DBT Skills Toolbox

DBT Skills Toolbox

Evidence-based coping strategies anyone can use, from Dialectical Behavioral Therapy

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DBT Skills Toolbox © 2025 by Vedika Bhatnagar is licensed under CC BY-SA 4.0

Contents

Lowering Stress and Overwhelm

Conflict Resolution Framework

Introduction

Reducing Unwanted Emotions

Review

Further Resources

Introduction

What is DBT?

DBT, or Dialectical Behavioral Therapy,is a form of psychotherapy developed by Marsha Linehan. Originally created to treat Borderline Personality Disorder, DBT is a specialized form of Cognitive Behavioral Therapy that focuses on skills to increase mindfulness, manage intense emotions, enhance relationships, and tolerate distressing situations. Since then, DBT has been shown to be effective in treating

a wide range of conditions.

Catherine T. Henry Center for Clinical Services https://www.chconline.org/clinicalservices/teen-dbt-skills-groups/

Introduction

Objectives

In this course, you'll learn three skills from DBT that anyone can apply in their daily lives and benefit from.DBT is not just for people with mental illness- these skills are practical tools that can support everyday emotional wellness in a variety of situations, including:

• Pausing and responding thoughtfully instead of reacting impulsively
• Staying calm in emotionally overwhelming situations
• Handling interpersonal conflict or communication challenges
• Regulating emotional intensity and returning to baseline faster

• Improving relationships by expressing your needs clearly

This content will not discuss specific mental illnesses or symptoms.

If you are experiencing significant mental health difficulties, please contact the GT Counseling Center's 24/7 line at 404-894-2575 or other crisis lines like 988.

Conflict Resolution Framework

Interpersonal Effectiveness

Conflict Resolution Framework

Interpersonal Effectiveness

Interpersonal Effectiveness is a DBT module that focuses on building healthier personal and professional relationships. It’s about knowing when and how to ask for what you need, say no, and set boundaries, while still maintaining respect for others and yourself. The goals of interpersonal effectiveness include:

• Improving communication

• Advocating effectively for your needs

• Maintaining self-respect in difficult situations

• Balancing being kind and being assertive

These skills can be used in any relationship- family, friends, romantic partners, colleagues, professors, and more! Go on to the next page to look at one of the most useful interpersonal effectiveness skills: DEAR MAN.

Adapted from Katie Molloy,Cambridgeshire & Peterborough NHS Foundation Trust https://www.youtube.com/watch?v=bGKBr1jM2O0

Conflict Resolution Framework

DEAR MAN

DEAR MAN is an acronym for a structured communication technique used to ask for something, set a boundary, or say no with the highest chance of success without damaging the relationship. The letters in DEAR are a step-by-step guide to construct your conversation. Click through each letter to see more details.

Reinforce

Assert

Express

Describe

Explain how the result also benefits the other person or the relationship, showing the "reward" in it for them if they agree.

Ask directly for what you want or need, or say no clearly. Be specific, no one can read your mind.

Clearly state your feelings and opinions about the situation. Don't assume they know how you feel.

Briefly describe the situation using facts only. Avoid judgment or assumptions.

Ex. "If you call, I'll be relieved and I won't be blowing up your phone to make sure you're okay. I'll also be much happier and calmer when you get back."

Ex. "You told me you would be home by dinner, but you didn't get back until 11."

Ex. "Could you please call me when you're going to be late? Could you come to dinner at least on weeknights?"

Ex. "I get worried when you come home so late. I feel frustrated when you miss dinner after saying you wouldn't."

Conflict Resolution Framework

DEAR MAN

The letters in MAN represent principles you should implement throughout your conversation. Click through each letter to see more details.

Mindful

Appear Confident

Negotiate

Stay focused on your goal, don’t get off-topic. Be like a broken record: keep asking/saying no over and over. Ignore attacks, threats, guilt-tripping, distractions, etc.

Offer alternatives or compromises. Be flexible and ask for suggestions. Focus on what could work.

Maintain eye contact, use a steady tone, keep your body language open and confident. Don't whisper, retreat, or back down on important aspects.

Ex. "How about you text me if you think you might be late? I can't just stop worrying about you, so what do you think we could do?"

Ex. "We can discuss my bad habit later, right now I'm asking you to call if you're going to be late."

Conflict Resolution Framework

Application

Now that you've learned the building blocks of DEARMAN, watch these two short videos to see example sketches of using it in a real scenario. When trying to apply DEARMAN yourself, it doesn't have to be as stilted, but try to include each component in order for the most effective conversation.

Lowering Stress and Overwhelm

Distress Tolerance

Lowering Stress and Overwhelm

Distress Tolerance

The Distress Tolerance DBT module teaches short-term crisis survival strategies. Any overwhelming emotional state can make it very difficult to think rationally and take steps to address the issue. Sometimes when we are highly distressed, in the moment we turn to ineffective or harmful coping strategies. These skills help you get through moments of emotional overload without making things worse.

