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DBT Skills
Core principle: Dialectical Behavior Therapy skills help with emotional regulation, distress tolerance, interpersonal effectiveness, and mindfulness. Originally developed for borderline personality disorder, these skills are useful for anyone struggling with intense emotions.
Four Skill Modules
1. Distress Tolerance
Skills for surviving crisis moments without making things worse.
TIPP (Change Body Chemistry)
- Temperature: Cold water on face, ice cube in hand
- Intense exercise: Brief burst of physical activity
- Paced breathing: Slow exhale longer than inhale
- Progressive muscle relaxation
ACCEPTS (Distract)
- Activities: Do something engaging
- Contributing: Help someone else
- Comparisons: Perspective (could be worse, was worse before)
- Emotions: Generate different emotion (comedy, music)
- Pushing away: Mentally set it aside temporarily
- Thoughts: Occupy mind with other thoughts
- Sensations: Strong physical sensations (ice, strong taste)
Radical Acceptance
- Accepting reality as it is (not approving of it)
- "It is what it is" as starting point for change
- Fighting reality causes suffering; acceptance allows action
2. Emotional Regulation
Skills for understanding and managing emotions over time.
Check the Facts
- What triggered the emotion?
- What am I interpreting or assuming?
- Does my emotional intensity fit the facts?
- Is there another way to see this?
Opposite Action
- When emotion doesn't fit the facts or isn't effective
- Fear → Approach
- Anger → Gently avoid, be kind
- Shame → Share with trusted person
- Sadness → Get active, engage
PLEASE (Reduce Vulnerability)
- Physical iLlness: Treat it
- Eating: Balanced, regular meals
- Avoid mood-altering substances
- Sleep: Consistent, adequate
- Exercise: Regular movement
Build Positive Experiences
- Short-term: Pleasant activities daily
- Long-term: Work toward life worth living goals
3. Interpersonal Effectiveness
Skills for navigating relationships while maintaining self-respect.
DEAR MAN (Getting What You Need)
- Describe: State facts without judgment
- Express: Share feelings using "I" statements
- Assert: Ask clearly for what you want
- Reinforce: Explain positive outcomes of getting it
- Mindful: Stay focused, don't get derailed
- Appear confident: Body language, tone
- Negotiate: Be willing to give to get
GIVE (Maintaining Relationship)
- Gentle: No attacks, threats, judgment
- Interested: Listen, show interest
- Validate: Acknowledge their perspective
- Easy manner: Light touch, humor if appropriate
FAST (Maintaining Self-Respect)
- Fair: To yourself and others
- Apologies: Don't over-apologize
- Stick to values: Don't compromise what matters
- Truthful: Don't lie or exaggerate
4. Mindfulness
Skills for present-moment awareness and wise action.
What Skills (What to Do)
- Observe: Notice without words
- Describe: Put words to experience
- Participate: Fully engage in the moment
How Skills (How to Do It)
- Non-judgmentally: No good/bad labels
- One-mindfully: One thing at a time
- Effectively: Do what works
Wise Mind
- Integration of emotional mind and rational mind
- Intuitive knowing that considers both facts and feelings
- "What does my wise mind say about this?"
When to Use DBT Skills
- Intense emotions that feel overwhelming
- Urges to engage in harmful behaviors
- Interpersonal conflict
- Crisis moments
- Chronic emotional dysregulation
- Self-harm or suicidal urges (crisis skills)
DBT Homework Examples
- Distress tolerance skill practice during urges
- Emotion diary with intensity ratings
- DEAR MAN planning for upcoming conversation
- Daily mindfulness practice (even 2 minutes)
- Opposite action experiment