Distract yourself from crisis urges with constructive activities.

# ACCEPTS Skill

---

## Definition

---

**ACCEPTS** is a Distress Tolerance skill in DBT used to distract yourself temporarily from overwhelming emotions. Each letter stands for a category of distraction techniques that can help you get through a crisis without making things worse.

---

## Purpose

---

Used to:

- Reduce emotional intensity to a tolerable level.
- Interrupt harmful impulses.
- Create space for wiser decision-making.
- Help you *cope ahead* with short-term distress when problems can’t be solved immediately.

---

## When to Use

---

Use ACCEPTS when:

- You feel emotionally flooded and unsafe.
- You are experiencing strong urges to act impulsively.
- You cannot change the crisis right away.
- You need to ride out an emotional wave without escalation.

---

## When *Not* to Use

---

Avoid using ACCEPTS if:

- The situation requires urgent problem-solving (e.g., medical emergency).
- You are using distraction to avoid important commitments long-term.
- You are denying the existence of real problems indefinitely.

---

## How-To

---

Here is what each letter stands for and how to apply it:

**A – Activities**

- Engage in healthy activities that require focus (e.g., cleaning, hobbies, exercise).

**C – Contributing**

- Do something kind for others (e.g., volunteer, send a caring text).

**C – Comparisons**

- Compare to a time you felt worse and survived, or to others coping effectively.

**E – Emotions**

- Generate different emotions by watching a funny video or listening to uplifting music.

**P – Pushing Away**

- Temporarily set the distressing situation aside mentally.

**T – Thoughts**

- Distract your mind by counting, doing puzzles, or reciting something memorized.

**S – Sensations**

- Use strong sensory input to shift focus (e.g., holding ice, taking a cold shower).

---

## Tips & Variations

---

- Try combining more than one letter for stronger distraction.
- Make an “ACCEPTS toolkit” with reminders for each category.
- Be mindful not to let distraction turn into chronic avoidance.

---

## Example

---

*Monica was triggered by an argument.*

1. **Activities:** Took her dog for a walk.
2. **Contributing:** Sent an encouraging message to her friend.
3. **Comparisons:** Reminded herself she survived worse arguments.
4. **Emotions:** Watched a lighthearted comedy show.
5. **Pushing Away:** Put her thoughts about the fight in an imaginary box.
6. **Thoughts:** Counted backward from 100 by sevens.
7. **Sensations:** Squeezed a stress ball.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, as part of DBT’s Distress Tolerance module. The acronym draws on cognitive-behavioral and mindfulness-based distraction methods.

---

## Related Skills

---

- IMPROVE the Moment
- Self-Soothing
- TIPP
- Radical Acceptance

---

## Limitations

---

May not be effective if:

- Used exclusively to avoid solving real problems.
- Emotions are left unprocessed over time.
- There is an immediate safety issue that requires action.

---

## Evidence Base

---

Research shows:

- Distraction reduces acute emotional arousal.
- Incorporating sensory strategies helps regulate nervous system responses.
- Regular practice increases emotional resilience.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [ACCEPTS Worksheet](https://www.therapistaid.com/worksheets/dbt-distress-tolerance-skills.pdf)
- *The Dialectical Behavior Therapy Skills Workbook* by McKay, Wood, and Brantley

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Neacsiu, A.D., Rizvi, S.L., & Linehan, M.M. (2010). "Dialectical Behavior Therapy Skills Use as a Mediator and Outcome of Treatment for Borderline Personality Disorder." *Behaviour Research and Therapy*, 48(9), 832–839.

ACCEPTS

Collect moments of positive emotion to build resilience.

# Accumulating Positive Experiences

---

## Definition

---

**Accumulating Positive Experiences (APE)** is a DBT Emotion Regulation skill designed to help you build a life worth living by consistently adding enjoyable, meaningful activities in the short and long term.

---

## Purpose

---

Used to:

- Increase positive emotions over time.
- Reduce vulnerability to negative emotions.
- Strengthen motivation and resilience.
- Counteract hopelessness and depression.

---

## When to Use

---

Use this skill when:

- You feel your life lacks joy or purpose.
- You are stuck in patterns of avoidance or numbness.
- You want to create habits that build happiness and meaning.

---

## When *Not* to Use

---

Avoid using if:

- You are in an acute crisis—use Distress Tolerance skills first.
- You are trying to avoid processing serious emotions (e.g., grief) without acknowledgment.
- You expect instant results; this is a long-term strategy.

---

## How-To

---

**Short Term:**

1. List pleasant activities you can do today or this week.
2. Schedule them on your calendar.
3. Participate fully and mindfully.

**Long Term:**

1. Identify important life areas (relationships, hobbies, career, spirituality).
2. Set realistic goals in each area.
3. Take small steps consistently.
4. Track your progress and celebrate successes.

---

## Tips & Variations

---

- Choose activities that align with your values.
- Start small—5–10 minutes a day can help.
- Use One-Mindfully to stay present while doing pleasant activities.
- Avoid judging yourself if you don’t feel “happy enough.”
- Pair with Build Mastery for an extra sense of accomplishment.

---

## Example

---

*Liam felt disconnected and sad after a breakup.*

**Short Term:**

- Called a friend for lunch.
- Watched a favorite movie.
- Took a walk in the park.

**Long Term:**

- Joined a local hiking club.
- Resumed painting as a hobby.
- Set a goal to reconnect with family monthly.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, as part of DBT’s Emotion Regulation module.

---

## Related Skills

---

- Build Mastery
- PLEASE
- Cope Ahead
- Opposite Action

---

## Limitations

---

May not be effective if:

- You expect immediate relief.
- You are unwilling to experiment with new activities.
- You are severely depressed and unable to engage—start smaller or seek professional support.

---

## Evidence Base

---

Research shows:

- Behavioral activation and pleasant event scheduling reduce depressive symptoms.
- Consistent positive experiences strengthen neural pathways associated with well-being.

---

## Further Reading

---

- *DBT Skills Training Manual* by Marsha Linehan
- [Behavioral Activation for Depression](https://www.apa.org/pubs/journals/features/ccp-74-4-459.pdf)
- *The Happiness Advantage* by Shawn Achor

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Lewinsohn, P.M. (1974). *A behavioral approach to depression*. In R.J. Friedman & M.M. Katz (Eds.), *The Psychology of Depression: Contemporary Theory and Research*.
- Achor, S. (2010). *The Happiness Advantage*. Crown Business.

Accumulating Positive Experiences

Focus on physical sensations to stay grounded in the present.

# Awareness of Body Sensations Skill

---

## Definition

---

**Awareness of Body Sensations** is the skill of intentionally paying attention to what you feel in your body.  
It helps you tune in to physical signals that are linked to your emotions and urges.

---

## Purpose

---

Used to:

- Increase mind-body connection.
- Recognize early signs of distress or escalation.
- Prevent impulsive reactions by catching sensations early.
- Ground yourself in the present moment.
- Improve emotion regulation and distress tolerance.

---

## When to Use

---

Use this skill when:

- You feel overwhelmed, disconnected, or numb.
- You want to understand how emotions manifest physically.
- You’re practicing mindfulness.
- You are preparing to use other DBT skills like Check the Facts or Opposite Action.

---

## When *Not* to Use

---

Avoid using if:

- You feel unsafe to notice body sensations due to trauma (work with a therapist).
- You are in severe crisis and need immediate action (use TIPP skills first).
- Focusing on sensations increases panic without grounding.

---

## How-To

---

1. **Find a Quiet Space:**

   - Sit or lie down comfortably.

2. **Scan Your Body:**

   - Start at your head, slowly move downward.
   - Notice tension, tingling, warmth, coolness, pain.

3. **Describe Sensations:**

   - Use neutral, factual language (e.g., “tight,” “fluttery,” “heavy”).

4. **Allow Sensations:**

   - Observe without trying to change them.

5. **Connect to Emotions:**

   - Consider what feeling the sensation may signal.

6. **Practice Acceptance:**

   - Remind yourself that sensations are temporary.

---

## Tips & Variations

---

- Pair this skill with **Mindfulness of Current Emotion**.
- Use body scan recordings or apps like Insight Timer.
- Journal about your sensations and associated emotions.
- If overwhelmed, open your eyes and focus on your environment.

---

## Example

---

*Maria noticed a pit in her stomach before a difficult conversation.*

- Sat quietly for 3 minutes.
- Noticed tightness in chest, shallow breathing.
- Recognized signs of anxiety.
- Validated: “My body is trying to protect me.”

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD** within DBT mindfulness skills.  
Inspired by:

- Mindfulness-Based Stress Reduction (Jon Kabat-Zinn).
- Somatic practices in psychology and meditation traditions.

---

## Related Skills

---

- Observe
- Describe
- Non-Judgmental Stance
- Mindfulness of Current Emotion

---

## Limitations

---

May not be effective if:

- You expect sensations to go away quickly.
- You judge sensations as “bad” or “wrong.”
- You are using the skill to avoid action or problem-solving indefinitely.

---

## Evidence Base

---

Research shows:

- Body scanning reduces stress and improves self-regulation.
- Awareness of sensations enhances emotional clarity.
- Mindfulness of the body can decrease avoidance and improve resilience.

---

## Further Reading

---

- *DBT Skills Training Manual* by Marsha Linehan
- *Wherever You Go, There You Are* by Jon Kabat-Zinn
- [Body Scan Meditation Script](https://www.mindful.org/body-scan-meditation/)

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Kabat-Zinn, J. (1990). *Full Catastrophe Living*. New York: Dell Publishing.
- Mehling, W.E. et al. (2011). Body awareness: a phenomenological inquiry into the common ground of mind-body therapies. *Philosophy, Ethics, and Humanities in Medicine*, 6(6).

Awareness of Body Sensations

Identify the sequence of events leading to problem behavior.

# Behavior Chain Analysis

---

## Definition

---

**Behavior Chain Analysis (BCA)** is a structured DBT tool that helps you examine the sequence of events, thoughts, feelings, and actions that led to a target behavior (usually a problem behavior).  
It allows you to identify links in the chain and plan interventions to change future patterns.

---

## Purpose

---

Used to:

- Understand why a problematic behavior occurred.
- Clarify vulnerabilities and triggers.
- Identify points where you could have used skills.
- Develop a plan to prevent future occurrences.

---

## When to Use

---

Use Behavior Chain Analysis when:

- You have engaged in a behavior you want to reduce or stop (e.g., self-harm, substance use, angry outbursts).
- You are stuck repeating unhelpful patterns.
- You need to figure out exactly what happened so you can do something different next time.

---

## When *Not* to Use

---

Avoid using if:

- You are too emotionally dysregulated to reflect safely.
- You are seeking to blame yourself or shame yourself rather than learn.
- The situation requires immediate crisis management rather than reflection.

---

## How-To

---

**1. Identify the Problem Behavior**

   - Be specific: What did you do?
   - Include time, place, and context.

**2. Describe the Chain of Events**

   - Start with prompting event(s): What set the chain in motion?
   - Record thoughts, feelings, body sensations, urges, and actions that occurred step by step.
   - Include internal and external factors.

**3. Identify Vulnerabilities**

   - What factors made you more likely to be triggered? (e.g., sleep deprivation, illness, stress)

**4. Identify Consequences**

   - What happened after the behavior (short-term and long-term)?
   - How did it affect you and others?

**5. Identify Missing Skills**

   - What DBT skills could have helped interrupt the chain?

**6. Develop a Prevention Plan**

   - What will you do differently next time?

**7. Plan Repair**

   - If needed, identify steps to repair damage (e.g., apologize, problem-solve).

---

## Tips & Variations

---

- Use written worksheets to organize your chain.
- Share your chain analysis with your therapist for coaching.
- Focus on learning, not self-judgment.
- Use clear and non-blaming language.
- Do chain analyses regularly to build awareness.

---

## Example

---

*Scenario: Maria self-harmed after an argument.*

**Behavior Chain:**

1. **Prompting Event**: Argument with partner.

2. **Links**:

   - Feeling rejected.
   - Thinking “I am worthless.”
   - Urge to escape feelings.
   - Remembering relief from past self-harm.
   - Going to bathroom and cutting.

3. **Consequences**:

   - Immediate relief.
   - Long-term shame and guilt.

4. **Missing Skills**:

   - Opposite Action.
   - Self-Soothing.
   - Distress Tolerance.

5. **Prevention Plan**:

   - Text support person.
   - Use TIPP skills.
   - Practice Radical Acceptance.

---

## Inventor / Origin

---

Behavior Chain Analysis was developed by **Marsha Linehan, Ph.D.**, as part of Dialectical Behavior Therapy.  
It integrates elements of behavioral analysis and cognitive-behavioral approaches to help individuals better understand their behaviors.

---

## Related Skills

---

- Chain Analysis of Problem Behaviors
- Missing Links Analysis
- Opposite Action
- Radical Acceptance
- Problem Solving

---

## Limitations

---

May not be effective if:

- Used punitively rather than compassionately.
- Skipped over critical details or triggers.
- The person is unwilling to reflect honestly.

---

## Evidence Base

---

Research shows:

- Behavior Chain Analysis improves awareness of patterns that maintain problem behaviors.
- It enhances skill generalization and relapse prevention.
- It is a core component of effective DBT treatment for emotion dysregulation.

---

## Further Reading

---

- Linehan, M.M. (2015). *DBT Skills Training Handouts and Worksheets*.
- [DBT Self Help - Behavior Chain](https://www.dbtselfhelp.com/html/behavior_chain.html)
- [Psych Central - How to Do a Behavior Chain Analysis](https://psychcentral.com/pro/recovery-expert/2016/05/how-to-do-a-behavior-chain-analysis)

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. Guilford Press.
- Rizvi, S.L., & Steffel, L.M. (2014). A Pilot Study of the DBT Prolonged Exposure Protocol in a Community Sample of PTSD and BPD. *Journal of Traumatic Stress*, 27(5), 605–611.
- Neacsiu, A.D., Rizvi, S.L., & Linehan, M.M. (2010). Dialectical Behavior Therapy Skills Use as a Mediator and Outcome of Treatment for Borderline Personality Disorder. *Behaviour Research and Therapy*, 48(9), 832–839.

Behavior Chain Analysis

Observe sensations throughout your body non-judgmentally.

# Body Scan

---

## Definition

---

**Body Scan** is a mindfulness practice where you direct your attention slowly and systematically through different parts of your body. It helps you notice sensations, tension, and areas of ease with curiosity and without judgment.

---

## Purpose

---

Used to:

- Increase awareness of physical sensations and how they relate to emotions.
- Release muscle tension and promote relaxation.
- Ground yourself in the present moment.
- Develop non-judgmental observation skills.
- Improve connection between mind and body.

---

## When to Use

---

Use Body Scan when:

- You feel disconnected from your body or emotionally numb.
- You are experiencing moderate stress or anxiety.
- You want to unwind before sleep.
- You’d like to strengthen mindfulness skills.

---

## When *Not* to Use

---

Avoid using if:

- You are in acute crisis or experiencing intense dissociation.
- Focusing on the body triggers trauma memories you are not ready to process.
- You are operating machinery or driving.

---

## How-To

---

**1. Get Comfortable**

   - Lie down or sit in a relaxed position.
   - Close your eyes or soften your gaze.

**2. Take a Few Deep Breaths**

   - Inhale slowly, exhale fully.
   - Let your body begin to settle.

**3. Focus Attention**

   - Start at the top of your head or the tips of your toes.
   - Bring your awareness to each area in turn.

**4. Notice Sensations**

   - Observe tightness, warmth, tingling, or absence of sensation.
   - Try not to label sensations as “good” or “bad.”

**5. Breathe Into Each Area**

   - Imagine your breath moving into any tense spots.
   - Allow sensations to shift naturally.

**6. Continue Slowly**

   - Move through all body parts at your own pace.
   - If your mind wanders, gently return attention.

**7. Close the Practice**

   - Take a few grounding breaths.
   - Gently wiggle your fingers and toes.
   - Open your eyes if they were closed.

---

## Tips & Variations

---

- Use a guided recording if you’re new to the practice.
- Try progressive muscle relaxation by tensing and releasing each area.
- Practice for 5–45 minutes depending on time available.
- Place a hand on your heart or stomach for added comfort.

---

## Example

---

*Scenario: Jamie feels stressed after a long day.*

**Body Scan Practice:**

1. They lie down on a yoga mat.
2. They start with the feet, noticing heaviness.
3. They breathe into the tightness in their shoulders.
4. After 20 minutes, their body feels calmer and more relaxed.

---

## Inventor / Origin

---

**Body Scan** comes from:

- Mindfulness-Based Stress Reduction (MBSR) developed by Jon Kabat-Zinn.
- Integrated into DBT by Marsha Linehan to build interoceptive awareness and reduce reactivity.

---

## Related Skills

---

- Observe
- One-Mindfully
- Wise Mind
- Self-Soothing
- Progressive Muscle Relaxation

---

## Limitations

---

May not be effective if:

- Practiced during severe dissociation or flashbacks.
- Used as avoidance when action is required.
- You judge sensations harshly or become frustrated.

---

## Evidence Base

---

Research shows:

- Body Scan reduces stress, anxiety, and physical pain.
- Increases body awareness and acceptance.
- Enhances emotional regulation over time.

---

## Further Reading

---

- *Full Catastrophe Living* by Jon Kabat-Zinn
- [Mindfulness Exercises: Body Scan](https://www.mindful.org/body-scan-meditation/)
- *The Mindful Way Through Depression* by Williams, Teasdale, Segal, and Kabat-Zinn

---

## References

---

- Kabat-Zinn, J. (1990). *Full Catastrophe Living*. Delacorte.
- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Segal, Z.V., Williams, J.M.G., & Teasdale, J.D. (2013). *Mindfulness-Based Cognitive Therapy for Depression*. Guilford Press.

Body Scan

Do activities that make you feel competent and effective.

# Build Mastery Skill

---

## Definition

---

**Build Mastery** is a DBT Emotion Regulation skill that involves engaging in activities that create a sense of accomplishment and competence, reducing feelings of helplessness and increasing confidence over time.

---

## Purpose

---

Used to:  

- Strengthen self-efficacy by regularly doing things that matter to you.
- Decrease vulnerability to depression and anxiety.
- Create positive emotions through achievement.
- Build resilience to stress.

---

## When to Use

---

Use Build Mastery:  

- When you feel stuck, unmotivated, or ineffective.
- To counter self-critical thoughts.
- As a daily practice to increase life satisfaction.
- When recovering from setbacks or failures.

---

## When *Not* to Use

---

Avoid using if:  

- You’re in crisis and need immediate distress tolerance skills.
- You’re physically unwell and need rest first.
- You’re using mastery activities to avoid addressing pressing problems.

---

## How-To

---

1. **Identify Mastery Areas:**

   - What are meaningful skills, hobbies, or tasks you care about?
   - What activities give you a sense of competence?

2. **Choose an Activity:**

   - Pick something achievable but slightly challenging.
   - Examples: cooking a new recipe, organizing a space, practicing an instrument.

3. **Schedule It:**

   - Plan when and where you will do it.

4. **Do It Mindfully:**

   - Focus on the process, not perfection.

5. **Acknowledge Your Effort:**

   - Notice and appreciate the accomplishment, no matter how small.

6. **Gradually Increase Challenge:**

   - Over time, select harder or more complex tasks.

---

## Tips & Variations

---

- Use a **Mastery Log** to track progress.
- Start with very small steps if you feel overwhelmed.
- Combine with **Opposite Action** when you want to avoid activity.
- Celebrate your successes with supportive people.

---

## Example

---

*Jordan felt worthless and unproductive.*

- **Mastery Area:** Photography.
- **Activity:** Take 10 photos in the neighborhood.
- **Outcome:** Felt proud and energized, less self-critical.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, as part of the Emotion Regulation module in Dialectical Behavior Therapy (DBT).

