SELF- RESPECT EFFECTIVENESS: Keeping or Improving Self- Respect

• Respecting your own values and beliefs.

• Acting in a way that makes you feel moral.

• Acting in a way that makes you feel capable and effective.

Questions

1. How do I want to

feel about myself

after the interaction is over (whether or not I get the

results or changes I want)?

2. What do I have to do to feel that way about myself? What will work?

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



interpersonal effectiveness Handout 5 (p. 1 of 2)

(Interpersonal Effectiveness Worksheets 4, 5; pp. 174–175 )

Guidelines for Objectives Effectiveness:

Getting What You Want (DEAR MAN)

A way to remember these skills is to remember the term DEAR MAN:

Describe

Express

Assert

Reinforce

(Stay) Mindful

Appear Conﬁdent

Negotiate

Describe Describe the current SITUATION (if necessary). Stick to the facts.

Tell the person exactly what you are reacting to.

“You told me you would be home by dinner but you didn’t get here until 11.”

Express Express your FEELINGS and OPINIONS about the situation.

Don’t assume that the other person knows how you feel.

“When you come home so late, I start worrying about you.”

Use phrases such as “I want” instead of “You should,” “I don’t want”

instead of “You shouldn’t.”

Assert Assert yourself by ASKING for what you want or SAYING NO clearly.

Do not assume that others will ﬁgure out what you want.

Remember that others cannot read your mind.

“I would really like it if you would call me when you are going to be late.”

Reinforce Reinforce (reward) the person ahead of time (so to speak)

by explaining positive effects of getting what you want or need.

If necessary, also clarify the negative consequences of not getting

what you want or need.

“I would be so relieved, and a lot easier to live with, if you do that.”

Remember also to reward desired behavior after the fact.

(

continued on next page

)

interpersonal effectiveness Handout 5 (p. 2 of 2)

(Stay)

Mindful

Keep your focus ON YOUR GOALS.

Maintain your position. Don’t be distracted. Don’t get off the topic.

“Broken record”: Keep asking, saying no, or expressing your opinion over and over and over.

Just keep replaying the same thing again and again.

Ignore attacks: If another person attacks, threatens, or tries to change the subject,

ignore the threats, comments, or attempts to divert you.

Do not respond to attacks. Ignore distractions.

Just keep making your point.

“I would still like a call.”

Appear conﬁdent Appear EFFECTIVE and competent.

Use a conﬁdent voice tone and physical manner;

make good eye contact.

No stammering, whispering, staring at the ﬂoor, retreating.

No saying, “I’m not sure,” etc.

Negotiate Be willing to GIVE TO GET.

Offer and ask for other solutions to the problem.

Reduce your request.

Say no, but offer to do something else or to solve the problem another way.

Focus on what will work.

“How about if you text me when you think you might be late?”

Turn the tables: Turn the problem over to the other person.

Ask for other solutions.

“What do you think we should do? . . . I can’t just stop worrying about

you [or I’m not willing to].”

Other ideas:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 5a

Applying DEAR MAN Skills

to a Difﬁcult Current Interaction

To turn around really difﬁcult situations, focus the skills on the other person’s behavior right now.

When other people have really good skills themselves, and keep refusing your legitimate requests

or pestering you to do something you don’t want to do.

Apply DEAR MAN Skills

1. Describe the current interaction. If the “broken record” and ignoring don’t work, make a

statement about what is happening between you and the person now, but without imputing

motives.

Example: “You keep asking me over and over, even though I have already said no several

times,” or “It is hard to keep asking you to empty the dishwasher when it is your month to do it.”

Not: “You obviously don’t want to hear what I am saying,” “You obviously don’t care about

me,” “Well, it’s obvious that what I have to say doesn’t matter to you,” “Obviously you think I’m

stupid.”

2. Express feelings or opinions about the interaction. For instance, in the middle of an

interaction that is not going well, you can express your feelings of discomfort in the situation.

Example: “I am sorry I cannot do what you want, but I’m ﬁnding it hard to keep discussing it,”

or “It’s becoming very uncomfortable for me to keep talking about this, since I can’t help it. I am

starting to feel angry about it,” or “I’m not sure you think this is important for you to do.”

Not: “I hate you!”, “Every time we talk about this, you get defensive,” “Stop patronizing me!”

3. Assert wishes in the situation. When another person is pestering you, you can ask him

or her to stop it. When a person is refusing a request, you can suggest that you put the

conversation off until another time. Give the other person a chance to think about it.

Example: “Please don’t ask me again. My answer won’t change,” or “OK, let’s stop discussing

this now and pick it up again sometime tomorrow,” or “Let’s cool down for a while and then get

together to ﬁgure out a solution.”

Not: “Would you shut up?” “You should do this!”, “You should really calm down and do what’s

right here.”

4. Reinforce. When you are saying no to someone who keeps asking, or when someone won’t

take your opinion seriously, suggest ending the conversation, since you aren’t going to change

your mind anyway. When trying to get someone to do something for you, you can suggest that

you will come up with a better offer later.

Example: “Let’s stop talking about this now. I’m not going to change my mind, and I think this is

just going to get frustrating for both of us,” or “OK, I can see you don’t want to do this, so let’s

see if we can come up with something that will make you more willing to do it.”

Not: “If you don’t do this for me, I’ll never do anything for you ever again,” “If you keep asking

me, I’ll get a restraining order against you,” “Gosh, you must be a terrible person for not doing

this/for asking me to do this.”

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



interpersonal effectiveness Handout 6

(Interpersonal Effectiveness Worksheets 4, 5; pp. 174–175 )

Guidelines for Relationship Effectiveness:

Keeping the Relationship (GIVE)

A way to remember these skills is to remember the word GIVE (DEAR MAN, GIVE):

(Be) Gentle

(Act) Interested

Validate

(Use an) Easy manner

(Be)

Gentle BE NICE and respectful.

No attacks: No verbal or physical attacks. No hitting, clenching ﬁsts. No harassment of any

kind. Express anger directly with words.

No threats: If you have to describe painful consequences for not getting what you want,

describe them calmly and without exaggerating.

No “manipulative” statements, no hidden threats. No “I’ll kill myself if you . . . ”

Tolerate a “no.” Stay in the discussion even if it gets painful. Exit gracefully.

No judging: No moralizing. No “If you were a good person, you would . . . ”

No “You should . . . ” or “You shouldn’t . . . ” Abandon blame.

No sneering: No smirking, eye rolling, sucking teeth. No cutting off or walking away.

No saying, “That’s stupid, don’t be sad,” “I don’t care what you say.”

(Act)

Interested

LISTEN and APPEAR INTERESTED in the other person.

Listen to the other person’s point of view.

Face the person; maintain eye contact; lean toward the person rather than

away. Don’t interrupt or talk over the person.

Be sensitive to the person’s wish to have the discussion at a later time. Be

patient.

Validate

With WORDS AND ACTIONS, show that you understand the other person’s

feelings and thoughts about the situation. See the world from the other person’s

point of view, and then say or act on what you see.

“I realize this is hard for you, and . . . ”, “I see that you are busy, and . . . ”

Go to a private place when the person is uncomfortable talking in a public

place.

(Use an)

Easy manner

Use a little humor.

SMILE. Ease the person along. Be light- hearted. Sweet-talk.

Use a “soft sell” over a “hard sell.” Be “political.”

Leave your attitude at the door.

Other ideas:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 6a

Expanding the V in GIVE: Levels of Validation

1.  Pay Attention: Look interested in the other person instead of bored (no

multitasking).

2. Reﬂect Back: Say back what you heard the other person say or do, to be

sure you understand exactly what the person is saying. No

judgmental language or tone of voice!

3. “Read Minds”: Be sensitive to what is not being said by the other person.

Pay attention to facial expressions, body language, what is

happening, and what you know about the person already.

Show you understand in words or by your actions. Check it

out and make sure you are right. Let go if you are not.

4. Understand: Look for how what the other person is feeling, thinking, or

doing makes sense, based on the person’s past experiences,

present situation, and/or current state of mind or physical

condition (i.e., the causes).

5. Acknowledge the Valid: Look for how the person’s feelings, thinking, or actions

are valid responses because they ﬁt current facts, or are

understandable because they are a logical response to

current facts.

6. Show Equality: Be yourself! Don’t “one-up” or “one-down” the other person.

Treat the other as an equal, not as fragile or incompetent.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



interpersonal effectiveness Handout 7

(Interpersonal Effectiveness Worksheets 4, 5; pp. 174–175 )

Guidelines for Self- Respect Effectiveness:

Keeping Respect for Yourself (FAST)

A way to remember these skills is to remember the word FAST (DEAR MAN, GIVE FAST).

(Be) Fair

(No) Apologies

Stick to Values

(Be) Truthful

(Be)

Fair

Be fair to YOURSELF and to the OTHER person.

Remember to VALIDATE YOUR OWN feelings and wishes,

as well as the other person’s.

(No)

Apologies

Don’t overapologize.

No apologizing for being alive or for making a request at all.

No apologies for having an opinion, for disagreeing.

No LOOKING ASHAMED, with eyes and head down or body slumped.

No invalidating the valid.

Stick to values

Stick to YOUR OWN values.

Don’t sell out your values or integrity for reasons that aren’t VERY important.

Be clear on what you believe is the moral or valued way of thinking and

acting, and “stick to your guns.”

(Be)

Truthful

Don’t lie. Don’t act helpless when you are not.

Don’t exaggerate or make up excuses.

Other ideas:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



interpersonal effectiveness Handout 8 (p. 1 of 3)

(Interpersonal Effectiveness Worksheet 6; p. 176 )

Evaluating Options for Whether or How Intensely to Ask

for Something or Say No

Before asking for something or saying no to a request, you have to decide how intensely you

want to hold your ground.

Options range from very low intensity, where you are very ﬂexible and accept the situation as

it is, to very high intensity, where you try every skill you know to change the situation and get

what you want.

OPTIONS

Low intensity (let go, give in)

Asking Saying No

Don’t ask; don’t hint. 1

Do what the other person wants without being

asked.

Hint indirectly; take no. 2 Don’t complain; do it cheerfully.

Hint openly; take no. 3 Do it, even if you’re not cheerful about it.

Ask tentatively; take no. 4 Do it, but show that you’d rather not.

Ask gracefully, but take no. 5 Say you’d rather not, but do it gracefully.

Ask conﬁdently; take no. 6 Say no conﬁdently, but reconsider.

Ask conﬁdently; resist no. 7 Say no conﬁdently; resist saying yes.

Ask ﬁrmly; resist no. 8 Say no ﬁrmly; resist saying yes.

Ask ﬁrmly; insist; negotiate; keep

trying.

Say no ﬁrmly; resist; negotiate;

keep trying.

Ask and don’t take no for

an answer.

10 Don’t do it.

High intensity (stay ﬁrm)

(

continued on next page

)

interpersonal effectiveness Handout 8 (p. 2 of 3)

FACTORS TO CONSIDER

When deciding how ﬁrm or intense

you want to be in asking or saying no, think about:

1. The other person’s or your own capability.

2. Your priorities.

3. The effect of your actions on your self- respect.

4. Your or the other’s moral and legal rights in the situation.

5. Your authority over the person (or his or hers over you).

6. The type of relationship you have with the person.

7. The effect of your action on long- versus short-term goals.

8. The degree of give and take in your relationship.

9. Whether you have done your homework to prepare.

10. The timing of your request or refusal.

1. CAPABILITY: • Is the person able to give you what you want? If YES, raise the intensity of ASKING.

• Do you have what the person wants? If NO, raise the intensity of NO.

2. PRIORITIES: • Are your GOALS very important? Increase intensity.

• Is your RELATIONSHIP shaky? Consider reducing intensity.

• Is your SELF- RESPECT on the line? Intensity should ﬁt your values.

3. SELF- RESPECT: • Do you usually do things for yourself? Are you careful to avoid acting helpless when

you are not? If YES, raise the intensity of ASKING.

• Will saying no make you feel bad about yourself, even when you are thinking about

it wisely? If NO, raise the intensity of NO.

4. RIGHTS: • Is the person required by law or moral code to give you what you want? If YES,

raise the intensity of ASKING.

• Are you required to give the person what he or she is asking for? Would saying no

violate the other person’s rights? If NO, raise the intensity of NO.

5. AUTHORITY: • Are you responsible for directing the person or telling the person what to do? If

YES, raise the intensity of ASKING.

• Does the person have authority over you (e.g., your boss, your teacher)? And is

what the person is asking within his or her authority? If NO, raise the intensity of

NO.

(

continued on next page

)

interpersonal effectiveness Handout 8 (p. 3 of 3)

6. RELATIONSHIP: • Is what you want appropriate to the current relationship? If YES, raise the intensity

of ASKING.

• Is what the person is asking for appropriate to your current relationship? If NO, raise

the intensity of NO.

7. LONG-TERM

VERSUS

SHORT-TERM

GOALS:

• Will not asking for what you want keep the peace now but create problems in the

long run? If YES, raise the intensity of ASKING.

• Is giving in to keep the peace right now more important than the long-term welfare

of the relationship? Will you eventually regret or resent saying no? If NO, raise the

intensity of NO.

8. GIVE AND TAKE: • What have you done for the person? Are you giving at least as much as you ask

for? Are you willing to give if the person says yes? If YES, raise the intensity of

ASKING.

• Do you owe this person a favor? Does he or she do a lot for you? If NO, raise the

intensity of NO.

9. HOMEWORK: • Have you done your homework? Do you know all the facts you need to know

to support your request? Are you clear about what you want? If YES, raise the

intensity of ASKING.

• Is the other person’s request clear? Do you know what you are agreeing to? If NO,

raise the intensity of NO.

10. TIMING: • Is this a good time to ask? Is the person “in the mood” for listening and paying

attention to you? Are you catching the person when he or she is likely to say yes to

your request? If YES, raise the intensity of ASKING.

• Is this a bad time to say no? Should you hold off answering for a while? If NO, raise

the intensity of NO.

Other factors:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



interpersonal effectiveness Handout 9 (p. 1 of 2)

(Interpersonal Effectiveness Worksheet 7; pp. 178–179 )

Troubleshooting:

When What You Are Doing Isn’t Working

Do I have the skills I need? Check out the instructions.

Review what has already been tried.

• Do I know how to be skillful in getting what I want?

• Do I know how to say what I want to say?

• Do I follow the skill instructions to the letter?

Do I know what I really want in this interaction?

Ask:

• Am I undecided about what I really want in this interaction?

• Am I unsure of my priorities?

• Am I having trouble balancing:

• Asking for too much versus too little?

• Saying no to everything versus saying yes to everything?

• Is fear or shame getting in the way of knowing what I really want?

Are short-term goals getting in the way of long-term goals?

Ask:

• Is “NOW, NOW, NOW” winning out over getting what I really want in the

future?

• Is emotion mind controlling what I say and do instead of WISE MIND?

(

continued on next page

)

interpersonal effectiveness Handout 9 (p. 2 of 2)

Are my emotions getting in the way of using my skills?

Ask:

• Do I get too upset to use my skills?

• Are my emotions so HIGH that I am over my skills breakdown point?

Are worries, assumptions, and myths getting in my way?

Ask:

• Are THOUGHTS about bad consequences blocking my action?

“They won’t like me,” “She will think I am stupid.”

• Are THOUGHTS about not deserving things getting in my way?

“I am such a bad person I don’t deserve this.”

• Am I calling myself NAMES that stop me from doing anything?

“I won’t do it right,” “I’ll probably fall apart,” “I’m so stupid.”

• Do I believe MYTHS about interpersonal effectiveness?

“If I make a request, this will show that I am a weak person,”

“Only wimps have values.”

Is the environment more powerful than my skills?

Ask:

• Are the people who have what I want or need more powerful than I am?

• Are other people more in control of the situation than I am?

• Will others be threatened if I get what I want?

• Do others have reasons for not liking me if I get what I want?

Other ideas:

Handouts for Building Relationships

and Ending Destructive Ones

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 10

Overview:

Building Relationships

and Ending Destructive Ones

FINDING AND GETTING PEOPLE TO LIKE YOU

Proximity, similarity, conversation skills,

expressing liking, and joining groups

MINDFULNESS OF OTHERS

Building closeness through mindfulness of others

ENDING DESTRUCTIVE/

INTERFERING RELATIONSHIPS

Staying in WISE MIND

Using skills

Staying safe

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 11 (p. 1 of 2)

(Interpersonal Effectiveness Worksheet 8 ; p. 183 )

Finding and Getting People to Like You

REMEMBER: ALL HUMAN BEINGS ARE LOVABLE.

But ﬁnding friends may take effort on your part.

LOOK FOR PEOPLE WHO ARE CLOSE BY YOU.

Familiarity often leads to liking and sometimes love.

To ﬁnd people you might like and who might like you, it is important to make sure that you

are frequently around and visible to a group of people. Many people ﬁnd friends who are

classmates or members of groups they join, or who work at or go to the same places.

LOOK FOR PEOPLE WHO ARE SIMILAR TO YOU.

We often make friends with people who share our interests and attitudes.

Though always agreeing with someone will not make you more attractive to them, a lot of

people are attracted to those who share the same important interests and attitudes, such as

politics, lifestyle, morals.

WORK ON YOUR CONVERSATION SKILLS.

Ask and respond to questions; respond with a little more info than requested.

Make small talk; don’t underestimate the value of chit-chat.

Self- disclose skillfully; keep your self- disclosure close to that of the other person.

Don’t interrupt; don’t start talking just fractionally before or after someone else.

Learn things to talk about: Watch others; read; increase your activities and experiences.

EXPRESS LIKING (SELECTIVELY).

We often like the people we think like us.

Express genuine liking for the other person. But don’t try to suck up to the other person or

grovel. Find things to compliment that are not super- obvious. Don’t praise too much too often,

and never use compliments to obtain favors.

(

continued on next page

)

Adapted by permission of the authors.

interpersonal effectiveness Handout 11 (p. 2 of 2)

JOIN AN ONGOING GROUP CONVERSATION.

If we wait for people to approach us, we may never have friends.

Sometimes we must make the ﬁrst move in ﬁnding friends. This often requires us to know how

to tell if a group is open or closed, and then, when it is open, how to approach and join in the

ongoing group.

FIGURE OUT IF A GROUP IS OPEN OR CLOSED.

In open groups new members are welcome.

In closed groups new members may not be welcome.

Open Groups

• Everyone is standing somewhat apart.

• Members occasionally glance around the

room.

• There are gaps in the conversation.

• Members are talking about a topic of

general interest.

Closed Groups

• Everyone is standing close together.

• Members attend exclusively to each other.

• There is a very animated conversation with

few gaps.

• Members seem to be pairing off.

FIGURE OUT HOW TO JOIN AN OPEN GROUP CONVERSATION.

Ways of Joining an Open Group Potential Outcomes

Move gradually closer to the group. It may not be clear from the slowness of your

approach that you want to join them; it might even

look as though you were creeping up and trying to

eavesdrop!

Offer to reﬁll members’ glasses/

serve them food.

That could be overdoing things a bit. What would you

do if they refused more food/drinks? Would it be clear

enough that you wanted to join the group?

Stand beside them and chip in on

their conversation.

That might seem rude. They haven’t invited you to

join them, and anyway, what exactly are you going to

say when you chip in?

Go up and introduce yourself. Isn’t that overly formal? Having introduced yourself,

then what do you say? Will they introduce themselves

to you? Wouldn’t you interrupt the conversation?

Wait for a break in the

conversation, stand beside a

friendly- looking member of the

group and say something like

“Mind if I join you?”

This makes your intention clear and doesn’t

seem rude or interrupt the conversation; group

members can then choose whether to introduce

themselves or not.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 11a

Identifying Skills to Find People

and Get Them to Like You

For each A and B pair, check the more effective responses.











 1A. Realize that good relationships

depend on what you do.

 1B. Think of relationships in

vague, abstract terms.











 7A. Stay out of conversations other people

are having, so people know you’re

respectful.

 7B. Politely ask to join in conversations, so

you can meet more people.











 2A. Expect people to beat a path

to your door.

 2B. Create and make full use of

opportunities to come into

regular contact with others.











 8A. Say nothing or everything about yourself,

regardless of what others reveal.

 8B. Disclose roughly the same amount of

personal information to others as they

disclose to you.











 3A. Mix with people who share

your attitudes and interests.

 3B. Mix with people with whom

you have little in common.







 9A. Keep good opinions of others to yourself.

 9B. If you like others, let them know.











 4A. Mix with people who respond

positively to you and to life

generally.

 4B. Mix with cynics and

pessimists.











 10A. Protect yourself, and comment only on

good points that are obvious to anyone

and everyone.

 10B. Don’t express liking indiscriminately.











 5A. Express your opinions and

attitudes, so that others can

recognize similarities with you.

 5B. Keep your opinions and

attitudes to yourself.











 11A. Rely on ﬂattery to get what you want

when you think it will work.

 11B. Don’t use ﬂattery to inﬂuence others.











 6A. Answer questions brieﬂy, and

seldom ask or return them.

 6B. Show interest in others by

asking questions.











 12A. Stand near a friendly- looking person

in a new group, wait for a lull in the

conversation, and then ask if it’s OK for

you to join the group.

 12B. Stand near a group of new people and

make sure your comments or opinions

are heard.

Adapted by permission of the authors.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 12

(Interpersonal Effectiveness Worksheet 9; p. 184 )

Mindfulness of Others

FRIENDSHIPS LAST LONGER WHEN WE ARE MINDFUL.

OBSERVE

 Pay attention with interest and curiosity to others around you.

 Stop multitasking; focus on the people you are with.

 Stay in the present rather than planning what to say next.

 Let go of a focus on self, and focus on others around you.

 Be open to new information about others.

 Notice judgmental thoughts about others, and let them go.

 Give up clinging to always being right.

DESCRIBE

 Replace judgmental words with descriptive words.

 Avoid assuming or interpreting what other people think about you

without checking the facts. (Remember, no one has ever observed

another person’s thoughts, motives, intentions, feelings, emotions,

desires, or experiences.)

 Avoid questioning other people’s motives (unless you have very

good reasons to do so).

 Give others the beneﬁt of the doubt.

PARTICIPATE

 Throw yourself into interactions with others.

 Go with the ﬂow, rather than trying to control the ﬂow.

 Become one with group activities and conversations.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 12a

Identifying Mindfulness of Others

For each A and B pair, check the more effective response.











 1A. Multi-task and expect the other

person to understand.

 1B. Give your complete attention to

the person you are with.











 6A. Be open to people’s changing their

minds about things, as well as their

beliefs or feelings.

 6B. Assume that when people change,

they are not trustworthy.











 2A. Figure that if you already know

someone, you don’t really have to

pay such close attention to them

any more.

 2B. Recognize that closeness is built

by attending to and learning more

and more about people you care

about.











 7A. Evaluate other people’s behaviors and

thoughts, and tell them that they are

wrong or that they should be different

when you feel sure you are right.

