DBT Training Manual

By Marsha M. Linehan, Ph.D

Related: Depression Bipolar Disorder

Dialectical behavior therapy

It recognises that people needs to accept themselves as they
are before they can effectively work on change.
Validation: emotions and experience should validated. This
creates trust and open communication.
Biosocial model
Behaviour Chain Analysis
Solving Ordinary Problems

Module 1: Mindfulness Skills

Core Mindfulness
Definition: Observing, describing, and participating fully in
the present moment without judgment.
Key Strategies:
Practice nonjudgmental awareness of thoughts,
emotions, and sensations.
Observe experiences without trying to change or
evaluate them.
Describe experiences using neutral language.
Act effectively by choosing how to respond mindfully.

Being mindful in the moment

Three States of Mind:
 Reasonable Mind: A state characterized by logical
thinking and analysis.
Emotion Mind: A state dominated by intense emotions
and reactions.
Wise Mind: The ideal state, which combines both reason
and emotion in a balanced way.
Mindfulness Skills:
Mindfulness skills help individuals develop and maintain Wise
Mind. These skills include:
Observing: Noticing what is happening in the present
moment, both internally and externally.
Describing: Using words to label and describe
experiences without judgment.
Participating: Engaging fully in the present moment,
immersing oneself in activities.
Mindfulness Practice:
Mindful Breathing: Paying attention to the breath to
anchor oneself in the present.
Mindful Eating: Eating slowly and savoring each bite with
full awareness.
Mindful Walking: Walking attentively, noticing each step
and sensation.
Obstacles to Mindfulness:
Common obstacles to mindfulness are discussed, including:
Judgment: The tendency to evaluate experiences as
good or bad.
Ruminating: Getting stuck in repetitive, unproductive
thoughts.
Distraction: Being pulled away from the present by
external factors.
 Avoidance: Attempting to escape or numb unpleasant
emotions.
The "What" and "How" Skills:
Mindfulness skills are divided into "What" and "How" skills:
"What" Skills: Focus on the "what" of mindfulness—what
to do to be mindful.
"How" Skills: Focus on the "how" of mindfulness—how to
practice these skills effectively.

Distress Tolerance
Definition: Coping with crises and intense emotions without
making things worse.
Key Strategies:
Understanding crisis survival skills
Distract: Engage in activities to redirect focus.
Self-Soothe: Use comforting strategies like self-care.
Improve the moment: Find ways to make the situation
more bearable.
Pros and Cons: Weigh the costs and benefits of different
actions.

Module 2: Emotion Regulation Skills

Understanding Emotions
Definition: Recognizing and identifying emotions accurately.
Key Strategies:
Identify primary and secondary emotions.
Observe emotional cues in the body.
Name emotions to gain control.

Reducing Vulnerability to Emotion Mind

 Definition: Strategies to prevent intense emotional reactions.
Key Strategies:
Build mastery through self-improvement.
Avoid or limit emotional triggers.
Balance acceptance and change.

Increasing Positive Emotions

Definition: Actively seeking and enhancing positive emotions.
Key Strategies:
Engage in pleasurable activities.
Build mastery in areas of interest.
Accumulate positive experiences.

Opposite Action
Definition: Changing emotional responses by acting opposite
to the emotion.
Key Strategies:
Identify when emotions are unwarranted.
Act in ways opposite to the emotion's urges.
Practice until new responses become natural.

Module 3: Interpersonal Effectiveness

Skills
Effective Interpersonal Skills
Definition: Strategies for assertiveness, maintaining self-
respect, and achieving objectives.
Key Strategies:
Use DEAR MAN to be clear, assertive, and get what you
want.
 GIVE to maintain and improve relationships.
FAST to maintain self-respect.

Relationship Effectiveness
Definition: Balancing priorities in relationships and
maintaining self-respect.
Key Strategies:
Prioritize objectives and self-respect.
Use the ABC PLEASE skill to regulate emotions.
Consider the pros and cons of different actions.

Understand dialectical dilemmas

Acceptance vs. Change: Balancing the acceptance of one's
current reality with the need for change.
Freedom vs. Discipline: Finding a balance between
freedom and structure in life.
Emotion vs. Reason: Integrating emotional responses
with rational thinking.
Short-Term vs. Long-Term Goals: Aligning immediate
desires with long-term objectives.

The Skill of Walking the Middle Path:

DBT teaches the skill of "walking the middle path" or finding a

synthesis between opposing truths.
This involves acknowledging the validity of both sides of a
dilemma and striving for a balanced approach.

Practicing Dialectical Thinking:

Individuals are encouraged to practice dialectical thinking by

considering the following:
 Avoiding Extreme Language: Use moderate and
balanced language rather than extreme, all-or-nothing
terms.
Considering Context: Recognize that situations and
emotions can change over time, leading to different
perspectives.
Seeking Synthesis: Look for creative solutions that
integrate opposing viewpoints.
Validation and Radical Acceptance: Validate your own
and others' experiences, even if they differ from your
own.

Radical Acceptance:

Radical Acceptance is a core skill discussed in this chapter. It

involves fully and unconditionally accepting the present
moment and reality, even when it's painful.
Acceptance is not approval; it's about acknowledging the
truth of the situation without judgment.

Applying Walking the Middle Path to Life:

The chapter provides examples of how the skill of walking the

middle path can be applied to various aspects of life, such as
relationships, decision-making, and emotional regulation.
Finding balance and synthesis in these areas can lead to
more effective problem-solving and emotional well-being.

Stages of treatment
Stage 1: Focuses on achieving behavioral control, reducing
life-threatening behaviors, and enhancing motivation for
therapy.
Stage 2: Shifts to addressing post-traumatic stress
responses and other problems that interfere with quality of
life.
Stage 3: Focuses on improving self-esteem, self-respect, and
self-compassion.
Stage 4: Emphasizes the pursuit of ordinary happiness and a
sense of connection to others.