---

## Related Skills

---

- Accumulating Positive Emotions
- Opposite Action
- Check the Facts
- Mindfulness Skills

---

## Limitations

---

May not be effective if:  

- Tasks are too overwhelming or unrealistic.
- You expect instant gratification.
- You’re using it to avoid essential responsibilities.

---

## Evidence Base

---

Research shows:  

- Mastery experiences improve mood and reduce depression.
- Small, daily accomplishments contribute to long-term well-being.
- Behavioral activation is an evidence-based treatment for depression.

---

## Further Reading

---

- *DBT Skills Training Manual* by Marsha Linehan
- [Behavioral Activation for Depression](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3081881/)
- *The How of Happiness* by Sonja Lyubomirsky

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Martell, C.R., Dimidjian, S., & Herman-Dunn, R. (2010). *Behavioral Activation for Depression*. Guilford Press.
- Lyubomirsky, S. (2008). *The How of Happiness*. Penguin Press.

Build Mastery

Align your emotions with the reality of the situation.

# Check the Facts Skill

---

## Definition

---

**Check the Facts** is the skill of evaluating whether your emotional reactions fit the actual situation.  
It involves comparing your interpretation of events with objective reality to help regulate intense emotions.

---

## Purpose

---

Used to:

- Reduce unnecessary emotional suffering.
- Align emotions with reality.
- Prevent impulsive or destructive behavior based on assumptions.
- Cultivate balanced thinking.

---

## When to Use

---

Use this skill when:

- Your emotions feel overwhelming or confusing.
- You’re about to act on strong urges.
- You suspect you might be jumping to conclusions.
- You want to respond more effectively.

---

## When *Not* to Use

---

Avoid using if:

- You’re in immediate danger (use crisis skills first).
- You are deliberately ignoring evidence (be willing to be honest).
- You’re using it to invalidate legitimate feelings without reflection.

---

## How-To

---

1. **Identify the Emotion:**

   - Name the emotion you feel.

2. **Describe the Situation:**

   - Stick to observable facts.

3. **Check for Interpretation:**

   - What are you telling yourself about the situation?

4. **Identify Facts:**

   - What evidence supports your thoughts?
   - What evidence does not support your thoughts?

5. **Ask:**

   - Is this emotion justified by the facts?
   - Does the intensity of the emotion fit the facts?

6. **Change or Act:**

   - If facts do not justify the emotion, consider changing thoughts or using Opposite Action.

---

## Tips & Variations

---

- Write down your interpretations vs. facts in two columns.
- Ask a trusted person for an outside perspective.
- Use mindfulness to observe interpretations without judgment.
- Revisit the situation later—facts often become clearer with time.

---

## Example

---

*Alex felt angry when a friend didn’t text back.*

- **Emotion:** Anger
- **Interpretation:** “She doesn’t care about me.”
- **Facts:** She was sick last week. She often takes time to respond.
- **Check:** No evidence she is ignoring me intentionally.
- **Action:** Decided to wait before assuming rejection.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD** as part of DBT emotion regulation.  
Related to principles in Cognitive Behavioral Therapy (CBT).

---

## Related Skills

---

- Opposite Action
- Observe
- Describe
- Mindfulness of Thoughts

---

## Limitations

---

May not be effective if:

- You’re unwilling to look at evidence honestly.
- You use it to dismiss all feelings rather than regulate them.
- You cannot access enough information to check your assumptions.

---

## Evidence Base

---

Research shows:

- Fact-checking interpretations can reduce anxiety and depression.
- Reappraising situations improves emotional resilience.
- Practicing this skill regularly strengthens cognitive flexibility.

---

## Further Reading

---

- *DBT Skills Training Manual* by Marsha Linehan
- *Mind Over Mood* by Greenberger & Padesky
- [DBT Skills Handouts](https://www.dbtselfhelp.com/html/check_the_facts.html)

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Greenberger, D., & Padesky, C. (2016). *Mind Over Mood*. Guilford Press.
- Beck, A.T. (1979). *Cognitive Therapy of Depression*. Guilford Press.

Check the Facts

Increase your dedication to goals and values.

# Commitment Strategies

---

## Definition

---

**Commitment Strategies** are techniques used to strengthen and maintain your intention to follow through on skill use, goals, or behavioral changes, especially when you encounter obstacles or ambivalence.

---

## Purpose

---

Used to:

- Solidify your dedication to change.
- Create accountability and structure.
- Overcome ambivalence about treatment or goals.
- Increase follow-through on commitments.

---

## When to Use

---

Use Commitment Strategies when:

- You feel uncertain about continuing treatment or a plan.
- You often make plans but fail to act on them.
- You notice avoidance or excuses creeping in.
- You are preparing for a significant behavioral change.

---

## When *Not* to Use

---

Avoid using if:

- You are in acute crisis and unable to think clearly.
- You feel coerced or pressured into commitment.
- You have not yet clarified your values or reasons for change.

---

## How-To

---

**1. Clarify Your Reasons for Change**

   - Why do you want to commit to this goal or skill?
   - What benefits will it bring you?

**2. Choose a Commitment Strategy**

   - Examples include:

     - **Making a Public Commitment**: Telling others.
     - **Writing a Commitment Statement**.
     - **Using Visual Reminders** (notes, posters).
     - **Scheduling Specific Times to Act**.
     - **Creating a Ritual or Ceremony** to mark commitment.

**3. Identify Potential Obstacles**

   - What thoughts or situations might derail you?

**4. Create a Plan for Staying Committed**

   - What will you do when you feel resistance?

**5. Review and Renew Commitments Regularly**

   - Check in with your commitment weekly.

---

## Tips & Variations

---

- Keep commitments realistic and specific.
- Use visual cues (e.g., sticky notes or phone reminders).
- Consider a symbolic act (like signing a contract with yourself).
- Pair with Willingness vs. Willfulness to increase openness.

---

## Example

---

*Scenario: Jordan often forgets to practice DBT skills.*

**Commitment Plan:**

1. Write a statement: “I am committed to practicing mindfulness for 5 minutes daily because I want to feel calmer and in control.”

2. Tell their therapist and partner.

3. Set a daily reminder on their phone.

4. Review progress every Sunday.

---

## Inventor / Origin

---

Commitment strategies are foundational in **behavioral therapy, DBT, and ACT**.  
They were formalized in DBT by **Marsha Linehan** as part of treatment adherence and skill-building.

---

## Related Skills

---

- Willingness vs. Willfulness
- Values Clarification
- Goal Setting
- Radical Acceptance

---

## Limitations

---

May not be effective if:

- The commitment feels externally imposed.
- The goal is vague or unrealistic.
- You avoid acknowledging ambivalence.

---

## Evidence Base

---

Research shows:

- Explicit commitment increases follow-through on behavior change.
- Commitment strategies enhance treatment retention and engagement.
- Public and written commitments are especially effective.

---

## Further Reading

---

- Linehan, M.M. (2015). *DBT Skills Training Handouts and Worksheets*.
- [DBT Self Help – Commitment Strategies](https://www.dbtselfhelp.com)
- Hayes, S.C. et al. (2011). *Acceptance and Commitment Therapy*.

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. Guilford Press.
- Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (1999). *Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change*.

Commitment Strategies

Mentally rehearse how you will handle difficult situations.

# Cope Ahead Skill

---

## Definition

---

**Cope Ahead** is an Emotion Regulation skill in Dialectical Behavior Therapy (DBT) that involves mentally rehearsing how you will cope with a future difficult situation. It’s a form of proactive problem-solving and visualization.

---

## Purpose

---

Used to:  

- Prepare for challenging events or emotions in advance.
- Increase confidence that you can handle distress.
- Reduce anxiety and avoidance.
- Develop a clear plan for effective coping.

---

## When to Use

---

Use Cope Ahead when:  

- You know you will face a stressful situation (e.g., a confrontation, public speaking, an anniversary of a trauma).
- You anticipate powerful emotions like anger, shame, sadness, or fear.
- You want to practice responding skillfully.

---

## When *Not* to Use

---

Avoid using if:  

- You’re currently in crisis (use crisis survival skills instead).
- You feel highly dissociative and visualization increases distress.
- You are prone to excessive rumination and the rehearsal fuels anxiety without solution.

---

## How-To

---

1. **Identify the Situation:**

   - Be specific about what will happen and why it might be difficult.

2. **Describe the Emotions:**

   - What emotions are likely to come up?

3. **Plan Skillful Coping:**

   - Choose which DBT skills you will use (e.g., Wise Mind, Opposite Action, Self-Soothing).

4. **Visualize the Scenario:**

   - Close your eyes and imagine yourself in the situation.
   - Picture handling it effectively from start to finish.

5. **Rehearse Coping:**

   - In your mind, walk through each step of using your skills.
   - Imagine managing thoughts, feelings, and behaviors successfully.

6. **Plan Aftercare:**

   - Decide what you will do to support yourself afterward.

7. **Repeat:**

   - Practice visualization regularly until you feel confident.

---

## Tips & Variations

---

- Write down your plan to make it more concrete.
- Pair with deep breathing to lower anticipatory anxiety.
- If visualization feels too intense, start with imagining just part of the situation.
- Combine with **PLEASE skills** (taking care of your body) for better emotional regulation.

---

## Example

---

*Maria was worried about a job interview.*

- **Situation:** Interview with potential employer.
- **Emotions:** Anxiety, self-doubt.
- **Skills:** Deep breathing, self-validation, Wise Mind.
- **Visualization:** Imagined greeting the interviewer, answering questions calmly, and thanking them.
- **Aftercare:** Planned a relaxing walk afterward.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, as part of the Emotion Regulation module in Dialectical Behavior Therapy.

---

## Related Skills

---

- Check the Facts
- Opposite Action
- Mindfulness
- Radical Acceptance

---

## Limitations

---

May not be effective if:  

- You don’t follow up with action.
- You only focus on worst-case scenarios.
- You avoid doing the actual practice.

---

## Evidence Base

---

Research shows:  

- Imagery rehearsal helps reduce anxiety and improve performance.
- Coping ahead increases perceived self-efficacy.
- Visualization can lower the intensity of emotional reactivity.

---

## Further Reading

---

- *DBT Skills Training Manual* by Marsha Linehan
- [Visualization Techniques in CBT and DBT](https://psychcentral.com/lib/visualization-and-guided-imagery)
- *The Relaxation and Stress Reduction Workbook* by Martha Davis

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Davis, M., Eshelman, E.R., & McKay, M. (2008). *The Relaxation and Stress Reduction Workbook*. New Harbinger Publications.
- Leahy, R.L. (2015). *Emotional Schema Therapy*. Guilford Press.

Cope Ahead

Create a clear plan for managing crises safely.

# Crisis Plan Development

---

## Definition

---

**Crisis Plan Development** is the process of creating a clear, step-by-step guide to follow during a mental health crisis to help ensure safety, stability, and effective use of coping strategies.

---

## Purpose

---

Used to:

- Prepare proactively for periods of severe distress.
- Reduce impulsive, harmful reactions.
- Ensure you have access to resources and support.
- Increase your sense of control during a crisis.

---

## When to Use

---

Develop and use a crisis plan when:

- You experience recurring suicidal thoughts or self-harm urges.
- You are at high risk of emotional dysregulation.
- You have a history of crisis episodes.
- You want to feel prepared and supported.

---

## When *Not* to Use

---

Avoid relying solely on a crisis plan if:

- You are in immediate danger (call emergency services instead).
- You are unwilling to consider any coping steps.
- You have not yet established basic safety.

---

## How-To

---

**1. Identify Early Warning Signs**

   - What signals that a crisis is developing?
   - Examples: insomnia, racing thoughts, urges to self-harm.

**2. List Helpful Coping Skills**

   - Include skills you have practiced successfully, such as:

     - Self-Soothing
     - TIPP
     - Wise Mind
     - Radical Acceptance

**3. Identify Safe People to Contact**

   - List names and phone numbers of supportive contacts.

**4. Create a Safe Environment**

   - Plan how to remove or limit access to harmful items.

**5. Specify Emergency Steps**

   - When will you call your therapist or 911?
   - Where will you go if you cannot stay safe at home?

**6. Document the Plan**

   - Write it down in a clear format.
   - Share it with trusted people.

**7. Review Regularly**

   - Update as your needs and resources change.

---

## Tips & Variations

---

- Keep a copy in your phone and another in your wallet.
- Practice using your plan during mild distress so it feels familiar.
- Include uplifting reminders (quotes, reasons for living).

---

## Example

---

*Scenario: Maria struggles with self-harm urges when overwhelmed.*

**Crisis Plan:**

1. Early Signs: Feeling trapped, numbness, intrusive thoughts.

2. Skills: TIPP, calling a friend, taking a walk, Self-Soothing box.

3. Contacts: Therapist (555-123-4567), Partner (555-987-6543).

4. Environment: Lock away medications.

5. Emergency: Call 911 if safety cannot be maintained.

---

## Inventor / Origin

---

Crisis planning is a staple of **dialectical behavior therapy**, designed by **Marsha Linehan** to reduce self-harm and hospitalization. It integrates concepts from safety planning and relapse prevention models.

---

## Related Skills

---

- Self-Soothing
- TIPP
- Radical Acceptance
- Willingness
- DEAR MAN (to ask for help)

---

## Limitations

---

May not be effective if:

- It is created in haste without genuine input.
- You don’t revisit or practice it.
- You avoid acknowledging your crisis patterns.

---

## Evidence Base

---

Research shows:

- Crisis plans reduce emergency service use.
- Clients with plans are more likely to use coping skills before self-harming.
- They increase feelings of safety and agency.

---

## Further Reading

---

- Linehan, M.M. (2015). *DBT Skills Training Handouts and Worksheets*.
- [National Suicide Prevention Lifeline](https://988lifeline.org)
- Stanley, B., & Brown, G.K. (2012). *Safety Planning Intervention*.

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. Guilford Press.
- Stanley, B., & Brown, G.K. (2012). *Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk*. Cognitive and Behavioral Practice.

Crisis Plan Development

Effectively assert your needs and set boundaries.

# DEAR MAN

---

## Definition

---

**DEAR MAN** is a core DBT Interpersonal Effectiveness skill that teaches you how to ask for what you want or say no to requests assertively while maintaining self-respect and healthy relationships.

---

## Purpose

---

Used to:

- Effectively express needs and boundaries.
- Improve the likelihood of getting your objectives met.
- Reduce anxiety about asserting yourself.
- Enhance relationships by being clear and direct.

---

## When to Use

---

Use this skill when:

- You need to ask for something important.
- You must say no but want to do so skillfully.
- You want to negotiate a compromise.
- You feel resentment building up due to unexpressed needs.

---

## When *Not* to Use

---

Avoid using if:

- You or the other person is in an extreme crisis (consider Distress Tolerance first).
- Timing is poor (e.g., high emotion, lack of privacy).
- Your goal is to vent rather than problem-solve.

---

## How-To

---

**DEAR MAN** is an acronym:

**D – Describe**

- Clearly describe the situation without judgment.
- Example: “Yesterday, you interrupted me three times during the meeting.”

**E – Express**

- Share how you feel or what you believe.
- Example: “I felt frustrated and dismissed.”

**A – Assert**

- State what you need or want.
- Example: “I’d like you to let me finish speaking.”

**R – Reinforce**

- Explain positive outcomes of cooperation.
- Example: “That way, we can work better as a team.”

**M – Mindful**

- Stay focused on your goal.
- Ignore distractions, attacks, or attempts to derail.
- Example: Broken record technique—repeat your request calmly.

**A – Appear Confident**

- Use a steady voice, eye contact, and open body language.

**N – Negotiate**

- Be willing to give to get.
- Offer alternatives or ask for suggestions.

---

## Tips & Variations

---

- Rehearse what you’ll say to feel prepared.
- Write down your DEAR MAN script beforehand.
- Use *GIVE* skills to maintain relationships.
- Pair with *FAST* skills to protect self-respect.
- If you feel shaky, practice with a trusted person first.

---

## Example

---

*Scenario: Asking for a project deadline extension.*

**D:** “The last two weeks, I’ve been managing multiple urgent client requests.”

**E:** “I feel overwhelmed and concerned about the quality of my work.”

**A:** “I’d like to request a two-day extension.”

**R:** “This will help me ensure the project meets our standards.”

**M:** Stay focused if your boss tries to change the topic.

**A:** Keep steady voice and posture.

**N:** “If two days isn’t possible, could I have until end of day tomorrow?”

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, as part of DBT Interpersonal Effectiveness skills training.

---

## Related Skills

---

- GIVE (to keep relationships)
- FAST (to maintain self-respect)
- Opposite Action (to approach conflict)

---

## Limitations

---

May not be effective if:

- The other person is unwilling to negotiate.
- You use it in a highly emotional or volatile situation.
- You are unclear about your objective.

---

## Evidence Base

---

Research shows:

- Assertiveness training improves relationship satisfaction.
- Structured communication increases chances of getting needs met.
- Practicing DEAR MAN reduces interpersonal anxiety.

---

## Further Reading

---

- *DBT Skills Training Manual* by Marsha Linehan
- [Assertiveness: APA resource](https://www.apa.org/topics/communication/assertiveness)
- *The Assertiveness Workbook* by Randy Paterson

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Paterson, R. (2000). *The Assertiveness Workbook*. New Harbinger Publications.
- Bower, S.A., & Bower, G.H. (2004). *Asserting Yourself: A Practical Guide for Positive Change*. Da Capo Press.

DEAR MAN

Put words to your observations to clarify and label your experience.

# Describe

---

## Definition

---

Describe is the second core mindfulness skill in Dialectical Behavior Therapy (DBT). It means **putting words to your experience without adding interpretations or judgments**. You name what you observe precisely and factually.

This skill builds on Observe by adding language, but still requires nonjudgmental awareness.

---

## Purpose

---

Used to:

- Clarify what you are experiencing.
- Separate facts from opinions.
- Reduce reactivity by accurately labeling thoughts and feelings.
- Enhance mindful awareness.

---

## When to Use

---

Use Describe when:

- You notice an emotion or thought and want to understand it.
- You are preparing to communicate your experience to someone else.
- You want to practice nonjudgmental awareness.
- You feel confused by internal experiences and need clarity.

---

## When *Not* to Use

---

Avoid using Describe if:

- You are in immediate danger and need to act rather than reflect.
- You feel overwhelmed and describing increases distress.
- You are tempted to start analyzing or criticizing instead of observing.

---

## How-To

---

1. **Observe first:** Notice the experience without labels.
2. **Apply words:** Use simple, factual statements.

   - Example: “I am noticing tightness in my chest.”
   - Not: “I am pathetic for feeling anxious.”

3. **Stick to facts:** Avoid evaluations and interpretations.
4. **Stay present:** Keep describing as the experience unfolds.
5. **Be concise:** Use clear, neutral language.

---

## Tips & Variations

---

- **Use “just the facts” language.**
- **Pair with Observe:** Observe first, then describe.
- **Practice describing with an external object** (e.g., describe a leaf) before applying it to thoughts.
- **Watch out for:** Slipping into judgments disguised as descriptions.

---

## Example

---

*Rina felt anger rising during a disagreement. She said silently to herself: “I notice my jaw is clenched. My heart is beating fast. I am thinking he doesn’t care about me. I feel anger.” This helped her respond calmly.*

---

## Inventor / Origin

---

Describe was integrated into DBT by **Marsha M. Linehan, PhD**, inspired by Zen mindfulness practices and behavioral strategies for labeling internal experiences.

---

## Related Skills

---

- **Observe:** Watching without words.
- **Participate:** Engaging fully in the moment.
- **Nonjudgmental Stance:** Avoiding evaluation of what is described.