 7B. If you do not approve of or agree

with what another person is doing

or thinking, try to understand how it

would make sense if you knew the

causes.











 3A. “My feelings are really hurt by

what you did, and the thought

went through my mind that you

hate me. I know that you don’t

really, but did you feel that way at

the time?”

 3B. “I know you hate me. There is

no other reason for what you did

to me. Don’t tell me differently,

either.”







 8A. “You should stop doing that.”

 8B. “I wish you would stop doing that.”







 9A. “You are lazy and have given up.”

 9B. “I worry that you have given up.”







 10A. “I don’t think that is correct.”

 10B. “How could you possibly think that?”











 4A. In social situations, throw yourself

into interactions.

 4B. Stay reserved and watch social

interactions so you don’t make

mistakes.











 11A. Stay in control so that relationships

turn out the way you want.

 11B. Go with the ﬂow much of the time

when in social interactions with

groups of friends.











 5A. Find people with your values.

 5B. Do little immoral things so as not

to be a drag on friendships.











 12A. Hold back in a conversation until you

are sure you like the person.

 12B. Throw yourself into a conversation

until you are sure you don’t like it.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 13

(Interpersonal Effectiveness Worksheet 10; pp. 185–186 )

Ending Relationships

A destructive relationship has the quality of destroying or completely spoiling either the quality

of the relationship or aspects of yourself—such as your physical body and safety, your self- esteem

or sense of integrity, your happiness or peace of mind, or your caring for the other person.

An interfering relationship is one that blocks or makes difﬁcult your pursuing goals that are impor-

tant to you; your ability to enjoy life and do things you like doing; your relationships with other per-

sons; or the welfare of others that you love.

Decide to end relationships in WISE MIND,

NEVER in emotion mind.

If the relationship is IMPORTANT and NOT destructive,

and there is reason to hope it can be improved, try

PROBLEM SOLVING to repair a difﬁcult relationship.

COPE AHEAD to troubleshoot

and practice ending the relationship ahead of time.

Be direct: Use the DEAR MAN GIVE FAST interpersonal

effectiveness skills.

Practice OPPOSITE ACTION FOR LOVE when you ﬁnd

you love the wrong person.

PRACTICE SAFETY FIRST!

Before leaving a highly abusive or life- threatening

relationship, call a local domestic violence hotline or the

toll-free National Domestic Violence Hotline (1-800-799-7233)

for help with safety planning and a referral to a qualiﬁed

professional. See also the International Directory of Domestic

Violence Agencies (

www.hotpeachpages.net

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 13a

Identifying How to End Relationships

For each A and B pair, check the more effective response.











 1A. If a relationship is threatening

your integrity or physical well-

being, it is probably your fault,

and you should see a therapist.

 1B. A relationship threatening your

integrity or physical well-being

is destructive, and you should

consider getting out of it.











In the middle of an argument, you are so mad at

the other person you don’t want to have anything to

do with this person any more.

 5A. You should end the relationship right then!

You may forget all about how enraging the

person is if you wait.

 5B. You should get out of emotion mind and into

Wise Mind, and evaluate whether to stay or

leave the relationship.











 2A. Relationships should be

easy. If it’s hard to have a

relationship with someone, it’s

probably not worth it, and you

should end it.

 2B. Most relationships need

problem solving to work.











 6A. If ending a destructive relationship will be

difﬁcult, it’s most effective to stay together.

 6B. If ending a destructive relationship will be

difﬁcult, it’s most effective to cope ahead of

time.











 3A. If you are in love with someone

who does not love you back,

practice DEAR MAN skills to

get the person to love you.

 3B. If you are in love with someone

who does not love you back,

practice opposite action to love.











 7A. In an abusive relationship, if the person

hits you, you should use your interpersonal

skills to tell the person you are leaving the

relationship.

 7B. In an abusive relationship, you should

seek professional assistance to leave the

relationship.











 4A. To decide whether to end a

relationship, do PROS and

CONS.

 4B. To decide whether to end a

relationship, use GIVE skills.











 8A. If you feel consistently invalidated in a

relationship, it is probably your fault.

 8B. If you are consistently invalidated, the

relationship is likely destructive.

Handouts for Walking

the Middle Path

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 14

(Interpersonal Effectiveness Worksheets 11–15; pp. 189–195 )

Overview:

Walking the Middle Path

Balancing Acceptance and Change

DIALECTICS

Balancing opposites while entering the paradox of “yes”

and “no,” “true” and “not true,” at the very same time.

VALIDATION

Including the valid and understanable in ourselves and others.

RECOVERING FROM INVALIDATION

From a nondefensive position, ﬁnd the valid, acknowledge

the invalid, and radically accept yourself.

STRATEGIES FOR CHANGING BEHAVIOR

Use behavioral principles to increase desired behaviors and

decrease undesired behaviors.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 15

(Interpersonal Effectiveness Worksheets 11, 11a, 11b ; pp. 189–191 )

Dialectics

DIALECTICS REMINDS US THAT

1. The universe is ﬁlled with opposing sides/opposing forces.

There is always more than one way to see a situation, and more than one way to solve a

problem.

Two things that seem like opposites can both be true.

2. Everything and every person is connected in some way.

The waves and the ocean are one.

The slightest move of the butterﬂy affects the furthest star.

3. Change is the only constant.

Meaning and truth evolve over time.

Each moment is new; reality itself changes with each moment.

4. Change is transactional.

What we do inﬂuences our environment and other people in it.

The environment and other people inﬂuence us.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 16

(Interpersonal Effectiveness Worksheets 11, 11a, 11b ; pp. 189–191 )

How to Think and Act Dialectically

 1. There is always more than one side to anything that exists. Look for both sides.

 Ask Wise Mind: What am I missing? Where is the kernel of truth in the other side?

 Let go of extremes: Change “either-or” to “both-and,” “always” or “never” to

“sometimes.”

 Balance opposites: Validate both sides when you disagree, accept reality, and work to

change.

 Make lemonade out of lemons.

 Embrace confusion: Enter the paradox of yes and no, or true and not true.

 Play devil’s advocate: Argue each side of your own position with equal passion.

 Use metaphors and storytelling to unstick and free the mind.

 Other ways to see all sides of a situation:

 2. Be aware that you are connected.

 Treat others as you want them to treat you.

 Look for similarities among people instead of differences.

 Notice the physical connections among all things.

 Other ways to stay aware of connections:

 3. Embrace change.

 Throw yourself into change: Allow it. Embrace it.

 Practice radical acceptance of change when rules, circumstances, people, and

relationships change in ways you don’t like.

 Practice getting used to change: Make small changes to practice this (e.g., purposely

change where you sit, who you talk with, what route you take when going to a familiar

place).

 Other ways to embrace change:

 4. Change is transactional: Remember that you affect your environment and your

environment affects you.

 Pay attention to your effect on others and how they affect you.

 Practice letting go of blame by looking for how your own and others’ behaviors are

caused by many interactions over time.

 Remind yourself that all things, including all behaviors, are caused.

 Other ways to see transactions:

Note. Adapted from Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007). Dialectical behavior therapy with suicidal adolescents. New York:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 16a

Examples of Opposite Sides That Can Both Be True

 1. You can want to change and be doing the best you can, AND still need to do better, try

harder, and be more motivated to change.

 2. You are tough AND you are gentle.

 3. You can be independent AND also want help. (You can allow somebody else to be

independent AND also give them help.)

 4. You can want to be alone AND also want to be connected to others.

 5. You can share some things with others AND also keep some things private.

 6. You can be by yourself AND still be connected to others.

 7. You can be with others AND be lonely.

 8. You can be a misﬁt in one group AND ﬁt in perfectly in another group. (A tulip in a rose

garden can also be a tulip in a tulip garden.)

 9. You can accept yourself the way you are AND still want to change. (You can accept others

as they are AND still want them to change.)

 10. At times you need to both control AND tolerate your emotions.

 11. You may have a valid reason for believing what you believe, AND you may still be wrong or

incorrect.

 12. Someone may have valid reasons for wanting something from you, AND you may have valid

reasons for saying no.

 13. The day can be sunny, AND it can rain.

 14. You can be mad at somebody AND also love and respect the person.

 15. (You can be mad at yourself AND also love and respect yourself.)

 16. You can have a disagreement with somebody AND also be friends.

 17. You can disagree with the rules AND also follow the rules.

 18. You can understand why somebody is feeling or behaving in a certain way, AND also

disagree with his or her behavior and ask that it be changed.

 19. Others:

Note. Adapted from Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007). Dialectical behavior therapy with suicidal adolescents. New York:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 16b

Important Opposites to Balance

 1. Accepting reality AND working to change it.

 2. Validating yourself and others AND acknowledging errors.

 3. Working AND resting.

 4. Doing things you need to do AND doing things you want to do.

 5. Working on improving yourself AND accepting yourself exactly as you are.

 6. Problem solving AND problem acceptance.

 7. Emotion regulation AND emotion acceptance.

 8. Mastering something on your own AND asking for help.

 9. Independence AND dependence.

 10. Openness AND privacy.

 11. Trust AND suspicion.

 12. Watching and observing AND participating.

 13. Taking from others AND giving to others.

 14. Focusing on yourself AND focusing on others.

 15. Others:

 16. Others:

 17. Others:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 16c

Identifying Dialectics

For each group, check the most dialectical response.











 1A. Pay attention to your effect on others.

 1B. Assume that others’ reactions to you

are unrelated to your treatment of

them.











 5A. Examine a difﬁcult relationship by

looking at how the interactions over

time between you and the other

person may be problematic.

 5B. Assume that difﬁculties in a

relationship are caused completely by

you or by the other person.











Saying:

 2A. “I know I am right about this.”

 2B. “I can see your point of view, even

though I do not agree with it.”

 2C. “The way you are thinking doesn’t

make any sense.”











Saying:

 6A. “It is hopeless. I cannot do it.”

 6B. “This is a breeze. I’ve got no

problems.”

 6C. “This is really hard for me, and I am

going to keep trying.”











Saying:

 3A. “Everyone always treats me unfairly.”

 3B. “I believe the coach should reconsider

his decision to cut me from the team.”

 3C. “Coaches know best who to keep on

teams and who to cut.”











 7A. When you disagree with someone,

be sure and be very clear about your

point of view.

 7B. When you disagree with someone, try

and see their point of view.











 4A. Judge friends as disloyal and uncaring

if they start changing in ways you don’t

like.

 4B. Accept that interests change.











 8A. Demand that relationships be stable

without changing.

 8B. Embrace change and see it as

inevitable.

Note. Adapted in part from Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007). Dialectical behavior therapy with suicidal adolescents. New York:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 17

(Interpersonal Effectiveness Worksheet 12; p. 192 )

Validation

VALIDATION MEANS:

• Finding the kernel of truth in another person’s perspective or situation; verifying the facts of

a situation.

• Acknowledging that a person’s emotions, thoughts, and behaviors have causes and are

therefore understandable.

• Not necessarily agreeing with the other person.

• Not validating what is actually invalid.

WHY VALIDATE?

• It improves our relationships by showing we are listening and understand.

• It improves interpersonal effectiveness by reducing:

1. Pressure to prove who is right

2. Negative reactivity

3. Anger

• It makes problem solving, closeness, and support possible.

• Invalidation hurts.

IMPORTANT THINGS TO VALIDATE

• The valid (and only the valid).

• The facts of a situation.

• A person’s experiences, feelings/emotions, beliefs, opinions, or thoughts about something.

• Suffering and difﬁculties.

REMEMBER:

• Every invalid response makes sense in some way.

• Validation is not necessarily agreeing.

• Validation doesn’t mean you like it.

• Only validate the valid!

Note. Adapted from Linehan, M. M. (1997). Validation and psychotherapy. In A. Bohart & L. Greenberg (Eds.), Empathy reconsidered: New

logical Association. Adapted by permission.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 18

(Interpersonal Effectiveness Worksheet 12; p. 192 )

A “How To” Guide to Validation

1. Pay Attention:

Look interested, listen, and observe. No multitasking. Make eye contact. Stay focused. Nod

occasionally. Respond with your face (e.g., smile at happy statements; look concerned when

hearing something painful).

2. Reﬂect Back:

Say back what you heard or observed to be sure you actually understand what the person is

saying. No judgmental language or voice tone!

Try to really “get” what the person feels or thinks. Have an open mind. (No disagreeing,

criticizing, or trying to change the person’s mind or goals.) Use a voice tone that allows the

other person to correct you . . . and check the facts!

Example: “So you are mad at me because you think I lied just to get back at you. Did I get it

right?”

3. “Read Minds”:

Be sensitive to what is not being said by the other person. Pay attention to facial

expressions, body language, what is happening, and what you know about the person

already. Show that you understand in words or by your actions. Be open to correction.

Example: When you are asking a friend for a ride at the end of a long day and the person

slumps down, say, “You look really tired. Let me look for someone else.”

4. Understand:

Look for how the other person feels, is thinking, or if he or she is making sense, given the

person’s history, state of mind or body, or current events (i.e. the causes)—even if you don’t

approve of the person’s behavior, or if his or her belief is incorrect. Say “It makes sense that

you . . . because . . . ”

Example: If you sent a party invitation to the wrong address, say, “I can see why you thought

I might be excluding you on purpose.”

5. Acknowledge the valid:

Show that you see that the person’s thoughts, feelings, or actions are valid, given current

reality and facts. Act as if the person’s behavior is valid.

Example: If you are criticized for not taking out the garbage on your day, admit that it is your

day and take it out. If people present a problem, help them solve it (unless they just want to

be heard). If people are hungry, give them food. Acknowledge the effort a person is making.

6. Show Equality:

Be yourself! Don’t “one-up” or “one-down” the other person. Treat the other as an equal, not

as fragile or incompetent.

Example: Be willing to admit mistakes. If someone introduces him- or herself by ﬁrst name,

introduce yourself by your ﬁrst name. Ask other people for their opinions. Give up being

defensive. Be careful in giving advice or telling someone what to do if you are not asked or

required to do so. Even then, remember you could be wrong.

Note. Adapted from Linehan, M. M. (1997). Validation and psychotherapy. In A. Bohart & L. Greenberg (Eds.), Empathy reconsidered: New

logical Association. Adapted by permission.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 18a

Identifying Validation

For each A and B pair, check the more effective response.











 1A. Think about your day when the other

person is talking about his or her day.

 1B. Throw yourself into listening about the

other person’s day.











 5A. Remember that people’s thoughts,

feelings, and behaviors don’t always

match. Check the facts.

 5B. Assume that you can tell exactly what

people are feeling and thinking.











 2A. If you are uncertain of people’s

thoughts and feelings, ask them what

they are thinking or feeling, or try to

imagine yourself in their situation.

 2B. Assume that if people want you

to know what they are thinking or

feeling, they will tell you.











 6A. Evaluate other people’s behaviors and

thoughts, and tell them that they are

wrong or that they should be different

when you feel sure you are right.

 6B. If you do not agree with what another

person is doing or thinking, try to

understand how it could make sense if

you understood the causes.











 3A. Observe the small clues that indicate

what is going on in social situations.

 3B. Observe only what people say, and

ignore nonverbal signals.











 7A. Assume that if you tell a person his

or her request of you makes sense,

that’s all you have to do to validate the

person.

 7B. When a person asks you for

something, giving the person what

has been asked for is validation.











 4A. Jump to conclusions about what

people mean.

 4B. Realize that the same behavior can

mean many things.











 8A. Assume that other people’s reactions

to you have nothing to do with yours to

them.

 8B. Treat each person with respect and as

an equal.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 19 (p. 1 of 2)

(Interpersonal Effectiveness Worksheet 13; p. 193 )

Recovering from Invalidation

NOTICE THAT INVALIDATION

CAN BE HELPFUL AND PAINFUL AT THE SAME TIME

Remember:

Invalidation Is Helpful When

1. It corrects important mistakes (your facts are wrong).

2. It stimulates intellectual and personal growth by listening

to other views.

3. Other:

Invalidation Is Painful When

1. You are being ignored.

2. You are not being repeatedly misunderstood.

3. You are being misread.

4. You are being misinterpreted.

5. Important facts in your life are ignored or denied.

6. You are receiving unequal treatment.

7. You are being disbelieved when being truthful.

8. Your private experiences are trivialized or denied.

9. Other:

(

continued on next page

)

interpersonal effectiveness Handout 19 (p. 2 of 2)

Be Nondefensive and Check the Facts

 Check ALL the facts to see if your responses are valid or invalid.

Check them out with someone you can trust to validate the valid.

 Acknowledge when your responses don’t make sense and are not

valid.

 Work to change invalid thinking, comments, or actions. (Also, stop

blaming. It rarely helps a situation.)

 Drop judgmental self- statements. (Practice opposite action.)

 Remind yourself that all behavior is caused and that you are doing

your best.

 Be compassionate toward yourself. Practice self- soothing.

 Admit that it hurts to be invalidated by others, even if they are right.

 Acknowledge when your reactions make sense and are valid in a

situation.

 Remember that being invalidated, even when your response is

actually valid, is rarely a complete catastrophe.

 Describe your experiences and actions in a supportive environment.

 Grieve traumatic invalidation and the harm it created.

 Practice radical acceptance of the invalidating person.

Validate Yourself Exactly the Way You Would

Validate Someone Else

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Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 19a

Identifying Self- Validation

For each A and B pair, check the more effective response when someone else invalidates you.











 1A. Describe your own experience, point

of view, emotion, or action in a matter-

of-fact way.

 1B. Say, “How stupid of me,” or put

yourself down for your response.











 4A. Jump to anger and call yourself a

wimp if you start feeling sad or alone.

 4B. Accept that it hurts to be invalidated,

and feel the pain.











 2A. Blast the other person and argue your

point of view, even if you might be

wrong.

 2B. When someone disagrees with what

you think or do, be open to being

wrong and being OK with that. Check

the facts.











 5A. When you make a mistake, remind

yourself that you are human, and

humans make mistakes.

 5B. Blame and punish yourself for being

wrong; avoid people who know you

were wrong.











 3A. When you are checking the facts

(if only in your mind), stand up for

yourself if you are correct or if your

response is reasonable.

 3B. Assume that your experience of the

facts is wrong. Give up and give in.

Judge yourself and the person who

invalidated you.











 6A. See yourself as “screwed up” or

“damaged goods,” and give in to

shame and misery.

 6B. Respond and talk to yourself with

understanding and compassion.

Remind yourself that all responses

are caused and make sense if you

explore the reasons long enough.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 20

(Interpersonal Effectiveness Worksheet 14; p. 194 )

Strategies for Increasing the Probability

of Behaviors You Want

Describe behaviors for yourself or others that you would like to start or increase:

Reinforcer = A consequence that increases frequency of a behavior.

Positive reinforcement = positive consequences (i.e., reward).

Behavior is increased by consequences a person wants, likes, or will work to get.

Examples:

Negative reinforcement = removal of negative events (i.e., relief).

Behavior is increased by consequences that stop or reduce something negative.

Examples:

Shaping = Reinforcing small steps toward the behavior you want.

• Reinforce small steps that lead toward the goal.

• As new behavior stabilizes, require a little bit more before reinforcing.

• Continue until you reach the goal behavior.

Examples of steps to a goal behavior:

Timing counts.

• Reinforce behavior immediately after it occurs.

• When shaping new behavior, at ﬁrst reinforce every instance of the behavior.

• Once behavior is established, gradually start to reinforce only some of the time.

CAUTION: When you vary reinforcement, behavior becomes

very

hard to stop.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 21

(Interpersonal Effectiveness Worksheet 15; p. 195 )

Strategies for Decreasing or Stopping

Unwanted Behaviors

Extinction = Stopping an ongoing reinforcement of behavior.

Extinction leads ﬁrst to a burst of behavior, and then to a decrease in behavior.

Examples:

Satiation = Providing relief or what is wanted

before

the behavior occurs.

Satiation reduces motivation for behavior and thus decreases its frequency.

Examples:

Punishment = An aversive consequence that decreases a behavior.

Behavior is decreased by consequences the person dislikes or will work to avoid.

Examples:

Behavior is decreased by consequences that stop or reduce something positive.

Examples:

Behavior is decreased when something the person wants is withheld until harmful effects of

problem behaviors are corrected and overcorrected.

Examples:

• Be sure that punishment is speciﬁc, is time- limited, and ﬁts the “crime.”

• Avoid a punitive tone; let the consequence do the work.

• If a natural punishment occurs, don’t undo it. Don’t add arbitrary punishment.

Be sure to reinforce alternative behavior to replace behavior you want stopped.

• Extinction and punishment weaken or suppress behavior, but do not eliminate it.

• Extinction and punishment do not teach new behavior.

• To keep a behavior from resurfacing, reinforce an alternative behavior.

• Punishment works only when the punisher is (or is likely to be) present.

• Punishment leads to avoidance of the person punishing.

Note. Adapted from Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007). Dialectical behavior therapy with suicidal adolescents. New York:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 22

(Interpersonal Effectiveness Worksheets 14, 15 ; pp. 194–195 )

Tips for Using Behavior Change Strategies Effectively

Summary so far:

Goal Consequence

Increase behavior (Reinforce) • Add positive consequence

• Remove aversive consequence

Weaken behavior (Extinguish) • Remove reinforcer

• Provide relief before unwanted behavior

Suppress

behavior

(Punish) • Add aversive consequence

• Remove positive consequence

Not all consequences are created equal.

“One person’s poison can be another person’s passion.”

Context counts. A reinforcer in one situation can be punishment in another.

Quantity counts. If a reinforcer is too little or too much, it will not work.

Natural consequences work best. Let them do the work when possible.

Ask what consequence the person would work to get (reinforcer) or work to avoid

(punisher).

Observe changes in behavior when a consequence is applied.

Behavior learned in one situation may not happen in another situation.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

interpersonal effectiveness Handout 22a

Identifying Effective Behavior Change Strategies

For each A and B pair, check the more effective response.











 1A. When you are trying to increase a

behavior, it is most effective to wait

for the full desired behavior before

reinforcing, so the person does not

think that halfway is good enough.

 1B. When you are trying to increase

a behavior, it is most effective to

reinforce small improvement in the

right direction, or else the person may

not continue to improve.











 5A. If a person’s problem behaviors

work to get things he or she wants,

it is most effective to punish those

behaviors to make them stop.

 5B. If a person’s problem behaviors work

to get things he or she wants, it is

most effective to stop reinforcing

those behaviors and instead give

rewards when the person uses more

skillful strategies to get what he or she

wants or needs.











 2A. The most effective punishment

is intense anger and swift verbal

criticism.

 2B. The most effective punishment is to

ﬁnd one that ﬁts the severity of the

problem behavior.











 6A. When you are punishing, ﬁgure that

a nonspeciﬁc punishment will be a

lot more effective, since it can’t be

avoided.

 6B. Use a speciﬁc and time- limited

negative consequence to decrease

behavior.











 3A. It is most effective to reinforce

behavior immediately after it occurs.

