The Expanded Dialectical Behavior Therapy Skills Training Manual

1. Embrace Dialectical Thinking: Balance Acceptance and Change

"Dialectically, our thoughts and beliefs come from somewhere, and they make sense given the context of that place."

Find the middle ground. Dialectical thinking is at the core of DBT, emphasizing the balance between accepting reality as it is and working towards change. This approach helps individuals navigate the complexities of life by recognizing that seemingly contradictory ideas can coexist and often contain elements of truth.

Practice synthesis. By embracing dialectics, you can:

• Avoid black-and-white thinking
• Recognize the validity in opposing viewpoints
• Find creative solutions to problems
• Increase flexibility in thoughts and behaviors

Apply to daily life. Implement dialectical thinking by:

• Acknowledging your current emotions while working towards change
• Accepting yourself as you are while striving for personal growth
• Recognizing others' perspectives even when you disagree

2. Master Mindfulness: The Foundation of Emotional Regulation

"Mindfulness means choosing to pay attention to this present moment, on purpose, without judgment."

Cultivate awareness. Mindfulness is the cornerstone of emotional regulation in DBT. It involves developing a nonjudgmental awareness of your thoughts, feelings, and surroundings in the present moment. This skill helps you respond to situations more effectively, rather than reacting impulsively.

Practice core mindfulness skills:

• Observe: Notice your experiences without trying to change them
• Describe: Put words to your observations without judgment
• Participate: Fully engage in the present moment

Incorporate mindfulness daily:

• Start with short, regular practices (e.g., 5-minute breathing exercises)
• Use everyday activities as opportunities for mindfulness (e.g., mindful eating)
• Apply mindfulness to emotional experiences to reduce their intensity

3. Develop Distress Tolerance Skills to Navigate Crisis

"Distress tolerance skills provide alternatives to help us cope in the short term without making our situation worse, and they keep us true to our priorities, goals, values, and Life Vision."

Build resilience. Distress tolerance skills are essential for managing intense emotions and crisis situations without resorting to harmful behaviors. These skills help you survive difficult moments and prevent further escalation of problems.

Key distress tolerance strategies:

• ACCEPTS: Activities, Contributing, Comparisons, Emotions, Push away, Thoughts, Sensations
• Self-Soothe: Use your five senses to calm yourself
• IMPROVE: Imagery, Meaning, Prayer, Relaxation, One thing at a time, Vacation, Encouragement
• Radical Acceptance: Fully accept reality to reduce suffering

Apply in high-stress situations:

• Create a crisis survival kit with reminders of these skills
• Practice regularly to build muscle memory for crisis moments
• Use these skills as a bridge until you can problem-solve effectively

4. Regulate Emotions Through Self-Care and Positive Experiences

"Emotions such as happiness do not just happen but are a byproduct of what we think and what we do: Positive events build positive emotion."

Prioritize emotional health. Emotion regulation skills help you understand, manage, and influence your emotional experiences. By focusing on self-care and creating positive experiences, you can reduce emotional vulnerability and increase resilience.

Key emotion regulation strategies:

• PLEASE skills: Physical health, List resources and barriers, Eat balanced meals, Avoid drugs/alcohol, Sleep hygiene, Exercise
• Build Positive Experiences: Schedule enjoyable activities
• Opposite Action: Act opposite to unhelpful emotional urges

Create an emotion-friendly lifestyle:

• Develop a consistent self-care routine
• Regularly engage in activities that bring joy and satisfaction
• Practice identifying and labeling emotions accurately

5. Enhance Interpersonal Effectiveness with Balanced Communication

"We build and maintain relationships by balancing our own wants, needs, and desires with those of the people around us."

Foster healthy relationships. Interpersonal effectiveness skills help you maintain self-respect, build and nurture relationships, and assert your needs effectively. These skills are crucial for navigating social interactions and conflicts.

Key interpersonal effectiveness strategies:

• FAST: Fair, Apologies (when needed), Stick to values, Truthful
• GIVE: Gentle, Interested, Validate, Easy manner
• DEAR MAN: Describe, Express, Assert, Reinforce, Mindful, Appear confident, Negotiate

Apply in various social contexts:

• Use these skills in personal and professional relationships
• Practice active listening and validation
• Balance assertiveness with respect for others' needs

6. Modify Cognitive Patterns for Flexible Thinking

"The goal with our thinking is to have it be flexible in order to be functional."