---

## Limitations

---

May not be effective if:

- You tend to overanalyze or ruminate.
- You confuse describing with storytelling or judging.
- You expect it to remove emotions instantly.

---

## Evidence Base

---

Research shows that practicing Describe:

- Increases emotional clarity and regulation.
- Supports mindfulness and distress tolerance.
- Decreases impulsivity.
- Is associated with improvements in BPD symptoms and mood stability.

---

## Further Reading

---

- [Mindfulness in DBT (Behavioral Tech)](https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/)
- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [Guided Mindfulness Practice - Describe (YouTube)](https://www.youtube.com/watch?v=KSlA4M7PN2E)

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. New York: Guilford Press.
- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.

Describe

Do what works instead of what feels right or fair in the moment.

# Effectiveness

---

## Definition

---

Effectiveness in DBT refers to **acting skillfully to get what you want and need, while maintaining relationships and self-respect**. It means choosing behaviors that work toward your goals instead of getting caught up in emotion-driven reactions.

This is often taught using the DEAR MAN acronym for assertive communication.

---

## Purpose

---

Used to:

- Increase the chances of getting your needs met.
- Maintain healthy relationships.
- Preserve your self-respect.
- Reduce interpersonal conflicts.
- Communicate assertively rather than passively or aggressively.

---

## When to Use

---

Use Effectiveness skills when:

- You want to ask for something.
- You need to say “no.”
- You need to negotiate or problem-solve.
- You’re in conflict with someone.
- You feel the urge to explode or shut down.

---

## When *Not* to Use

---

Avoid using Effectiveness if:

- Safety is at risk and immediate action is needed.
- The other person is unable or unwilling to engage (e.g., intoxicated, violent).
- You are too dysregulated to communicate calmly (in which case, use distress tolerance first).

---

## How-To

---

1. **Define Your Goal:** What do you want from this interaction?
2. **Use DEAR MAN:**

   - **D – Describe** the situation factually.
   - **E – Express** your feelings and opinions.
   - **A – Assert** by asking clearly or saying no.
   - **R – Reinforce** by explaining benefits of your request.
   - **M – Mindful:** Stay focused, don’t be distracted.
   - **A – Appear Confident:** Use a steady voice and body language.
   - **N – Negotiate:** Be willing to give and take.

3. **Maintain Self-Respect:** Stick to your values.
4. **Balance Relationship Needs:** Be fair and considerate.

---

## Tips & Variations

---

- **Rehearse ahead of time** to build confidence.
- **Use a calm tone** even if you feel upset.
- **Be concise and clear.**
- **Watch out for:** passive-aggression, blaming, or threats.
- Pair with **FAST** skills to preserve self-respect.

---

## Example

---

*Jamal needed his roommate to clean up shared spaces. He practiced DEAR MAN:*

- **Describe:** “I’ve noticed dishes are left in the sink overnight.”
- **Express:** “I feel frustrated because I can’t use the kitchen in the morning.”
- **Assert:** “I’d like you to please clean up by the end of the day.”
- **Reinforce:** “That way, it’s more comfortable for both of us.”

He stayed calm and confident, repeating his request when his roommate tried to change the topic.

---

## Inventor / Origin

---

Effectiveness skills are part of **Interpersonal Effectiveness** in DBT, developed by **Marsha M. Linehan, PhD**, combining assertiveness training, cognitive-behavioral therapy, and principles from dialectics.

---

## Related Skills

---

- **DEAR MAN:** For assertiveness.
- **GIVE:** To maintain relationships.
- **FAST:** To maintain self-respect.
- **Mindfulness:** To stay present during interactions.

---

## Limitations

---

May not be effective if:

- The other person is abusive or dangerous.
- You cannot access your skills due to intense emotion.
- The situation requires immediate action over discussion.

---

## Evidence Base

---

Research shows that Effectiveness skills:

- Improve interpersonal functioning.
- Reduce conflict and resentment.
- Increase self-confidence.
- Are associated with better outcomes in BPD and mood disorders.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [DEAR MAN Skill (Therapistaid)](https://www.therapistaid.com/worksheets/dear-man.pdf)
- [Interpersonal Effectiveness Overview](https://dialecticalbehaviortherapy.com/interpersonal-effectiveness/)

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. New York: Guilford Press.
- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.

Effectiveness

Protect your self-respect during interactions.

# FAST Skill

---

## Definition

---

**FAST** is a DBT skill set focused on maintaining your **self-respect effectiveness** during interpersonal interactions. The acronym stands for:

- **F**air
- **A**pologies (limited)
- **S**tick to values
- **T**ruthful

It helps you stand up for yourself, communicate clearly, and keep your integrity even under pressure.

---

## Purpose

---

Used to:

- Maintain self-respect in difficult conversations.
- Avoid compromising your values to please others.
- Reduce guilt and resentment that arise from ignoring your needs.
- Communicate assertively without aggression or passivity.

---

## When to Use

---

Use FAST when:

- You are tempted to compromise your principles to avoid conflict.
- You are setting a boundary.
- You feel pressured to apologize unnecessarily.
- You need to remain true to yourself in a disagreement.
- You want to ensure you respect yourself after the interaction.

---

## When *Not* to Use

---

Avoid using if:

- The interaction requires compromise for safety or crisis resolution.
- You are emotionally dysregulated (use distress tolerance first).
- The context is purely about relationship repair (consider GIVE).

---

## How-To

---

**1. F – Be Fair**

   - Be fair to yourself and the other person.
   - Acknowledge your feelings and theirs.

**2. A – No Apologies (or limit them)**

   - Don’t over-apologize for existing, having needs, or disagreeing.
   - Apologize only when appropriate.

**3. S – Stick to Your Values**

   - Stay committed to your principles.
   - Do not sell out your beliefs to gain approval.

**4. T – Be Truthful**

   - Don’t exaggerate, lie, or make excuses.
   - Be honest about what you think and feel.

---

## Tips & Variations

---

- Practice using a calm, confident tone.
- Combine FAST with DEAR MAN if you need both assertiveness and self-respect.
- Role-play situations where you tend to give in.
- Use reminders (e.g., sticky notes with "FAST") before conversations.

---

## Example

---

*Scenario: Your friend wants you to lend them money you’re uncomfortable parting with.*

- **Fair:** “I know this is stressful for you, and I also have to take care of my own expenses.”
- **Apologies:** “I’m sorry, but I can’t” (one genuine apology, not repeated).
- **Stick to Values:** “It’s important to me to stay financially stable.”
- **Truthful:** “I don’t feel comfortable lending money right now.”

---

## Inventor / Origin

---

Created by **Marsha Linehan, PhD**, as part of Dialectical Behavior Therapy to help individuals preserve self-respect during interpersonal exchanges.

---

## Related Skills

---

- DEAR MAN (assertiveness)
- GIVE (relationship effectiveness)
- Radical Acceptance
- Mindfulness

---

## Limitations

---

May not be effective if:

- Safety is at risk.
- The situation requires urgent compromise.
- The other person is not receptive to assertive communication.

---

## Evidence Base

---

Research shows:

- FAST increases assertiveness and reduces resentment.
- Helps individuals with BPD maintain boundaries.
- Improves self-esteem by aligning actions with values.

---

## Further Reading

---

- *DBT Skills Training Manual* by Marsha Linehan
- [Assertiveness Skills – Therapist Aid](https://www.therapistaid.com/therapy-guide/assertive-communication)
- *Radical Acceptance* by Tara Brach

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Bohus, M., & Wolf-Arehult, M. (2019). *Interpersonal Skills for Emotion Regulation*. Hogrefe Publishing.
- Fruzzetti, A.E. (2006). *The High Conflict Couple*. New Harbinger Publications.

FAST

Maintain healthy relationships with kindness and validation.

# GIVE

---

## Definition

---

**GIVE** is a core DBT Interpersonal Effectiveness skill designed to help you maintain and strengthen relationships while communicating your needs. It emphasizes respect, validation, and a gentle approach.

---

## Purpose

---

Used to:

- Improve closeness and trust in relationships.
- Communicate effectively without damaging connection.
- Balance assertiveness with kindness.
- Maintain relationships during conflicts or disagreements.

---

## When to Use

---

Use this skill when:

- You want to ask for something but also protect the relationship.
- You are setting a boundary with someone important to you.
- You need to resolve conflict without escalating tension.
- You’re concerned about hurting someone’s feelings.

---

## When *Not* to Use

---

Avoid using if:

- You need to be extremely firm or direct (DEAR MAN may be better).
- The other person is abusive or threatening.
- You are in an emergency situation requiring clear boundaries.

---

## How-To

---

**GIVE** is an acronym:

**G – Gentle**

- Be courteous and temperate.
- No attacks, threats, or judging.
- Example: “I understand this is hard to hear.”

**I – Interested**

- Listen and appear interested.
- Maintain eye contact.
- Don’t interrupt or look distracted.

**V – Validate**

- Acknowledge the other person’s feelings, thoughts, or difficulties.
- Example: “I see that you’re frustrated.”

**E – Easy Manner**

- Use humor if appropriate.
- Smile, relax your body.
- Keep the tone light to lower defensiveness.

---

## Tips & Variations

---

- Practice in low-stakes situations first.
- Use a calm, steady voice.
- If emotions escalate, pause and return when calmer.
- Combine GIVE with DEAR MAN if you are both requesting and maintaining the relationship.
- Remember: Validation does not mean agreeing.

---

## Example

---

*Scenario: Telling a friend you can’t attend their event.*

**Gentle:** “I really appreciate the invite.”

**Interested:** “Can you tell me more about how it’s going to work?”

**Validate:** “I know you were counting on me being there.”

**Easy Manner:** Smile gently. “I wish I could, but I have other plans. Maybe we can catch up afterward.”

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, as part of DBT Interpersonal Effectiveness skills training.

---

## Related Skills

---

- DEAR MAN (assertive requests)
- FAST (self-respect effectiveness)
- Validation skills
- Active Listening

---

## Limitations

---

May not be effective if:

- The other person is unwilling to reciprocate respect.
- You are too upset to stay gentle or validating.
- You are in a toxic relationship where boundaries are repeatedly ignored.

---

## Evidence Base

---

Research shows:

- Validating and gentle communication reduces conflict.
- Skills like GIVE can increase satisfaction and trust.
- Using GIVE regularly helps maintain positive relationships over time.

---

## Further Reading

---

- *DBT Skills Training Manual* by Marsha Linehan
- [Effective Communication Tips – Mayo Clinic](https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/communication/art-20044735)
- *Nonviolent Communication* by Marshall Rosenberg

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Rosenberg, M.B. (2003). *Nonviolent Communication: A Language of Life*. PuddleDancer Press.
- Fruzzetti, A.E. (2006). *The High Conflict Couple: A DBT Guide to Finding Peace, Intimacy & Validation*. New Harbinger Publications.

GIVE

Relax your face to signal openness and acceptance.

# Half-Smiling Skill

---

## Definition

---

**Half-Smiling** is a mindfulness practice in which you gently raise the corners of your mouth into a subtle, peaceful smile.  
It’s a way of signaling openness, acceptance, and willingness to your body and mind, even in distressing situations.

---

## Purpose

---

Used to:

- Help reduce tension and resistance.
- Foster calm and acceptance in the face of discomfort.
- Soften anger, anxiety, and shame.
- Engage the parasympathetic nervous system (the “rest and digest” response).

---

## When to Use

---

Use Half-Smiling when:

- You feel tightness in your face or jaw during strong emotions.
- You want to practice acceptance of reality.
- You are stuck in judgment or resentment.
- You need a simple, discreet mindfulness exercise anywhere.

---

## When *Not* to Use

---

Avoid using if:

- You feel coerced or pressured to pretend you’re okay.
- Smiling feels invalidating to your pain (e.g., you need to cry or express).
- You have not first acknowledged and named your emotions.

---

## How-To

---

1. **Relax Your Face:**

   - Let your forehead, jaw, and shoulders soften.

2. **Take a Few Deep Breaths:**

   - Gently exhale tension.

3. **Half-Smile:**

   - Slightly lift the corners of your mouth.
   - Keep the rest of your face relaxed.

4. **Focus Attention:**

   - Mindfully notice sensations in your face and body.
   - Allow any emotions to be present without pushing them away.

5. **Hold the Half-Smile:**

   - Maintain for at least a few breaths.
   - You can keep it longer if you like.

---

## Tips & Variations

---

- Pair Half-Smiling with **Mindful Breathing**.
- Practice in front of a mirror to see the expression.
- Use Half-Smiling while lying down or sitting comfortably.
- Try combining with **Willing Hands** (palms open, facing upward).

---

## Example

---

*Sam was feeling anxious before a presentation.*

- Paused, unclenched jaw, and took a breath.
- Softened mouth into a half-smile.
- Felt calmer and more accepting of the anxiety.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD** as part of DBT’s mindfulness skills.  
Inspired by:

- Zen Buddhist teachings on mindful presence.
- Thich Nhat Hanh’s practices of gentle smiling to cultivate peace.

---

## Related Skills

---

- Willing Hands
- Mindful Breathing
- Radical Acceptance

---

## Limitations

---

May not be effective if:

- Used as avoidance to suppress valid emotions.
- You expect immediate relief or “happiness.”
- You feel forced to use it without readiness.

---

## Evidence Base

---

Research shows:

- Half-Smiling can activate parasympathetic response.
- Facial feedback can lower stress and improve mood.
- Mindfulness practices including Half-Smiling increase distress tolerance.

---

## Further Reading

---

- *The Miracle of Mindfulness* by Thich Nhat Hanh
- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [DBT Self Help - Half-Smiling](https://www.dbtselfhelp.com/html/half-smile.html)

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Ekman, P., & Friesen, W.V. (1978). *Facial Action Coding System*.
- Thich Nhat Hanh (1975). *The Miracle of Mindfulness*.

Half-Smiling

Use positive mental strategies to make distress more bearable.

# IMPROVE the Moment Skill

---

## Definition

---

**IMPROVE the Moment** is a Distress Tolerance skill in DBT that helps you cope with crisis situations by shifting your mindset or environment to temporarily make the present moment more bearable. Each letter stands for a specific strategy to “improve” your experience.

---

## Purpose

---

Used to:

- Survive intense emotional pain without making the situation worse.
- Prevent impulsive or self-destructive behaviors.
- Soothe yourself and foster a sense of hope and meaning.

---

## When to Use

---

Use IMPROVE when:

- You’re in an emotional crisis and can’t immediately change the situation.
- You feel urges to engage in problematic coping (e.g., self-harm, substance use).
- You need tools to get through the next few minutes or hours.

---

## When *Not* to Use

---

Avoid using this skill if:

- Immediate problem-solving or safety planning is required.
- You are avoiding urgent responsibilities indefinitely.
- You are using it to deny or minimize real problems.

---

## How-To

---

**I – Imagery**

- Visualize a peaceful, safe place or successful coping.

**M – Meaning**

- Find or create meaning in the crisis (e.g., personal growth, values).

**P – Prayer**

- Engage in prayer or spiritual connection (if relevant to you).

**R – Relaxation**

- Practice deep breathing, muscle relaxation, or stretching.

**O – One Thing in the Moment**

- Focus all attention on just one small task or sensation.

**V – Vacation**

- Take a short break from stress (e.g., step outside, unplug briefly).

**E – Encouragement**

- Use self-encouraging phrases (e.g., “I can handle this,” “This will pass”).

---

## Tips & Variations

---

- You don’t have to do every letter—pick what fits.
- Create a list of go-to strategies under each letter.
- Combine IMPROVE with Self-Soothing for extra support.

---

## Example

---

*Aaron felt panicked after a breakup.*

1. **Imagery:** Closed his eyes and pictured hiking in the mountains.
2. **Meaning:** Reminded himself this experience helps him grow stronger.
3. **Prayer:** Silently asked for strength from a higher power.
4. **Relaxation:** Focused on slow, steady breaths.
5. **One Thing:** Paid attention only to the feeling of his feet on the floor.
6. **Vacation:** Took a 30-minute walk alone.
7. **Encouragement:** Repeated, “I will get through this.”

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD** as part of DBT’s Distress Tolerance skills module, blending Eastern mindfulness practices with cognitive-behavioral strategies.

---

## Related Skills

---

- Self-Soothing
- Radical Acceptance
- TIPP Skill
- Pros and Cons

---

## Limitations

---

May not be effective if:

- You expect it to fix the underlying problem.
- You are in immediate danger and need urgent action.
- You use it exclusively as an avoidance strategy.

---

## Evidence Base

---

Research shows:

- Imagery and relaxation reduce physiological stress.
- Finding meaning and self-encouragement build resilience.
- Consistent use improves emotional regulation over time.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [IMPROVE the Moment Worksheet](https://www.therapistaid.com/worksheets/improve-the-moment.pdf)
- *The Dialectical Behavior Therapy Skills Workbook* by McKay, Wood, and Brantley

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Neacsiu, A.D., Rizvi, S.L., & Linehan, M.M. (2010). "Dialectical Behavior Therapy Skills Use as a Mediator and Outcome of Treatment for Borderline Personality Disorder." *Behaviour Research and Therapy*, 48(9), 832–839.

IMPROVE

Recognize and name your feelings accurately.

# Identifying Emotions Skill

---

## Definition

---

**Identifying Emotions** is the practice of mindfully observing, labeling, and understanding your emotions in the moment.  
It helps you build emotional awareness so you can respond skillfully instead of reacting impulsively.

---

## Purpose

---

Used to:

- Increase clarity about what you feel.
- Reduce confusion, numbness, or overwhelm.
- Improve communication about your emotions.
- Make effective decisions in line with your values.
- Decrease emotional vulnerability over time.

---

## When to Use

---

Use Identifying Emotions when:

- You feel upset but don’t know exactly why.
- You have intense or mixed feelings.
- You want to regulate or validate your emotions.
- You are preparing to communicate your feelings to someone else.

---

## When *Not* to Use

---

Avoid using if:

- You feel unsafe or too activated to reflect (first regulate with TIPP or self-soothing).
- You are trying to suppress or overanalyze emotions.
- You’re judging yourself harshly for having feelings.

---

## How-To

---

1. **Pause and Notice:**

   - Stop what you’re doing.
   - Take a breath.

2. **Check Physical Sensations:**

   - Notice your body (e.g., tight chest, racing heart).

3. **Observe Thoughts:**

   - What thoughts or urges are present?

4. **Identify Emotions:**

   - Name the feeling(s) as precisely as you can.
   - Use an emotion word list if needed.

5. **Check Intensity:**

   - Rate how strong the emotion feels (0–10).

6. **Validate:**

   - Remind yourself it’s okay to feel this way.

---

## Tips & Variations

---

- Keep an **emotion journal** to track feelings over time.
- Use apps like Moodnotes or Daylio for daily mood logging.
- Pair this skill with **Describe** and **Observe**.
- Practice when calm so it’s easier during crises.

---

## Example

---

*Alex felt tense and irritable after work.*

- Paused and breathed.
- Noticed clenched fists and headache.
- Identified emotions: frustration (6/10), sadness (3/10).
- Validated: “Of course I feel this way; it was a hard day.”

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD** as part of DBT’s Emotion Regulation module.  
Grounded in:

- Cognitive-behavioral therapy.
- Mindfulness practices.
- Emotion theory research by Paul Ekman and others.

---

## Related Skills

---

- Observe
- Describe
- Check the Facts
- Opposite Action

---

## Limitations

---

May not be effective if:

- You rush or force yourself to find a “perfect” label.
- You judge or shame yourself for emotions.
- You try to skip validation and move straight to problem-solving.

---

## Evidence Base

---

Research shows:

- Naming emotions reduces amygdala reactivity and calms the nervous system.
- Labeling feelings increases emotional clarity and distress tolerance.
- Awareness practices are linked to better emotion regulation.