 3B. It is most effective to reward behavior

after a delay so that the person

does not expect that you will always

provide a reward.











 7A. If a person’s mean behavior makes

you feel hurt, it is most effective to

punish the behavior by taking away

gifts that you previously gave the

person.

 7B. If a person’s mean behavior makes

you feel hurt, it is most effective to

punish the behavior by not doing

favors for the person until his or her

behavior improves.











 4A. It is common that people reward

others’ problematic behaviors without

even realizing it.

 4B. People do not reward others’

problematic behaviors, because that

would be stupid.











 8A. After a punished behavior stops, it is

most effective to reward an alternative

behavior that you want.

 8B. After a punished behavior stops,

it is most effective to continue the

punishment, so that you send a very

clear message that the problematic

behavior is unacceptable.

Emotion

RegulationHandouts

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



eMotion reGulation Handout 1

(Emotion Regulation Worksheet 1; p. 271 )

Goals of Emotion Regulation

UNDERSTAND AND NAME

YOUR OWN EMOTIONS

 Identify (observe and describe) your emotions.

 Know what emotions do for you.

 Other:

DECREASE

THE FREQUENCY

OF UNWANTED EMOTIONS

 Stop unwanted emotions from starting in the ﬁrst place.

 Change unwanted emotions once they start.

 Other:

DECREASE

EMOTIONAL VULNERABILITY

 Decrease vulnerability to emotion mind.

 Increase resilience, your ability to cope with difﬁcult things and positive emotions.

 Other:

DECREASE

EMOTIONAL SUFFERING

 Reduce suffering when painful emotions overcome you.

 Manage extreme emotions so that you don’t make things worse.

 Other:

Handouts for Understanding

andNaming Emotions

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Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

eMotion reGulation Handout 2

(Emotion Regulation Worksheets 2–4a, 16 ; pp. 275–282, 312 )

Overview:

Understanding and Naming Emotions

WHAT EMOTIONS DO FOR YOU

There are reasons why we have emotions.

We need them!

FACTORS THAT MAKE

REGULATING EMOTIONS HARD

Lack of skills, reinforcing consequences, moodiness, rumination/

worrying, myths about emotions, and biology can interfere

with changing emotions.

A MODEL FOR DESCRIBING EMOTIONS

Emotions are complex responses.

Changing any part of the system can change the entire response.

WAYS TO DESCRIBE EMOTIONS

Learning to observe, describe, and name your emotion

can help you regulate your emotions.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



eMotion reGulation Handout 3

(Emotion Regulation Worksheets 2–2c; pp. 275–278 )

What Emotions Do for You

EMOTIONS MOTIVATE (AND ORGANIZE) US FOR ACTION

• Emotions motivate our behavior. Emotions prepare us for action.

The action urge of speciﬁc emotions is often “hard-wired” in biology.

• Emotions save time in getting us to act in important situations.

Emotions can be especially important when we don’t have time to think things through.

• Strong emotions help us overcome obstacles—in our minds and in the environment.

EMOTIONS COMMUNICATE TO (AND INFLUENCE) OTHERS

• Facial expressions are hard-wired aspects of emotions.

Facial expressions communicate faster than words.

• Our body language and voice tone can also be hard-wired.

Like it or not, they also communicate our emotions to others.

• When it is important to communicate to others, or send them a message,

it can be very hard to change our emotions.

• Whether we intend it or not, our communication of emotions inﬂuences others.

EMOTIONS COMMUNICATE TO OURSELVES

• Emotional reactions can give us important information about a situation.

Emotions can be signals or alarms that something is happening.

• Gut feelings can be like intuition—a response to something important about the situation.

This can be helpful if our emotions get us to check out the facts.

• Caution: Sometimes we treat emotions as if they are facts about the world: The stronger

the emotion, the stronger our belief that the emotion is based on fact. (Examples: “If I feel

unsure, I am incompetent,” “If I get lonely when left alone, I shouldn’t be left alone,” “If I feel

conﬁdent about something, it is right,” “If I’m afraid, there must be danger,” “I love him, so

he must be OK.”)

• If we assume that our emotions represent facts about the world, we may use them to justify

our thoughts or our actions. This can be trouble if our emotions get us to ignore the facts.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



eMotion reGulation Handout 4

(Emotion Regulation Worksheets 3, 16; pp. 279, 312 )

What Makes It Hard to Regulate Your Emotions

BIOLOGY

 Biological factors can make emotion regulation harder.

LACK OF SKILL

 You don’t know what to do to regulate your emotions.

REINFORCEMENT OF EMOTIONAL BEHAVIOR

 Your environment reinforces you when you are highly emotional.

MOODINESS

 Your current mood controls what you do instead of your Wise Mind.

 You don’t really want to put in time and effort to regulate your emotions.

EMOTIONAL OVERLOAD

 High emotional arousal causes you to reach a skills breakdown point.

You can’t follow skills instructions or ﬁgure out what to do.

EMOTION MYTHS

 Myths (e.g., mistaken beliefs) about emotions get in the way of your

ability to regulate emotions.

 Myths that emotions are bad or weak lead to avoiding emotions.

 Myths that extreme emotions are necessary or are part of who you are

keep you from trying to regulate your emotions.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

eMotion reGulation Handout 4a

(Emotion Regulation Worksheet 3; p. 279 )

Myths about Emotions

1. There is a right way to feel in every situation.

Challenge:

2. Letting others know that I am feeling bad is a weakness.

Challenge:

3. Negative feelings are bad and destructive.

Challenge:

4. Being emotional means being out of control.

Challenge:

5. Some emotions are stupid.

Challenge:

6. All painful emotions are a result of a bad attitude.

Challenge:

7. If others don’t approve of my feelings, I obviously shouldn’t feel the way I do.

Challenge:

8. Other people are the best judges of how I am feeling.

Challenge:

9. Painful emotions are not important and should be ignored.

Challenge:

10. Extreme emotions get you a lot further than trying to regulate your emotions.

Challenge:

11. Creativity requires intense, often out-of- control emotions.

Challenge:

12. Drama is cool.

Challenge:

13. It is inauthentic to try to change my emotions.

Challenge:

14. Emotional truth is what counts, not factual truth.

Challenge:

15. People should do whatever they feel like doing.

Challenge:

16. Acting on your emotions is the mark of a truly free individual.

Challenge:

17. My emotions are who I am.

Challenge:

18. My emotions are why people love me.

Challenge:

19. Emotions can just happen for no reason.

Challenge:

20. Emotions should always be trusted.

Challenge:

21. Other myth:

Challenge:



eMotion reGulation Handout 5

(Emotion Regulation Worksheets 4, 4a; pp. 281–282 )

Model for Describing Emotions

Training Handouts and Worksheets, Second Edition, and DBT Skills Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.).

(Thoughts/beliefs about

prompting event)

Biological Changes

Brain changes

(neural firing)

Nervous system changes

(internal body changes

that affect muscles

and autonomic system

firing—blood vessels,

heart rate, temperature)

Experiences

Body sensations (feelings)

Action urges

Expressions

Face and Body Language

(facial expression, posture,

gestures, skin color)

Words

(what you say)

Actions

(your behavior)

Preexisting

Vulnerability Factors

Interpretation

Attention/Awareness

Prompting Event

Attention/Awareness

Prompting Event 2

Secondary

Emotions

Aftereffects

Emotion

Name

Awareness

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

eMotion reGulation Handout 6 (p. 1 of 10)

(Emotion Regulation Worksheets 4, 4a; pp. 281–282 )

Ways to Describe Emotions

ANGER WORDS

anger bitterness fury indignation vengefulness

aggravation exasperation grouchiness irritation wrath

agitation ferocity grumpiness outrage

annoyance frustration hostility rage

Prompting Events for Feeling Anger

• Having an important goal blocked.

• You or someone you care about being

attacked or threatened by others.

• Losing power, status, or respect.

• Not having things turn out as expected.

• Physical or emotional pain.

• Other:

Interpretations of Events That Prompt Feelings of Anger

• Believing that you have been treated unfairly.

• Blaming.

• Believing that important goals are being

blocked or stopped.

• Believing that things “should” be different

than they are.

• Rigidly thinking, “I’m right.”

• Judging that the situation is illegitimate or

wrong.

• Ruminating about the event that set off the

anger in the ﬁrst place.

• Other:

Biological Changes and Experiences of Anger

• Muscles tightening.

• Teeth clamping together.

• Hands clenching.

• Feeling your face ﬂush or get hot.

• Feeling like you are going to explode.

• Being unable to stop tears.

• Wanting to hit someone, bang the wall, throw

something, blow up.

• Wanting to hurt someone.

• Other:

Expressions and Actions of Anger

• Physically or verbally attacking.

• Making aggressive or threatening gestures.

• Pounding, throwing things, breaking things.

• Walking heavily, stomping, slamming doors.

• Walking out.

• Using a loud, quarrelsome, or sarcastic voice.

• Using obscenities or swearing.

• Criticizing or complaining.

• Clenching your hands or ﬁsts.

• Frowning, not smiling, mean expression.

• Brooding or withdrawing from others.

• Crying.

• Grinning.

• A red or ﬂushed face.

• Other:

Aftereffects of Anger

• Narrowing of attention.

• Attending only to the situation that’s making

you angry.

• Ruminating about the situation making you

angry or about situations in the past.

• Imagining future situations that will make you

angry.

• Depersonalization, dissociative experiences,

numbness.

• Other:

(

continued on next page

)

Note. Adapted from Table 3 in Shaver, P., Schwartz, J., Kirson, D., & O’Connor, C. (1987). Emotion knowledge: Further exploration of a proto-

Adapted by permission.

eMotion reGulation Handout 6 (p. 2 of 10)

DISGUST WORDS

disgust aversion dislike distaste repugnance resentment sickened

abhorrence condescension derision hate repelled revolted spite

antipathy contempt disdain loathing repulsion scorn vile

Prompting Events for Feeling Disgust

• Seeing/smelling human or animal waste

products.

• Having a person or an animal that is dirty,

slimy, or unclean come close to you.

• Tasting something or being forced to swallow

something you really don’t want.

• Seeing or being near a dead body.

• Touching items worn or owned by a stranger,

dead person, or disliked person.

• Observing or hearing about a person who

grovels or who strips another person of

dignity.

• Seeing blood; getting blood drawn.

• Observing or hearing about a person acting

with extreme hypocrisy/fawning.

• Observing or hearing about betrayal, child

abuse, racism, or other types of cruelty.

• Being forced to watch something that deeply

violates your own Wise Mind values.

• Being confronted with someone who is

deeply violating your own Wise Mind values.

• Being forced to engage in or watch unwanted

sexual contact.

• Other:

Interpretations of Events That Prompt Feelings of Disgust

• Believing that:

• You are swallowing something toxic.

• Your skin or your mind is being

contaminated.

• Your own body or body parts are ugly.

• Others are evil or the “scum” of the earth,

or that they disrespect authority or the

group.

• Disapproving of/feeling morally superior to

another.

• Extreme disapproval of yourself or your own

feelings, thoughts, or behaviors.

• Judging that a person is deeply immoral or

has sinned or violated the natural order of

things.

• Judging someone’s body as extremely ugly.

• Other:

Biological Changes and Experiences of Disgust

• Feelings of nausea; sick feeling.

• Urge to vomit, vomiting, gagging, choking.

• Having a lump in your throat.

• Aversion to drinking or eating.

• Intense urge to destroy or get rid of

something.

• Urge to take a shower.

• Urge to run away or push away.

• Feeling contaminated, dirty, unclean.

• Feeling mentally polluted.

• Fainting.

• Other:

Expressions and Actions of Disgust

• Vomiting, spitting out.

• Closing your eyes, looking away.

• Washing, scrubbing, taking a bath.

• Changing your clothes; cleaning spaces.

• Avoiding eating or drinking.

• Pushing or kicking away; running away.

• Treating with disdain or disrespect.

• Stepping over; crowding another person out.

• Physically attacking causes of your disgust.

• Using obscenities or cursing.

• Clenching your hands or ﬁsts.

• Frowning, or not smiling.

• Mean or unpleasant facial expression.

• Speaking with a sarcastic voice tone.

• Nose and top lip tightened up; smirking.

• Other:

Aftereffects of Disgust

• Narrowing of attention.

• Ruminating about the situation that’s making

you feel disgusted.

• Becoming hypersensitive to dirt.

• Other:

(

continued on next page

)

eMotion reGulation Handout 6 (p. 3 of 10)

ENVY WORDS

envy craving displeased greed pettiness

bitterness discontented dissatisﬁed “green-eyed” resentment

covetous disgruntled down- hearted longing wishful

Prompting Events for Feeling Envy

• Someone has something you really want or

need but don’t or can’t have.

• You are not part of the “in” crowd.

• Someone appears to have everything.

• You are alone while others are having fun.

• Someone else gets credit for what you’ve

done.

• Someone gets positive recognition for

something and you don’t.

• Others get something you really want and

you don’t get it.

• Being around people who have more than

you have.

• Someone you are competing with is more

successful than you in an area important to

you.

• Other:

Interpretations of Events That Prompt Feelings of Envy

• Thinking you deserve what others have.

• Thinking others have more than you.

• Thinking about how unfair it is that you have

such a bad lot in life compared to others.

• Thinking you have been treated unfairly by

life.

• Thinking you are unlucky.

• Thinking you are inferior, a failure, or

mediocre in comparison to others whom you

want to be like.

• Comparing yourself to others who have more

than you.

• Comparing yourself to people who have

characteristics that you wish you had.

• Thinking you are unappreciated.

• Other:

Biological Changes and Experiences of Envy

• Muscles tightening.

• Teeth clamping together, mouth tightening.

• Feeling your face ﬂush or get hot.

• Feeling rigidity in your body.

• Pain in the pit of the stomach.

• Having an urge to get even.

• Hating the other person.

• Wanting to hurt the people you envy.

• Wanting the person or people you envy to

lose what they have, to have bad luck, or to

be hurt.

• Feeling pleasure when others experience

failure or lose what they have.

• Feeling unhappy if another person

experiences some good luck.

• Feeling motivated to improve yourself.

• Other:

Expressions and Actions of Envy

• Doing everything you can to get what the

other person has.

• Working a lot harder than you were to get

what you want.

• Trying to improve yourself and your situation.

• Taking away or ruining what the other person

has.

• Attacking or criticizing the other person.

• Doing something to get even.

• Doing something to make the other person

fail or lose what he or she has.

• Saying mean things about the other person

or making the person look bad to others.

• Trying to show the other person up, to look

better than the other person.

• Avoiding persons who have what you want.

• Other:

Aftereffects of Envy

• Narrowing of attention.

• Attending only to what others have that you

don’t.

• Ruminating when others have had more than

you.

• Discounting what you do have; not

appreciating things you have or things others

do for you.

• Ruminating about what you don’t have.

• Making resolutions to change.

• Other:

(

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)

eMotion reGulation Handout 6 (p. 4 of 10)

FEAR WORDS

fear dread horror nervousness shock uneasiness

anxiety edginess hysteria overwhelmed tenseness worry

apprehension fright jumpiness panic terror

Prompting Events for Feeling Fear

• Having your life, your health, or your well-

being threatened.

• Being in the same situation (or a similar one)

where you have been threatened or gotten

hurt in the past, or where painful things have

happened.

• Flashbacks.

• Being in situations where you have seen

others threatened or be hurt.

• Silence.

• Being in a new or unfamiliar situation.

• Being alone (e.g., walking alone, being home

alone, living alone).

• Being in the dark.

• Being in crowds.

• Leaving your home.

• Having to perform in front of others.

• Pursuing your dreams.

• Other:

Interpretations of Events That Prompt Feelings of Fear

• Believing that:

• You might die, or you are going to die.

• You might be hurt or harmed.

• You might lose something valuable.

• Someone might reject, criticize, or dislike

you.

• You will embarrass yourself.

• Failure is possible; expecting to fail.

• Believing that:

• You will not get help you want or need.

• You might lose help you already have.

• You might lose someone important.

• You might lose something you want.

• You are helpless or are losing a sense of

control.

• You are incompetent or are losing mastery.

• Other:

Biological Changes and Experiences of Fear

• Breathlessness.

• Fast heartbeat.

• Choking sensation, lump in throat.

• Muscles tensing, cramping.

• Clenching teeth.

• Urge to scream or call out.

• Feeling nauseated.

• Getting cold; feeling clammy.

• Feeling your hairs standing on end.

• Feeling of “butterﬂies” in stomach.

• Wanting to run away or avoid things.

• Other:

Expressions and Actions of Fear

• Fleeing, running away.

• Running or walking hurriedly.

• Hiding from or avoiding what you fear.

• Engaging in nervous, fearful talk.

• Pleading or crying for help.

• Talking less or becoming speechless.

• Screaming or yelling.

• Darting eyes or quickly looking around.

• Frozen stare.

• Talking yourself out of doing what you fear.

• Freezing, or trying not to move.

• Crying or whimpering.

• Shaking, quivering, or trembling.

• A shaky or trembling voice.

• Sweating or perspiring.

• Diarrhea, vomiting.

• Hair erect.

• Other:

Aftereffects of Fear

• Narrowing of attention.

• Being hypervigilant to threat.

• Losing your ability to focus or becoming

disoriented or dazed.

• Losing control.

• Imagining the possibility of more loss or

failure.

• Isolating yourself.

• Ruminating about other threatening times.

• Other:

(

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)

eMotion reGulation Handout 6 (p. 5 of 10)

HAPPINESS WORDS

happiness satisfaction joviality exhilaration ecstasy

joy bliss triumph optimism gladness

enjoyment enthusiasm contentment zest pride

relief jolliness excitement eagerness elation

amusement thrill jubilation gaiety glee

enthrallment cheerfulness zaniness pleasure rapture

hope euphoria delight zeal

Prompting Events for Feeling Happiness

• Receiving a wonderful surprise.

• Reality exceeding your expectations.

• Getting what you want.

• Getting something you have worked hard for

or worried about.

• Things turning out better than you thought

they would.

• Being successful at a task.

• Achieving a desirable outcome.

• Receiving esteem, respect, or praise.

• Receiving love, liking, or affection.

• Being accepted by others.

• Belonging somewhere or with someone or a

group.

• Being with or in contact with people who love

or like you.

• Having very pleasurable sensations.

• Doing things that create or bring to mind

pleasurable sensations.

• Other:

Interpretations of Events That Prompt Feelings of Happiness

• Interpreting joyful events just as they are, without adding or subtracting.

• Other:

Biological Changes and Experiences of Happiness

• Feeling excited.

• Feeling physically energetic, active.

• Feeling like giggling or laughing.

• Feeling your face ﬂush.

• Feeling calm all the way through.

• Urge to keep doing what is associated with

happiness.

• Feeling at peace.

• Feeling open or expansive.

• Other:

Expressions and Actions of Happiness

• Smiling.

• Having a bright, glowing face.

• Being bouncy or bubbly.

• Communicating your good feelings.

• Sharing the feeling.

• Silliness.

• Hugging people.

• Jumping up and down.

• Saying positive things.

• Using an enthusiastic or excited voice.

• Being talkative or talking a lot.

• Other:

Aftereffects of Happiness

• Being courteous or friendly to others.

• Doing nice things for other people.

• Having a positive outlook; seeing the bright

side.

• Having a high threshold for worry or

annoyance.

• Remembering and imagining other times you

have felt joyful.

• Expecting to feel joyful in the future.

• Other:

(

continued on next page

)

eMotion reGulation Handout 6 (p. 6 of 10)

JEALOUSY WORDS

jealous clutching fear of losing someone/

something

rivalrous wary

cautious defensive suspicious watchful

clinging mistrustful possessive self- protective

Prompting Events for Feeling Jealous

• An important relationship is threatened or in

danger of being lost.

• A potential competitor pays attention to

someone you love.

• Someone:

• Is threatening to take away important things

in your life.

• Goes out with the person you like.

• Ignores you while talking to a friend of

yours.

• Is more attractive, outgoing, or self-

conﬁdent than you.

• You are treated as unimportant by a person

you want to be close to.

• Your partner tells you that he or she desires

more time alone.

• Your partner appears to ﬂirt with someone

else.

• A person you are romantically involved with

looks at someone else.

• You ﬁnd the person you love is having an

affair with someone else.

• Other:

Interpretations of Events That Prompt Feelings of Jealousy

• Believing that:

• Your partner does not care for you any

more.

• You are nothing to your partner.

• Your partner is going to leave you.

• Your partner is behaving inappropriately.

• You don’t measure up to your peers.

• I deserve more than what you are receiving.

• Believing that:

• You were cheated.

• No one cares about you.

• Your rival is possessive and competitive.

• Your rival is insecure.

• Your rival is envious.

• Other:

Biological Changes and Experiences of Jealousy

• Breathlessness.

• Fast heartbeat.

• Choking sensation, lump in throat.

• Muscles tensing.

• Teeth clenching.

• Becoming suspicious of others.

• Having injured pride.

• Feelings of rejection.

• Needing to be in control.

• Feeling helpless.

• Wanting to grasp or keep hold of what you

have.

• Wanting to push away or eliminate your rival.

Expressions and Actions of Jealousy

• Violent behavior or threats of violence toward

the person threatening to take something

away.

• Attempting to control the freedom of the

person you are afraid of losing.

• Verbal accusations of disloyalty or

unfaithfulness.

• Spying on the person.

• Interrogating the person; demanding

accounting of time or activities.

• Collecting evidence of wrongdoings.

• Clinging; enhanced dependency.

• Increased or excessive demonstrations of

love.

• Other:

Aftereffects of Jealousy

• Narrowing of attention.

• Seeing the worst in others.

• Being mistrustful across the board.

• Being hypervigilant to threats to your

relationships.

• Becoming isolated or withdrawn.

• Other:

(

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)

eMotion reGulation Handout 6 (p. 7 of 10)

LOVE WORDS

love attraction enchantment limerence sympathy

adoration caring fondness longing tenderness

affection charmed infatuation lust warmth

arousal compassion kindness passion

desire liking sentimentality

Prompting Events for Feeling Love

• A person:

• Offers or gives you something you want,

need, or desire.

• Does things you want or need.

• Does things you particularly value or

admire.

• Feeling physically attracted to someone.

• Being with someone you have fun with.

• You spend a lot of time with a person.

• You share a special experience with a

person.

• You have exceptionally good communication

with a person.

• Other:

Interpretations of Events That Prompt Feelings of Love

• Believing that a person loves, needs, or appreciates you.

• Thinking that a person is physically attractive.

• Judging a person’s personality as wonderful, pleasing, or attractive.

• Believing that a person can be counted on, or will always be there for you.

• Other:

Biological Changes and Experiences of Love

• When you are with or thinking about

someone:

• Feeling excited and full of energy.

• Fast heartbeat.

• Feeling self- conﬁdent.

• Feeling invulnerable.

• Feeling happy, joyful, or exuberant.

• Feeling warm, trusting, and secure.

• Feeling relaxed and calm.