The goals of distress tolerance include:

• Tolerating emotional pain in the moment
• Avoiding impulsive reactions during distress
• Calming your body quickly
• Grounding yourself in reality

Go to the next page to explore a fast-acting distress tolerance technique called TIPP.

Dr. Stephanie Vaughn, Psychotherapy Academyhttps://psychotherapyacademy.org/courses/dbt-training-online/modules/guide-to-dbt-skills-training-group/section/distress-tolerance-skills/

Lowering Stress and Overwhelm

TIPP Skill

The distress tolerance skill TIPP is an acroynm for four ways to force your emotional intensity down and regulate your body based on biological principles. Once your distress is reduced to the point where you can think more clearly, you can decide how to deal with the situation. Click on each of the cards to learn more.

Progressive Muscle Relaxation

Intense Exercise

Paced Breathing

Temperature

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Andrea Piacquadio https://www.pexels.com/@olly/

Lowering Stress and Overwhelm

Paced Breathing Practice

Breathe with the animation to practice paced breathing. Inhale through your nose while the circle expands, and exhale through your mouth while the circle shrinks.

John Turner https://quietkit.com/4-6-breathing/

Reducing Unwanted Emotions

Emotion Regulation

Reducing Unwanted Emotions

Emotion Regulation

The DBT Emotion Regulation module helps you understand your emotional patterns, reduce emotional vulnerability, and learn the most effective coping strategies for your emotions. The goals of emotion regulation include:

• Naming and understanding your emotions

• Reducing sensitivity to emotional triggers

• Responding in ways that align with your values, not your impulses

• Developing positive coping strategies tailored to your experiences

Go to the next slide to learn about checking the facts and opposite action, two strategies that help you evaluate and shift your emotional responses.

Marsha M. Linehan, DBT Skills Training Handouts and Worksheets, Second Edition

Reducing Unwanted Emotions

Check the Facts

Identify the emotion you're feeling. Label it with one or two emotion words (ex. frustrated, hurt, anxious, disappointed, jealous)

Identify

Sometimes, our emotions are based on inaccurate assumptions or interpretations of situations instead of the actual events. Checking the facts helps you evaluate whether your emotional reaction fits the actual situation. Expand each category to learn more.

Think about the event that prompted this emotion. Describe what happened, sticking to the observable facts without any judgements or interpretations.

Describe

Consider your interpretations and assumptions about the prompting event. What other possible interpretations are there? What could the other point of view be? What are some negative possible outcomes, and how likely are they to occur? What are some positive or neutral outcomes, and how likely are they to occur?

Analyze

Check

Ask yourself: Does the type of emotion and its intensity fit the actual facts? Or is my emotion disproportionately strong or misplaced for the actual situation?

Reducing Unwanted Emotions

Opposite Action

If the type or intensity of your emotion does fit the facts, then you can turn to problem-solving measures to deal with the event and accept the emotional experience. But if you realize that your emotion doesn't fit the facts, or acting on it would make things worse, we can use opposite action. Opposite action asks for us to act opposite to our emotion urge. Our emotions often come with an action urge, which describes the way that we want to react to it. We can identify what the emotion wants us to do, and intentionally act in the complete opposite way. If we can fully commit to doing this, we avoid making emotional situations worse in the short term and reduce the likelihood that we experience that emotion again in the long term. Our thoughts and feelings will eventually catch up. Click on the button to see more details on emotion urges and opposite action, then move to the next slide.

Review and Reflection

Question 1

Question 2

Question 3

Question 4

Question 5

Question 6

References

Content:Core Evidence & Research. (2022, October 6). Behavioral Tech Institute. https://behavioraltech.org/evidence/Linehan, M. M. (2014). DBT Skills Training Handouts and Worksheets, Second Edition. Guilford Publications. Marsha Linehan. (n.d.). Behavioral Research & Therapy Clinics; University of Washington. Retrieved March 22, 2025, from https://depts.washington.edu/uwbrtc/our-team/marsha-linehan/