---

## Further Reading

---

- *DBT Skills Training Manual* by Marsha Linehan
- *Emotions Revealed* by Paul Ekman
- [Greater Good: How to Identify Your Emotions](https://greatergood.berkeley.edu/article/item/how_to_identify_your_emotions)

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Ekman, P. (2003). *Emotions Revealed*. New York: Times Books.
- Kircanski, K., Lieberman, M.D., & Craske, M.G. (2012). Feelings into words: Contributions of language to exposure therapy. *Psychological Science*, 23(10), 1086–1091.

Identifying Emotions

Build a life aligned with your values and purpose.

# Increase Positive Emotions (Long Term)

---

## Definition

---

**Increase Positive Emotions (Long Term)** is a skill from the Emotion Regulation module of Dialectical Behavior Therapy (DBT) that focuses on building a life worth living by creating a sustained sense of fulfillment, satisfaction, and meaning over time.

---

## Purpose

---

Used to:

- Reduce vulnerability to negative emotions and depression.
- Develop habits that bring ongoing joy and satisfaction.
- Support long-term mental health and resilience.
- Foster a sense of purpose and accomplishment.

---

## When to Use

---

Use this skill when:

- You feel empty, numb, or directionless.
- You are ready to invest in long-term improvements.
- You want to create a more meaningful and satisfying life.
- You feel stuck in chronic dissatisfaction or boredom.

---

## When *Not* to Use

---

Avoid using if:

- You are in acute crisis or overwhelmed (use distress tolerance first).
- You lack basic safety or stability (e.g., housing, sobriety).
- You need immediate relief from intense distress.

---

## How-To

---

1. **Identify Values:**

   - Reflect on what matters most to you (e.g., family, learning, health).

2. **Set Long-Term Goals:**

   - Break down big dreams into clear, manageable objectives.

3. **Make a Plan:**

   - List steps to move toward your goals.

4. **Act Consistently:**

   - Schedule regular actions that align with your values.

5. **Track Progress:**

   - Notice small successes and adjust plans as needed.

6. **Reward Yourself:**

   - Reinforce positive steps with encouragement or treats.

---

## Tips & Variations

---

- Be specific—vague goals are hard to achieve.
- Celebrate progress, not perfection.
- Pair this skill with **Build Mastery** to develop competence.
- Use a journal or app to monitor goals.
- Expect setbacks—it’s normal. Problem-solve instead of quitting.

---

## Example

---

*Maria valued creativity and connection.*

- **Values:** Creativity, helping others.
- **Goal:** Volunteer to teach art.
- **Steps:**

  - Research local nonprofits.
  - Apply to volunteer.
  - Schedule first class.

- **Outcome:** Over several months, Maria felt more fulfilled and proud.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, as part of Dialectical Behavior Therapy’s Emotion Regulation skills.

---

## Related Skills

---

- Build Mastery
- Accumulating Positive Emotions (Short Term)
- Cope Ahead
- Mindfulness of Current Emotions

---

## Limitations

---

May not be effective if:

- You expect instant gratification.
- You’re not clear about your core values.
- You lack support or resources to work toward goals.

---

## Evidence Base

---

Research shows:

- Long-term goal pursuit builds well-being and reduces depression.
- Values-based action increases meaning and satisfaction.
- Regular engagement in meaningful activities strengthens resilience.

---

## Further Reading

---

- *DBT Skills Training Manual* by Marsha Linehan
- *The Happiness Trap* by Russ Harris
- [ACT Mindfully](https://www.actmindfully.com.au/)

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Harris, R. (2008). *The Happiness Trap*. Trumpeter Books.
- Seligman, M.E.P. (2011). *Flourish: A Visionary New Understanding of Happiness and Well-Being*. Free Press.

Increase Positive Emotions (Long Term)

Engage in activities that bring immediate joy or pleasure.

# Increase Positive Emotions (Short Term)

---

## Definition

---

**Increase Positive Emotions (Short Term)** is an Emotion Regulation skill in Dialectical Behavior Therapy (DBT) that involves intentionally engaging in activities that create positive feelings in the moment. It helps counterbalance negative emotions by adding pleasant experiences to daily life.

---

## Purpose

---

Used to:

- Boost your mood in the short term.
- Build resilience against distress.
- Break patterns of avoidance and withdrawal.
- Encourage mindful enjoyment of life.

---

## When to Use

---

Use this skill when:

- You feel stuck in sadness, anger, or emptiness.
- You’ve been neglecting pleasurable activities.
- You want to increase motivation and energy.
- You need a mood lift to prevent escalation into crisis.

---

## When *Not* to Use

---

Avoid using if:

- You’re in immediate crisis requiring distress tolerance.
- You feel too overwhelmed to participate in any activity.
- Engaging in pleasurable activities could reinforce harmful behaviors (e.g., overspending, substance use).

---

## How-To

---

1. **Identify Positive Activities:**

   - Make a list of things you usually enjoy or have enjoyed in the past.

2. **Schedule and Plan:**

   - Choose at least one activity to do each day, even if it’s brief.

3. **Act Mindfully:**

   - Focus your attention fully on the experience without multitasking.

4. **Participate Fully:**

   - Engage with openness and willingness.

5. **Savor the Experience:**

   - Notice what feels pleasant and allow yourself to appreciate it.

---

## Tips & Variations

---

- Start small—5 minutes of enjoyable activity is better than none.
- Try something new if old activities feel stale.
- Combine with **One-Mindfully** for maximum impact.
- Keep a journal to track positive experiences.
- Be patient; enjoyment can take time to return if you feel numb or depressed.

---

## Example

---

*Derek noticed he was feeling empty and disconnected.*

- **Chosen Activities:**

  - Listening to favorite music.
  - Drinking tea by the window.
  - Texting a friend.

- **Mindfulness:**

  - Focused fully on the taste of the tea and warmth in his hands.

- **Outcome:**

  - Felt calmer and more connected to the present.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, as part of the Emotion Regulation module of Dialectical Behavior Therapy.

---

## Related Skills

---

- Build Positive Experiences (Long Term)
- Mindfulness
- Self-Soothing
- Opposite Action

---

## Limitations

---

May not be effective if:

- You expect immediate, intense happiness.
- You engage in activities without mindfulness.
- You rely exclusively on short-term pleasure without working on long-term goals.

---

## Evidence Base

---

Research shows:

- Regular positive activities reduce depression and anxiety symptoms.
- Mindful savoring of pleasant experiences improves emotional well-being.
- Building positive emotions can increase resilience to stress.

---

## Further Reading

---

- *The How of Happiness* by Sonja Lyubomirsky
- [DBT Skills Training Manual](https://www.guilford.com/books/DBT-Skills-Training-Manual/Marsha-M-Linehan/9781462516995)
- [Positive Psychology Center](https://ppc.sas.upenn.edu/)

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Lyubomirsky, S. (2007). *The How of Happiness: A New Approach to Getting the Life You Want*. Penguin Press.
- Fredrickson, B.L. (2001). "The Role of Positive Emotions in Positive Psychology: The Broaden-and-Build Theory of Positive Emotions." *American Psychologist*, 56(3), 218–226.

Increase Positive Emotions (Short Term)

Balance objectives, relationships, and self-respect.

# Interpersonal Effectiveness

---

## Definition

---

**Interpersonal Effectiveness** is a set of DBT skills designed to help individuals communicate their needs and desires clearly, maintain healthy relationships, and keep their self-respect. These skills balance assertiveness with respect and aim to achieve goals in social interactions.

---

## Purpose

---

Used to:

- Ask for what you want or need effectively.
- Say no while preserving the relationship.
- Build and maintain positive relationships.
- Maintain self-respect in interactions.

---

## When to Use

---

Use these skills when:

- You need to make a request or assert a boundary.
- You feel conflicted between your needs and preserving a relationship.
- You’re concerned about how you are perceived.
- You are navigating conflict or negotiation.
- You want to be more skillful in interpersonal situations.

---

## When *Not* to Use

---

Avoid using if:

- The interaction is physically unsafe.
- The other person is unwilling to engage respectfully.
- You’re too emotionally dysregulated to be skillful (use distress tolerance skills first).

---

## How-To

---

Interpersonal Effectiveness is often taught through three skill sets:

1. **Objective Effectiveness (DEAR MAN)**

   - Getting what you want.

   - *Describe, Express, Assert, Reinforce, Mindful, Appear Confident, Negotiate.*

2. **Relationship Effectiveness (GIVE)**

   - Maintaining or improving the relationship.

   - *Gentle, Interested, Validate, Easy Manner.*

3. **Self-Respect Effectiveness (FAST)**

   - Maintaining your own values and self-respect.

   - *Fair, Apologies (no excessive), Stick to values, Truthful.*

---

## Tips & Variations

---

- Decide which goal is most important (objective, relationship, or self-respect) before interacting.
- Practice role-playing challenging situations.
- Use mindfulness to notice judgments or assumptions.
- Validate yourself even if the other person doesn’t validate you.

---

## Example

---

*Scenario: Asking a coworker to stop interrupting you in meetings.*

- **Objective Effectiveness:** “I’d appreciate it if you could let me finish my thoughts before jumping in.”

- **Relationship Effectiveness:** “I value your input and want to keep our teamwork positive.”

- **Self-Respect Effectiveness:** “It’s important to me to speak up respectfully.”

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, as part of Dialectical Behavior Therapy (DBT) to help clients navigate relationships and assert needs without harming connection or self-respect.

---

## Related Skills

---

- DEAR MAN (assertiveness)
- GIVE (relationship maintenance)
- FAST (self-respect)
- Validation
- Mindfulness of current interactions

---

## Limitations

---

May not be effective if:

- The person you are engaging with is abusive.
- Safety is at risk.
- You are emotionally flooded and unable to use skills calmly.

---

## Evidence Base

---

Research shows:

- Interpersonal Effectiveness skills improve communication, self-confidence, and relationship satisfaction.
- Practicing these skills reduces interpersonal conflict and increases assertiveness.
- Used widely in DBT for Borderline Personality Disorder, but effective for anyone seeking better communication.

---

## Further Reading

---

- *DBT Skills Training Manual* by Marsha Linehan
- [Assertiveness Training – Psychology Today](https://www.psychologytoday.com/us/basics/assertiveness)
- *Nonviolent Communication* by Marshall Rosenberg

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Bohus, M., & Wolf-Arehult, M. (2019). *Interpersonal Skills for Emotion Regulation*. Hogrefe Publishing.
- Fruzzetti, A.E. (2006). *The High Conflict Couple*. New Harbinger Publications.

Interpersonal Effectiveness

Cultivate compassion and goodwill toward yourself and others.

# Loving Kindness Meditation

---

## Definition

---

**Loving Kindness Meditation** (also called *Metta Meditation*) is a practice of directing warm, compassionate thoughts and well-wishes toward yourself and others. It helps cultivate empathy, connection, and positive emotions.

---

## Purpose

---

Used to:

- Increase feelings of goodwill, compassion, and acceptance.
- Reduce anger, resentment, and self-criticism.
- Strengthen emotional resilience.
- Promote a sense of interconnectedness.

---

## When to Use

---

Use Loving Kindness Meditation when:

- You feel judgmental or critical of yourself or others.
- You are struggling with loneliness or disconnection.
- You want to enhance positive emotions.
- You need to balance intense negative feelings with warmth.

---

## When *Not* to Use

---

Avoid using if:

- You are in crisis or experiencing overwhelming distress (start with grounding skills first).
- You have unresolved trauma making compassion-based practices triggering.
- You feel obligated rather than willing to engage.

---

## How-To

---

**1. Get Settled**

   - Sit or lie down comfortably.
   - Close your eyes or lower your gaze.

**2. Take a Few Deep Breaths**

   - Center your attention on your breath.
   - Allow your body to relax.

**3. Begin with Yourself**

   - Silently repeat phrases of goodwill:

     - “May I be safe.”
     - “May I be happy.”
     - “May I be healthy.”
     - “May I live with ease.”

**4. Extend to Someone You Care About**

   - Bring a loved one to mind.
   - Repeat the phrases for them:

     - “May you be safe…happy…healthy…at ease.”

**5. Extend to a Neutral Person**

   - Imagine someone you don’t know well.
   - Offer them the same wishes.

**6. Extend to Someone Difficult**

   - Visualize someone with whom you have tension.
   - Offer them the phrases sincerely, if possible.

**7. Extend to All Beings**

   - Imagine all people and creatures.
   - “May all beings be safe…happy…healthy…at ease.”

**8. Close the Practice**

   - Take a few breaths.
   - Gently open your eyes.

---

## Tips & Variations

---

- Use guided audio to start.
- If offering compassion to a difficult person feels too hard, skip that step.
- Use imagery (e.g., sending light or warmth) to reinforce intention.
- Keep sessions brief at first (5–10 minutes).

---

## Example

---

*Scenario: Marcus feels deep resentment toward a coworker.*

**Practice:**

1. Marcus sits comfortably and breathes deeply.
2. He begins by offering compassion to himself.
3. He visualizes his coworker and slowly repeats, “May you be happy, may you be at ease.”
4. Though uncomfortable, he notices softening over time.

---

## Inventor / Origin

---

**Loving Kindness Meditation** originates from:

- Ancient Buddhist traditions.
- Integrated into DBT by Marsha Linehan to enhance acceptance and positive affect.

---

## Related Skills

---

- Radical Acceptance
- Self-Soothing
- Mindfulness of Current Emotion
- Turning the Mind

---

## Limitations

---

May not be effective if:

- Practiced while emotionally dysregulated without grounding first.
- Attempted with unwillingness or resentment.
- Used to suppress valid emotions rather than process them.

---

## Evidence Base

---

Research shows:

- Increases positive emotions and empathy.
- Reduces symptoms of depression and anxiety.
- Strengthens social connection and self-compassion.

---

## Further Reading

---

- *Lovingkindness* by Sharon Salzberg
- [Greater Good Science Center: Loving Kindness](https://greatergood.berkeley.edu/topic/loving_kindness)
- [Mindful.org - Loving Kindness Meditation](https://www.mindful.org/a-loving-kindness-meditation-to-boost-compassion/)

---

## References

---

- Salzberg, S. (1995). *Lovingkindness: The Revolutionary Art of Happiness*. Shambhala.
- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Hofmann, S.G., Grossman, P., & Hinton, D.E. (2011). Loving-Kindness and Compassion Meditation: Potential for Psychological Interventions. *Clinical Psychology Review*, 31(7), 1126–1132.

Loving Kindness Meditation

# Mindful Eating

---

## Definition

---

**Mindful Eating** is the practice of bringing full awareness and non-judgmental attention to the experience of eating. It involves noticing the colors, smells, textures, tastes, and thoughts that arise while consuming food.

---

## Purpose

---

Used to:

- Develop a healthier relationship with food.
- Increase enjoyment and satisfaction from meals.
- Recognize hunger and fullness cues.
- Reduce impulsive or emotional eating.
- Break patterns of mindless consumption.

---

## When to Use

---

Use Mindful Eating when:

- You tend to eat quickly or without awareness.
- You struggle with emotional or binge eating.
- You want to savor meals more fully.
- You feel disconnected from hunger and fullness signals.

---

## When *Not* to Use

---

Avoid using if:

- You are in a crisis or high distress that needs other coping skills first.
- You have an active eating disorder that requires professional treatment guidance (consult your treatment team).
- You feel extreme guilt or shame around eating—seek compassionate support.

---

## How-To

---

**1. Prepare**

   - Take a few deep breaths before you start eating.
   - Remove distractions (put down your phone, turn off screens).

**2. Observe**

   - Look at your food: What colors and textures do you see?
   - Notice any smells and sensations that arise.

**3. Savor Each Bite**

   - Take a small bite and chew slowly.
   - Pay attention to the taste and mouthfeel.

**4. Notice Thoughts and Feelings**

   - Are you judging the food or yourself?
   - Are you eating out of hunger, boredom, or emotion?
   - Label thoughts gently: “Planning,” “Judging,” “Remembering.”

**5. Check In**

   - Pause occasionally to notice hunger and fullness levels.
   - Ask: “How satisfied am I right now?”

**6. End with Gratitude**

   - Reflect on where the food came from and your experience.

---

## Tips & Variations

---

- Try the “3 Raisin Exercise”: eat 3 raisins slowly, observing every sensation.
- Use a Mindful Eating journal to record observations.
- Practice eating in silence for part of your meal.
- If you get distracted, gently return your attention to eating.

---

## Example

---

*Scenario: Anna often eats lunch at her desk, finishing without tasting anything.*

**Mindful Eating Practice:**

1. She takes 3 deep breaths before eating.
2. She observes the colors of her salad.
3. She chews each bite slowly, noticing textures.
4. She pauses halfway to check fullness.
5. She reflects: “I feel satisfied and calm.”

---

## Inventor / Origin

---

While **Marsha Linehan’s DBT** emphasizes mindfulness broadly, mindful eating also draws from **Jon Kabat-Zinn’s Mindfulness-Based Stress Reduction (MBSR)** and principles of mindful awareness practices.

---

## Related Skills

---

- Observe
- One-Mindfully
- Non-Judgmental Stance
- Radical Acceptance

---

## Limitations

---

May not be effective if:

- Practiced mechanically without genuine curiosity.
- Used as a sole intervention for severe eating disorders (seek specialized treatment).
- Attempted during intense distress when other skills are needed first.

---

## Evidence Base

---

Research shows:

- Mindful eating can reduce binge eating episodes.
- It improves psychological well-being and body awareness.
- It helps regulate emotional eating behaviors.

---

## Further Reading

---

- *The Mindful Eating Workbook* by Vincci Tsui
- [Center for Mindful Eating](https://www.thecenterformindfuleating.org/)
- *Mindful Eating* by Jan Chozen Bays

---

## References

---

- Kabat-Zinn, J. (1990). *Full Catastrophe Living*. Delacorte.
- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Bays, J.C. (2009). *Mindful Eating: A Guide to Rediscovering a Healthy and Joyful Relationship with Food*. Shambhala.

Mindful Eating

Bring focused awareness to each step you take.

# Mindful Walking

---

## Definition

---

**Mindful Walking** is a mindfulness practice that involves walking slowly and deliberately while bringing full awareness to each step and the experience of moving through space. This skill helps anchor your mind in the present moment and cultivate calm.

---

## Purpose

---

Used to:

- Ground yourself when feeling anxious or disconnected.
- Reduce stress through movement and presence.
- Increase awareness of bodily sensations.
- Practice non-judgmental observation in motion.
- Integrate mindfulness into daily life.

---

## When to Use

---

Use Mindful Walking when:

- You feel restless, agitated, or stuck in your head.
- You want to practice mindfulness outside of seated meditation.
- You have difficulty sitting still for long periods.
- You’d like a gentle way to center yourself between activities.

---

## When *Not* to Use

---

Avoid using if:

- You are in a crowded or unsafe area where you can’t focus safely.
- You are experiencing overwhelming distress that requires other grounding strategies first.
- You need to walk quickly to meet an urgent obligation.

---

## How-To

---

**1. Choose Your Path**

   - Find a safe, quiet place (e.g., hallway, garden, park path).
   - Decide if you will walk in a straight line or a circle.

**2. Stand Still First**

   - Take a few deep breaths.
   - Notice your feet touching the ground.

**3. Begin Walking Slowly**

   - Walk at a pace slower than usual.
   - Focus on the sensation of each foot lifting and making contact.

**4. Anchor Attention**

   - Silently say: “Lifting… moving… placing” with each step.
   - If your mind wanders, gently bring it back to your feet.

**5. Expand Awareness**

   - Notice the air on your skin, sounds around you, and sights without judgment.