• Wanting the best for a person.

• Wanting to give things to a person.

• Wanting to see and spend time with a person.

• Wanting to spend your life with a person.

• Wanting physical closeness or sex.

• Wanting emotional closeness.

Expressions and Actions of Love

• Saying “I love you.”

• Expressing positive feelings to a person.

• Eye contact, mutual gaze.

• Touching, petting, hugging, holding, cuddling.

• Sexual activity.

• Smiling.

• Sharing time and experiences with someone.

• Doing things that the other person wants or

needs.

• Other:

Aftereffects of Love

• Only seeing a person’s positive side.

• Feeling forgetful or distracted; daydreaming.

• Feeling openness and trust.

• Feeling “alive,” capable.

• Remembering other people you have loved.

• Remembering other people who have loved

you.

• Remembering other positive events.

• Believing in yourself; believing you are

wonderful, capable, competent.

• Other:

(

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)

eMotion reGulation Handout 6 (p. 8 of 10)

SADNESS WORDS

sadness disappointment pity crushed disconnected depression

despair homesickness anguish displeasure suffering glumness

grief neglect dismay insecurity dejection melancholy

misery alienation hurt sorrow gloom alone

agony discontentment rejection defeat loneliness woe

di straught unhappiness

Prompting Events for Feeling Sadness

• Losing something or someone irretrievably.

• The death of someone you love.

• Things not being what you expected or

wanted.

• Things being worse than you expected.

• Being separated from someone you care for.

• Getting what you don’t want.

• Not getting what you have worked for.

• Not getting what you believe you need in life.

• Being rejected, disapproved of, or excluded.

• Discovering that you are powerless or

helpless.

• Being with someone else who is sad or in

pain.

• Reading or hearing about other people’s

problems or troubles in the world.

• Being alone, or feeling isolated or like an

outsider.

• Thinking about everything you have not

gotten.

• Thinking about your losses.

• Thinking about missing someone.

• Other:

Interpretations of Events That Prompt Feelings of Sadness

• Believing that a separation from someone will

last for a long time or will never end.

• Believing that you will not get what you want

or need in your life.

• Seeing things or your life as hopeless.

• Believing that you are worthless or not

valuable.

• Other:

Biological Changes and Experiences of Sadness

• Feeling tired, run down, or low in energy.

• Feeling lethargic, listless; wanting to stay in

bed all day.

• Feeling as if nothing is pleasurable any more.

• Pain or hollowness in your chest or gut.

• Feeling empty.

• Feeling as if you can’t stop crying, or if you

ever start crying you will never be able to

stop.

• Difﬁculty swallowing.

• Breathlessness.

• Dizziness.

• Other:

Expressions and Actions of Sadness

• Avoiding things.

• Acting helpless; staying in bed; being

inactive.

• Moping, brooding, or acting moody.

• Making slow, shufﬂing movements.

• Withdrawing from social contact.

• Avoiding activities that used to bring pleasure.

• Giving up and no longer trying to improve.

• Saying sad things.

• Talking little or not at all.

• Using a quiet, slow, or monotonous voice.

• Eyes drooping.

• Frowning, not smiling.

• Posture slumping.

• Sobbing, crying, whimpering.

• Other:

Aftereffects of Sadness

• Not being able to remember happy things.

• Feeling irritable, touchy, or grouchy.

• Yearning and searching for the thing lost.

• Having a negative outlook.

• Blaming or criticizing yourself.

• Ruminating about sad events in the past.

• Insomnia.

• Appetite disturbance, indigestion.

• Other:

(

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)

eMotion reGulation Handout 6 (p. 9 of 10)

SHAME WORDS

shame culpability embarrassment mortiﬁcation shyness

contrition discomposure humiliation self- conscious

Prompting Events for Feeling Shame

• Being rejected by people you care about.

• Having others ﬁnd out that you have done

something wrong.

• Doing (or feeling or thinking) something

that people you admire believe is wrong or

immoral.

• Comparing some aspect of yourself or your

behavior to a standard and feeling as if you

do not live up to that standard.

• Being betrayed by a person you love.

• Being laughed at/made fun of.

• Being criticized in public/in front of someone

else; remembering public criticism.

• Others attacking your integrity.

• Being reminded of something wrong,

immoral, or “shameful” you did in the past.

• Being rejected or criticized for something you

expected praise for.

• Having emotions/experiences that have been

invalidated.

• Exposure of a very private aspect of yourself

or your life.

• Exposure of a physical characteristic you

dislike.

• Failing at something you feel you are (or

should be) competent to do.

• Other:

Interpretations of Events That Prompt Feelings of Shame

• Believing that others will reject you (or have

rejected you).

• Judging yourself to be inferior, not “good

enough,” not as good as others; self-

invalidation.

• Comparing yourself to others and thinking

that you are a “loser.”

• Believing yourself unlovable.

• Thinking that you are bad, immoral, or wrong.

• Thinking that you are defective.

• Thinking that you are a bad person or a

failure.

• Believing your body (or a body part) is too

big, too small, or ugly.

• Thinking that you have not lived up to others’

expectations of you.

• Thinking that your behavior, thoughts, or

feelings are silly or stupid.

• Other:

Biological Changes and Experiences of Shame

• Pain in the pit of the stomach.

• Sense of dread.

• Wanting to shrink down and/or disappear.

• Wanting to hide or cover your face and body.

• Other:

Expressions and Actions of Shame

• Hiding behavior or a characteristic from other

people.

• Avoiding the person you have harmed.

• Avoiding persons who have criticized you.

• Avoiding yourself— distracting, ignoring.

• Withdrawing; covering the face.

• Bowing your head, groveling.

• Appeasing; saying you are sorry over and

over and over.

• Looking down and away from others.

• Sinking back; slumped and rigid posture.

• Halting speech; lowered volume while talking.

• Other:

Aftereffects of Shame

• Avoiding thinking about your transgression;

shutting down; blocking all emotions.

• Engaging in distracting, impulsive behaviors

to divert your mind or attention.

• High amount of “self-focus”; preoccupation

with yourself.

• Depersonalization, dissociative experiences,

numbness, or shock.

• Attacking or blaming others.

• Conﬂicts with other people.

• Isolation, feeling alienated.

• Impairment in problem- solving ability.

• Other:

(

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)

eMotion reGulation Handout 6 (p. 10 of 10)

GUILT WORDS

guilt culpability remorse apologetic regret sorry

Prompting Events for Feeling Guilt

• Doing or thinking something you believe is

wrong.

• Doing or thinking something that violates your

personal values.

• Not doing something you said that you would

do.

• Committing a transgression against another

person or something you value.

• Causing harm/damage to another person or

object.

• Causing harm/damage to yourself.

• Being reminded of something wrong you did

in the past.

• Other:

Interpretations of Events That Prompt Feelings of Guilt

• Thinking that your actions are to blame for

something.

• Thinking that you behaved badly.

• Thinking, “If only I had done something

differently . . . ”

• Other:

Biological Changes and Experiences of Guilt

• Hot, red face.

• Jitteriness, nervousness.

• Suffocating.

• Other:

Expressions and Actions of Guilt

• Trying to repair the harm, make amends for the wrongdoing, ﬁx the damage, change the

outcome.

• Asking for forgiveness, apologizing, confessing.

• Giving gifts/making sacriﬁces to try to make up for the transgression.

• Bowing your head; kneeling before the person.

Aftereffects of Guilt

• Making resolutions to change.

• Making changes in behavior.

• Joining self-help programs.

• Other:

Other Important Emotion Words

• Weariness, dissatisfaction, disinclination.

• Distress.

• Shyness, fragility, reserve, bashfulness, coyness, reticence.

• Cautiousness, reluctance, suspiciousness, caginess, wariness.

• Surprise, amazement, astonishment, awe, startle, wonder.

• Boldness, bravery, courage, determination.

• Powerfulness, a sense of competence, capability, mastery.

• Dubiousness, skepticism, doubtfulness.

• Apathy, boredom, dullness, ennui, ﬁdgetiness, impatience, indifference, listlessness.

Handouts for Changing

EmotionalResponses

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

eMotion reGulation Handout 7

(Emotion Regulation Worksheets 5–8; pp. 285–290 )

Overview:

Changing Emotional Responses

CHECK THE FACTS

Check out whether your emotional reactions ﬁt the facts

of the situation.

Changing your beliefs and assumptions to ﬁt the facts can help

you change your emotional reactions to situations.

OPPOSITE ACTION

When your emotions do not ﬁt the facts,

or when acting on your emotions is not effective,

acting opposite (all the way)

will change your emotional reactions.

PROBLEM SOLVING

When the facts themselves are the problem,

solving the problem

will reduce the frequency of negative emotions.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



eMotion reGulation Handout 8

(Emotion Regulation Worksheet 5; p. 285 )

Check the Facts

FACTS

Many emotions and actions are set off by our thoughts and interpretations of events,

not by the events themselves.

Event → Thoughts → Emotions

Our emotions can also have a big effect on our thoughts about events.

Event → Emotion → Thoughts

Examining our thoughts and checking the facts can help us change our emotions.

HOW TO CHECK THE FACTS

1. Ask: What is the emotion I want to change?

(See Emotion Regulation Handout 6: Ways of Describing Emotions.)

2. Ask: What is the event prompting my emotion?

Describe the facts that you observed through your senses.

Challenge judgments, absolutes, and black-and-white descriptions.

(See Mindfulness Handout 4: Taking Hold of Your Mind: “What” Skills.)

3. Ask: What are my interpretations, thoughts, and assumptions about the

event?

Think of other possible interpretations.

Practice looking at all sides of a situation and all points of view.

Test your interpretations and assumptions to see if they ﬁt the facts.

4. Ask: Am I assuming a threat?

Label the threat.

Assess the probability that the threatening event will really occur.

Think of as many other possible outcomes as you can.

5. Ask: What’s the catastrophe?

Imagine the catastrophe really occurring.

Imagine coping well with a catastrophe (through problem solving, coping

ahead, or radical acceptance).

6. Ask: Does my emotion and/or its intensity ﬁt the actual facts?

Check out facts that ﬁt each emotion.

Ask Wise Mind.

(See Emotion Regulation Handout 11: Figuring Out Opposite Actions, and Emotion

Regulation Handout 13: Reviewing Problem Solving and Opposite Action.)

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

eMotion reGulation Handout 8a

(Emotion Regulation Worksheet 5; p. 285 )

Examples of Emotions That Fit the Facts

Fear

1. There is a threat to your life or that of someone you care about.

2. There is a threat to your health or that of someone you care about.

3. There is a threat to your well-being or that of someone you care about.

4. Other:

Anger

1. An important goal is blocked or a desired activity is interrupted or prevented.

2. You or someone you care about is attacked or hurt by others.

3. You or someone you care about is insulted or threatened by others.

4. The integrity or status of your social group is offended or threatened.

5. Other:

Disgust

1. Something you are in contact with could poison or contaminate you.

2. Somebody whom you deeply dislike is touching you or someone you care about.

3. You are around a person or group whose behavior or thinking could seriously

damage or harmfully inﬂuence you or the group you are part of.

4. Other:

Envy

1. Another person or group gets or has things you don’t have that you want or need.

2. Other:

Jealousy

1. A very important and desired relationship or object in your life is in danger of

being damaged or lost.

2. Someone is threatening to take a valued relationship or object away from you.

3. Other:

Love

1. Loving a person, animal, or object enhances quality of life for you or for those you

care about.

2. Loving a person, animal, or object increases your chances of attaining your own

personal goals.

3. Other:

Sadness

1. You have lost something or someone permanently.

2. Things are not the way you wanted or expected and hoped them to be.

3. Other:

Shame

1. You will be rejected by a person or group you care about if characteristics of

yourself or of your behavior are made public.

2. Other:

Guilt

1. Your own behavior violates your own values or moral code.

2. Other:

Intensity and duration of an emotion are justiﬁed by:

1. How likely it is that the expected outcomes will occur.

2. How great and/or important the outcomes are.

3. How effective the emotion is in your life now.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



eMotion reGulation Handout 9

(Emotion Regulation Worksheet 6; p. 287 )

Opposite Action and Problem Solving:

Deciding Which to Use

Opposite action = Acting opposite to an emotion’s action urge

Problem solving = Avoiding or changing (solving) a problem event

Ask:

Does this emotion

fit the facts?

Check the facts

Ye s

Be mindful

of current

emotions

(Emotion Regulation

Handout 22)

Act on

emotion/

action urge

Problem-solve

unwanted

emotions

(Emotion Regulation

Handout 12)

Do not act on

emotion/

action urge

Consider

opposite action

(Emotion

Regulation

Handouts 10–11)

Do not act on

emotion/

action urge

Change thoughts

to fit the facts

(Emotion

Regulation

Handout 8)

opposite action

(Emotion

Regulation

Handouts 10–11)

Be mindful

of current

emotions

(Emotion

Regulation

Handout 22)

Act, but

accept the

consequences

gracefully

Reconsider

opposite

action

Ye s

Ask:

Is acting on this

emotion effective?

Check Wise Mind

Ask:

Is acting on this

emotion effective?

Check Wise Mind

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



eMotion reGulation Handout 10

(Emotion Regulation Worksheet 7; p. 288 )

Opposite Action

Use opposite action when your emotions do NOT ﬁt the facts

or when acting on your emotions is NOT effective.

EVERY EMOTION HAS AN ACTION URGE.

CHANGE THE EMOTION BY ACTING OPPOSITE TO ITS ACTION URGE.

Consider these examples:

EMOTION ACTION URGE OPPOSITE ACTION

Fear Run away/avoid Approach/don’t avoid

Anger Attack Gently avoid/be a little nice

Sadness Withdraw/isolate Get active

Shame Hide/avoid Tell the secret to people who will accept it

HOW TO DO OPPOSITE ACTION, STEP BY STEP

Step 1.

IDENTIFY AND NAME THE EMOTION you want to change.

Step 2.

CHECK THE FACTS to see if your emotion is justiﬁed by the facts.

Check also whether the intensity and duration of the emotion ﬁt the facts.

(Example: “Irritation” ﬁts the facts when your car is cut in front of; “road rage” does not.)

An emotion is justiﬁed when your emotion ﬁts the facts.

Step 3. IDENTIFY AND DESCRIBE YOUR ACTION URGES.

Step 4.

ASK WISE MIND: Is expression or acting on this emotion effective in this situation?

If your emotion does not ﬁt the facts or if acting on your emotion is not effective:

Step 5.

IDENTIFY OPPOSITE ACTIONS to your action urges.

Step 6.

ACT OPPOSITE ALL THE WAY to your action urges.

Step 7.

REPEAT ACTING OPPOSITE to your action urges until your emotion changes.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



eMotion reGulation Handout 11 (p. 1 of 9)

(Emotion Regulation Worksheet 7; p. 288 )

Figuring Out Opposite Actions

FEAR

Fear FITS THE FACTS of a situation whenever there is a THREAT to:

A. Your life or that of someone you care about.

B. Your health or that of someone you care about.

C. Your well-being or that of someone you care about.

D. Other example:

Follow these suggestions when your fear is NOT JUSTIFIED by the facts or NOT EFFECTIVE:

OPPOSITE ACTIONS for Fear

Do the OPPOSITE of your fearful action urges. For example:

1. Do what you are afraid of doing . . . OVER AND OVER.

2. APPROACH events, places, tasks, activities, and people you are afraid of.

3. Do things to give yourself a sense of CONTROL and MASTERY over your fears.

ALL-THE-WAY OPPOSITE ACTIONS for Fear

4. Keep your EYES AND EARS OPEN and focused on the feared event.

Look around slowly; explore.

5. Take in the information from the situation (i.e., notice that you are safe).

6. Change POSTURE AND KEEP A CONFIDENT VOICE TONE.

Keep your head and eyes up, and your shoulders back but relaxed.

Adopt an assertive body posture (e.g., knees apart, hands on hips, heels a bit out).

7. Change your BODY CHEMISTRY.

For example, do paced breathing by breathing in deeply and breathing out slowly.

(

continued on next page

)

eMotion reGulation Handout 11 (p. 2 of 9)

ANGER

Anger FITS THE FACTS of a situation whenever:

A. An important goal is blocked or a desired activity is interrupted or prevented.

B. You or someone you care about is attacked or hurt by others.

C. You or someone you care about is insulted or threatened by others.

D. The integrity or status of your social group is offended or threatened.

E. Other example:

Follow these suggestions when your anger is NOT JUSTIFIED by the facts or is NOT EFFECTIVE:

OPPOSITE ACTIONS for Anger

Do the OPPOSITE of your angry action urges. For example:

1. GENTLY AVOID the person you are angry with (rather than attacking).

2. TAKE A TIME OUT, and breathe in and out deeply and slowly.

3. BE KIND (rather than mean or insulting).

ALL-THE-WAY OPPOSITE ACTIONS for Anger

4. IMAGINE UNDERSTANDING and empathy for the other person.

Step into the other person’s shoes. Try to see the situation from the other person’s

point of view.

Imagine really good reasons for what has happened.

5. CHANGE YOUR POSTURE.

Unclench hands, with palms up and ﬁngers relaxed (WILLING HANDS).

Relax chest and stomach muscles.

Unclench teeth.

Relax facial muscles. Half-smile.

6. CHANGE YOUR BODY CHEMISTRY.

For example, do paced breathing by breathing in deeply and breathing out slowly.

Or, run or engage in another physically energetic, nonviolent activity.

(

continued on next page

)

eMotion reGulation Handout 11 (p. 3 of 9)

DISGUST

Disgust FITS THE FACTS of a situation whenever:

A. Something you are in contact with could poison or contaminate you.

B. Somebody whom you deeply dislike is touching you or someone you care about.

C. You are around a person or group whose behavior or thinking could seriously damage

or harmfully inﬂuence you or the group you are part of.

D. Other example:

Follow these suggestions when your disgust is NOT JUSTIFIED by the facts or is NOT EFFECTIVE:

OPPOSITE ACTIONS for Disgust

Do the OPPOSITE of your disgusted action urges. For example:

1. MOVE CLOSE. Eat, drink, stand near, or embrace what you found disgusting.

2. Be KIND to those you feel contempt for; step into the other person’s shoes.

ALL-THE-WAY OPPOSITE ACTIONS for Disgust

3. IMAGINE UNDERSTANDING and empathy for the person you feel disgust or contempt for.

Try to see the situation from the other person’s point of view.

Imagine really good reasons for how the other person is behaving or looking.

4. TAKE IN what feels repulsive.

Be sensual (inhaling, looking at, touching, listening, tasting).

5. CHANGE YOUR POSTURE.

Unclench hands with palms up and ﬁngers relaxed (willing hands).

Relax chest and stomach muscles.

Unclench teeth.

Relax facial muscles.

Half-smile.

6. CHANGE YOUR BODY CHEMISTRY.

For example, do paced breathing by breathing in deeply and breathing out slowly.

(

continued on next page

)

eMotion reGulation Handout 11 (p. 4 of 9)

ENVY

Envy FITS THE FACTS of a situation whenever:

A. Another person or group has what you want or need but don’t have.

B. Other example:

Follow these suggestions when your envy is NOT JUSTIFIED by the facts or is NOT EFFECTIVE:

OPPOSITE ACTIONS for Envy

Do the OPPOSITE of your envious action urges. For example:

1. INHIBIT DESTROYING what the other person has.

2. COUNT YOUR BLESSINGS. Make a list of the things you are thankful for.

ALL-THE-WAY OPPOSITE ACTIONS for Envy

3. COUNT ALL your blessings.

Avoid discounting some blessings.

Avoid exaggerating your deprivations.

4. Stop EXAGGERATING others’ net worth or value; check the facts.

5. CHANGE YOUR POSTURE.

Unclench hands with palms up and ﬁngers relaxed (WILLING HANDS).

Relax chest and stomach muscles.

Unclench teeth.

Relax facial muscles.

Half-smile.

6. CHANGE YOUR BODY CHEMISTRY.

For example, do paced breathing by breathing in deeply and breathing out slowly.

(

continued on next page

)

eMotion reGulation Handout 11 (p. 5 of 9)

JEALOUSY

Jealousy FITS THE FACTS of a situation whenever:

A. Someone is threatening to take a very important and desired relationship or object away

from you.

B. An important and desired relationship is in danger of being damaged or lost.

C. Other example:

Follow these suggestions when your jealousy is NOT JUSTIFIED by the facts or is NOT EFFECTIVE:

OPPOSITE ACTIONS for Jealousy

Do the OPPOSITE of your jealous action urges. For example:

1. LET GO of controlling others’ actions.

2. SHARE the things and people you have in your life.

ALL-THE-WAY OPPOSITE ACTIONS for Jealousy

3. STOP SPYING or snooping.

Suppress probing questions (“Where were you? Who were you with?”).

Fire your “private detective.”

4. NO AVOIDING. Listen to all the details. Focus on sensations.

Keep your eyes open; look around.

Take in all the information about the situation.

5. CHANGE YOUR POSTURE.

Unclench hands with palms up and ﬁngers relaxed (WILLING HANDS).

Relax chest and stomach muscles.

Unclench teeth.

Relax facial muscles.

Half-smile.

6. CHANGE YOUR BODY CHEMISTRY.

For example, do paced breathing by breathing in deeply and breathing out slowly.

(

continued on next page

)

eMotion reGulation Handout 11 (p. 6 of 9)

LOVE

Love (other than universal love for all) FITS THE FACTS of a situation whenever:

A. Loving a person, animal, or object enhances quality of life for you or for those you care

about.

B. Loving a person, animal, or object increases your chances of attaining your own

personal goals.

C. Other example:

Follow these suggestions when your love is NOT JUSTIFIED by the facts or is NOT EFFECTIVE:

OPPOSITE ACTIONS for Love

Do the OPPOSITE of your loving action urges. For example:

1. AVOID the person, animal, or object you love.

2. DISTRACT yourself from thoughts of the person, animal, or object.

3. REMIND yourself of why love is not justiﬁed (rehearse the “cons” of loving) when loving

thoughts do arise.

ALL-THE-WAY OPPOSITE ACTIONS for Love

4. AVOID CONTACT with everything that reminds you of a person you love: pictures, letters/

messages/e-mails, belongings, mementos, places you were together, places you planned

to or wanted to go together, places where you know the person has been or will be. No

following, waiting for, or looking for the person.

5. STOP EXPRESSING LOVE for the person, even to friends. Be unfriendly toward the person

(e.g., “unfriend” the person on Facebook, Twitter, etc.).

6. ADJUST YOUR POSTURE AND EXPRESSIONS if you are around the person you love.

No leaning toward him or her.

No getting close enough to touch.

No sighing/gazing at the person.