Media: Benuto, L. (2018, April 30). DEAR MAN. YouTube. https://youtu.be/oCQdmbXLMVs?si=BU5e9RwbRzEG_1mq Cambridgeshire & Peterborough NHS Foundation Trust. (2020, May 27). Episode 5 Part 2: Introduction to Interpersonal Effectiveness Skills. YouTube. https://www.youtube.com/watch?v=bGKBr1jM2O0 Jones Mindful Living. (2021, May 19). DEAR Man Role Play. YouTube. https://www.youtube.com/watch?v=1NhezU0Wv_A Linehan, M. M. (2014). DBT Skills Training Handouts and Worksheets, Second Edition. Guilford Publications. Teen DBT Skills Groups. (n.d.). Catherine T Harvey Center for Clinical Services; Children’s Health Council. Retrieved March 22, 2025, from https://www.chconline.org/clinicalservices/teen-dbt-skills-groups/ Turner, J. (2023). 4-6 Breathing Technique (start here). QuietKit. https://quietkit.com/4-6-breathing/ Vaughn, S. (2023, November 8). DBT Distress Tolerance Skills: Tip Skill, Stop Skill, and More. Psychotherapy Academy. https://psychotherapyacademy.org/courses/dbt-training-online/modules/guide-to-dbt-skills-training-group/section/distress-tolerance-skills/

Further Reading

If you are interested in learning more about DBT, here are some resources in addition to the references for this guide!

• Free DBT course with videos and worksheets: https://dialecticalbehaviortherapy.com/
• Overview of every DBT skill: https://dbt.tools/index.php
• The Dialectical Behavioral Therapy Skills Workbook by Jeffrey Brantley, Jeffrey C. Wood, and Matthew McKay: uploads-ssl.webflow.com/60e4eec45f2723b891728a20/6127c9afb9830c5891f1cfee_DBT-Skills-Workbook.pdf
• DBT groups in Atlanta: https://www.psychologytoday.com/us/groups/ga/atlanta?category=dialectical-dbt

Congratulations!

You have completed the DBT Skills Toolbox. I hope these strategies are helpful for you!

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Intense Exercise

What is it?

How do I do it?

Often, emotions like anxiety, fear, and anger can make you feel "amped up" with energy, feeling tense, alert, jittery, or panicky. These physiological symptoms can reinforce your emotions and make it harder to return to baseline. Doing some intense exercise for a short period of time can burn off the physical energy, giving it somewhere to escape and letting you feel tired, not wired. This can also actually trick your body into thinking that symptoms like elevated heart rate and sweating are because of the exercise, not the raging anxiety, making it much easier to convince your brain that nothing is amiss and it should regulate back to calm.

Any physical activity that raises your heart rate and makes you breathe hard. Examples include:

• Run up and down the stairs 5 times
• Do 20+ jumping jacks or burpees
• Run around the building 3 times

• Your regular workout, if possible

Paced Breathing

What is it?

How do I do it?

Paced breathing is a simple breathing exercise to help control your emotions that many of us are familiar with. You want to intentionally slow your breathing pace down significally, taking long, slow breaths that you can feel expanding your chest. Count slowly while you breathe, and try to breathe out for longer than your inhale. Slowing down our breathing can help our nervous system regulate and ensure we are getting enough oxygen.

Breathe in slowly for 4 seconds and breathe out for 6 seconds. Count in your head while you breathe. You might need to adjust the pace to be comfortable for you while stretching it out as slowly as possible.

DBT is effective in treating...

• Borderline Personality Disorder and other Cluster B personality disorders
• Depression and treatment resistant depression
• Suicidality
• Self-harm
• Addiction/substance use disorder
• Bipolar disorder
• Binge eating disorder
• Bulimia
• ADHD (attention-deficit hyperactivity disorder)
• PTSD (post-traumatic stress disorder)

And these are only the conditions studied in full randomized control trials- there are many more studies showing effectiveness for even more conditions!

Core Evidence & Research - Behaviorial Tech Institute, 2022

Progressive Muscle Relaxation

What is it?

How do I do it?

Progressive muscle relaxation is used to help release physical tension in your body from intense emotions. It also helps ground you in the way your body feels. The basic idea is to pick a body part, usually starting from your toes and moving upwards. While you inhale deeply, tense that body part as hard as you can, feeling the muscle squeeze. Then on your exhale, relax your muscles completely and feel the body part completely lose tension.

Lie down on your back and start with your feet. Follow the listed steps for each body part, then move on to the next.A suggested progression could be toes, feet, calves, knees, thighs, butt, pelvis, abdomen, chest, hands, arms, shoulders, neck, mouth, cheeks, eyes, and finally entire face. You should feel very relaxed and heavy when complete.

Temperature

How do I do it?

What is it?

When you submerge your face under cold water, a process known as the mammialian dive reflex kicks in. Your parasympathetic nervous system forces your heart rate to slow down, to conserve energy and oxygen. Blood flow is also redirected to your heart and brain. We can take advantage of this physiological effect to quickly calm down and help regulate our emotions. It feels a little silly to do, but it's very powerful.

Most effective: Fill a big bowl with ice cubes and cold water. Hold your breath and submerge as much of your face as you can in the water. Stay submerged for about 30 seconds or until it starts to be painful, then come up. Repeat as many times as you can stand, at least 3-4 times. Less effective alternatives: Splash cold water on your face, hold an ice pack on your eyes and cheeks, or take a cold shower.