**6. Complete with Intention**

   - When done, stand still and take a few closing breaths.
   - Acknowledge your practice with kindness.

---

## Tips & Variations

---

- Try barefoot walking on grass or carpet to heighten sensory awareness.
- Sync your breath with your steps (inhale for 3 steps, exhale for 3).
- Practice for 5–10 minutes, or longer as comfortable.
- Use a soft gaze or close your eyes briefly (if safe) to deepen focus.

---

## Example

---

*Scenario: Sam feels overwhelmed after a stressful call.*

**Mindful Walking Practice:**

1. He steps into the hallway.
2. He stands still, breathing deeply.
3. He walks slowly, silently repeating “lifting… moving… placing.”
4. After 10 minutes, he feels more grounded and calm.

---

## Inventor / Origin

---

**Mindful Walking** is adapted from:

- Zen Buddhist walking meditation (Kinhin).
- Mindfulness-Based Stress Reduction (Jon Kabat-Zinn).
- Incorporated into DBT by Marsha Linehan to help clients integrate mindfulness into daily life.

---

## Related Skills

---

- Observe
- One-Mindfully
- Non-Judgmental Stance
- Mindful Eating
- Radical Acceptance

---

## Limitations

---

May not be effective if:

- Practiced in a distracting or unsafe environment.
- Used to avoid necessary problem-solving.
- Attempted when extremely dysregulated without other coping tools.

---

## Evidence Base

---

Research shows:

- Mindful walking reduces stress and improves mood.
- It increases body awareness and attention regulation.
- Regular practice contributes to better emotional resilience.

---

## Further Reading

---

- *Walking Meditation* by Thich Nhat Hanh
- [Mindful Walking Practice - Greater Good Science Center](https://greatergood.berkeley.edu/article/item/seven_steps_to_mindful_walking)
- *Wherever You Go, There You Are* by Jon Kabat-Zinn

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Kabat-Zinn, J. (1990). *Full Catastrophe Living*. Delacorte.
- Hanh, T.N. (2015). *How to Walk*. Parallax Press.

Mindful Walking

Observe and experience an emotion fully without judgment.

# Mindfulness of Current Emotion

---

## Definition

---

**Mindfulness of Current Emotion** is a DBT skill designed to help you notice, experience, and accept your emotions without judgment, suppression, or acting impulsively on them. The skill emphasizes staying present with your feelings rather than avoiding or escaping them.

---

## Purpose

---

Used to:

- Reduce emotional suffering by allowing emotions to pass naturally.
- Decrease reactivity and impulsive behaviors.
- Build tolerance for intense feelings.
- Increase understanding of your emotional experience.

---

## When to Use

---

Use Mindfulness of Current Emotion when:

- You feel overwhelmed by intense emotion.
- You notice a strong urge to avoid, suppress, or react impulsively.
- You want to understand an emotion more fully.
- You are practicing emotional acceptance.

---

## When *Not* to Use

---

Avoid using this skill exclusively if:

- You are in immediate crisis and safety is at risk (use distress tolerance first).
- You are dissociating or feeling detached from reality.
- You are using substances that significantly impair awareness.

---

## How-To

---

**1. Identify the Emotion**

   - Name the emotion you are feeling.

**2. Observe the Emotion**

   - Notice where it shows up in your body.
   - Be curious about the sensations, urges, and thoughts.

**3. Allow the Emotion**

   - Breathe into the feeling.
   - Let it be there without trying to push it away.

**4. Acknowledge You Can Survive It**

   - Remind yourself that emotions are temporary.
   - Say: “I can ride this out.”

**5. Don’t Judge**

   - Avoid labeling the emotion as good or bad.
   - Just notice it as a passing experience.

**6. Let Go When Ready**

   - When it naturally shifts or subsides, let it go gently.

---

## Tips & Variations

---

- Use mindful breathing to anchor yourself as you observe.
- Imagine the emotion as a wave that rises, crests, and falls.
- Use imagery: visualize sitting beside the emotion, watching it.
- Practice regularly with less intense emotions first.

---

## Example

---

*Scenario: Cam feels an overwhelming wave of sadness after an argument.*

**Steps Practiced:**

1. Identify: “This is sadness.”

2. Observe: Heavy chest, tearfulness.

3. Allow: Breathe deeply, soften resistance.

4. Acknowledge: “I can feel this without acting.”

5. Don’t Judge: Avoid thoughts like “I shouldn’t feel this way.”

6. Let Go: After 15 minutes, the intensity decreases.

---

## Inventor / Origin

---

Mindfulness of Current Emotion was developed by **Marsha Linehan** as part of DBT’s Emotion Regulation module. It draws on Eastern mindfulness practices and cognitive-behavioral principles.

---

## Related Skills

---

- Radical Acceptance
- Observing
- Describing
- Opposite Action
- Non-Judgmental Stance

---

## Limitations

---

May not be effective if:

- You have not practiced mindfulness regularly.
- You are in active crisis or at risk of harm.
- The emotion triggers dissociation or overwhelming distress.

---

## Evidence Base

---

Research shows:

- Practicing mindfulness reduces emotional avoidance.
- Mindfulness of emotion improves emotion regulation and decreases impulsivity.
- Mindfulness-based interventions are associated with reductions in depression and anxiety.

---

## Further Reading

---

- Linehan, M.M. (2015). *DBT Skills Training Manual*.
- Kabat-Zinn, J. (1990). *Full Catastrophe Living*.
- Mindfulness-Based Cognitive Therapy resources.

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. Guilford Press.
- Baer, R.A. (2003). Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review. *Clinical Psychology: Science and Practice*.

Mindfulness of Current Emotion

See experiences as they are without labeling them as good or bad.

# Non-Judgmental Stance

---

## Definition

---

Non-Judgmental Stance is the practice of **observing thoughts, feelings, and situations without labeling them as good or bad, right or wrong**. It is about seeing reality clearly and describing events factually rather than reacting with criticism or evaluation.

---

## Purpose

---

Used to:

- Reduce emotional suffering created by judgments.
- Improve mindfulness and acceptance.
- Decrease reactivity and shame.
- Promote clarity and effective action.

---

## When to Use

---

Use Non-Judgmental Stance when:

- You feel overwhelmed by self-criticism.
- You are caught up in blaming others.
- You are experiencing painful emotions.
- You want to observe thoughts and feelings objectively.

---

## When *Not* to Use

---

Avoid using Non-Judgmental Stance if:

- You are in immediate danger (judgments may signal a threat).
- A situation requires you to make quick safety decisions.
- You are using it to avoid accountability for harmful behavior.

---

## How-To

---

1. **Observe** what is happening internally and externally.
2. **Describe** the facts without adding evaluations.
   - Instead of “This is terrible,” say “This is happening.”
   - Instead of “I’m a failure,” say “I feel disappointed.”
3. **Notice judgments when they arise.**
4. **Let judgments go**—return to describing.
5. **Practice self-compassion** rather than criticism.

---

## Tips & Variations

---

- Use a neutral tone when describing.
- Practice by narrating an activity without adjectives.
- Remind yourself: “A judgment is just a thought, not a fact.”
- Pair with Radical Acceptance when judgments are strong.
- Keep a **Judgment Log** to track common judgmental thoughts.

---

## Example

---

*Sara thought, “I’m worthless because I made a mistake.” She paused and replaced the judgment with description:*

- “I notice tightness in my chest.”
- “I made a mistake at work.”
- “I feel regret.”

By doing this, her shame decreased, and she could problem-solve more effectively.

---

## Inventor / Origin

---

Non-Judgmental Stance is a core part of **Mindfulness in DBT**, developed by **Marsha M. Linehan, PhD**, based on principles of Zen practice and cognitive-behavioral therapy.

---

## Related Skills

---

- Observe
- Describe
- Radical Acceptance
- Self-Compassion
- One-Mindfully

---

## Limitations

---

May not be effective if:

- You are in acute crisis needing immediate action.
- You confuse acceptance with approval of harmful behavior.
- You use it to avoid setting healthy boundaries.

---

## Evidence Base

---

Research indicates that practicing Non-Judgmental Stance:

- Reduces emotional intensity.
- Increases distress tolerance.
- Improves psychological flexibility.
- Helps manage shame and self-criticism.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [Mindfulness Skills (Therapistaid)](https://www.therapistaid.com/therapy-worksheet/mindfulness-skills)
- *Radical Acceptance* by Tara Brach
- [Non-Judgmental Stance Overview](https://dialecticalbehaviortherapy.com/mindfulness/)

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. New York: Guilford Press.
- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.

Non-Judgmental Stance

Notice your thoughts, sensations, and feelings without trying to change them.

# Observe

---

## Definition

---

Observe is the first mindfulness skill in Dialectical Behavior Therapy (DBT). It means **noticing your experience without trying to change it**. You simply watch thoughts, sensations, and feelings as they arise, like watching clouds drift across the sky.

It is also called *bare attention* or *noticing mind*.

---

## Purpose

---

Used to:

- Build awareness of internal experiences.
- Reduce automatic or impulsive reactions.
- Create space between trigger and response.
- Strengthen the ability to stay present without judgment.

---

## When to Use

---

Use Observe when:

- You feel overwhelmed by emotions and want to ground yourself.
- You want to learn about patterns in thoughts or feelings.
- You need to de-escalate reactivity in stressful moments.
- Practicing any mindfulness or acceptance skill.

---

## When *Not* to Use

---

Avoid using Observe if:

- You are in immediate danger and need to act quickly.
- You feel highly dissociated or detached (you may need grounding first).
- You are using it to avoid necessary action (e.g., procrastination).

---

## How-To

---

1. **Anchor attention:** Choose what to observe (breath, body sensation, thought, external sound).
2. **Notice:** Watch carefully as each sensation, thought, or feeling arises.
3. **Let go of judgment:** Don’t label the experience as good or bad.
4. **Return attention:** If your mind wanders, gently bring it back.
5. **Stay present:** Keep observing, moment by moment.

---

## Tips & Variations

---

- **Imagery:** Imagine you are a scientist studying your own mind.
- **Labeling:** Use simple mental notes: “thinking,” “feeling,” “sensing.”
- **Five Senses:** Observe sounds, smells, tastes, sights, and touch to stay grounded.
- **Watch out for:** Getting caught in analysis rather than observation.

---

## Example

---

*Carlos was anxious before a job interview. He sat quietly and observed the tightness in his chest, the thoughts about failure, and the urge to leave. He didn’t judge or try to change anything, just noticed the flow of experience.*

---

## Inventor / Origin

---

Observe was adapted into DBT by **Marsha M. Linehan, PhD**. The skill draws heavily on Zen Buddhist mindfulness practices and behavioral psychology.

---

## Related Skills

---

- **Describe:** Labeling what you observe.
- **Participate:** Fully engaging in the moment.
- **Nonjudgmental Stance:** Accepting what is without evaluation.

---

## Limitations

---

May not be effective if:

- You are in a highly dissociative state and unable to focus.
- You use observation as a way to ruminate or obsess.
- You expect it to immediately remove discomfort.

---

## Evidence Base

---

Research has shown that learning Observe as part of DBT:

- Increases mindfulness and attention control.
- Decreases emotional reactivity.
- Supports distress tolerance and emotion regulation in BPD and mood disorders.
- Improves outcomes in DBT treatment programs.

---

## Further Reading

---

- [Mindfulness in DBT (Behavioral Tech)](https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/)
- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [Observe Skill Guided Practice (YouTube)](https://www.youtube.com/watch?v=sMG3QdFttJ4)

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. New York: Guilford Press.
- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.

Observe

Focus on one thing at a time with your full attention.

# One-Mindfully

---

## Definition

---

One-Mindfully is a core mindfulness skill in Dialectical Behavior Therapy (DBT). It means **focusing your attention on one thing at a time**, fully immersing yourself in the present moment without distraction.

It teaches you to be fully engaged in what you’re doing rather than dividing your awareness between multiple activities or thoughts.

---

## Purpose

---

Used to:

- Reduce overwhelm and stress.
- Improve concentration and effectiveness.
- Break patterns of multitasking or dissociation.
- Promote a sense of calm and clarity.
- Help with emotion regulation by anchoring in the present.

---

## When to Use

---

Use One-Mindfully when:

- You are distracted or scattered.
- You notice you’re doing several things at once without awareness.
- You want to savor an experience.
- You feel anxious and need to ground yourself.
- You are practicing any other DBT skill and need to focus.

---

## When *Not* to Use

---

Avoid using One-Mindfully if:

- You are in an emergency requiring divided attention.
- You are dissociating severely and need to reorient with grounding first.
- You feel unsafe and need to be aware of multiple factors.

---

## How-To

---

1. **Pick One Activity:** Choose something to focus on (e.g., washing dishes, eating, breathing).
2. **Direct Your Attention:** Bring your mind fully to the chosen activity.
3. **Let Go of Distractions:** If your mind wanders, gently return focus without judgment.
4. **Repeat as Needed:** Every time you drift away, come back to the present.

---

## Tips & Variations

---

- **Use your senses:** Notice sights, sounds, textures, smells, and tastes.
- **Pair with Describe:** Put words to what you’re experiencing to anchor your attention.
- **Practice during routine tasks:** Walking, showering, eating.
- **Watch out for:** Criticizing yourself when your mind drifts—wandering is normal.

---

## Example

---

*While drinking her morning coffee, Priya decided to practice One-Mindfully. She focused on the warmth of the mug, the aroma, and the taste of each sip. Each time she thought about her to-do list, she gently brought her attention back to the coffee.*

---

## Inventor / Origin

---

One-Mindfully is part of the DBT mindfulness module created by **Marsha M. Linehan, PhD**. It integrates Zen Buddhist principles of single-pointed concentration and cognitive-behavioral strategies for focus.

---

## Related Skills

---

- **Observe:** Notice what’s happening.
- **Describe:** Put experiences into words.
- **Nonjudgmental Stance:** Avoid labeling experiences as good or bad.
- **Participate:** Immerse yourself fully.

---

## Limitations

---

May not be effective if:

- You are in a highly stimulating or unsafe environment.
- You are emotionally dysregulated and need grounding before focusing.
- You feel compelled to avoid the present due to trauma triggers.

---

## Evidence Base

---

Research indicates practicing One-Mindfully:

- Increases attention and working memory.
- Reduces rumination and anxiety.
- Enhances emotion regulation and distress tolerance.
- Improves daily functioning and overall well-being.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [One-Mindfully Practice Exercises](https://dialecticalbehaviortherapy.com/mindfulness/one-mindfully/)
- [Mindfulness Skills in DBT (Behavioral Tech)](https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/)

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. New York: Guilford Press.
- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.

One-Mindfully

Act opposite to your emotion’s urge when the emotion is not justified.

# Opposite Action Skill

---

## Definition

---

**Opposite Action** is the practice of doing the exact opposite of what your emotion urges you to do when the emotion does not fit the facts or its intensity is unhelpful.  
It is a powerful emotion regulation strategy to change emotional experiences by changing behavior.

---

## Purpose

---

Used to:

- Reduce the intensity of unhelpful emotions.
- Help you act effectively rather than react impulsively.
- Break patterns of avoidance, withdrawal, or aggression.
- Build mastery and confidence in emotional situations.

---

## When to Use

---

Use Opposite Action when:

- The emotion doesn’t fit the facts.

  - Example: Feeling shame when you’ve done nothing wrong.

- The emotion fits the facts but acting on it will be harmful.

  - Example: Feeling fear about giving a presentation but needing to do it anyway.

- You want to reduce the intensity of an emotion.

---

## When *Not* to Use

---

Avoid using if:

- The emotion **does** fit the facts and acting on it is helpful.

  - Example: Fear in the presence of real danger.

- You’re in crisis and need distress tolerance first.

- You’re trying to invalidate your feelings instead of regulating them.

---

## How-To

---

1. **Identify the Emotion:**

   - Name and validate what you feel.

2. **Check the Facts:**

   - Does the emotion fit the situation?

3. **Determine the Action Urge:**

   - What does the emotion make you want to do?

4. **Choose the Opposite Action:**

   - Do the opposite behavior, fully and wholeheartedly.

5. **Repeat:**

   - Practice consistently until the emotion changes.

---

## Tips & Variations

---

- Use body posture and facial expressions to help shift the feeling.
- Combine with mindfulness: be aware of resistance and do it anyway.
- Start with small steps if opposite action feels overwhelming.

---

## Example

---

*Maria felt sadness after a breakup and wanted to isolate.*

- **Emotion:** Sadness
- **Urge:** Stay in bed, avoid people.
- **Opposite Action:** Get out of bed, call a friend, engage in activities.
- **Outcome:** Mood improved after connecting with others.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD** in Dialectical Behavior Therapy (DBT).  
Inspired by behavioral activation approaches in CBT.

---

## Related Skills

---

- Check the Facts
- Problem Solving
- Mindfulness of Current Emotion

---

## Limitations

---

May not be effective if:

- You only do it halfway (must be wholehearted).
- You haven’t first checked that the emotion doesn’t fit the facts.
- The action requires more support or skills to implement safely.

---

## Evidence Base

---

Research shows:

- Opposite Action can reduce depression symptoms via behavioral activation.
- It is effective in reducing avoidance and improving functioning.
- Consistent practice rewires habitual emotional responses.

---

## Further Reading

---

- *DBT Skills Training Manual* by Marsha Linehan
- [DBT Self Help - Opposite Action](https://www.dbtselfhelp.com/html/opposite_action.html)
- *Behavioral Activation for Depression* by Martell et al.

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Martell, C.R., Dimidjian, S., & Herman-Dunn, R. (2010). *Behavioral Activation for Depression*. Guilford Press.
- Beck, A.T. (1979). *Cognitive Therapy of Depression*. Guilford Press.

Opposite Action

Reduce emotional vulnerability by taking care of your body.

# PLEASE Skill

---

## Definition

---

**PLEASE** is an acronym in DBT for a set of skills focused on reducing emotional vulnerability by taking care of your body and physical health.  
It stands for:  

- **PL**: Treat Physical iLlness  
- **E**: Balanced Eating  
- **A**: Avoid mood-altering drugs  
- **S**: Balanced Sleep  
- **E**: Exercise regularly

---

## Purpose

---

Used to:  

- Build a stable foundation for emotional regulation.
- Reduce reactivity to stress.
- Prevent mood swings triggered by neglecting physical self-care.
- Increase resilience and well-being.

---

## When to Use

---

Use PLEASE skills:  

- Daily as part of routine self-care.
- When feeling emotionally sensitive or prone to dysregulation.
- If you notice patterns of neglecting your body’s needs.
- During recovery from illness or major life changes.

---

## When *Not* to Use

---

Avoid using as a replacement for:  

- Crisis survival skills when in acute distress (use distress tolerance first).
- Professional treatment if medical issues require specialized care.
- Addressing trauma without therapeutic support.

---

## How-To

---

1. **Treat Physical Illness (PL):**

   - Get medical care.
   - Follow treatment plans.
   - Take prescribed medications.

2. **Balanced Eating (E):**

   - Eat regular meals.
   - Avoid extreme dieting or bingeing.
   - Monitor caffeine and sugar intake.

3. **Avoid Mood-Altering Drugs (A):**

   - Abstain from non-prescribed substances.
   - Reduce alcohol if it impacts mood.

4. **Balanced Sleep (S):**

   - Get enough sleep (7–9 hours for most adults).
   - Keep a consistent schedule.
   - Address insomnia proactively.

5. **Exercise Regularly (E):**

   - Move your body in ways you enjoy.
   - Aim for moderate activity most days.

---

## Tips & Variations

---

- Track your PLEASE habits in a journal.
- Pair with Mindfulness skills to notice how your body feels.
- Create a small daily ritual to check in on each area.