(

continued on next page

)

eMotion reGulation Handout 11 (p. 7 of 9)

SADNESS

Sadness FITS THE FACTS of a situation whenever:

A. You have lost something or someone permanently.

B. Things are not the way you want or expected and hoped them to be.

C. Other example:

Follow these suggestions when sadness is NOT JUSTIFIED by the facts or is NOT EFFECTIVE:

OPPOSITE ACTIONS for Sadness

Do the OPPOSITE of your sad action (or inaction) urges. For example:

1. Get ACTIVE; approach.

2. AVOID AVOIDING.

3. BUILD MASTERY: Do things that make you feel competent and self- conﬁdent.

(See Emotion Regulation Handout 19: Build Mastery and Cope Ahead.)

4. Increase PLEASANT EVENTS.

ALL-THE-WAY OPPOSITE ACTIONS for Sadness

5. Pay attention to the PRESENT MOMENT!

Be mindful of your environment—each detail as it unfolds.

Experience new or positive activities you are engaging in.

6. CHANGE YOUR POSTURE (adopt a “bright” body posture, with head up, eyes open, and

shoulders back).

Keep an upbeat voice tone.

7. CHANGE YOUR BODY CHEMISTRY.

For example, increase physical movement (run, jog, walk, or do other active exercise).

(

continued on next page

)

eMotion reGulation Handout 11 (p. 8 of 9)

SHAME

Shame FITS THE FACTS of a situation whenever:

A. You will be rejected by a person or group you care about if your personal characteristics

or behavior are made public.

B. Other example:

Follow these suggestions when both shame and guilt

are NOT JUSTIFIED by the facts or are NOT EFFECTIVE:











OPPOSITE ACTIONS for Shame

Do the OPPOSITE of your action urges. For example:

1. MAKE PUBLIC your personal characteristics or your behavior (with people who won’t

reject you).

2. REPEAT the behavior that sets off shame over and over (without hiding the behavior from

those who won’t reject you).

ALL-THE-WAY OPPOSITE ACTIONS for Shame

3. NO APOLOGIZING or trying to make up for a perceived transgression.

4. TAKE IN all the information from the situation.

5. CHANGE YOUR BODY POSTURE. Look innocent and proud. Lift your head; “puff up”

your chest; maintain eye contact. Keep your voice tone steady and clear.

Follow these suggestions when shame is NOT JUSTIFIED by the facts or is NOT EFFECTIVE, but

GUILT IS JUSTIFIED (your behavior does violate your own moral values):











OPPOSITE ACTIONS for Shame

Do the OPPOSITE of your action urges. For example:

1. MAKE PUBLIC your behavior (with people who won’t reject you).

2. APOLOGIZE for your behavior.

3. REPAIR the transgressions, or work to prevent or repair similar harm for others.

4. COMMIT to avoiding that mistake in the future.

5. ACCEPT the consequences gracefully.

ALL-THE-WAY OPPOSITE ACTIONS for Shame

6. FORGIVE yourself. Acknowledge the causes of your behavior.

7. LET IT GO.

(

continued on next page

)

eMotion reGulation Handout 11 (p. 9 of 9)

GUILT

Guilt FITS THE FACTS of a situation whenever:

A. Your behavior violates your own values or moral code.

B. Other example:

Follow these suggestions when both guilt and shame

are NOT JUSTIFIED by the facts or are NOT EFFECTIVE:











OPPOSITE ACTIONS for Guilt

Do the OPPOSITE of your action urges. For example:

1. MAKE PUBLIC your personal characteristics or your behavior (with people who won’t

reject you).

2. REPEAT the behavior that sets off guilt over and over (without hiding the behavior from

those who won’t reject you).

ALL-THE-WAY OPPOSITE ACTIONS for Guilt

3. NO APOLOGIZING or trying to make up for a perceived transgression.

4. TAKE IN all the information from the situation.

5. CHANGE YOUR BODY POSTURE. Look innocent and proud. Lift your head; “puff up”

your chest; maintain eye contact. Keep your voice tone steady and clear.

Follow these suggestions when guilt is NOT JUSTIFIED by the facts or is NOT EFFECTIVE

but SHAME IS JUSTIFIED (you will be rejected by people you care about if found out):











OPPOSITE ACTIONS for Guilt

1. HIDE your behavior (if you want to stay in the group).

2. USE INTERPERSONAL SKILLS (if you want to stay in the group).

3. WORK TO CHANGE the person’s or group’s values.

4. JOIN A NEW GROUP that ﬁts your values (and will not reject you).

5. REPEAT the behavior that sets off guilt over and over with your new group.

ALL-THE-WAY OPPOSITE ACTIONS for Guilt

6. VALIDATE YOURSELF.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



eMotion reGulation Handout 12

(Emotion Regulation Worksheet 8; pp. 289–290 )

Problem Solving

Step 1. FIGURE OUT and DESCRIBE the problem situation.

Step 2. CHECK THE FACTS (

all

the facts) to be sure you have the right problem situation!

If your facts are correct and

the situation is the problem,

continue with

STEP 3.

If your facts are not correct,

go back and repeat

STEP 1.

Step 3. IDENTIFY YOUR GOAL in solving the problem.

• Identify what needs to happen or change for you to feel OK.

• Keep it simple, and choose something that can actually happen.

Step 4. BRAINSTORM lots of solutions.

• Think of as many solutions as you can. Ask for suggestions from people you trust.

• Do not be critical of any ideas at ﬁrst. (Wait for Step 5 to evaluate ideas.)

Step 5. CHOOSE a solution that ﬁts the goal and is likely to work.

• If you are unsure, choose two solutions that look good.

• Do PROS and CONS to compare the solutions.

• Choose the best to try ﬁrst.

Step 6. Put the solution into ACTION.

• ACT! Try out the solution.

• Take the ﬁrst step, and then the second . . .

Step 7. EVALUATE the results of using the solution.

It worked? YEA!!! It didn’t work?

Go back to

STEP 5 and choose a new solution to try.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



eMotion reGulation Handout 13 (p. 1 of 3)

(Emotion Regulation Worksheets 6, 7, 8; pp. 287–290 )

Reviewing Opposite Action and Problem Solving

Justifying Events

Act Opposite

to Emotion Urge

(for Unjustiﬁed Emotion)

Act on Emotion Urge,

Problem-Solve, or Avoid

(for Justiﬁed Emotion)

Fear

A. Your life is in danger.

B. Your health is in

danger.

C. Your well-being is in

danger.

1. Do what you are afraid

of doing . . . over and

over.

2. Approach what you are

afraid of.

3. Do what gives you a

sense of control and

mastery.

1. Freeze/run if danger is near.

2. Remove the threatening event.

3. Do what gives you a sense

of control and mastery of the

fearful event.

4. Avoid the threatening event.

Anger

A. An important goal is

blocked or a desired

activity is interrupted or

prevented.

B. You or someone you

care about is attacked

or hurt (physically or

emotionally) by others.

C. You or someone

you care about is

insulted, offended, or

threatened by others.

1. Gently avoid.

2. Take a time out.

3. Do something kind.

4. Imagine understanding:

Step into the other

person’s shoes.

5. Imagine really good

reasons for what

happened.

1. Fight back when being attacked,

if you have nothing to lose by

ﬁghting.

2. Overcome obstacles to goals.

3. Work to stop further attacks,

insults, and threats.

4. Avoid or walk out on people

who are threatening.

Disgust

A. Something you are

in contact with could

poison or contaminate

you.

B. You are close to a

person or group whose

actions or thinking

could seriously

damage or harm you

or the group you are

part of.

1. Move close. Embrace.

2. Be kind; step into the

other person’s shoes.

3. Take in what feels

repulsive.

4. See the situation from

the other person’s point

of view.

1. Remove/clean up revolting

things.

2. Inﬂuence others to stop

harmful actions/stop things that

contaminate your community.

3. Avoid or push away harmful

people or things.

4. Imagine understanding a

person who has done disgusting

things.

(

continued on next page

)

Justifying Events

Act Opposite

to Emotion Urge

(for Unjustiﬁed Emotion)

Act on Emotion Urge,

Problem-Solve, or Avoid

(for Justiﬁed Emotion)

Envy

A. Another person or

group gets or has

things you don’t have

that you want or need.

1. Inhibit destroying other

people’s things.

2. Count your blessings.

3. Imagine how it all

makes sense.

4. Stop exaggerating

others’ worth or value.

1. Improve yourself and your life.

2. Get others to be fair.

3. Devalue what others have that

you don’t have.

4. Put on rose- colored glasses.

5. Avoid people who have more

than you.

Jealousy

A. An important and

desired relationship or

object is in danger of

being damaged or lost.

B. Someone is

threatening to take

away an important and

desired relationship or

object.

1. Let go of trying to

control others.

2. Share what you have

with others.

3. Stop spying and

snooping.

4. No avoiding; take in all

the information.

1. Protect what you have.

2. Work at being more desirable to

the person(s) you want to be in

a relationship with (i.e., ﬁght for

relationships).

3. Leave the relationship.

Love

A. Loving a valued/

admired person, animal,

or object enhances the

quality of life for you or

those you care about.

B. Loving the person,

animal, or object

increases your chances

of attaining your own

personal goals.

1. Avoid the person,

animal, or object you

love altogether.

2. Distract yourself from

thoughts of the beloved.

3. Avoid contact with

all reminders of the

beloved.

4. Remind yourself of why

love is not justiﬁed.

1. Be with the person, animal, or

thing that you love.

2. Touch, hold, etc., the beloved.

3. Avoid separations when

possible.

4. If the beloved is lost, ﬁght to ﬁnd

or get the beloved back (if it may

be possible).

Sadness

A. You have lost

something or someone

permanently.

B. Things are not the

way you expected or

wanted or hoped for.

1. Activate your behavior.

2. Avoid avoiding.

3. Build mastery: Do

things that make you

feel competent and self-

conﬁdent.

4. Increase pleasant

events.

5. Pay attention to

pleasant events.

1. Grieve; have a memorial service;

visit the cemetery (but don’t build

a house at the cemetery).

2. Retrieve/replace what is lost.

3. Plan how to rebuild a life worth

living without the beloved or

expected outcomes in your life.

4. Accumulate positives.

5. Build mastery: Do things that

make you feel competent and

self- conﬁdent.

6. Communicate need for help.

7. Accept help offered.

8. Put on rose- colored glasses.

(

continued on next page

)

eMotion reGulation Handout 13 (p. 2 of 3)

Justifying Events

Act Opposite

to Emotion Urge

(for Unjustiﬁed Emotion)

Act on Emotion Urge,

Problem-Solve, or Avoid

(for Justiﬁed Emotion)

Shame

A. You will be rejected

by a very important

person or group if

characteristics of

yourself or of your

behavior are made

public.

1. Make public your

personal characteristics

or behavior (with people

who won’t reject you).

2. Repeat the behavior

without hiding from

people who won’t reject

you.

3. Or, if your moral code is

violated, apologize and

repair; forgive yourself;

and let it go.

1. Hide what will get you rejected.

2. Appease those offended.

3. Change your behavior or

personal characteristics to ﬁt in.

4. Avoid groups who disapprove

of you.

5. Find a new group that ﬁts

your values or that likes your

personal characteristics.

6. Work to change society’s or a

person's values.

Guilt

A. Your own behavior

violates your own

values or moral code.

1. Do what makes you feel

guilty over and over and

over.

2. Make public your

behavior (with people

who won’t reject you).

Or, if you will be rejected

by others:

3. Hide your behavior.

4. Use interpersonal skills.

5. Work to change your

group’s values or join a

new group.

1. Seek forgiveness.

2. Repair the harm; make things

better (or, if not possible, work

to prevent or repair similar harm

for others).

3. Accept the consequences

gracefully.

4. Commit to avoiding behaviors

that violate your moral values in

the future.

eMotion reGulation Handout 13 (p. 3 of 3)

Handouts for Reducing Vulnerability

toEmotion Mind

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

eMotion reGulation Handout 14

(Emotion Regulation Worksheets 9–14b; pp. 293–307 )

Overview:

Reducing Vulnerability to Emotion Mind—

Building a Life Worth Living

A way to remember these skills is to remember the term ABC PLEASE.

ACCUMULATE POSITIVE EMOTIONS

Short Term: Do pleasant things that are possible now.

Long Term: Make changes in your life so that positive

events will happen more often in the future. Build a “life

worth living.”

BUILD MASTERY

Do things that make you feel competent and effective

to combat helplessness and hopelessness.

COPE AHEAD OF TIME

WITH EMOTIONAL SITUATIONS

Rehearse a plan ahead of time so that you are

prepared to cope skillfully with emotional situations.

PLEASE

TAKE CARE OF YOUR MIND

BY TAKING CARE OF YOUR BODY

Treat PhysicaL illness, balance Eating,

avoid mood-Altering substances, balance Sleep,

and get Exercise.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



eMotion reGulation Handout 15

(Emotion Regulation Worksheets 9, 10, 13 ; pp. 293–295, 302 )

Accumulating Positive Emotions: Short Term

Accumulate positive emotions in the short term by doing these things.

BUILD POSITIVE EXPERIENCES NOW

• INCREASE PLEASANT EVENTS that lead to positive emotions.

• Do ONE THING each day from the Pleasant Events List.

(See Emotion Regulation Handout 16.)

• Practice opposite action; AVOID AVOIDING.

• BE MINDFUL of pleasant events (no multitasking).

BE MINDFUL OF POSITIVE EXPERIENCES

• FOCUS your attention on positive moments when they are happening.

No multitasking.

• REFOCUS your attention when your mind wanders to the negative.

• PARTICIPATE and ENGAGE fully in each experience.

BE UNMINDFUL OF WORRIES

Such as . . .

• When the positive experience will end.

• Whether you deserve this positive experience.

• How much more might be expected of you now.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



eMotion reGulation Handout 16 (p. 1 of 3)

(Emotion Regulation Worksheets 9, 10, 13 ; pp. 293–295, 302 )

Pleasant Events List

1. Working on my car

2. Planning a career

3. Getting out of (paying down) debt

4. Collecting things (baseball cards, coins,

stamps, rocks, shells, etc.)

5. Going on vacation

6. Thinking how it will be when I finish

school

7. Recycling old items

8. Going on a date

9. Relaxing

10. Going to or watching a movie

11. Jogging, walking

12. Thinking, “I have done a full day’s work”

13. Listening to music

14. Thinking about past parties

15. Buying household gadgets

16. Lying in the sun

17. Planning a career change

18. Laughing

19. Thinking about past trips

20. Listening to other people

21. Reading magazines or newspapers

22. Engaging in hobbies (stamp collecting,

model building, etc.)

23. Spending an evening with good friends

24. Planning a day’s activities

25. Meeting new people

26. Remembering beautiful scenery

27. Saving money

28. Going home from work

29. Eating

30. Practicing karate, judo, yoga

31. Thinking about retirement

32. Repairing things around the house

33. Working on machinery (cars, boats,

etc.)

34. Remembering the words and deeds of

loving people

35. Wearing shocking clothes

36. Having quiet evenings

37. Taking care of my plants

38. Buying, selling stock

39. Going swimming

40. Doodling

41. Exercising

42. Collecting old things

43. Going to a party

44. Thinking about buying things

45. Playing golf

46. Playing soccer

47. Flying kites

48. Having discussions with friends

49. Having family get- togethers

50. Riding a bike or motorbike

51. Running track

52. Going camping

53. Singing around the house

54. Arranging flowers

55. Practicing religion (going to church,

group praying, etc.)

56. Organizing tools

57. Going to the beach

58. Thinking, “I’m an OK person”

59. Having a day with nothing to do

60. Going to class reunions

61. Going skating, skateboarding,

rollerblading

62. Going sailing or motorboating

63. Traveling or going on vacations

64. Painting

65. Doing something spontaneously

66. Doing needlepoint, crewel, etc.

67. Sleeping

68. Driving

69. Entertaining, giving parties

70. Going to clubs (garden clubs, Parents

without Partners, etc.)

71. Thinking about getting married

72. Going hunting

(

continued on next page

)

Note. For adults or adolescents. Adapted from Linehan, M. M., Sharp, E., & Ivanoff, A. M. (1980, November). The Adult Pleasant Events Sched-

ule. Paper presented at the meeting of the Association for Advancement of Behavior Therapy, New York. Adapted by permission of the authors.

eMotion reGulation Handout 16 (p. 2 of 3)

73. Singing with groups

74. Flirting

75. Playing musical instruments

76. Doing arts and crafts

77. Making a gift for someone

78. Buying/downloading music

79. Watching boxing, wrestling

80. Planning parties

81. Cooking

82. Going hiking

83. Writing (books, poems, articles)

84. Sewing

85. Buying clothes

86. Going out to dinner

87. Working

88. Discussing books; going to a book club

89. Sightseeing

90. Getting a manicure/pedicure or facial

91. Going to the beauty parlor

92. Early morning coffee and newspaper

93. Playing tennis

94. Kissing

95. Watching my children (play)

96. Thinking, “I have a lot more going for

me than most people”

97. Going to plays and concerts

98. Daydreaming

99. Planning to go (back) to school

100. Thinking about sex

101. Going for a drive

102. Refinishing furniture

103. Watching TV

104. Making lists of tasks

105. Walking in the woods (or at the

waterfront)

106. Buying gifts

107. Completing a task

108. Going to a spectator sport (auto racing,

horse racing)

109. Teaching

110. Photography

111. Going fishing

112. Thinking about pleasant events

113. Staying on a diet

114. Playing with animals

115. Flying a plane

116. Reading fiction

117. Acting

118 . Being alone

119. Writing diary entries or letters

120. Cleaning

121. Reading nonfiction

122. Taking children places

123. Dancing

124. Weightlifting

125. Going on a picnic

126. Thinking, “I did that pretty well,” after

doing something

127. Meditating, yoga

128. Having lunch with a friend

129. Going to the mountains

130. Playing hockey

131. Working with clay or pottery

132. Glass blowing

133. Going skiing

134. Dressing up

135. Reflecting on how I’ve improved

136. Buying small things for myself (perfume,

golf balls, etc.)

137. Talking on the phone

138. Going to museums

139. Thinking religious thoughts

140. Lighting candles

141. White-water canoeing/rafting

142. Going bowling

143. Doing woodworking

144. Fantasizing about the future

145. Taking ballet/tap- dancing classes

146. Debating

147. Sitting in a sidewalk café

148. Having an aquarium

149. Participating in “living history” events

150. Knitting

151. Doing crossword puzzles

152. Shooting pool

153. Getting a massage

154. Saying, “I love you”

155. Playing catch, taking batting practice

156. Shooting baskets

157. Seeing and/or showing photos

158. Thinking about my good qualities

159. Solving riddles mentally

160. Having a political discussion

161. Buying books

(

continued on next page

)

eMotion reGulation Handout 16 (p. 3 of 3)

162. Taking a sauna or a steam bath

163. Checking out garage sales

164. Thinking about having a family

165. Thinking about happy moments in my

childhood

166. Splurging

167. Going horseback riding

168. Doing something new

169. Working on jigsaw puzzles

170. Playing cards

171. Thinking, “I’m a person who can cope”

172. Taking a nap

173. Figuring out my favorite scent

174. Making a card and giving it to someone

I care about

175. Instant- messaging/texting someone

176. Playing a board game (e.g., Monopoly,

Life, Clue, Sorry)

17 7. Putting on my favorite piece of clothing

178. Making a smoothie and drinking it

slowly

179. Putting on makeup

180. Thinking about a friend’s good qualities

181. Completing something I feel great about

182. Surprising someone with a favor

183. Surfing the Internet

184. Playing video games

185. E-mailing friends

186. Going walking or sledding in a snowfall

187. Getting a haircut

188. Installing new software

189. Buying a CD or music on iTunes

190. Watching sports on TV

191. Taking care of my pets

192. Doing volunteer service

193. Watching stand-up comedy on YouTube

194. Working in my garden

195. Participating in a public performance

(e.g., a flash mob)

196. Blogging

197. Fighting for a cause

198. Conducting experiments

199. Expressing my love to someone

200. Going on field trips, nature walks,

exploring (hiking away from known

routes, spelunking)

201. Gathering natural objects (wild foods or

fruit, driftwood)

202. Going downtown or to a shopping mall

203. Going to a fair, carnival, circus, zoo, or

amusement park

204. Going to the library

205. Joining or forming a band

206. Learning to do something new

207. Listening to the sounds of nature

208. Looking at the moon or stars

209. Outdoor work (cutting or chopping

wood, farm work)

210. Playing organized sports (baseball,

softball, football, Frisbee, handball,

paddleball, squash, soccer, tennis,

volleyball, etc.)

211. Playing in the sand, a stream, the

grass; kicking leaves, pebbles, etc.

212. Protesting social, political, or

environmental conditions

213. Reading cartoons or comics

214. Reading sacred works

215. Rearranging or redecorating my room

or the house

216. Selling or trading something

217. Snowmobiling or riding a dune buggy/

ATV

218. Social networking

219. Soaking in the bathtub

220. Learning or speaking a foreign

language

221. Talking on the phone

222. Composing or arranging songs or music

223. Thrift store shopping

224. Using computers

225. Visiting people who are sick, shut in, or

in trouble

Other:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



eMotion reGulation Handout 17

(Emotion Regulation Worksheets 9, 11–11b, 13 ; pp. 293–294, 296–300, 302 )

Accumulating Positive Emotions: Long Term

Accumulate positive emotions in the long term

to build a “life worth living.”

That is, make changes in your life so that positive events will occur in the future.

Step 1. Avoid avoiding.

Start now to do what is needed to build the life you want. If you are not sure about

what to do, follow the steps below.

Step 2. Identify values that are important to you.

ASK: What values are really important to me in my life?

Examples: Be productive; be part of a group; treat others well; be physically ﬁt.

Step 3. Identify one value to work on now.

ASK: What is really important to me, right now, to work on in my life?

Example: Be productive.

Step 4. Identify a few goals related to this value.

ASK: What speciﬁc goals can I work on that will make this value part of my life?

Examples: Get a job where I can do something useful.

Be more active keeping up with important tasks at home.

Find a volunteer job that will use skills I already have.

Step 5. Choose one goal to work on now.

Do pros and cons, if necessary, to select a goal to work on now.

Example: Get a job where I can do something useful.

Step 6. Identify small action steps toward your goal.

ASK: What small steps can I take to get to my goal?

Examples: Visit places and look for job openings on the Internet in my area.

Submit applications for jobs at places I want to work.

Write résumé.

Check out beneﬁts at places I might want to work.

Step 7. Take one action step now.

Example: Go on Internet and check for jobs in my area.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



eMotion reGulation Handout 18 (p. 1 of 3)

(Emotion Regulation Worksheets 10, 12, 13 ; pp. 295, 301–302 )

Values and Priorities List

In my own Wise Mind, I believe it is important to:

 A. Attend to relationships.

1. Repair old relationships.

2. Reach out for new relationships.

3. Work on current relationships.

4. End destructive relationships.

Other:

 B. Be part of a group.

5. Have close and satisfying relationships with others.

6. Feel a sense of belonging.

7. Receive affection and love.

8. Be involved and intimate with others; have and keep close friends.

9. Have a family; stay close to and spend time with family members.

10. Have people to do things with.

Other:

 C. Be powerful and able to inﬂuence others.

11. Have the authority to approve or disapprove of what people do, or to control how

resources are used.