Challenge rigid thoughts. Cognitive modification skills help you identify and change unhelpful thought patterns that contribute to emotional distress and ineffective behaviors. By developing more flexible thinking, you can respond to situations more adaptively.

Key cognitive modification strategies:

• Identify common thinking traps (e.g., black-and-white thinking, overgeneralization)
• Use the REASON skill: Rational, Emotions matter, Alternative views, Self-trust, Old beliefs, New thoughts
• Practice dialectical thinking to find balance in opposing viewpoints

Implement cognitive flexibility:

• Regularly challenge automatic negative thoughts
• Seek alternative perspectives in difficult situations
• Use evidence to support or refute your beliefs

7. Build Problem-Solving Skills for Effective Decision Making

"Problems of various types and levels of difficulty frequent our lives. If we do not actively work to solve our problems, they grow in number and size, and we end up chronically overwhelmed or even paralyzed by them."

Tackle challenges systematically. Problem-solving skills enable you to approach difficulties in a structured, effective manner. By breaking down problems and considering multiple solutions, you can make better decisions and reduce feeling overwhelmed.

Key problem-solving steps:

1. Identify and define the problem clearly
2. Generate multiple potential solutions
3. Evaluate the pros and cons of each option
4. Choose and implement the best solution
5. Assess the outcome and adjust if necessary

Enhance problem-solving abilities:

• Practice brainstorming without judgment
• Seek input from others for fresh perspectives
• Learn from both successes and failures in problem-solving attempts

8. Address Addictive Behaviors with Proactive Strategies

"Recovery from an addiction is possible, even for the most 'hopeless' addicts. By making a choice to recover, developing a plan, seeking and accepting support from others, and taking recovery one day (or moment) at a time, you can do it."

Break harmful cycles. Addressing addictive behaviors requires a comprehensive approach that combines understanding, acceptance, and proactive strategies. By recognizing triggers and developing coping mechanisms, you can work towards sustainable recovery.

Key addiction management strategies:

• Practice dialectical abstinence: Commit to abstinence while accepting setbacks
• Identify and manage triggers
• Use urge-surfing techniques to ride out cravings
• Develop a strong support network

Build a recovery-oriented lifestyle:

• Create new, healthy routines to replace addictive behaviors
• Practice mindfulness to increase awareness of urges and emotions
• Engage in activities that provide natural rewards and satisfaction

9. Create a Satisfying Life Through Structured Routines

"Life is more satisfying when we develop routines that include predictable and enjoyable relaxation and fun balanced with responsibilities."

Design your ideal day. Building a satisfying life involves creating structured routines that balance responsibilities with enjoyable activities. This structure provides a sense of stability and purpose, reducing vulnerability to emotional distress.

Key components of a satisfying routine:

• ROUTINE: Responsibilities, Ongoing structure, Use of skills, Traditions, Interests, Novelty, Envision a satisfying life
• Balance "want to" and "have to" activities
• Incorporate self-care, productivity, and leisure

Implement life-enhancing routines:

• Start with small, manageable changes to your daily schedule
• Regularly assess and adjust your routines for optimal satisfaction
• Include activities that align with your values and long-term goals

10. Navigate Social Media Mindfully in the Digital Age

"Like any tool, these forms of communication are neither good nor bad in and of themselves, but their use (or misuse) has the ability to either add to or detract from relationships."

Engage consciously online. In today's digital world, mindful use of social media and technology is crucial for maintaining healthy relationships and emotional well-being. By approaching these tools with awareness and intention, you can harness their benefits while minimizing potential negative impacts.

Guidelines for mindful media use (MEDIA):

• Moments can live on: Consider the lasting impact of your posts
• Everyone could possibly see: Assume nothing is truly private
• Don't post in Emotion Mind: Avoid impulsive communications
• Imagine possible outcomes: Think through potential consequences
• Add to communications positively: Contribute thoughtfully to online spaces

Foster healthy digital habits:

• Set boundaries for technology use (e.g., device-free times or zones)
• Practice being present in face-to-face interactions
• Regularly assess how social media use impacts your emotions and relationships

Last updated: October 8, 2024