---

## Example

---

*Sam felt irritable and exhausted.*

- **Check:** Sleep was only 3 hours/night, skipping meals.
- **Action:** Improved sleep hygiene, scheduled meals.
- **Outcome:** Less reactive and more focused within a week.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD** as part of the Emotion Regulation module in Dialectical Behavior Therapy (DBT).

---

## Related Skills

---

- ABC PLEASE
- Check the Facts
- Opposite Action
- Self-Soothing

---

## Limitations

---

May not be effective if:

- Underlying medical conditions are untreated.
- Practiced inconsistently.
- You lack support to change long-standing habits.

---

## Evidence Base

---

Research shows:  

- Sleep and nutrition have significant impacts on emotional regulation.
- Exercise reduces depression and anxiety.
- Substance use worsens mood dysregulation.

---

## Further Reading

---

- *DBT Skills Training Manual* by Marsha Linehan
- [Behavioral Sleep Medicine](https://www.sleepfoundation.org/)
- *Why We Sleep* by Matthew Walker

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Walker, M. (2017). *Why We Sleep*. Scribner.
- Substance Abuse and Mental Health Services Administration. (2020). *Treatment Improvement Protocol*.

PLEASE

Fully engage in the present activity with openness and awareness.

# Participate

---

## Definition

---

Participate is the third core mindfulness skill in Dialectical Behavior Therapy (DBT). It means **entering fully into the present activity with awareness and wholehearted engagement**, letting go of self-consciousness or overthinking.

This skill allows you to be immersed in what you are doing, rather than observing yourself from the outside.

---

## Purpose

---

Used to:

- Feel connected to the moment.
- Act with authenticity and spontaneity.
- Reduce avoidance and dissociation.
- Increase mastery and enjoyment of activities.

---

## When to Use

---

Use Participate when:

- You are practicing mindfulness and ready to move from observing to engaging.
- You want to strengthen your connection to valued activities.
- You are doing something important but feel disconnected or distracted.
- You need to build confidence in being fully present.

---

## When *Not* to Use

---

Avoid using Participate if:

- You are in a dangerous situation requiring careful observation.
- You feel emotionally dysregulated and need to step back first.
- You are likely to lose control in a triggering environment.

---

## How-To

---

1. **Observe and Describe:** Begin by noticing and labeling what is happening.
2. **Let go of self-consciousness:** Stop worrying about how you look or whether you’re doing it right.
3. **Throw yourself into the experience:** Engage with your whole self—mind, body, and emotion.
4. **Stay present:** If your mind drifts, gently return to the activity.
5. **Act intuitively:** Trust yourself rather than overanalyzing.

---

## Tips & Variations

---

- **Imagine stepping into the role fully, like an actor in a play.**
- **Combine with Observe and Describe to maintain awareness.**
- **Practice in low-stakes situations first.**
- **Watch out for:** Getting caught up in judgment or rumination while participating.

---

## Example

---

*During a group drumming circle, Tony noticed feeling anxious about looking awkward. He reminded himself to Participate. He let go of the thought “I’m doing it wrong,” felt the rhythm, and joined in fully. His anxiety decreased as he immersed himself in drumming.*

---

## Inventor / Origin

---

Participate was developed as a DBT mindfulness skill by **Marsha M. Linehan, PhD**, combining Zen practice (wholehearted engagement) and behavioral activation concepts.

---

## Related Skills

---

- **Observe:** Watch your experience.
- **Describe:** Put words to what you notice.
- **Nonjudgmental Stance:** Let go of evaluations.
- **One-Mindfully:** Focus on one thing at a time.

---

## Limitations

---

May not be effective if:

- You are in crisis and need to pause to assess safety.
- You struggle with impulsivity that increases when fully immersed.
- You have unprocessed trauma that makes being fully present overwhelming.

---

## Evidence Base

---

Research suggests that practicing Participate:

- Increases mindfulness and distress tolerance.
- Decreases dissociation and emotional avoidance.
- Improves engagement in valued activities.
- Contributes to emotion regulation and well-being.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [Participate Mindfulness Exercises](https://dialecticalbehaviortherapy.com/mindfulness/participate/)
- [Mindfulness in DBT (Behavioral Tech)](https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/)

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. New York: Guilford Press.
- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.

Participate

Identify and act on practical steps to address issues.

# Problem Solving

---

## Definition

---

**Problem Solving** is an Emotion Regulation skill in Dialectical Behavior Therapy (DBT) that provides a structured approach to identifying and addressing practical problems that trigger emotional distress.

---

## Purpose

---

Used to:

- Reduce distress by taking effective action.
- Increase a sense of control and competence.
- Break down overwhelming situations into manageable steps.
- Prevent avoidance and procrastination.

---

## When to Use

---

Use this skill when:

- You face a solvable problem or obstacle.
- Avoidance or inaction is increasing your suffering.
- You feel stuck and need a clear plan.
- You want to build confidence in handling challenges.

---

## When *Not* to Use

---

Avoid using if:

- The situation is unsolvable (e.g., grief, the past)—use Radical Acceptance instead.
- You are in immediate crisis—use Distress Tolerance first.
- You need emotional support more than action in the moment.

---

## How-To

---

1. **Describe the Problem:**

   - Be specific and objective about what’s happening.

2. **Check the Facts:**

   - Make sure you have accurate information and aren’t assuming.

3. **Identify Your Goal:**

   - Clarify what you want to accomplish.

4. **Brainstorm Solutions:**

   - List as many options as possible without judging.

5. **Evaluate Pros and Cons:**

   - Consider each solution’s feasibility and consequences.

6. **Choose a Solution:**

   - Pick the most effective or least harmful option.

7. **Make an Action Plan:**

   - Break the solution into small, specific steps.

8. **Act and Evaluate:**

   - Try the plan, then assess whether it worked.

---

## Tips & Variations

---

- If overwhelmed, ask a trusted person to help brainstorm.
- Write down your plan to clarify steps.
- Remember: No solution is perfect. Aim for *effective enough*.
- If stuck, use the DBT skill **Cope Ahead** to visualize success.
- Practice self-validation if you feel discouraged.

---

## Example

---

*Sam was behind on bills and felt paralyzed with shame.*

- **Describe:** Bills are overdue by 2 months.
- **Facts:** Utilities will be shut off if unpaid.
- **Goal:** Pay at least part of the balance.
- **Brainstorm:**

  - Ask for payment extension.
  - Use savings.
  - Borrow money.
  - Set up payment plan.

- **Pros and Cons:**

  - Extension: buys time.
  - Savings: no debt.
  - Borrow: fast, but creates obligation.

- **Choose:** Request an extension.

- **Action Plan:**

  1. Call utility company by noon tomorrow.
  2. Request payment arrangement.
  3. Schedule payment reminder.

- **Outcome:** Extension granted. Shame reduced.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, as part of the Emotion Regulation and Problem-Solving modules in DBT.

---

## Related Skills

---

- Check the Facts
- Pros and Cons
- Cope Ahead
- Radical Acceptance

---

## Limitations

---

May not be effective if:

- The problem is not under your control.
- You lack motivation or resources to follow through.
- You’re using it to avoid emotions rather than address them.

---

## Evidence Base

---

Research shows:

- Structured problem solving reduces depression and anxiety.
- Effective problem solving increases self-efficacy and well-being.
- Skills training in problem solving is a key component of DBT’s success.

---

## Further Reading

---

- *DBT Skills Training Manual* by Marsha Linehan
- *Problem-Solving Therapy* by Arthur Nezu & Christine Nezu
- [Mind Tools Problem Solving Resources](https://www.mindtools.com/)

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Nezu, A.M., Nezu, C.M., & D’Zurilla, T.J. (2012). *Problem-Solving Therapy*. Springer.
- D’Zurilla, T.J., & Goldfried, M.R. (1971). *Problem solving and behavior modification*. Journal of Abnormal Psychology, 78(1), 107–126.

Problem Solving

Weigh the benefits and costs of acting on an urge or tolerating distress.

# Pros and Cons Skill

---

## Definition

---

**Pros and Cons** is a Distress Tolerance skill used to carefully weigh the **advantages and disadvantages** of acting on an urge or choosing alternative behaviors. It helps you make thoughtful decisions when emotions are high.

---

## Purpose

---

Used to:

- Delay impulsive reactions.
- Clarify potential outcomes.
- Reinforce commitment to long-term goals.
- Increase motivation to use skills instead of problem behaviors.

---

## When to Use

---

Use Pros and Cons when:

- You feel an urge to engage in a harmful behavior (e.g., self-harm, substance use, lashing out).
- You are deciding whether to tolerate distress or give in to urges.
- You need clarity on the impact of choices.

---

## When *Not* to Use

---

Avoid using this skill if:

- You are in immediate danger and must act quickly.
- You are in a situation where delaying action would create harm.
- You are too dysregulated to think clearly (use STOP first).

---

## How-To

---

1. **Identify the Behavior.**  
   What are you considering doing? Example: Self-harm, using substances, quitting a job impulsively.

2. **List Pros and Cons of Acting on the Urge.**  
   - Short-term benefits and drawbacks.

3. **List Pros and Cons of NOT Acting on the Urge.**  
   - Long-term benefits and drawbacks.

4. **Review Your Lists.**  
   Read them slowly and carefully. Focus on long-term goals and values.

5. **Visualize Outcomes.**  
   Imagine the likely consequences of each option.

6. **Decide Mindfully.**  
   Choose the path that aligns with your Wise Mind.

---

## Tips & Variations

---

- Write lists down to make them concrete.
- Use a worksheet (DBT handouts often include templates).
- Keep your list somewhere visible to remind you during crises.
- Read your lists out loud to reinforce commitment.
- Revisit your lists regularly, even when calm, to strengthen motivation.

---

## Example

---

*Casey wants to binge eat after a stressful day.*

- **Pros of Binge Eating:**
  - Immediate comfort
  - Numbs feelings

- **Cons of Binge Eating:**
  - Guilt and shame later
  - Stomach pain
  - Undermines health goals

- **Pros of NOT Binge Eating:**
  - Feels empowered
  - Stays on track with self-care

- **Cons of NOT Binge Eating:**
  - Has to tolerate uncomfortable emotions

**Decision:** Tolerate distress and use self-soothing skills.

---

## Inventor / Origin

---

Pros and Cons is a core **Distress Tolerance skill in DBT**, developed by **Marsha Linehan, PhD**. It is adapted from cognitive-behavioral techniques that emphasize decisional balance.

---

## Related Skills

---

- STOP Skill
- Crisis Survival Strategies
- Radical Acceptance
- TIPP Skills

---

## Limitations

---

May not be effective if:

- You avoid reviewing the cons of harmful behavior.
- You rush through the lists without reflection.
- You are too dysregulated to think logically.

---

## Evidence Base

---

Research shows:

- Pros and Cons increases motivation to use skills over maladaptive coping.
- Strengthens commitment to behavioral change.
- Reduces impulsivity.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [DBT Self-Help: Pros and Cons](https://www.dbtselfhelp.com/html/pros_and_cons.html)
- *The Dialectical Behavior Therapy Skills Workbook* by McKay, Wood, and Brantley
- [Decisional Balance in CBT](https://www.psychologytools.com/resource/decisional-balance/)

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. New York: Guilford Press.
- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.

Pros and Cons

Fully accept reality as it is instead of fighting against it.

# Radical Acceptance Skill

---

## Definition

---

**Radical Acceptance** is a core DBT Distress Tolerance skill that involves fully and completely accepting reality as it is, without judgment, resistance, or avoidance—even if you dislike it or it feels unfair.

---

## Purpose

---

Used to:

- Reduce suffering caused by fighting reality.
- Free up mental and emotional energy to respond effectively.
- Help end cycles of bitterness, resentment, or denial.
- Promote peace and psychological flexibility.

---

## When to Use

---

Use Radical Acceptance when:

- You are stuck in rumination about why something “shouldn’t be happening.”
- You feel paralyzed by anger, bitterness, or denial.
- You cannot change the past or aspects of the present.
- You notice that fighting reality is making pain worse.

---

## When *Not* to Use

---

Avoid using Radical Acceptance if:

- You have the ability and responsibility to change the situation (e.g., unsafe conditions, abuse).
- You are using “acceptance” as an excuse for inaction or enabling harm.
- You are in acute danger requiring immediate intervention.

---

## How-To

---

1. **Notice you are resisting reality.**

   - What thoughts are you having? (“It shouldn’t be this way.”)

2. **Name what you are fighting.**

   - Be specific: “I am rejecting that this relationship ended.”

3. **Remind yourself that reality is as it is, whether you approve or not.**

4. **Use your body:**

   - Breathe deeply.
   - Relax your face and shoulders.
   - Unclench your jaw.

5. **Use self-talk:**

   - “This is happening right now.”
   - “I don’t have to like it to accept it.”

6. **Practice acceptance over and over.**

   - Radical Acceptance is a process, not a one-time event.

---

## Tips & Variations

---

- Pair Radical Acceptance with self-compassion.
- Use visualization (imagine yourself opening your hands to reality).
- Distinguish acceptance from approval: accepting doesn’t mean you condone.
- Practice with small annoyances to build skill.

---

## Example

---

*Jorge lost his job unexpectedly.*

1. **Resisting:** “This is unfair. It shouldn’t have happened.”

2. **Radical Acceptance:** “It did happen. I lost my job. This is reality.”

3. **Action:** After accepting, he started making plans to look for new work.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, Radical Acceptance integrates concepts from:

- Zen mindfulness practices
- Behavioral psychology
- Stoicism

---

## Related Skills

---

- Willingness
- Turning the Mind
- Mindfulness
- Self-Compassion

---

## Limitations

---

May not be effective if:

- Used to avoid appropriate problem-solving.
- You expect it to immediately remove all pain.
- You are in denial about the consequences of acceptance.

---

## Evidence Base

---

Research shows:

- Acceptance-based strategies reduce emotional suffering.
- Practicing Radical Acceptance improves coping and reduces avoidance.
- Mindfulness and acceptance together increase psychological resilience.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [Radical Acceptance Article](https://www.psychologytoday.com/us/blog/pieces-mind/201206/radical-acceptance)
- *Radical Acceptance* by Tara Brach

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (2011). *Acceptance and Commitment Therapy: The Process and Practice of Mindful Change*.

Radical Acceptance

Pause and ground yourself before reacting to strong emotions.

# STOP Skill

---

## Definition

---

STOP is a Distress Tolerance skill used to **pause before reacting impulsively**, especially when you are emotionally triggered. The acronym stands for:

- **S**: Stop
- **T**: Take a step back
- **O**: Observe
- **P**: Proceed mindfully

---

## Purpose

---

Used to:

- Prevent impulsive actions that worsen a situation.
- Ground yourself in the present moment.
- Respond effectively rather than reacting emotionally.
- Maintain self-respect and align actions with your goals.

---

## When to Use

---

Use the STOP skill when:

- You feel strong urges to act impulsively.
- You are about to say or do something you might regret.
- You are overwhelmed by intense emotions.
- You need to buy time to think clearly.

---

## When *Not* to Use

---

Avoid using STOP if:

- You are in immediate physical danger that requires rapid action.
- Pausing could lead to greater harm.
- You are avoiding necessary assertive action.

---

## How-To

---

1. **S — Stop.**  
   Freeze. Do not move a muscle. Don’t react. Just stop.

2. **T — Take a step back.**  
   Take a deep breath. Remove yourself mentally or physically from the situation if needed.

3. **O — Observe.**  
   Notice what’s happening inside and around you.

   - What thoughts are showing up?
   - What urges do you feel?
   - What sensations are in your body?

4. **P — Proceed mindfully.**  
   Decide how you want to act. Consider your Wise Mind, your goals, and what will be effective.

---

## Tips & Variations

---

- Practice STOP in less intense situations to build the skill.
- Pair STOP with paced breathing or grounding exercises.
- Use a visual reminder (e.g., a STOP sign image on your phone).
- If you can’t remember all steps, simply pausing and breathing can help.

---

## Example

---

*Alex received a text that made them angry and wanted to immediately reply with insults. Instead, they:*

- **S:** Stopped and didn’t type.
- **T:** Took a deep breath and set their phone down.
- **O:** Observed their racing heart and clenched jaw.
- **P:** Chose to wait 10 minutes before deciding how to respond.

---

## Inventor / Origin

---

STOP is part of the **Distress Tolerance skills module in DBT**, created by **Marsha M. Linehan, PhD**. It integrates principles from mindfulness and crisis survival strategies.

---

## Related Skills

---

- Wise Mind
- TIPP Skills
- Pros and Cons
- Mindfulness of Current Emotion

---

## Limitations

---

May not be effective if:

- You repeatedly use STOP to avoid addressing problems.
- You are in a situation requiring immediate safety action.
- You don’t practice the skill in lower-stakes moments first.

---

## Evidence Base

---

Research shows the STOP skill:

- Reduces impulsive behavior.
- Supports emotional regulation.
- Improves crisis management.
- Increases sense of control during distress.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [DBT Self-Help: STOP Skill](https://www.dbtselfhelp.com/html/stop.html)
- *The Dialectical Behavior Therapy Skills Workbook* by McKay, Wood, and Brantley
- [Mindfulness in DBT](https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/)

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. New York: Guilford Press.
- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.

STOP

Pause and respond thoughtfully to distress.

# STOPP Skill

---

## Definition

---

**STOPP** is a skill for interrupting impulsive reactions, pausing, and grounding yourself before responding. It stands for:

- **S** – Stop
- **T** – Take a breath
- **O** – Observe
- **P** – Pull back/Perspective
- **P** – Practice what works

---

## Purpose

---

Used to:

- Reduce reactivity and impulsivity.
- Create space between trigger and response.
- Engage wise mind and effective action.
- Lower emotional intensity.

---

## When to Use

---

Use the STOPP skill when:

- You feel an urge to act on strong emotions.
- You notice rising anxiety, anger, or distress.
- You are about to say or do something you may regret.
- You need to step back to gain clarity.

---

## When *Not* to Use

---

Avoid using if:

- You are in imminent danger and need to act quickly for safety.
- You are too dissociated to focus (ground yourself first).
- You are using it to avoid processing necessary emotions over the long term.

---

## How-To

---

**1. S – Stop**

   - Freeze. Do nothing. Pause.

**2. T – Take a Breath**

   - Slowly inhale and exhale. Focus fully on the breath.

**3. O – Observe**

   - Notice what is happening: thoughts, feelings, body sensations, urges.

**4. P – Pull Back / Perspective**

   - Detach a little. Ask yourself:

     - What’s the bigger picture?
     - What would I tell a friend in this situation?
     - Is this thought a fact or opinion?

**5. P – Practice What Works**

   - Choose your next step skillfully:

     - What will be most effective?
     - What aligns with my values and goals?
     - What’s the wise mind response?

---

## Tips & Variations

---

- Write the acronym STOPP on a card to keep with you.
- Practice it with small stressors before using it in crises.
- Combine with grounding techniques or self-soothing.
- Visualize a stop sign when you begin.

---

## Example

---

*Scenario: Nina receives an angry text from her partner.*

**Practice:**

1. **S:** Nina stops and sets her phone down.
2. **T:** She takes three slow breaths.
3. **O:** She notices her racing heart and urge to fire back.
4. **P:** She remembers her values of respectful communication.
5. **P:** She waits 10 minutes and replies calmly.

---

## Inventor / Origin

---

Originally developed in cognitive-behavioral therapy frameworks.  
Marsha Linehan adapted similar pausing strategies into DBT distress tolerance and mindfulness skills.  
The expanded STOPP acronym was popularized by Dr. Carol Vivyan and CBT resources in the UK.

---

## Related Skills

---

- Wise Mind
- Check the Facts
- Radical Acceptance
- TIP/TIPP Skills

---

## Limitations

---

May not be effective if:

- You don’t practice it when calm (harder to use under stress).
- You expect it to “erase” feelings instantly.
- You skip steps or rush.