12. Be a leader.

13. Make a great deal of money.

14. Be respected by others.

15. Be seen by others as successful; become well known; obtain recognition and status.

16. Compete successfully with others.

17. Be popular and accepted.

Other:

 D. Achieve things in life.

18. Achieve signiﬁcant goals; be involved in undertakings I believe are signiﬁcant.

19. Be productive.

20. Work toward goals; work hard.

21. Be ambitious.

Other:

(

continued on next page

)

Adapted from Schwartz, S. H. (1992). Universals in the content and structure of values: Theory and empirical tests in 20 countries. In M.

Adapted by permission of Elsevier B.V.

eMotion reGulation Handout 18 (p. 2 of 3)

 E. Live a life of pleasure and satisfaction.

22. Have a good time.

23. Seek fun and things that give pleasure.

24. Have free time.

25. Enjoy the work I do.

Other:

 F. Keep life full of exciting events, relationships, and things.

26. Try new and different things in life.

27. Be daring and seek adventures.

28. Have an exciting life.

Other:

 G. Behave respectfully.

29. Be humble and modest; do not draw attention to myself.

30. Follow traditions and customs; behave properly.

31. Do what I am told and follow rules.

32. Treat others well.

Other:

 H. Be self- directed.

33. Follow my own path in life.

34. Be innovative, think of new ideas, and be creative.

35. Make my own decisions and be free.

36. Be independent; take care of myself and those I am responsible for.

37. Have freedom of thought and action; be able to act in terms of my own priorities.

Other:

 I. Be a spiritual person.

38. Make room in life for spirituality; live life according to spiritual principles.

39. Practice a religion or faith.

40. Grow in understanding of myself, my personal calling, and life’s real purpose.

41. Discern and do the will of God (or a higher power) and ﬁnd lasting meaning in life.

Other:

 J. Be secure.

42. Live in secure and safe surroundings.

43. Be physically healthy and ﬁt.

44. Have a steady income that meets my own and my family’s basic needs.

Other:

(

continued on next page

)

eMotion reGulation Handout 18 (p. 3 of 3)

 K. Recognize the universal good of all things.

45. Be fair, treat people equally, and provide equal opportunities.

46. Understand different people; be open- minded.

47. Care for nature and the environment.

Other:

 L. Contribute to the larger community.

48. Help people and those in need; care for others’ well-being; improve society.

49. Be loyal to friends and devoted to close people; be committed to a group that shares

my beliefs, values, and ethical principles.

50. Be committed to a cause or to a group that has a larger purpose beyond my own.

51. Make sacriﬁces for others.

Other:

 M. Work at self- development.

52. Develop a personal philosophy of life.

53. Learn and do challenging things that help me grow and mature as a human being.

Other:

 N. Have integrity.

54. Be honest, and acknowledge and stand up for my personal beliefs.

55. Be a responsible person; keep my word to others.

56. Be courageous in facing and living life.

57. Be a person who pays debts to others and repairs damage I have caused.

58. Be accepting of myself, others, and life as it is; live without resentment.

Other:

 O. Other:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



eMotion reGulation Handout 19

(Emotion Regulation Worksheets 12, 13 ; pp. 301–302 )

Build Mastery and Cope Ahead

Build Mastery

1. Plan on doing at least one thing each day to build a sense of accomplishment.

Example:

2. Plan for success, not failure.

• Do something difﬁcult, but possible.

3. Gradually increase the difﬁculty over time.

• If the ﬁrst task is too difﬁcult, do something a little easier next time.

4. Look for a challenge.

• If the task is too easy, try something a little harder next time.

Cope Ahead of Time with Difﬁcult Situations

1. Describe the situation that is likely to prompt problem behavior.

• Check the facts. Be speciﬁc in describing the situation.

• Name the emotions and actions likely to interfere with using your skills.

2. Decide what coping or problem- solving skills you want to use in the situation.

• Be speciﬁc. Write out in detail how you will cope with the situation and with your

emotions and action urges.

3. Imagine the situation in your mind as vividly as possible.

• Imagine yourself IN the situation NOW, not watching the situation.

4. Rehearse in your mind coping effectively.

• Rehearse in your mind exactly what you can do to cope effectively.

• Rehearse your actions, your thoughts, what you say, and how to say it.

• Rehearse coping effectively with new problems that come up.

• Rehearse coping effectively with your most feared catastrophe.

5. Practice relaxation

after

rehearsing.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



eMotion reGulation Handout 20

(Emotion Regulation Worksheets 9, 14 ; pp. 293–294, 303 )

Taking Care of Your Mind by Taking Care

of Your Body

Remember these as PLEASE skills.

1. Treat PhysicaL Illness. Take care of your body. See a doctor when

necessary. Take prescribed medication.

E 2. Balance Eating. Don’t eat too much or too little. Eat regularly

and mindfully throughout the day. Stay

away from foods that make you feel overly

emotional.

A 3. Avoid Mood-Altering Substances. Stay off illicit drugs, and use alcohol in

moderation (if at all).

S 4. Balance Sleep. Try to get 7–9 hours of sleep a night, or at

least the amount of sleep that helps you feel

good. Keep to a consistent sleep schedule,

especially if you are having difﬁculty

sleeping.

E 5. Get Exercise. Do some sort of exercise every day. Try to

build up to 20 minutes of daily exercise.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

eMotion reGulation Handout 20a

(Emotion Regulation Worksheet 14a; pp. 304–306 )

Nightmare Protocol, Step by Step

When Nightmares Keep You from Sleeping

1. Practice relaxation, pleasant imagery, and coping skills ﬁrst, to be sure

you are ready to work on changing your nightmares.

Do progressive relaxation, paced breathing, and/or Wise Mind exercises;

listen to music or guided imagery; review the distress tolerance crisis survival

skills.

2. Choose a recurring nightmare you would like to work on.

This will be your target nightmare. Select a nightmare you can manage now.

Put off trauma nightmares until you are ready to work with them—or, if you

target a trauma nightmare, skip Step 3.

3. Write down your target nightmare.

Include sensory descriptions (sights, smells, sounds, tastes, etc.). Also

include any thoughts, feelings, and assumptions about yourself during the

dream.

4. Choose a changed outcome for the nightmare.

The change should occur BEFORE anything traumatic or bad happens to you

or others in the nightmare. Essentially, you want to come up with a change

that will prevent the bad outcome of the usual nightmare from occurring. Write

an ending that will give you a sense of peace when you wake up.

Note: Changes in the nightmare can be very unusual and out of the ordinary

(e.g., you might become a person with superhuman powers who is able

to escape to safety or ﬁght off attackers). Changed outcomes can include

changed thoughts, feelings, or assumptions about yourself.

5. Write down the full nightmare with the changes.

6. REHEARSE and RELAX each night before going to sleep.

Rehearse the changed nightmare by visualizing the entire dream with the

changes each night, before practicing relaxation techniques.

7. REHEARSE and RELAX during the day.

Visualize the entire dream with the change, and practice relaxation as often

as possible during the day.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

eMotion reGulation Handout 20b

(Emotion Regulation Worksheet 14b; p. 307 )

Sleep Hygiene Protocol

When You Can’t Sleep, What to Do Instead of Ruminating

TO INCREASE THE LIKELIHOOD OF RESTFULNESS/SLEEP:

1. Develop and follow a consistent sleep schedule even on weekends. Go to bed and get up

at the same times each day, and avoid anything longer than a 10-minute nap during the day.

2. Do not use your bed in the daytime for things like watching TV, talking on the phone, or

reading.

3. Avoid caffeine, nicotine, alcohol, heavy meals, and exercise late in the day before going to

sleep.

4. When prepared to sleep, turn off the light, and keep the room quiet and the

temperature comfortable and relatively cool. Try an electric blanket if you are cold; putting

your feet outside of the blanket or turning on a fan directed toward your bed if you are hot; or

wearing a sleeping mask, using earplugs, or turning on a “white noise” machine if needed.

5. Give yourself half an hour to at most an hour to fall asleep. If it doesn’t work, evaluate

whether you are calm, or anxious (even if only “background anxiety”), or ruminating.

6. DO NOT CATASTROPHIZE. Remind yourself that you need rest, and aim for reverie (i.e.,

dreaminess) and resting your brain. Sell yourself on the idea that staying awake is not a

catastrophe. Do not decide to give up on sleeping for the night and get up for the “day.”

IF YOU ARE CALM BUT WIDE AWAKE:

7. Get out of bed; go to another room and read a book or do some other activity that will not

wake you up further. As you begin to get tired and/or sleepy, go back to bed.

8. Try a light snack (e.g., an apple).

IF YOU ARE ANXIOUS OR RUMINATING

9. Use the cold water TIP skill. Get right back in bed and do the paced breathing TIP skill.

(See Distress Tolerance Handout 6: TIP Skills: Changing Your Body Chemistry.)

Remember, if you have any medical condition, get medical approval before using cold water.

10. Try the 9–0 meditation practice. Breathe in deeply and breathe out slowly, saying in your

mind the number 9. On the next breath out, say 8; then say 7; and so on until you breathe out

saying 0. Then start over, but this time start with 8 (instead of 9) as you breathe out, followed

by 7, and so on until you reach 0. Next start with 6 as you breathe out, and so on to 0. Then

start with 5, then with 4, and so on until you have gone all the way down to starting with 1. (If

you get lost, start over with the last number you remember.) Continue until you fall asleep.

11. Focus on the bodily sensation of the rumination (rumination is often escape from difﬁcult

emotional sensations).

12. Reassure yourself that worries in the middle of the night are just “middle-of-the-night-

thinking,” and that in the morning you will think and feel differently.

13. Read an emotionally engrossing novel for a few minutes until you feel somewhat tired. Then

stop reading, close your eyes, and try to continue the novel in your head.

14. If rumination doesn’t stop, follow these guidelines: “If it’s solvable, solve it. If it is insolvable,

go deep into the worry all the way to the “catastrophe”—the very worst outcome you can

imagine—and then imagine coping ahead with the catastrophe.

(See Emotion Regulation Handout 19: Build Mastery and Cope Ahead.)

If nothing else works, with eyes closed, listen to public radio (BBC, NPR, etc.) at low volume

(use headphones if necessary). Public radio is a good choice for this, because there is little ﬂuctua-

tion in voice tone or volume.

Handouts for Managing Really

Difcult Emotions

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

eMotion reGulation Handout 21

(Emotion Regulation Worksheets 15, 16 ; pp. 311–312 )

Overview:

Managing Really Difﬁcult Emotions

MINDFULNESS OF CURRENT EMOTIONS

Suppressing emotion increases suffering.

Mindfulness of current emotions is the path to emotional freedom.

MANAGING EXTREME EMOTIONS

Sometimes emotional arousal is so high that you can’t use any skills,

particularly if the skills are complicated or take any thought on your part.

This is a skills breakdown point.

Crisis survival skills are needed.

TROUBLESHOOTING AND REVIEW

There are many ways to change emotions.

It can be helpful to have a list of the important skills

to look at when you can’t remember the skills you need to regulate

your emotions.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



eMotion reGulation Handout 22

(Emotion Regulation Worksheet 15; p. 311 )

Mindfulness of Current Emotions:

Letting Go of Emotional Suffering

OBSERVE YOUR EMOTION

• Step back and just notice your emotion.

• Experience your emotion as a WAVE, coming and going.

• Now imagine surﬁng the emotion wave.

• Try not to BLOCK or SUPPRESS the emotion.

• Don’t try to GET RID of or PUSH away the emotion.

• Don’t try to KEEP the emotion around.

• Don’t HOLD ON to it.

• Don’t AMPLIFY it.

PRACTICE MINDFULNESS OF BODY SENSATIONS

• Notice WHERE in your body you are feeling emotional sensations.

• Experience the SENSATIONS as fully as you can.

• Observe how LONG it takes before the emotion goes down.

REMEMBER: YOU ARE NOT YOUR EMOTION

• Do not necessarily ACT on your emotion.

• Remember times when you have felt DIFFERENT.

PRACTICE LOVING YOUR EMOTION

• RESPECT your emotion.

• Do not JUDGE your emotion.

• Practice WILLINGNESS.

• Radically ACCEPT your emotion.

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eMotion reGulation Handout 23

Managing Extreme Emotions

Follow these suggestions when emotional arousal is very HIGH—so extreme that your ability to

use your skills breaks down.

First, observe and describe that you are at your SKILLS BREAKDOWN POINT:

 Your distress is extreme.

 You are overwhelmed.

 You cannot focus your mind on anything but the emotion itself.

 Your mind shuts down; your brain stops processing information.

 You cannot solve problems or use complicated skills.

Now check the facts. Are you really “falling apart” at this level of distress?

If no, USE YOUR SKILLS.

If yes, go to Step 1: You are at your SKILLS BREAKDOWN POINT.

Step 1. Use crisis survival skills to bring down your arousal:

(See Distress Tolerance Handouts 6–9a.)

• TIP your body chemistry.

• DISTRACT yourself from the emotional events.

• SELF- SOOTHE through the ﬁve senses.

• IMPROVE the moment you are in.

Step 2. Return to mindfulness of current emotions.

(See Emotion Regulation Handout 22.)

Step 3. Try other emotion regulation skills (if needed).

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

eMotion reGulation Handout 24 (p. 1 of 2)

(Emotion Regulation Worksheet 16; p. 312 )

Troubleshooting Emotion Regulation Skills: When What

You Are Doing Isn’t Working

CHECK YOUR BIOLOGICAL SENSITIVITY

• ASK: Am I biologically more vulnerable?

Do I have untreated physical illness or distress?

Am I out of balance on eating, use of drugs, sleep, exercise?

Have I taken medications as prescribed?

• WORK on your PLEASE skills.

1. Take care of physical illness and distress.

2. Take medications as prescribed. Check if others are needed.

3. Try again.

CHECK YOUR SKILLS

• REVIEW what you have tried.

Did you try a skill likely to be effective?

Did you follow the skill instructions to the letter?

• WORK on your skills.

1. Review and try other skills.

2. Get coaching if you need it.

3. Try again.

CHECK FOR REINFORCERS

• ASK: Do my emotions . . .

COMMUNICATE an important message or inﬂuence people to do things?

MOTIVATE me to do things I think are important?

VALIDATE my beliefs or my identity?

FEEL GOOD?

• IF YES:

1. Practice interpersonal effectiveness skills to communicate.

2. Work to ﬁnd new reinforcers to motivate yourself.

3. Practice self- validation.

4. Do PROS AND CONS for changing emotions.

(See Emotion Regulation Worksheet 1.)

(

continued on next page

)

eMotion reGulation Handout 24 (p. 2 of 2)

CHECK YOUR MOOD

• ASK: Am I putting in the time and effort that solving my problem will take?

• IF NO:

1. Do PROS AND CONS for working hard on skills.

2. Practice RADICAL ACCEPTANCE and WILLINGNESS skills.

3. Practice the mindfulness skills of PARTICIPATING and EFFECTIVENESS

(See Mindfulness Handouts 4 and 5.)

CHECK FOR EMOTIONAL OVERLOAD

• ASK: Am I too upset to use complicated skills?

• IF YES, ask: Can the problems I am worrying about be easily solved now?

• IF YES, do PROBLEM SOLVING.

(See Emotion Regulation Handouts 9, 12.)

• IF NO, practice mindfulness of CURRENT EMOTIONS.

(See Emotion Regulation Handout 22.)

• IF your emotions are too high for you to think straight:

• Go to TIP skills.

(See Distress Tolerance Handout 5.)

CHECK FOR EMOTION MYTHS GETTING IN THE WAY

• CHECK FOR:

Judgmental myths about emotions (e.g., “Some emotions are stupid,” “There is a

right way to feel in every situation”)?

Beliefs that emotions and identity are the same (e.g., “My emotions are who I

am”)?

• IF YES:

1. Check the facts.

2. Challenge myths.

3. Practice thinking nonjudgmentally.

eMotion reGulation Handout 25

Review of Skills for Emotion Regulation

Name Emotions

Describe Emotions

1. Accumulate positive emotions

2. Build mastery

3. Cope ahead

4. PLEASE skills

Reduce Emotional Vulnerability

Change Emotional

Thoughts and Interpretations

Check the Facts

Reduce Emotional Prompting Events

Problem Solving

Distraction

Manage Aftereffects

Repeat for Secondary Emotions

Distress Tolerance Skills

Reduce

Emotional Reactions

and

High Arousal

Crisis Survival

Strategies

Mindfulness

of Current Emotions

Change

Emotional Reactions

Opposite Action

(all the way)

Opposite

Body Language

Opposite Words

Training Handouts and Worksheets, Second Edition, and DBT Skills Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

Distress Tolerance Handouts

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

distress tolerance Handout 1

Goals of Distress Tolerance

SURVIVE CRISIS SITUATIONS

Without Making Them Worse

ACCEPT REALITY

Replace Suffering and Being “Stuck”

with Ordinary Pain and the Possibility of Moving Forward

BECOME FREE

Of Having to Satisfy

the Demands of Your Own

Desires, Urges, and Intense Emotions

OTHER:

Handouts for Crisis Survival Skills

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distress tolerance Handout 2

(Distress Tolerance Worksheets 1–7b; pp. 369–388 )

Overview:

Crisis Survival Skills

These are skills for tolerating painful events, urges, and emotions when you cannot make

things better right away.

The STOP Skill

Pros and Cons

TIP Your Body Chemistry

Distract with Wise Mind ACCEPTS

Self- Soothe with the Five Senses

Improve the Moment

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

distress tolerance Handout 3

When to Use Crisis Survival Skills

YOU ARE IN A CRISIS when the situation is:

• Highly stressful.

• Short-term (that is, it won’t last a long time).

• Creates intense pressure to resolve the crisis now.

USE CRISIS SURVIVAL SKILLS when:

1. You have intense pain that cannot be helped quickly.

2. You want to act on your emotions, but it will only make things worse.

3. Emotion mind threatens to overwhelm you, and you need to stay skillful.

4. You are overwhelmed, yet demands must be met.

5. Arousal is extreme, but problems can’t be solved immediately.

DON’T USE CRISIS SURVIVAL SKILLS for:

• Everyday problems.

• Solving all your life problems.

• Making your life worth living.

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

distress tolerance Handout 4

(Distress Tolerance Worksheets 2, 2a; pp. 372–373 )

STOP Skill

Stop Do not just react. Stop! Freeze! Do not move a

muscle! Your emotions may try to make you act

without thinking. Stay in control!

Take a step back Take a step back from the situation. Take a break. Let

go. Take a deep breath. Do not let your feelings make

you act impulsively.

Observe Notice what is going on inside and outside you. What

is the situation? What are your thoughts and feelings?

What are others saying or doing?

Proceed mindfully Act with awareness. In deciding what to do, consider

your thoughts and feelings, the situation, and other

people’s thoughts and feelings. Think about your

goals. Ask Wise Mind: Which actions will make it

better or worse?

Note. Adapted from an unpublished worksheet by Francheska Perepletchikova and Seth Axelrod, with their permission.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



distress tolerance Handout 5

(Distress Tolerance Worksheets 3, 3a; pp. 374–375 )

Pros and Cons

Use pros and cons any time you have to decide between two courses of action.

 An urge is a crisis when it is very strong and when acting on the urge will make things worse in

the long term.

 Make a list of the pros and cons of acting on your crisis urges. These might be to engage in

dangerous, addictive, or harmful behaviors, or they might be to give in, give up, or avoid doing

what is necessary to build a life you want to live.

 Make another list of the pros and cons of resisting crisis urges—that is, tolerating the distress

and not giving in to the urges.

 Use the grid below to evaluate both sets of pros and cons (this type of grid is also used in

Distress Tolerance Worksheet 3). Or you can use the type of grid seen in Distress Tolerance

Worksheet 3a and in the pros-and-cons worksheets for other modules.

PROS CONS

Acting

on crisis

urges

Pros of acting on impulsive urges,

giving in, giving up, or avoiding what

needs to be done.

Cons of acting on impulsive urges,

giving in, giving up, or avoiding what

needs to be done.

Resisting

crisis

urges

Pros of resisting impulsive urges,

doing what needs to be done, and

not giving up.

Cons of resisting impulsive urges,

doing what needs to be done, and

not giving up.

Before an overwhelming crisis urge hits:

Write out your pros and cons; carry them with you.

Rehearse your pros and cons over and over.

When an overwhelming crisis urge hits:

Review your pros and cons. Get out your list and read it over again.

• Imagine the positive consequences of resisting the urge.

• Think of the negative consequences of giving in to crisis behaviors.

• Remember past consequences when you have acted on crisis urges.

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

distress tolerance Handout 6

(Distress Tolerance Worksheet 4; p. 376 )

TIP Skills: Changing Your Body Chemistry

To reduce extreme emotion mind

fast

Remember these as TIP skills:

TIP THE TEMPERATURE of your face with COLD WATER*

(to calm down fast)

• Holding your breath, put your face in a bowl of cold water,

or hold a cold pack (or zip-lock bag of cold water) on your eyes and cheeks.

• Hold for 30 seconds. Keep water above 50°F.

INTENSE EXERCISE*

(to calm down your body when it is revved up by emotion)

• Engage in intense exercise, if only for a short while.

• Expend your body’s stored up physical energy by running, walking fast, jumping,

playing basketball, lifting weights, etc.











PACED BREATHING

(pace your breathing by slowing it down)

• Breathe deeply into your belly.

• Slow your pace of inhaling and exhaling way down (on average, ﬁve to six breaths

per minute).

• Breathe out more slowly than you breathe in (for example, 5 seconds in and 7

seconds out).

PAIRED MUSCLE RELAXATION

(to calm down by pairing muscle relaxation with breathing out)

• While breathing into your belly deeply tense your body muscles (not so much as

to cause a cramp).

• Notice the tension in your body.

• While breathing out, say the word “Relax” in your mind.

• Let go of the tension.

• Notice the difference in your body.

*Caution: Very cold water decreases your heart rate rapidly. Intense exercise will increase heart rate. Consult your health care provider before

using these skills if you have a heart or medical condition, a lowered base heart rate due to medications, take a beta- blocker, are allergic to

cold, or have an eating disorder.

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Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 6a

(Distress Tolerance Worksheet 4; p. 376 )

Using Cold Water, Step by Step

COLD WATER CAN WORK WONDERS

When you put your full face into cold water . . . or you put a zip-lock bag

with cold water on your eyes and upper cheeks, and hold your breath, it

tells your brain you are diving underwater.

This causes the “dive response” to occur. (It may take 15–30 seconds to

start.)

Your heart slows down, blood ﬂow to nonessential organs is reduced, and

blood ﬂow is redirected to the brain and heart.

This response can actually help regulate your emotions.

This will be useful as a distress tolerance strategy when you are having

a very strong, distressing emotion, or when you are having very strong

urges to engage in dangerous behaviors.