---

## Evidence Base

---

Research shows:

- Pausing and mindful breathing help reduce impulsive behavior.
- Improves emotion regulation and problem-solving.
- Regular practice builds stronger prefrontal regulation over time.

---

## Further Reading

---

- [DBT Self Help - STOP Skill](https://www.dbtselfhelp.com/html/stop.html)
- Vivyan, C. (2009). *How to Tame Your Anger: A CBT Handbook*.
- [Get Self Help UK - STOPP](https://www.getselfhelp.co.uk/stopp/)

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Vivyan, C. (2009). *CBT Worksheets and Resources*.
- Baer, R.A. (2003). Mindfulness Training as a Clinical Intervention: A Conceptual and Empirical Review. *Clinical Psychology: Science and Practice*, 10(2), 125–143.

STOPP Skill

Prepare steps to protect yourself during dangerous situations.

# Safety Planning

---

## Definition

---

**Safety Planning** is the creation of a structured, prioritized list of actions, coping strategies, and support contacts to use when experiencing suicidal thoughts, urges to self-harm, or other high-risk crises. It is a proactive method to enhance safety and stabilize emotions before harm occurs.

---

## Purpose

---

Used to:

- Prevent suicide and self-harm.
- Increase a sense of preparedness and control.
- Clarify clear, actionable steps during crisis.
- Reinforce commitment to staying safe.

---

## When to Use

---

Use Safety Planning when:

- You have a history of suicidal ideation or self-harm.
- You experience frequent intense emotional distress.
- You are transitioning out of inpatient care or emergency services.
- You want a structured backup plan to support yourself.

---

## When *Not* to Use

---

Avoid relying exclusively on safety planning if:

- You are in immediate danger and require emergency intervention.
- You have not yet identified any skills or supports you are willing to use.
- You have limited motivation to participate in planning.

---

## How-To

---

**1. Recognize Warning Signs**

   - List personal signals that crisis is approaching (e.g., hopelessness, isolation).

**2. Use Internal Coping Strategies**

   - Identify skills you can do alone:

     - Mindfulness
     - TIPP
     - Self-Soothing

**3. Contact People for Distraction**

   - List social supports you can call or spend time with.

**4. Contact Supportive Professionals**

   - Include therapist, psychiatrist, crisis hotline.

**5. Restrict Access to Lethal Means**

   - Remove or secure weapons, pills, sharp objects.

**6. Emergency Contacts and Steps**

   - When to call 911, go to ER, or contact crisis line.

**7. Document and Share**

   - Keep it visible and accessible.
   - Share with trusted people and professionals.

---

## Tips & Variations

---

- Use a wallet card or app (e.g., *My3*) for easy access.
- Review and update every few months.
- Practice using parts of the plan during mild distress.

---

## Example

---

*Scenario: Sam has chronic suicidal ideation.*

**Safety Plan:**

1. Warning Signs: Withdrawing from friends, giving away belongings.

2. Coping Skills: Deep breathing, DBT Opposite Action, music.

3. Distraction Contacts: Sister (555-111-2222).

4. Professionals: Therapist (555-333-4444).

5. Means Restriction: Partner holds medications.

6. Emergency: Call 911 if unable to maintain safety.

---

## Inventor / Origin

---

Safety Planning was popularized by **Barbara Stanley, PhD**, and **Gregory Brown, PhD** as part of suicide prevention protocols. It has been incorporated into DBT by **Marsha Linehan** as a key strategy in crisis management.

---

## Related Skills

---

- Crisis Plan Development
- Radical Acceptance
- Willingness
- Opposite Action
- Wise Mind

---

## Limitations

---

May not be effective if:

- The plan is superficial or not individualized.
- It is never reviewed or practiced.
- There is no commitment to use it in crisis.

---

## Evidence Base

---

Research shows:

- Safety Planning reduces suicidal behavior and hospital visits.
- Increases coping skill use.
- Enhances confidence in crisis management.

---

## Further Reading

---

- Stanley, B., & Brown, G.K. (2012). *Safety Planning Intervention: A Brief Intervention to Mitigate Suicide Risk*.
- [Suicide Prevention Resource Center](https://www.sprc.org)
- Linehan, M.M. (2015). *DBT Skills Training Handouts and Worksheets*.

---

## References

---

- Stanley, B., & Brown, G.K. (2012). *Safety Planning Intervention*. Cognitive and Behavioral Practice.
- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. Guilford Press.

Safety Planning

Calm yourself by engaging your five senses in comforting activities.

# Self-Soothing Skill

---

## Definition

---

**Self-Soothing** is a Distress Tolerance skill in DBT that involves comforting yourself through the deliberate use of your five senses: sight, sound, smell, taste, and touch. It is designed to reduce distress by engaging pleasant sensory experiences that promote calm and grounding.

---

## Purpose

---

Used to:

- Decrease emotional pain without acting impulsively.
- Nurture and care for yourself in healthy ways.
- Cultivate feelings of safety and comfort during difficult moments.

---

## When to Use

---

Use Self-Soothing when:

- You feel intense sadness, fear, or anger.
- You are experiencing urges to self-harm or use substances.
- You want to gently regulate emotion without problem-solving right away.

---

## When *Not* to Use

---

Avoid using this skill if:

- You are in immediate danger and need to take action.
- You are trying to suppress emotions long-term instead of processing them.
- Self-soothing activities could become compulsive or avoidant.

---

## How-To

---

1. **Sight:** Look at calming or beautiful things (e.g., nature, art, candles).
2. **Hearing:** Listen to soothing music, sounds of nature, or calming voices.
3. **Smell:** Use pleasant scents (e.g., essential oils, fresh flowers, your favorite lotion).
4. **Taste:** Mindfully savor comforting food or drink (e.g., herbal tea, chocolate).
5. **Touch:** Wrap yourself in a soft blanket, take a warm bath, hold something comforting.

---

## Tips & Variations

---

- Create a *Self-Soothing Kit* with items for each sense.
- Rotate activities so they stay effective.
- Combine multiple senses at once for greater impact.
- Practice when you’re calm so it’s easier to use when distressed.

---

## Example

---

*Lena feels lonely and overwhelmed after work.*

1. Lights a scented candle (smell).
2. Wraps up in a cozy blanket (touch).
3. Listens to gentle piano music (hearing).
4. Sips chamomile tea slowly (taste).
5. Looks at photos of a peaceful beach (sight).

---

## Inventor / Origin

---

Self-Soothing was integrated into DBT by **Marsha Linehan, PhD**, as part of the Distress Tolerance skills module, drawing on practices from mindfulness, behavioral therapy, and sensory-based interventions.

---

## Related Skills

---

- IMPROVE the Moment
- Pros and Cons
- TIPP Skill
- Radical Acceptance

---

## Limitations

---

May not be effective if:

- You expect it to solve the root of the problem.
- You engage in self-soothing only as avoidance.
- You are unable to access comforting sensory tools in the moment.

---

## Evidence Base

---

Research shows:

- Self-Soothing lowers physiological arousal and distress.
- Regular practice improves resilience to emotional crises.
- Mindful sensory engagement can increase emotional regulation capacity.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [Self-Soothing Techniques](https://www.therapistaid.com/worksheets/self-soothing.pdf)
- *The Dialectical Behavior Therapy Skills Workbook* by McKay, Wood, and Brantley
- [DBT Self-Help: Self-Soothing](https://www.dbtselfhelp.com/html/self-soothe.html)

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Neacsiu, A.D., Rizvi, S.L., & Linehan, M.M. (2010). "Dialectical Behavior Therapy Skills Use as a Mediator and Outcome of Treatment for Borderline Personality Disorder." *Behaviour Research and Therapy*, 48(9), 832–839.

Self-Soothing

Acknowledge your own feelings and experiences as real and important.

# Self-Validation

---

## Definition

---

**Self-Validation** is the skill of recognizing, acknowledging, and accepting your own thoughts, emotions, sensations, and behaviors without judgment. It involves treating your internal experiences as real, understandable, and legitimate.

---

## Purpose

---

Used to:

- Build self-respect and self-compassion.
- Reduce shame and self-criticism.
- Increase emotional regulation by accepting what is.
- Decrease dependence on external validation.

---

## When to Use

---

Use Self-Validation when:

- You notice harsh self-judgment or shame.
- You feel emotionally overwhelmed and want to soothe yourself.
- You are invalidating your own experiences (e.g., “I shouldn’t feel this way”).
- You want to build confidence and trust in yourself.

---

## When *Not* to Use

---

Avoid relying solely on Self-Validation if:

- You are using validation to justify harmful behaviors.
- You are avoiding taking responsibility for actions that affect others.
- You need to take immediate problem-solving steps instead.

---

## How-To

---

**1. Observe and Describe**

   - Notice and label what you feel without judgment.

   - *“I feel angry and hurt right now.”*

**2. Acknowledge the Valid**

   - Recognize why it makes sense you feel this way.

   - *“Anyone in my situation might feel this.”*

**3. Normalize the Experience**

   - Remember that emotions are human and universal.

   - *“It’s okay to feel sad when I lose something important.”*

**4. Be Kind to Yourself**

   - Use self-compassionate statements.

   - *“This is hard, and I’m doing the best I can.”*

**5. Practice Non-Judgment**

   - Avoid labeling feelings as bad or wrong.

---

## Tips & Variations

---

- Use a mirror or journal to practice validating statements aloud.
- Pair Self-Validation with Wise Mind for clarity.
- Create affirmations or mantras to remind yourself of your worth.

---

## Example

---

*Scenario: Eli feels guilty for needing time alone.*

**Self-Validation Practice:**

1. Observe: “I feel guilty and selfish.”

2. Acknowledge: “I’ve always been told I should put others first.”

3. Normalize: “Needing alone time is a basic human need.”

4. Kindness: “It’s okay to take care of myself.”

---

## Inventor / Origin

---

Self-Validation is a key component of DBT developed by **Marsha Linehan**. It draws on mindfulness practices and validation techniques from behavioral psychology and compassion-focused therapy.

---

## Related Skills

---

- Mindfulness
- Non-Judgmental Stance
- Radical Acceptance
- Self-Soothing
- Wise Mind

---

## Limitations

---

May not be effective if:

- You use it as an excuse for harmful behavior.
- You haven’t developed skills to manage strong emotions.
- It is used in isolation without other DBT skills.

---

## Evidence Base

---

Research shows:

- Self-Validation reduces emotional reactivity.
- Increases resilience and coping.
- Supports positive self-concept and well-being.

---

## Further Reading

---

- Linehan, M.M. (2015). *DBT Skills Training Manual*.
- Kristin Neff’s work on self-compassion: [Self-Compassion Resources](https://self-compassion.org)
- Brach, T. (2019). *Radical Compassion*.

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. Guilford Press.
- Neff, K. (2011). *Self-Compassion: The Proven Power of Being Kind to Yourself*.
- Brach, T. (2003). *Radical Acceptance*.

Self-Validation

Apply DBT skills consistently in daily life.

# Skills Generalization

---

## Definition

---

**Skills Generalization** refers to the practice of applying DBT skills learned in therapy sessions to a wide range of real-life situations, contexts, and environments. It is about moving from knowing skills intellectually to living them consistently.

---

## Purpose

---

Used to:

- Make DBT skills effective outside of therapy.
- Build confidence in managing emotions in daily life.
- Strengthen adaptive coping across different settings.
- Promote long-term behavior change and resilience.

---

## When to Use

---

Use Skills Generalization when:

- You want to maintain progress between sessions.
- You notice yourself reverting to old patterns in stressful situations.
- You encounter new challenges that require skillful responses.
- You feel confident in practice but struggle in real-world application.

---

## When *Not* to Use

---

Avoid focusing exclusively on generalization if:

- You have not yet learned foundational DBT skills.
- You feel too emotionally dysregulated to practice without support.
- You are in a crisis where immediate stabilization is the priority.

---

## How-To

---

**1. Identify Skills to Generalize**

   - Choose specific skills you have practiced (e.g., Wise Mind, Opposite Action).

**2. Pinpoint Target Situations**

   - Make a list of real-life contexts where you want to apply them.

   - *“I will practice DEAR MAN with my supervisor this week.”*

**3. Create Reminders**

   - Use cue cards, phone alerts, or visual reminders to prompt skill use.

**4. Rehearse in Imagery**

   - Visualize yourself using the skill successfully.

**5. Practice in Real Time**

   - Apply the skill in the moment, even if imperfectly.

**6. Reflect and Troubleshoot**

   - After practicing, review what worked and what you can improve.

---

## Tips & Variations

---

- Keep a **Skills Generalization Log** to track attempts and outcomes.
- Role-play difficult situations with a therapist or trusted person.
- Reward yourself for practicing skills, even if the result isn’t perfect.

---

## Example

---

*Scenario: Jo has learned Radical Acceptance in therapy but struggles to apply it at work.*

**Generalization Plan:**

1. Identify: Radical Acceptance

2. Target: Receiving negative feedback from supervisor

3. Reminder: Sticky note on desk

4. Rehearsal: Visualization each morning

5. Practice: Use acceptance statements during feedback

6. Reflect: Journal about the experience

---

## Inventor / Origin

---

Skills Generalization is a core principle in DBT, emphasized by **Marsha Linehan**, who designed DBT to help clients bridge the gap between therapy and daily life. It is built into all aspects of DBT’s treatment structure.

---

## Related Skills

---

- Mindfulness
- Behavior Chain Analysis
- Coping Ahead
- Self-Monitoring
- Problem Solving

---

## Limitations

---

May not be effective if:

- You lack motivation to practice between sessions.
- You do not have support to reinforce learning.
- You attempt to generalize too many skills at once.

---

## Evidence Base

---

Research shows:

- Skills generalization is a critical factor in DBT treatment success.
- Clients who consistently practice skills in daily life have better outcomes.
- Generalization predicts long-term improvements in emotion regulation.

---

## Further Reading

---

- Linehan, M.M. (2015). *DBT Skills Training Manual*.
- Behavioral Skills Generalization strategies in cognitive-behavioral therapy.
- DBT Skills Application Guides and workbooks.

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. Guilford Press.
- Swenson, C.R. (2016). *DBT Principles in Action: Acceptance, Change, and Dialectics*.

Skills Generalization

Develop strategies to address problem behaviors or situations.

# Solution Analysis

---

## Definition

---

**Solution Analysis** is a structured DBT problem-solving process that guides you through systematically identifying, evaluating, and selecting effective solutions to address a problematic situation or behavior.  
It helps you think through options instead of reacting impulsively.

---

## Purpose

---

Used to:

- Generate alternative solutions to problems.
- Evaluate pros and cons of each solution.
- Choose the most effective plan.
- Increase a sense of mastery and control over problems.

---

## When to Use

---

Use Solution Analysis when:

- You feel stuck in a difficult situation.
- You need to make an important decision.
- You are preparing to cope ahead for a likely problem.
- You want to avoid repeating ineffective patterns.

---

## When *Not* to Use

---

Avoid using if:

- You are in immediate crisis requiring safety measures first.
- You are too emotionally activated to think clearly (try TIPP first).
- The problem requires urgent action before analysis.

---

## How-To

---

**1. Describe the Problem Situation**

   - Be clear and objective.
   - Focus on what is happening now, not past blame.

**2. Identify Your Goals**

   - What do you want to accomplish in this situation?

**3. Brainstorm Possible Solutions**

   - Generate as many options as you can, without judgment.

**4. Evaluate Each Solution**

   - Consider short-term and long-term consequences.
   - Assess effectiveness, feasibility, and potential risks.

**5. Choose the Best Solution**

   - Select the option most likely to meet your goals.

**6. Make an Action Plan**

   - Break the solution into specific steps.
   - Prepare for obstacles.

**7. Implement and Evaluate**

   - Try the plan.
   - Reflect afterward on what worked and what you might change.

---

## Tips & Variations

---

- Use a worksheet to organize each step.
- If no perfect solution exists, pick the most effective “good enough” option.
- Practice radical acceptance for aspects you cannot control.
- Combine with Cope Ahead to rehearse carrying out your plan.

---

## Example

---

*Scenario: Jordan keeps missing deadlines at work.*

**Problem Description:**

- Repeatedly submitting reports late.

**Goal:**

- Submit next report on time.

**Possible Solutions:**

1. Set earlier personal deadline.
2. Use a daily reminder.
3. Request support from supervisor.
4. Work on report at same time each day.

**Evaluation:**

- Solution 1 is effective and feasible.
- Solution 2 helps maintain focus.
- Solution 3 may feel uncomfortable but increases accountability.
- Solution 4 supports consistency.

**Chosen Solution:**

- Combine Solutions 1 and 2.

**Action Plan:**

- Block time on calendar.
- Set reminders.
- Commit to finishing draft 2 days early.

---

## Inventor / Origin

---

Solution Analysis was developed by **Marsha Linehan, Ph.D.**, within Dialectical Behavior Therapy.  
It draws on behavioral problem-solving and CBT decision-making frameworks.

---

## Related Skills

---

- Behavior Chain Analysis
- Pros and Cons
- Cope Ahead
- Radical Acceptance
- Problem Solving

---

## Limitations

---

May not be effective if:

- You avoid brainstorming honestly.
- You skip evaluating consequences.
- You choose based on impulse rather than goals.
- You feel pressured to pick a “perfect” solution.

---

## Evidence Base

---

Research shows:

- Structured problem-solving increases coping effectiveness.
- Solution Analysis can reduce emotional reactivity.
- It promotes skillful action and reduces avoidance.

---

## Further Reading

---

- Linehan, M.M. (2015). *DBT Skills Training Handouts and Worksheets*.
- [DBT Self Help - Problem Solving](https://www.dbtselfhelp.com/html/problem_solving.html)
- [DBT Center of Michigan](https://www.dbtmi.com/)

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. Guilford Press.
- Neacsiu, A.D., Rizvi, S.L., & Linehan, M.M. (2010). Dialectical Behavior Therapy Skills Use as a Mediator and Outcome of Treatment for Borderline Personality Disorder. *Behaviour Research and Therapy*, 48(9), 832–839.

Solution Analysis

Use body-based techniques to quickly lower emotional arousal.

# TIPP Skill

---

## Definition

---

**TIPP** stands for **Temperature, Intense Exercise, Paced Breathing, and Progressive Muscle Relaxation**. It is a Distress Tolerance skill used to rapidly reduce extreme emotional arousal by directly regulating the body’s physiological state.

---

## Purpose

---

Used to:

- Bring the nervous system out of “fight, flight, or freeze.”
- Reduce overwhelming emotions quickly.
- Regain control during crises.
- Stabilize the body before using other coping skills.

---

## When to Use

---

Use TIPP when:

- You are feeling intense distress or panic.
- You are experiencing overwhelming anger, anxiety, or urges.
- You need to calm down quickly to prevent acting impulsively.

---

## When *Not* to Use

---

Avoid using this skill if:

- You have medical conditions that contraindicate cold exposure or intense exercise.
- You are already calm or only mildly upset.
- You need a long-term solution rather than immediate relief.

---

## How-To

---

**T - Temperature**

1. Hold your breath and submerge your face in a bowl of cold water for 30 seconds, or apply ice packs to the eyes and cheeks.
2. This activates the “mammalian dive reflex,” slowing your heart rate.

**I - Intense Exercise**

1. Engage in vigorous exercise (e.g., running in place, jumping jacks) for 10–20 minutes.
2. This burns off adrenaline and calms the body.