(This strategy works best when you are sitting quietly— activity and

distraction may make it less effective.)

TRY IT OUT!

*Caution: Very cold water decreases your heart rate. If you have any heart or medical condition, have a lowered base heart rate due to medica-

tions, or are on a beta- blocker, consult your health care provider before using these skills. Avoid ice water if you are allergic to the cold.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 6b

(Distress Tolerance Worksheet 4a; p. 377 )

Paired Muscle Relaxation, Step by Step

If you have decided to practice paired muscle relaxation, it can be very helpful to practice

relaxing each of your muscles ﬁrst.

When you are starting, practice in a quiet place to reduce distractions, and make sure that you

have enough time. As you improve with practice, you will want to practice in many different kinds of

places, so that you can relax effectively when you most need to.

Remember that effectiveness improves with practice. If judgments arise, observe them, let

them go, and return to your practice. If you become anxious, try focusing on breathing in to the

count of 5 and out to the count of 7 (or the counts you have already determined for paced breathing),

breathing all the while into your belly until you can return to relaxation exercises.

Now that you are ready to begin . . .

1. Get your body into a comfortable position in which you can relax. Loosen tight clothing. Lie or

sit down, with all body parts uncrossed and no body part supporting any others.

2. For each area of the body listed below, gather tension by tightening muscles. Focus on the

sensation of tightness in and around that area. Hold the tension as you inhale for 5–6 seconds,

then release and breathe out.

3. As you release, say in your mind very slowly the word “Relax.”

4. Observe the changes in sensations as you relax for 10–15 seconds then move on to the next

muscle.

Start ﬁrst with each of the 16 muscle groups.

Once you can do that, practice with medium groups of muscles and then large groups.

Once you are good at that, practice tensing your entire body at once.

When you tense your entire body, you are like a robot—stiff, nothing moving.

When you relax your entire body, you are like a rag doll—all muscles drooping down.

Once you can relax all your muscles, practice three or four times a day until you can routinely

relax your entire body rapidly.

By practicing pairing exhaling and the word “Relax” with relaxing your muscles, you will

eventually be able to relax just by letting go and saying the word “Relax.”

Large

Medium

Small

















1. Hands and wrists: Make ﬁsts with both hands and pull ﬁsts up on the wrists.

2. Lower and upper arms: Make ﬁsts and bend both arms up to touch your shoulders.

3. Shoulders: Pull both shoulders up to your ears.





















4. Forehead: Pull eyebrows close together, wrinkling forehead.

5. Eyes: Shut eyes tightly.

6. Nose and upper cheeks: Scrunch up nose; bring upper lips and cheeks up toward eyes.







7. Lips and lower face: Press lips together; bring edges of lips back toward ears.

8. Tongue and mouth: Teeth together; tongue pushing on upper mouth.











9. Neck: Push head back into chair, ﬂoor, or bed, or push chin down to chest.







10. Chest: Take deep breath and hold it.

11. Back: Arch back, bringing shoulder blades together.

















12. Stomach: Hold stomach in tightly.

13. Buttocks: Squeeze buttocks together.











14. Upper legs and thighs: Legs out; tense thighs.

15. Calves: Legs out; point toes down.

16. Ankles: Legs out; point toes together, heels out, toes curled under.

Remember, paired relaxation is a skill. It takes time to develop. With practice, you will notice the beneﬁts.

Note. Adapted from Smith, R. E. (1980). Development of an integrated coping response through cognitive– affective stress management train-

Hemisphere Publishing Corporation. Adapted by permission.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 6c

(Distress Tolerance Worksheet 4b; p. 378 )

Effective Rethinking and Paired Relaxation,

Step by Step

Step 1. Write down the prompting event that is often related to distressing emotions and that you

want to work on reducing your emotional reactions to.

Step 2. Ask: “What must I be telling myself (that is, what are my interpretations and thoughts)

about the event that causes such distress and arousal?” Write these down. Examples:

“He hates me,” “I can’t stand this!” “I can’t do this,” “I’ll never make it,” “I’m out of control!”

Step 3. Rethink the situation and its meaning in a way that counteracts the thoughts and interpreta-

tions producing stress and distressing emotions. As you rethink the situation, write down as many

effective thoughts as you can to replace the stressful thoughts.

Step 4. When you are not in the stressful prompting event, practice imagining the stressful event:

a. At the same time, while breathing in, say to yourself an effective self- statement.

b. When breathing out, say “Relax” while intentionally relaxing all your muscles.

Step 5. Keep practicing every chance you get until you have mastered the strategy.

Step 6. When a stressful situation occurs, practice effective rethinking and paired relaxation.

Note. Adapted from Smith, R. E. (1980). Development of an integrated coping response through cognitive– affective stress management train-

Hemisphere Publishing Corporation. Adapted by permission.

Emotional arousal

Stressful

prompting event

What I tell myself

Effective self-statement . . .

“ . . . So . . .

. . . relax.”

(breathing in . . . )

( . . . breathing out)

Examples:

“It’s not that important . . . so . . . relax.

“I may not like this, but I can definitely stand

it . . . so . . . relax.”

“I need to concentrate and not make myself

uptight . . . so . . . relax.”

“I’m in control . . . so . . . relax.”

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

distress tolerance Handout 7

(Distress Tolerance Worksheets 5–5b; pp. 379–381 )

Distracting

A way to remember these skills is the phrase “Wise Mind ACCEPTS.”

With Activities:

 Focus attention on a task you need to get

done.

 Rent movies; watch TV.

 Clean a room in your house.

 Find an event to go to.

 Play computer games.

 Go walking. Exercise.

 Surf the Internet. Write e-mails.

 Play sports.

 Go out for a meal or eat a favorite food.

 Call or go out with a friend.

 Listen to your iPod; download music.

 Build something.

 Spend time with your children.

 Play cards.

 Read magazines, books, comics.

 Do crossword puzzles or Sudoku.

 Other:

With Contributing:

 Find volunteer work to do.

 Help a friend or family member.

 Surprise someone with something nice (a

card, a favor, a hug).

 Give away things you don’t need.

 Call or send an instant message encouraging

someone or just saying hi.

 Make something nice for someone else.

 Do something thoughtful.

 Other:

With Comparisons:

 Compare how you are feeling now to a time

when you felt different.

 Think about people coping the same as you or

less well than you.

 Compare yourself to those less fortunate.

 Watch reality shows about others’ troubles;

read about disasters, others’ suffering.

 Other:

With different Emotions:

 Read emotional books or stories, old letters.

 Watch emotional TV shows; go to emotional

movies.

 Listen to emotional music.

(Be sure the event creates different emotions.)

Ideas: Scary movies, joke books, comedies,

funny records, religious music, soothing music

or music that ﬁres you up, going to a store and

reading funny greeting cards.

 Other:

With Pushing away:

 Push the situation away by leaving it for a

while.

 Leave the situation mentally.

 Build an imaginary wall between yourself and

the situation.

 Block thoughts and images from your mind.

 Notice ruminating: Yell “No!”

 Refuse to think about the painful situations.

 Put the pain on a shelf. Box it up and put it

away for a while.

 Deny the problem for the moment.

 Other:

With other Thoughts:

 Count to 10; count colors in a painting or

poster or out the window; count anything.

 Repeat words to a song in your mind.

 Work puzzles.

 Watch TV or read.

 Other:

With other Sensations:

 Squeeze a rubber ball very hard.

 Listen to very loud music.

 Hold ice in your hand or mouth.

 Go out in the rain or snow.

 Take a hot or cold shower.

 Other:

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Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



distress tolerance Handout 8

(Distress Tolerance Worksheet 6–6b; pp. 382–384 )

Self- Soothing

A way to remember these skills is to think of soothing each of your FIVE SENSES.

With Vision:

 Look at the stars at night.

 Look at pictures you like in a book.

 Buy one beautiful ﬂower.

 Make one space in a room pleasing to look at.

 Light a candle and watch the ﬂame.

 Set a pretty place at the table using your best

things.

 Go people- watching or window- shopping.

 Go to a museum or poster shop with beautiful

art.

 Sit in the lobby of a beautiful old hotel.

 Look at nature around you.

 Walk in a pretty part of town.

 Watch a sunrise or a sunset.

 Go to a dance performance, or watch it on TV.

 Be mindful of each sight that passes in front of

you.

 Take a walk in a park or a scenic hike.

 Browse through stores looking at things.

 Other:

With Hearing:

 Listen to soothing or invigorating music.

 Pay attention to sounds of nature (waves,

birds, rainfall, leaves rustling).

 Pay attention to the sounds of the city (trafﬁc,

horns, city music).

 Sing to your favorite songs.

 Hum a soothing tune.

 Learn to play an instrument.

 Burn a CD or make an iPod mix with music

that will get you through tough times. Turn it

on.

 Be mindful of any sounds that come your way,

letting them go in one ear and out the other.

 Turn on the radio.

 Other:

With Smell:

 Use your favorite soap, shampoo, aftershave,

cologne, or lotions, or try them on in the store.

 Burn incense or light a scented candle.

 Open a package of coffee and inhale the

aroma.

 Put lemon oil on your furniture.

 Put potpourri or eucalyptus oil in a bowl in your

room.

 Sit in a new car and breathe the aroma.

 Boil cinnamon. Make cookies, bread, or

popcorn.

 Smell the roses.

 Walk in a wooded area and mindfully breathe

in the fresh smells of nature.

 Open the window and smell the air.

 Other:

With Taste:

 Eat some of your favorite foods.

 Drink your favorite soothing drink, such

as herbal tea, hot chocolate, a latté, or a

smoothie.

 Treat yourself to a dessert.

 Eat macaroni and cheese or another favorite

childhood food.

 Sample ﬂavors in an ice cream store.

 Suck on a piece of peppermint candy.

 Chew your favorite gum.

 Get a little bit of a special food you don’t

usually spend the money on, such as fresh-

squeezed orange juice or your favorite candy.

 Really taste the food you eat. Eat one thing

mindfully.

 Other:

With Touch:

 Take a long hot bath or shower.

 Pet your dog or cat.

 Have a massage. Soak your feet.

 Put creamy lotion on your whole body.

 Put a cold compress on your forehead.

 Sink into a comfortable chair in your home.

 Put on a blouse or shirt that has a pleasant

feel.

 Take a drive with the car windows rolled down.

 Run your hand along smooth wood or leather.

 Hug someone.

 Put clean sheets on the bed.

 Wrap up in a blanket.

 Notice touch that is soothing.

 Other:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 8a

(Distress Tolerance Worksheet 6c; p. 385 )

Body Scan Meditation Step by Step

Sit on a chair, or lie on your back on the ﬂoor with legs uncrossed. Put your arms in a comfortable

position by your side, on your abdomen, or (if sitting) put them on your thighs palms up. Open your

eyes partially to let light in. If you are lying on the ﬂoor, put a cushion under your knees if need

be. Imagine your breath ﬂowing to each part of your body as your attention gently moves up your

body. Adopt a mind of curiosity and interest as you focus on each part of your body.

Focus on your breathing. Notice how the air moves in and out of your body.

• Take several deep breaths until you begin to feel comfortable and relaxed.

• Direct your attention to the toes of your left foot.

• Notice the sensations in that part of your body while remaining aware of your breathing.

• Imagine each breath ﬂowing to your toes.

• Looking with curiosity, ask, “What am I feeling in this part of my body?”

• Focus on your left toes for several minutes.

• Then move your focus to the arch and heel of your left foot, and hold it there for a minute or

two while continuing to pay attention to your breathing.

• Notice the sensations on your skin of warmth or coldness; notice the weight of your foot on

the ﬂoor.

• Imagine your breath ﬂowing to the arch and heel of your left foot.

• Ask, “What are the feelings in the arch and heel of my left foot?”

• Follow the same procedure as you move to your left ankle, calf, knee, upper legs, and thigh.

• Repeat with the right leg, starting with your toes.

• Then move through your pelvis, and lower back, and around to your stomach.

• Focus on the rising and falling of your belly as your breath goes in and out.

• Then go on to your chest; left hand, arm, and shoulder; right hand, arm, and shoulder; neck,

chin, tongue, mouth, lips, and lower face; and nose.

• Notice your breath as it comes in and out of your nostrils.

• Then focus on your upper cheeks, eyes, forehead, and scalp.

• Finally, focus on the very top of your hair.

• Then let go of your body altogether.

Don’t worry if you notice that thoughts, sounds, or other sensations come into your awareness.

Just notice them and then gently refocus your mind. Don’t worry if your mind has been drawn away

from the object of your attention and you ﬁnd yourself thinking about something else (it nearly

always happens). Just calmly, gently, but with resolution, turn your mind back to the part of the body

you’ve reached. You may need to bring your attention back over and over. You are not alone in this.

It is this bringing of your attention back over and over and over, without judgment or harshness, that

is the essential element of the meditation.

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

distress tolerance Handout 9

(Distress Tolerance Worksheets 7, 7a, 7b; pp. 386–388 )

Improving the Moment

A way to remember these skills is the word IMPROVE.

With Imagery:

 Imagine very relaxing scenes.

 Imagine a secret room within yourself. Furnish

it the way you like. Close and lock the door on

anything that can hurt you.

 Imagine everything going well.

 Make up a calming fantasy world.

 Imagine hurtful emotions draining out of you

like water out of a pipe.

 Remember a happy time and imagine yourself

in it again; play out the time in your mind

again.

 Other:

With Meaning:

 Find purpose or meaning in a painful situation.

 Focus on whatever positive aspects of a

painful situation you can ﬁnd.

 Repeat these positive aspects in your mind.

 Remember, listen to, or read about spiritual

values.

 Other:

With Prayer:

 Open your heart to a supreme being, God, or

your own Wise Mind.

 Ask for strength to bear the pain.

 Turn things over to God or a higher being.

 Other:

With Relaxing actions:

 Take a hot bath or sit in a hot tub.

 Drink hot milk.

 Massage your neck and scalp.

 Practice yoga or other stretching.

 Breathe deeply.

 Change your facial expression.

 Other:

With One thing in the moment:

 Focus your entire attention on just what you

are doing.

 Keep yourself in the moment.

 Put your mind in the present.

 Focus your entire attention on the physical

 Listen to a sensory awareness recording (or

use Distress Tolerance Handout 9a)

 Other:

With a brief Vacation:

 Give yourself a brief vacation.

 Get in bed; pull the covers up over your head.

 Go to the beach or the woods for the day.

 Get a magazine and read it with chocolates.

 Turn off your phone for a day.

 Take a blanket to the park and sit on it for a

whole afternoon.

 Take a 1-hour breather from hard work.

 Take a brief vacation from responsibility.

 Other:

With self-Encouragement and rethinking the situation:

 Cheerlead yourself: “You go, girl!” “You da

man!”

 “I will make it out of this.”

 “I’m doing the best I can.”

 Repeat over and over: “I can stand it.”

 “This too shall pass.”

 “I will be OK.”

 “It won’t last forever.”

 Other:

List (and then practice) rethoughts that are particularly important in your crisis situations (e.g., “The fact that he did

not pick me up doesn’t mean he doesn’t love me”):

 

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 9a

Sensory Awareness, Step by Step

Find a comfortable position. Staying in this position, listen to the questions below, listening for your

response after each question. If you do not have a recording of these questions, you can make

one for yourself (or ask a friend to make one), recording each question with about 5 seconds

between each question.

1. Can you feel your hair touching your head?

2. Can you feel your belly rising and falling as you breathe?

3. Can you feel the space between your eyes?

4. Can you feel the distance between your ears?

5. Can you feel your breath touching the back of your eyes while you inhale?

6. Can you picture something far away?

7. Can you notice your arms touching your body?

8. Can you feel the bottoms of your feet?

9. Can you imagine a beautiful day at the beach?

10. Can you notice the space within your mouth?

11. Can you notice the position of your tongue in your mouth?

12. Can you feel a breeze against your cheek?

13. Can you feel how one arm is heavier than the other?

14. Can you feel a tingling or numbness in one hand?

15. Can you feel how one arm is more relaxed than the other?

16. Can you feel a change in the temperature in the air around you?

17. Can you feel how your left arm is warmer than the right?

18. Can you imagine how it would feel to be a rag doll?

19. Can you notice any tightness in your left forearm?

20. Can you imagine something very pleasant?

21. Can you imagine what it would feel like to ﬂoat on a cloud?

22. Can you imagine what it would feel like to be stuck in molasses?

23. Can you picture something far away?

24. Can you feel a heaviness in your legs?

25. Can you imagine ﬂoating in warm water?

26. Can you notice your body hanging on your bones?

27. Can you allow yourself to drift lazily?

28. Can you feel your face getting soft?

29. Can you imagine a beautiful ﬂower?

30. Can you feel how one arm and leg are heavier than the other?

Note. Items 29 and 30 are adapted from Goldfried, M. R., & Davison, G. C. (1976). Clinical behavior therapy. New York: Holt, Rinehart & Win-

Handouts for Reality

AcceptanceSkills

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



distress tolerance Handout 10

(Distress Tolerance Worksheets 8–12a; pp. 391–400 )

Overview:

Reality Acceptance Skills

These are skills for how to live a life that is not the life you want.

RADICAL ACCEPTANCE

TURNING THE MIND

WILLINGNESS

HALF- SMILING AND WILLING HANDS

ALLOWING THE MIND:

MINDFULNESS OF CURRENT THOUGHTS

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Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



distress tolerance Handout 11

(Distress Tolerance Worksheets 8–9a; pp. 391–395 )

Radical Acceptance

(When you cannot keep painful events and emotions from coming your way.)

WHAT IS RADICAL ACCEPTANCE?

1. Radical means all the way, complete and total.

2. It is accepting in your mind, your heart, and your body.

3. It’s when you stop ﬁghting reality, stop throwing tantrums because reality is not

the way you want it, and let go of bitterness.

WHAT HAS TO BE ACCEPTED?

1. Reality is as it is (the facts about the past and the present are the facts, even if

you don’t like them).

2. There are limitations on the future for everyone (but only realistic limitations need

to be accepted).

3. Everything has a cause (including events and situations that cause you pain and

suffering).

4. Life can be worth living even with painful events in it.

WHY ACCEPT REALITY?

1. Rejecting reality does not change reality.

2. Changing reality requires ﬁrst accepting reality.

3. Pain can’t be avoided; it is nature’s way of signaling that something is wrong.

4. Rejecting reality turns pain into suffering.

5. Refusing to accept reality can keep you stuck in unhappiness, bitterness, anger,

sadness, shame, or other painful emotions.

6. Acceptance may lead to sadness, but deep calmness usually follows.

7. The path out of hell is through misery. By refusing to accept the misery that is

part of climbing out of hell, you fall back into hell.

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Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 11a

Radical Acceptance: Factors That Interfere

RADICAL ACCEPTANCE IS NOT:

Approval, compassion, love, passivity, or against change.

FACTORS THAT INTERFERE WITH ACCEPTANCE

 1. You don’t have the skills for acceptance; you do not know

how to accept really painful events and facts.

 2. You believe that if you accept a painful event, you are

making light of it or are approving of the facts, and that

nothing will be done to change or prevent future painful

events.

 3. Emotions get in the way (unbearable sadness; anger at

the person or group that caused the painful event; rage at

the injustice of the world; overwhelming shame about who

you are; guilt about your own behavior).

 Other:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 11b

(Distress Tolerance Worksheets 9, 9a; pp. 394–395 )

Practicing Radical Acceptance Step by Step

 Observe that you are questioning or ﬁghting reality (“It shouldn’t be this way”).

 Remind yourself that the unpleasant reality is just as it is and cannot be changed (“This is what

happened”).

 Remind yourself that there are causes for the reality. Acknowledge that some sort of history led

up to this very moment. Consider how people’s lives have been shaped by a series of factors.

Notice that given these causal factors and how history led up to this moment, this reality had to

occur just this way (“This is how things happened”).

 Practice accepting with the whole self (mind, body, and spirit). Be creative in ﬁnding ways

to involve your whole self. Use accepting self-talk—but also consider using relaxation;

mindfulness of your breath; half- smiling and willing hands while thinking about what feels

unacceptable; prayer; going to a place that helps bring you to acceptance; or imagery.

 Practice opposite action. List all the behaviors you would do if you did accept the facts. Then

act as if you have already accepted the facts. Engage in the behaviors that you would do if you

really had accepted.

 Cope ahead with events that seem unacceptable. Imagine (in your mind’s eye) believing what

you don’t want to accept. Rehearse in your mind what you would do if you accepted what

seems unacceptable.

 Attend to body sensations as you think about what you need to accept.

 Allow disappointment, sadness, or grief to arise within you.

 Acknowledge that life can be worth living even when there is pain.

 Do pros and cons if you ﬁnd yourself resisting practicing acceptance.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



distress tolerance Handout 12

(Distress Tolerance Worksheets 8, 8a, 10 ; pp. 391–392, 396 )

Turning the Mind

TURNING THE MIND is like facing a fork in the road. You

have to turn your mind toward the acceptance road, and

away from the road of rejecting reality.

TURNING THE MIND is choosing to accept.

The CHOICE to accept does not itself equal acceptance.

It just puts you on the path.

TURNING THE MIND, STEP BY STEP

1. OBSERVE that you are not accepting.

(Look for anger, bitterness, annoyance;

avoiding emotions; saying “Why me?”,

“Why is this happening?”, “I can’t stand

this,” “It shouldn’t be this way.”)

2. Go within yourself and MAKE AN

INNER COMMITMENT to accept reality

as it is.

3. DO IT AGAIN, over and over. Keep

turning your mind to acceptance each

time you come to the fork in the road

where you can reject reality or accept it.

4. DEVELOP A PLAN for catching yourself

in the future when you drift out of

acceptance.

If you are here . . .

Rejection

Acceptance

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Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



distress tolerance Handout 13

(Distress Tolerance Worksheets 8, 8a, 10 ; pp. 391–392, 396 )

Willingness

Willingness is readiness to enter and participate fully in life and living.

Find a WILLING RESPONSE to each situation.

Willingness is DOING JUST WHAT IS NEEDED:

• In each situation.

• Wholeheartedly, without dragging your feet.

Willingness is listening very carefully to your WISE MIND, and then

acting from your WISE MIND.

Willingness is ACTING WITH AWARENESS that you are connected

to the universe (to the stars, people you like and don’t like, the ﬂoor,

etc.).

Replace WILLFULNESS with WILLINGNESS.

• Willfulness is REFUSING TO TOLERATE the moment.

• Willfulness is refusing to make changes that are needed.

• Willfulness is GIVING U P.

• Willfulness is the OPPOSITE OF “DOING WHAT WORKS.”

• Willfulness is trying to FIX EVERY SITUATION.

• Willfulness is insisting on BEING IN CONTROL.

• Willfulness is ATTACHMENT TO “ME, ME, ME” and “what I want

right now!”

WILLINGNESS, STEP BY STEP

1. OBSERVE the willfulness. Label it. Experience it.

2. RADICALLY ACCEPT that at this moment you feel (and may be

acting) willful. You cannot ﬁght willfulness with willfulness.

3. TURN YOUR MIND toward acceptance and willingness.

4. Try HALF- SMILING and a WILLING POSTURE.

5. When willfulness is immovable, ASK, “WHAT’S THE THREAT?”

Situations where I notice my own:

Willfulness:

Willingness:

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Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



distress tolerance Handout 14

(Distress Tolerance Worksheets 8, 8a, 11; pp. 391–392, 397 )

Half- Smiling and Willing Hands

Accepting reality with your body.

HALF- SMILING

1st. Relax your face from the top of your head down to your chin and jaw.

Let go of each facial muscle (forehead, eyes, and brows; cheeks,

mouth, and tongue; teeth slightly apart). If you have difﬁculty, try

tensing your facial muscles and then letting go.

A tense smile is a grin (and might tell your brain you are hiding or

masking your real feelings).

2nd. Let both corners of your lips go slightly up, just so you can feel them.

It is not necessary for others to see it. A half-smile is slightly

upturned lips with a relaxed face.

3rd. Try to adopt a serene facial expression.

Remember, your face communicates to your brain; your body

connects to your mind.

WILLING HANDS

Standing:

Drop your arms down from your shoulders; keep them

straight or bent slightly at the elbows. With hands

unclenched, turn your hands outward, with thumbs out to

your sides, palms up, and ﬁngers relaxed.

Sitting:

Place your hands on your lap or your thighs. With hands

unclenched, turn your hands outward, with palms up and

ﬁngers relaxed.

Lying down:

Arms by your side, hands unclenched, turn your palms

up with ﬁngers relaxed.

Remember, your hands communicate to your brain; your body connects to

your mind.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 14a (p. 1 of 2)

(Distress Tolerance Worksheet 10; p. 396 )

Practicing Half- Smiling and Willing Hands

1. HALF-SMILE WHEN YOU FIRST WAKE UP IN THE MORNING.

Hang a branch, any other sign, or even the word “smile” on the ceiling or wall, so that you see it

right away when you open your eyes. This sign will serve as your reminder. Use these seconds

before you get out of bed to take hold of your breath. Inhale and exhale three breaths gently

while maintaining a half-smile. Follow your breaths. Add willing hands to your half-smile, or

practice willing hands alone.

2. HALF-SMILE DURING YOUR FREE MOMENTS.

Anywhere you ﬁnd yourself sitting or standing, half-smile. Look at a child, a leaf, a painting on a

wall, or anything that is relatively still, and smile. Inhale and exhale quietly three times.

3. HALF-SMILE WITH WILLING HANDS WHILE YOU ARE LISTENING TO MUSIC.

Listen to a piece of music for 2 or 3 minutes. Pay attention to the words, music, rhythm, and

sentiments of the music you are listening to (not your daydreams of other times). Half-smile

while watching your inhalations and exhalations. Adopt a willing-hands posture.

4. HALF-SMILE WITH WILLING HANDS WHEN YOU ARE IRRITATED.

When you realize “I’m irritated,” half-smile or adopt a willing-hands posture at once. Inhale and

exhale quietly, maintaining a half-smile or willing hands for three breaths.

5. HALF-SMILE IN A LYING-DOWN POSITION.

Lie on your back on a ﬂat surface, without the support of mattress or pillow. Keep your two arms

loosely by your sides, and keep your two legs slightly apart, stretched out before you. Maintain

willing hands and a half-smile. Breathe in and out gently, keeping your attention focused on

your breath. Let go of every muscle in your body. Relax each muscle as though it were sinking

down through the ﬂoor, or as though it were as soft and yielding as a piece of silk hanging in

the breeze to dry. Let go entirely, keeping your attention only on your breath and half-smile.

Think of yourself as a cat, completely relaxed before a warm ﬁre, whose muscles yield without

resistance to anyone’s touch. Continue for 15 breaths.

6. HALF-SMILE IN A SITTING POSITION.

Sit on the ﬂoor with your back straight, or on a chair with your two feet touching the ﬂoor. Half-

smile. Inhale and exhale while maintaining the half-smile. Let go.

(

continued on next page

)

distress tolerance Handout 14a (p. 2 of 2)

7. HALF-SMILE WITH WILLING HANDS WHILE YOU ARE CONTEMPLATING A PERSON

YOU DISLIKE OR ARE ANGRY WITH.

• Sit quietly. Breathe and smile a half-smile. Hold your hands open with palms up.

• Imagine the image of the person who has caused you suffering.

• Regard the features you dislike the most or ﬁnd the most repulsive.

• Try to examine what makes this person happy and what causes suffering in his or her

daily life.

• Imagine the person’s perceptions; try to see what patterns of thought and reason this

person follows.

• Examine what motivates this person’s hopes and actions.

• Finally, consider the person’s consciousness. See whether the person’s views and

insights are open and free or not, and whether or not the person has been inﬂuenced by

any prejudices, narrow- mindedness, hatred, or anger.

• See whether or not the person is master of him- or herself.

• Continue until you feel compassion rise in your heart like a well ﬁlling with fresh water,

and your anger and resentment disappear. Practice this exercise many times on the

same person.

Notes/Other times to half-smile and/or form willing hands:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)



distress tolerance Handout 15

(Distress Tolerance Worksheets 8, 8a, 12 ; pp. 391–392, 399 )

Mindfulness of Current Thoughts

1. OBSERVE YOUR THOUGHTS.

• As waves, coming and going.

• Not suppressing thoughts.

• Not judging thoughts.

• Acknowledging their presence.

• Not keeping thoughts around.

• Not analyzing thoughts.

• Practicing willingness.

• Stepping back and observing

thoughts as they run in and out of

your mind.

2. ADOPT A CURIOUS MIND.

• Ask, “Where do my thoughts come from?” Watch and see.

• Notice that every thought that comes also goes out of your mind.

• Observe but do not evaluate your thoughts. Let go of judgments.

3. REMEMBER: YOU ARE NOT YOUR THOUGHTS.

• Do not necessarily act on thoughts.

• Remember times when you have had very different thoughts.

• Remind yourself that catastrophic thinking is “emotion mind.”

• Remember how you think when you are not feeling such intense suffering

and pain.

4. DON’T BLOCK OR SUPPRESS THOUGHTS.

• Ask, “What sensations are these thoughts trying to avoid?” Turn your mind

to the sensation. Then come back to the thought. Repeat several times.

• Step back; allow your thoughts to come and go as you observe your breath.

• Play with your thoughts: Repeat them out loud over and over as fast as

you can. Sing them. Imagine the thoughts as the words of a clown, as

recordings getting all tangled up; as cute animals you can cuddle up to; as

bright colors running through your mind; as only sounds.

• Try loving your thoughts.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 15a (p. 1 of 2)

(Distress Tolerance Worksheets 8, 8a, 12 ; pp. 391–392, 399 )

Practicing Mindfulness of Thoughts

PRACTICE MINDFULNESS OF THOUGHTS BY OBSERVING THEM

 1. Notice thoughts as they come into your mind. As a thought comes into your mind, say

“a thought has entered my mind.” Label the thought as a thought, saying, “The thought

[describe thought] arose in my mind.” Use a gentle voice tone.

 2. As you notice thoughts in your mind, ask, “Where did the thought come from?” Then watch

your mind to see if you can see where it came from.

 3. Step back from your mind, as if you are on top of a mountain and your mind is just a boulder

down below. Gaze at your mind, watching what thoughts come up when you are watching it.

Come back into your mind before you stop.

 4. Close your eyes and scan your body for the ﬁrst physical sensation that you notice. Then

scan your mind for the ﬁrst thought you notice. Shuttle back and forth between scanning for

physical sensations and scanning for thoughts. Another time, replace scanning your body

for physical sensations to scanning yourself for any emotional feelings. Then shuttle back

and forth between an emotional feeling and a thought.

PRACTICE MINDFULNESS OF THOUGHTS BY USING WORDS AND VOICE TONE

 5. Verbalize thoughts or beliefs out loud, using a nonjudgmental voice tone, over and over and

over:

 As fast as you can until the thoughts make no sense.

 Very, very slowly (one syllable or word per breath).

 In a different voice from yours (high- or low- pitched, like a cartoon character or celebrity).

 As a dialogue on a TV comedy show (“You’ll never believe what thought went through

my mind. I was thinking, ‘I’m a jerk.’ Can you believe that?”).

 As songs, sung wholeheartedly and dramatically, in a tune that ﬁts the thoughts.

PRACTICE MINDFULNESS OF THOUGHTS WITH OPPOSITE ACTION

 6. Relax your face and body while imagining accepting your thoughts as only thoughts—

sensations of the brain.

 7. Imagine things you would do if you stopped believing everything you think.

 8. Rehearse in your mind the things that you would do if you did not view your thoughts as

facts.

 9. Practice loving your thoughts as they go through your mind.

(

continued on next page

)

distress tolerance Handout 15a (p. 2 of 2)

PRACTICE MINDFULNESS OF THOUGHTS BY IMAGINING THAT YOUR MIND IS:

 10. A conveyor belt, and that thoughts and feelings are coming down the belt. Put each thought

or feeling in a box labeled with the type of thought that it is (e.g., worry thoughts, thoughts

about my past, thoughts about my mother, planning what to do thoughts). Just keep

observing and sorting thoughts into the labeled boxes.

 11. A river, and that thoughts and feelings are boats going down the river. Imagine sitting on the

grass, watching the boats go by. Try not to jump on the boat.

 12. A railroad track, and that thoughts and feelings are train cars going by. Try not to jump on

the train.

 13. A leaf that has dropped off a tree into a beautiful creek ﬂowing by you as you sit on the

grass. Each time a thought or image comes into your mind, imagine that it is written or

pictured on the leaf ﬂoating by. Let each leaf go by, watching as it goes out of sight.

 14. The sky, and thoughts have wings and can ﬂy through the sky. Watch as each ﬂies out of

sight.

 15. The sky, and thoughts are clouds. Notice each thought-cloud as it drifts by, letting it drift out

of your mind.

 16. A white room with two doors. Through one door, thoughts come in; through the other,

thoughts go out. Watch each thought with attention and curiosity until it leaves. Let go of

judgments. Let go of analyzing thoughts and of ﬁguring out if they ﬁt the facts. As a thought

comes into your mind, say, “A thought has entered my mind.”

Other:

Handouts for Skills When the Crisis

IsAddiction

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 16

(Distress Tolerance Worksheets 13–18; pp. 403–410 )

Overview:

When the Crisis Is Addiction

Skills for backing down from addiction.

You can remember them as D, C, B, A.

DIALECTICAL ABSTINENCE











CLEAR MIND

COMMUNITY REINFORCEMENT

BURNING BRIDGES

AND BUILDING NEW ONES











ALTERNATE REBELLION

ADAPTIVE DENIAL

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 16a

Common Addictions

In case you thought you had no addictions, here is a list.

You are

addicted

when you are unable to stop a behavior pattern or use of

substances, despite negative consequences and despite your best efforts to stop.

 Alcohol

 Attention seeking

 Avoiding:

 Auto racing

 Betting

 Bulimia (purging/vomiting)

 Cheating

 Coffee

 Colas

 Collecting:

 Art

 Coins

 Junk

 Clothes

 Shoes

 Music

 Other:

 Computers

 Criminal activities

 Dieting

 Drugs (illicit and prescribed)

 Diuretics

 E-mail

 Food/eating

 Carbohydrates

 Chocolate

 Speciﬁc food:

 Gambling

 Games/puzzles

 Gossiping

 Imagining/fantasizing

 Internet

 Internet games

 Kleptomania/stealing/shoplifting

 Lying

 Pornography

 Reckless driving

 Risky behaviors

 Self- inﬂicted injury/self- mutilation

 Sex

 Shopping

 Sleeping

 Smartphone apps

 Smoking/tobacco

 Social networking

 Speed

 Spiritual practices

 Sports activities:

 Biking

 Body building

 Hiking/rock climbing

 Running

 Weight lifting

 Other:

 Television

 Texting

 Vandalism

 Videos

 Video games

 Working

 Other:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 17

(Distress Tolerance Worksheet 14; pp. 404–406 )

Dialectical Abstinence

SYNTHESIS = DIALECTICAL ABSTINENCE

The goal is not to engage in addictive behavior again—

in other words, to achieve complete abstinence.

However, if there is a slip, the goal is to minimize harm

and get back to abstinence as soon as possible.

Pros: It works!

Cons: It’s work. You don’t get a vacation.

(You’re always either abstinent or working to get back to abstinence.)

An example of expecting the best and planning for the trouble spots:

Olympic athletes must believe and behave as though they can win

every race, even though they have lost before and will lose again.

HARM REDUCTION

(Acknowledging there will be

slips; minimizing the damage,

but not demanding perfection)

ABSTINENCE

(Swearing off

addictive behavior)

vs.

Pro: People who commit to

abstinence stay off longer.

Con: It takes longer for people

to get back “on the wagon”

once they fall off.

Pro: When a slip does happen,

people can get back “on the

wagon” faster.

Con: People who commit to

harm reduction relapse quicker.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 17a

(Distress Tolerance Worksheet 14; pp. 404–406 )

Planning for Dialectical Abstinence

Plan for Abstinence

 1. Enjoy your success, but with a clear mind; plan for temptations to relapse.

 2. Spend time or touch base with people who will reinforce you for abstinence.

 3. Plan reinforcing activities to do instead of addictive behaviors.

 4. Burn bridges: Avoid cues and high-risk situations for addictive behaviors.

 5. Build new bridges: Develop images, smells, and mental activities (such as,

urge surﬁng) to compete with information associated with craving.

 6. Find alternative ways to rebel.

 7. Publicly announce abstinence; deny any idea of lapsing to addiction.

Plan for Harm Reduction

 1. Call your therapist, sponsor, or mentor for skills coaching.

 2. Get in contact with other effective people who can help.

 3. Get rid of temptations; surround yourself with cues for effective behaviors.

 4. Review skills and handouts from DBT.

 5. Opposite action (Emotion Regulation Handout 10) can be rehearsed

to ﬁght guilt and shame. If no other option works, go to an anonymous

meeting of any sort and publicly report your lapse.

 6. Building mastery and coping ahead for emotional situations (Emotion

Regulation Handout 19), and checking the facts (Emotion Regulation

Handout 8), can be used to ﬁght feelings of being out of control.

 7. Interpersonal skills (Interpersonal Effectiveness Handouts 5–7), such as

asking for help from family, friends, sponsors, ministers, or counselors,

can also be helpful. If you are isolated, help can often be found via online

support groups.

 8. Conduct a chain analysis to analyze what prompted the lapse (General

Handouts 7, 7a).

 9. Problem-solve right away to ﬁnd a way to “get back on the wagon” and

repair any damage you have done (Emotion Regulation Handout 12).

 10. Distract yourself, self- soothe, and improve the moment.

 11. Cheerlead yourself.

 12. Do pros and cons of stopping addictive behaviors (Distress Tolerance

Handout 5).

 13. Stay away from extreme thinking. Don’t let one slip turn into a disaster.

 14. Recommit to 100% total abstinence.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 18

(Distress Tolerance Worksheet 15; p. 407 )

Clear Mind

Addict mind is:

Impulsive

One- minded

Willing to do anything for a “ﬁx”

When in

addict mind,

you are ruled

by the addiction. The urges for habitual

problem behaviors determine your

thoughts, emotions, and behaviors.

Clean mind is:

Naive

Risk- taking

Oblivious to dangers

When in

clean mind,

you are clean

but oblivious to dangers that might

cue habitual problem behaviors. You

believe you are invincible and immune

to future temptation.

Both extremes are

DANGEROUS

CLEAR MIND: The safest place to be.

You are clean, but you remember addict mind.

You radically accept that relapse is

not impossible

You enjoy your

success

, while still

expecting urges and cues

and

planning

for when you’re tempted.

ADDICT

MIND

FOGGY MIND

CLEAR

MIND

CLEAN

MIND



 

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 18a

(Distress Tolerance Worksheet 16; p. 408 )

Behavior Patterns Characteristic of Addict Mind

and of Clean Mind

ADDICT MIND

 Engaging in addictive behavior.

 Thinking, “I don’t really have a problem with

addiction.”

 Thinking, “I can do a little.”

 Thinking, “I can indulge my habit, if only on

weekends.”

 Thinking, “I can’t stand this!”

 Glamorizing addiction.

 Surﬁng the Internet for ways to engage in

addictive behaviors.

 Buying paraphernalia (food, drugs, videos,

etc.) for addictive behavior.

 Selling or exchanging items related to

addictive behaviors.

 Stealing to pay for addiction.

 Prostituting for money or for paraphernalia.

 Lying.

 Hiding.

 Isolating.

 Acting always busy; “Got to go!”

 Breaking promises.

 Committing crimes.

 Acting like a corpse.

 Having “no life.”

 Acting desperate/obsessed.

 Not looking people in the eyes.

 Having poor hygiene.

 Avoiding doctors.

 Other:

CLEAN MIND

 Engaging in apparently irrelevant behaviors

that in the past inevitably led to addictive

behavior.

 Thinking, “I’ve learned my lesson.”

 Thinking, “I can control the habit.”

 Thinking, “I don’t really have an addiction

problem any more.”

 Stopping or cutting back medication that helps

with addiction.

 Being in environments where others engage in

addictive behaviors.

 Seeing friends who are still addicted.

 Living with people who are addicted.

 Keeping addiction paraphernalia.

 Carrying around extra money.

 Being irresponsible with bills.

 Dressing like an addict.

 Not going to meetings.

 Not confronting the problems that fuel my

addictive behaviors.

 Acting as if only willpower is needed.

 Isolating.

 Believing, “I can do this alone.”

 Thinking, “I can take pain medicine/diet/

engage in addictive behavior if prescribed or

advised; I don’t need to say anything about my

past addiction.”

 Thinking, “I can’t stand this!”

 Other:

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 19

(Distress Tolerance Worksheet 16; p. 408 )

Community Reinforcement

Community reinforcement means replacing addiction reinforcers

with abstinence reinforcers.

REINFORCING ABSTINENCE IS CRITICAL

Reinforcers in your environment play a powerful role in encouraging or discouraging addictive

behaviors.

To stop addictive behavior, you have to ﬁgure out how to make a lifestyle without your

addictive behaviors more rewarding than a lifestyle with your addictive behaviors.

You have to ﬁnd a way to get behaviors incompatible with addictions to pay off and be

rewarded by those around you.

Willpower is not sufﬁcient. If it were, we would all be perfect!

REPLACE ADDICTION REINFORCERS WITH ABSTINENCE REINFORCERS

Begin a series of action steps that will increase your chances of accumulating positive events

to replace addictive behavior.

 Search for people to spend time with who aren’t addicted.

 Increase the number of enjoyable activities you engage in that do not involve your

addiction.

 If you cannot decide what people or activities you like, sample a lot of different groups of

people and a lot of different activities.

ABSTINENCE SAMPLING

 Commit to days off your addiction, and observe the beneﬁts that naturally occur.

 Temporarily avoid high-risk addiction triggers, and replace these with competing behaviors

to get you through the sampling period.

 Observe all the extra positive events occurring when you are not engaging in addictive

behaviors.

Note. Adapted from Meyers, R. J., & Squires, D. D. (2001, September). The community reinforcement approach. Retrieved from www.bhrm.org/

guidelines/CRAmanual.pdf. Adapted by permission of the authors.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 20

(Distress Tolerance Worksheet 17; p. 409 )

Burning Bridges and Building New Ones

BURNING BRIDGES

Accept at the most radical level that you are not going to engage in addictive behavior

again, and then move actively to cut off all addictive behavior options.

 1. Make an absolute commitment to abstinence from the addictive behavior, which is

(describe addictive behavior). Then walk into the garage of

abstinence and slam the garage door shut. (Remember that the tiniest slit of space

can let an entire elephant in.)

 2. List everything in your life that makes addiction possible.

 3. Get rid of these things:

 Throw out contact information of people who collude with you.

 Get rid of all possible cues and temptations.

 4. List and do everything you can that will make it hard or impossible to continue your

addictive behavior.

 Ruthlessly and at every moment, tell the truth about your behavior.

 Tell all your friends and family that you have quit.

BUILDING NEW BRIDGES

Create visual images and smells that will compete with the information loaded into

your visual and olfactory brain systems when cravings occur.

Cravings and urges are strongly related to vivid images and smells of what is craved. The stron-

ger the imagery or smell, the stronger the craving.

 Build different images or smells to think about. Try to keep these images or smells

in memory when you have an unwanted craving. For example, whenever you crave

a cigarette, imagine being on the beach; see and smell it in your mind to reduce the

craving.

 When you have unwanted cravings, look at moving images or surround yourself with

smells unrelated to the addiction. Moving images and new smells will compete with your

cravings.

 “Urge-surf” by imagining yourself on a surfboard riding the waves of your urges. Notice

them coming and going, rising high, going low, and ﬁnally going away.

sion to photocopy this handout is granted to purchasers of DBT Skills Training Handouts and Worksheets, Second Edition, and DBT Skills

Training Manual, Second Edition, for personal use and use with individual clients only. (See page ii of this packet for details.)

distress tolerance Handout 21

(Distress Tolerance Worksheet 18; p. 410 )

Alternate Rebellion and Adaptive Denial

ALTERNATE REBELLION

When addictive behaviors are a way to rebel against authority, conventions, and the boredom

of not breaking rules or laws, try alternate rebellion. Alternate rebellion replaces destructive

rebellion and keeps you on a path to your goals.

Examples:

 Shave your head.

 Wear crazy underwear.

 Wear unmatched shoes.

 Have secret thoughts.

 Express unpopular views.

 Do random acts of kindness.

 Vacation with your family at a nudist colony.

 Write a letter saying exactly what you want to.

 Dye your hair a wild color.

 Get a tattoo or body piercing.

 Wear clothes inside out.

 Don’t bathe for a week.

 Print a slogan on a t-shirt.

 Paint your face.

 Dress up or dress down where

doing so is unexpected.

ADAPTIVE DENIAL

When your mind can’t tolerate craving for addictive behaviors, try adaptive denial.

 Give logic a break when you are doing this. Don’t argue with yourself.

 When urges hit, deny that you want the problem behavior or substance. Convince yourself

you want something other than the problem behavior. For example, reframe an urge to

have a cigarette as an urge to have a ﬂavored toothpick; an urge to have alcohol as an

urge to have something sweet; or an urge to gamble as an urge to alternate rebellion (see

above).

Other:

Be adamant with yourself in your denial, and engage in the alternative behavior.

 Put off addictive behavior. Put it off for 5 minutes, then put it off for another 5 minutes, and

so on and on, each time saying, “I only have to stand this for 5 minutes.” By telling yourself

each day you will be abstinent for today (or each hour for just this hour, and so on), you are

saying, “This is not forever. I can stand this right now.”