**P - Paced Breathing**

1. Slow your breathing to about 5–6 breaths per minute.
2. Inhale for 4 counts, exhale for 6–8 counts.

**P - Progressive Muscle Relaxation**

1. Tense and relax muscle groups in sequence.
2. Focus on the contrast between tension and release.

---

## Tips & Variations

---

- Keep a bowl of ice water ready if you struggle with panic attacks.
- Combine steps (e.g., cold water followed by paced breathing).
- Adjust duration of exercises based on your fitness level.
- Use TIPP discreetly—carrying an ice pack in your bag or doing breathing exercises anywhere.

---

## Example

---

*Jordan feels the urge to self-harm after an argument.*

1. Runs in place for 5 minutes.
2. Submerges face in cold water.
3. Practices slow breathing for 5 minutes.
4. Feels calmer and more able to call a friend.

---

## Inventor / Origin

---

TIPP is part of **DBT Distress Tolerance Skills**, created by **Marsha Linehan, PhD**. The skill integrates principles from behavioral therapy, biology, and mindfulness practice.

---

## Related Skills

---

- STOP Skill
- Self-Soothing
- Radical Acceptance
- Pros and Cons

---

## Limitations

---

May not be effective if:

- Practiced inconsistently or without preparation.
- You have severe medical restrictions.
- You expect it to solve underlying problems permanently.

---

## Evidence Base

---

Research shows:

- TIPP effectively decreases heart rate and emotional arousal.
- Immediate physiological calming improves ability to use other DBT skills.
- Cold water immersion reduces panic symptoms.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [Mayo Clinic: Relaxation Techniques](https://www.mayoclinic.org/tests-procedures/relaxation-techniques/about/pac-20385099)
- *The Dialectical Behavior Therapy Skills Workbook* by McKay, Wood, and Brantley
- [DBT Self-Help: TIPP](https://www.dbtselfhelp.com/html/tipp.html)

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Gratz, K.L., & Gunderson, J.G. (2006). "Preliminary Data on an Acceptance-Based Emotion Regulation Group Intervention for Deliberate Self-Harm Among Women with Borderline Personality Disorder." *Behavior Therapy*, 37(1), 25–35.

TIPP

Commit again and again to accepting reality whenever resistance returns.

# Turning the Mind Skill

---

## Definition

---

**Turning the Mind** is a DBT Distress Tolerance skill that involves making a conscious, internal commitment to accept reality as it is, over and over again. It is the moment when you *turn your mind* toward willingness and away from resistance.

---

## Purpose

---

Used to:

- Bridge the gap between recognizing reality and fully accepting it.
- Counteract avoidance, denial, or bitterness.
- Choose to engage with reality rather than fighting it.
- Move into more effective action.

---

## When to Use

---

Use Turning the Mind when:

- You notice you are rejecting reality (“I refuse to accept this”).
- You feel stuck in anger or resentment.
- You’ve acknowledged something painful but keep slipping into non-acceptance.
- You need to recommit to acceptance moment by moment.

---

## When *Not* to Use

---

Avoid using if:

- You are in active danger that requires immediate problem-solving.
- Acceptance would reinforce passivity in harmful situations.
- You need to take action first to ensure safety.

---

## How-To

---

1. **Observe that you are not accepting reality.**

   - “I can feel myself clenching, fighting this.”

2. **Notice the urge to reject reality.**

   - Label it: “Resistance.”

3. **Turn your mind toward acceptance.**

   - It is an *internal shift*—you are choosing willingness.

4. **Do it again, and again.**

   - Every time you drift back to rejection, recommit.

5. **Use supportive self-statements:**

   - “I am choosing to accept this reality as it is.”
   - “Acceptance is the only way through.”

---

## Tips & Variations

---

- Use visual imagery: picture yourself turning a wheel or opening a door.
- Pair with deep breathing and mindful observation.
- Expect to turn the mind many times—it’s not a one-time event.
- Practice with small frustrations before tackling big challenges.

---

## Example

---

*Marisol’s partner ended their relationship.*

- **Initial Reaction:** “I can’t accept this. It’s too unfair.”

- **Turning the Mind:** “I am choosing to accept that this relationship is over.”

- **Follow-Up:** She repeated this phrase whenever the urge to reject reality came back.

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, Turning the Mind is grounded in:

- Zen mindfulness principles
- Behavioral commitment strategies
- Acceptance-based approaches to distress tolerance

---

## Related Skills

---

- Radical Acceptance
- Willingness
- Mindfulness of Current Emotion

---

## Limitations

---

May not be effective if:

- You expect it to remove emotional pain instantly.
- You confuse acceptance with approval or resignation.
- You have not first clearly identified what you are resisting.

---

## Evidence Base

---

Research shows:

- Repeated practice of acceptance reduces suffering.
- Mindful commitment enhances psychological flexibility.
- Turning the Mind supports better coping during crises.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [Turning the Mind Resource](https://www.dbtselfhelp.com/html/turning_the_mind.html)
- *Radical Acceptance* by Tara Brach

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (2011). *Acceptance and Commitment Therapy: The Process and Practice of Mindful Change*.

Turning the Mind

# Urge Surfing

---

## Definition

---

**Urge Surfing** is a mindfulness-based skill that helps you ride out cravings or urges without acting on them.  
You visualize the urge as a wave that rises, peaks, and eventually falls, while observing it nonjudgmentally.  

---

## Purpose

---

Used to:

- Manage impulses, cravings, or addictive behaviors.
- Increase distress tolerance and reduce reactivity.
- Learn that urges are temporary and do not control you.
- Build confidence in your ability to tolerate discomfort.

---

## When to Use

---

Use Urge Surfing when:

- You feel the urge to engage in a behavior you want to change (e.g., self-harm, substance use, binge eating).
- You notice cravings building.
- You want to pause before acting on any strong compulsion.

---

## When *Not* to Use

---

Avoid using if:

- You are in immediate danger or risk of harming yourself or others.
- You are too dissociated to observe sensations safely.
- You need a more active coping strategy (e.g., distraction) in early recovery.

---

## How-To

---

**1. Notice the Urge**

   - Pause and bring awareness to the urge or craving as it arises.
   - Label it: “I am experiencing an urge to...”

**2. Focus on Your Breath**

   - Breathe slowly and deeply.
   - Use the breath as your anchor.

**3. Observe Sensations**

   - Scan your body and notice where you feel the urge (e.g., tightness in chest, restlessness in hands).
   - Describe the sensations in detail without judgment.

**4. Visualize the Wave**

   - Imagine the urge like a wave in the ocean.
   - Watch it rise, crest, and fall.
   - Know that the wave will subside.

**5. Allow and Stay Present**

   - Do not fight the urge or try to push it away.
   - Let it be there while you remain grounded in the moment.

**6. Repeat as Needed**

   - Continue observing until the intensity decreases.

---

## Tips & Variations

---

- Use grounding phrases: “This will pass,” “I am safe,” “Urges are temporary.”
- Time yourself: urges often peak within 20–30 minutes.
- Pair with TIPP or Self-Soothing if distress is very high.
- Practice when urges are mild to build confidence.
- Some people prefer to visualize the urge as a cloud passing by or a train moving past the station.

---

## Example

---

*Scenario: Kevin has a strong urge to drink after work.*

**Practice:**

1. Kevin pauses and says, “I am having an urge to drink.”
2. He sits quietly and focuses on slow breathing.
3. He notices tightness in his stomach and tingling in his arms.
4. He imagines the urge rising like a wave.
5. He watches it crest and gradually subside without reacting.

---

## Inventor / Origin

---

Urge Surfing was developed by psychologist **Alan Marlatt, Ph.D.**, a pioneer in relapse prevention and mindfulness-based addiction treatment.  
Marsha Linehan incorporated similar principles into DBT distress tolerance.

---

## Related Skills

---

- Observe
- Non-Judgmental Stance
- TIPP
- Radical Acceptance
- Opposite Action

---

## Limitations

---

May not be effective if:

- Urge intensity is overwhelming and you lack other coping supports.
- Used alone without additional relapse prevention planning.
- You expect it to eliminate urges instantly.

---

## Evidence Base

---

Research shows:

- Mindfulness-based relapse prevention reduces substance use relapse rates.
- Urge Surfing increases tolerance of cravings and reduces impulsive action.
- Regular practice strengthens prefrontal regulation and lowers reactivity.

---

## Further Reading

---

- Marlatt, G.A., & Donovan, D.M. (Eds.). (2005). *Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors*.
- [Mindfulness-Based Relapse Prevention](https://www.mindfulrp.com/)
- [DBT Self Help - Urge Surfing](https://www.dbtselfhelp.com/html/urge_surfing.html)

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Bowen, S., Chawla, N., & Marlatt, G.A. (2010). *Mindfulness-Based Relapse Prevention for Addictive Behaviors*. Guilford Press.
- Baer, R.A. (2003). Mindfulness Training as a Clinical Intervention. *Clinical Psychology: Science and Practice*, 10(2), 125–143.

Urge Surfing

Acknowledge and accept another person's feelings as understandable.

# Validation Skills

---

## Definition

---

**Validation Skills** are techniques used to acknowledge, accept, and communicate understanding of another person’s feelings, thoughts, and behaviors without necessarily agreeing with them. Validation means letting someone know their experience makes sense within their context.

---

## Purpose

---

Used to:

- Reduce emotional escalation.
- Build trust and strengthen relationships.
- Help others feel understood and accepted.
- Improve problem-solving by calming intense emotions.

---

## When to Use

---

Use validation when:

- Someone is upset or emotionally dysregulated.
- You want to de-escalate conflict.
- You notice someone feeling misunderstood, shamed, or criticized.
- You want to deepen emotional connection.

---

## When *Not* to Use

---

Avoid using if:

- The person is in immediate danger (prioritize safety).
- You are in a crisis and need to use distress tolerance first.
- The validation would be inauthentic or manipulative.

---

## How-To

---

DBT teaches **6 Levels of Validation** (adapted from Marsha Linehan):

**1. Be Present**

   - Pay full attention with eye contact, nodding, and an open posture.
   - Put away distractions.

**2. Reflect**

   - Repeat or paraphrase what you heard.
   - “It sounds like you’re feeling really frustrated.”

**3. Mind Reading**

   - Notice and label feelings even if they weren’t said.
   - “I can tell you’re feeling disappointed.”

**4. Understand History**

   - Acknowledge how past experiences make current feelings understandable.
   - “Given everything you’ve been through, it makes sense you’d feel this way.”

**5. Normalize**

   - State that anyone might feel this way in similar circumstances.
   - “Most people would be overwhelmed in this situation.”

**6. Radical Genuineness**

   - Be fully authentic and equal.
   - “I respect how hard you’re working to cope.”

---

## Tips & Variations

---

- Use a warm, calm tone.
- Avoid jumping to problem-solving before validation.
- Validate before offering feedback or advice.
- Self-validate your own experience, too.

---

## Example

---

*Scenario: Your partner is upset about a mistake at work.*

- **Be Present:** Sit down, face them, maintain soft eye contact.
- **Reflect:** “You’re upset that the project didn’t go as planned.”
- **Mind Reading:** “You seem embarrassed and worried about what your boss thinks.”
- **Understand History:** “Considering how much effort you put in, that’s understandable.”
- **Normalize:** “Anyone would feel this way after working so hard.”
- **Radical Genuineness:** “I really admire how much you care.”

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD** as part of Dialectical Behavior Therapy to help people with intense emotions feel acknowledged and validated.

---

## Related Skills

---

- Mindfulness
- Radical Acceptance
- Interpersonal Effectiveness (DEAR MAN, GIVE, FAST)

---

## Limitations

---

May not be effective if:

- Used insincerely (can feel patronizing).
- The other person is in a crisis needing immediate intervention.
- Overused to avoid setting limits or solving problems.

---

## Evidence Base

---

Research shows:

- Validation reduces emotional arousal.
- Helps build secure attachments.
- Increases willingness to collaborate on solutions.

---

## Further Reading

---

- *DBT Skills Training Manual* by Marsha Linehan
- [Validation Skills – Therapist Aid](https://www.therapistaid.com/worksheets/validation-skills.pdf)
- *Radical Acceptance* by Tara Brach

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. Guilford Press.
- Fruzzetti, A.E. & Iverson, K.M. (2006). *Validation: Theory, Research, and Training*. National Center for PTSD.
- Tatkin, S. (2011). *Wired for Love*. New Harbinger Publications.

Validation Skills

# Values Clarification

---

## Definition

---

**Values Clarification** is a reflective skill used to help you identify what matters most to you—your core principles, priorities, and deeply held beliefs.  
It guides you in aligning your actions with these values, increasing a sense of purpose and meaning.

---

## Purpose

---

Used to:

- Gain clarity on what you truly care about.
- Make decisions consistent with your values.
- Reduce confusion about conflicting goals.
- Increase motivation to engage in valued actions.

---

## When to Use

---

Use Values Clarification when:

- You feel lost, aimless, or unmotivated.
- You struggle with making decisions.
- You notice that your behavior conflicts with your beliefs.
- You want to set long-term goals.

---

## When *Not* to Use

---

Avoid using if:

- You are in immediate crisis (use crisis survival skills first).
- You are too emotionally dysregulated to reflect calmly.
- You feel pressured to choose values to please others.

---

## How-To

---

**1. Reflect on What Matters**

   - Ask yourself: What do I care most about? What would I want my life to stand for?

**2. Identify Core Values**

   - Examples: Honesty, compassion, family, growth, stability.

**3. Rank or Prioritize**

   - Which values feel most central right now?

**4. Explore Gaps**

   - Are there areas where your actions don’t match your values?

**5. Set Values-Based Goals**

   - Choose small steps that embody your highest values.

**6. Revisit Regularly**

   - Your values may shift over time. Check in with yourself.

---

## Tips & Variations

---

- Use journaling to explore values.
- Try the “Funeral Exercise”: Imagine what you’d want people to say about you at the end of your life.
- Consider using values cards or lists to prompt ideas.
- Combine with Build Mastery or Cope Ahead to set specific goals.

---

## Example

---

*Scenario: Maya feels unmotivated and stuck.*

**Reflection:**

- What matters most? Helping others, personal growth, and authenticity.

**Identified Values:**

1. Service
2. Learning
3. Honesty

**Values-Behavior Gaps:**

- Not volunteering despite valuing service.
- Avoiding feedback, which conflicts with growth.

**Action Plan:**

- Sign up for a volunteer shift.
- Ask a trusted colleague for constructive feedback.

---

## Inventor / Origin

---

Values Clarification originated in **humanistic psychology** and was popularized by Louis Raths, Merrill Harmin, and Sidney Simon (1966).  
It has since been integrated into DBT and Acceptance and Commitment Therapy (ACT).

---

## Related Skills

---

- Build Mastery
- Mindfulness
- Radical Acceptance
- Problem Solving
- Goal Setting

---

## Limitations

---

May not be effective if:

- You rely on others’ values rather than your own.
- You expect clarity without reflection.
- You become overwhelmed by perfectionism.

---

## Evidence Base

---

Research shows:

- Values clarification increases motivation and engagement.
- Aligning actions with values improves well-being.
- It helps reduce experiential avoidance and indecision.

---

## Further Reading

---

- Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (2011). *Acceptance and Commitment Therapy: The Process and Practice of Mindful Change*.
- [DBT Self Help – Values Clarification](https://www.dbtselfhelp.com/html/values_clarification.html)
- [ACT Mindfully](https://www.actmindfully.com.au/)

---

## References

---

- Raths, L.E., Harmin, M., & Simon, S.B. (1966). *Values and Teaching: Working with Values in the Classroom*. Charles Merrill.
- Linehan, M.M. (2015). *DBT Skills Training Handouts and Worksheets*. Guilford Press.

Values Clarification

Be open and flexible rather than stubborn or resistant to reality.

# Willingness vs. Willfulness Skill

---

## Definition

---

**Willingness** means choosing to do what works in each situation, with openness and flexibility.  
**Willfulness** is the opposite—stubbornly refusing to tolerate reality, clinging to control, or giving up entirely.

---

## Purpose

---

Used to:

- Help you let go of rigid, self-defeating behaviors.
- Foster an open, accepting attitude that promotes effective action.
- Support problem-solving and acceptance in distressing situations.
- Increase psychological flexibility and resilience.

---

## When to Use

---

Use Willingness when:

- You catch yourself resisting reality or digging in your heels.
- You are stuck in unhelpful patterns (e.g., procrastination, passive-aggression).
- You want to act skillfully, rather than react impulsively.
- You need to accept what you cannot change and do what is needed.

---

## When *Not* to Use

---

Avoid using if:

- Immediate action is required for safety, not acceptance.
- You are in situations of abuse where compliance may be dangerous.
- You have not identified whether your willfulness serves a protective purpose that needs exploring first.

---

## How-To

---

1. **Observe Willfulness:**

   - Notice signs of resistance (“I won’t,” “I shouldn’t have to,” “No.”).
   - Label it: “Willfulness.”

2. **Radically Accept the Moment:**

   - Acknowledge reality: “This is what is happening.”

3. **Turn the Mind Toward Willingness:**

   - Decide to open yourself to doing what works.
   - Recommit each time willfulness returns.

4. **Ask:**

   - “What is the effective action here?”
   - “What would willingness look like right now?”

5. **Act Willingly:**

   - Take the next right step, however small.

---

## Tips & Variations

---

- Use body posture: unclench fists, relax shoulders, soften your face.
- Imagine physically laying down your resistance.
- Willingness does *not* mean liking the situation—it means accepting it.
- Keep practicing; willingness is a choice you make over and over.

---

## Example

---

*Devon was told they needed to redo a project at work.*

- **Willfulness:** “I refuse. It’s not fair.”
- **Shift:** Recognize resistance and name it.
- **Willingness:** “I don’t like this, but I will do what is needed to move forward.”

---

## Inventor / Origin

---

Developed by **Marsha Linehan, PhD**, this skill draws on:

- Zen concepts of radical acceptance
- Behavioral principles of effectiveness
- Mindfulness of internal resistance

---

## Related Skills

---

- Radical Acceptance
- Turning the Mind
- Mindfulness of Current Emotion

---

## Limitations

---

May not be effective if:

- You use it as avoidance (e.g., to avoid expressing boundaries).
- You expect willingness to remove discomfort.
- You haven’t acknowledged and validated your emotions first.

---

## Evidence Base

---

Research shows:

- Practicing willingness reduces experiential avoidance.
- Willingness increases adaptive coping and psychological well-being.
- Mindfulness-based acceptance improves emotional regulation.

---

## Further Reading

---

- *DBT Skills Training Handouts and Worksheets* by Marsha Linehan
- [Willingness vs. Willfulness Overview](https://www.dbtselfhelp.com/html/willingness_vs__willfulness.html)
- *Radical Acceptance* by Tara Brach

---

## References

---

- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.
- Hayes, S.C., Strosahl, K.D., & Wilson, K.G. (2011). *Acceptance and Commitment Therapy: The Process and Practice of Mindful Change*.

Willingness vs. Willfulness

Combines your emotional mind and rational mind into balanced inner wisdom.

# Wise Mind

---

## Definition

---

Wise Mind is a core concept in Dialectical Behavior Therapy (DBT) that represents the integration of **Emotion Mind** and **Reasonable Mind**. It is the inner wisdom that arises when you balance logic and emotion. Rather than denying feelings or ignoring facts, Wise Mind allows you to access a deeper, intuitive knowing.

Other names: *Centered Self*, *Inner Knowing*, *Balanced Mind.*

---

## Purpose

---

Used to help you:

- Make effective decisions when overwhelmed by intense feelings or overthinking.
- Access clarity and calm in emotionally charged situations.
- Improve self-trust and self-awareness.
- Regulate emotional responses without suppressing them.

---

## When to Use

---

Turn to Wise Mind when you:

- Feel torn between strong emotions and logical reasoning.
- Need to respond thoughtfully rather than react impulsively.
- Are unsure about how to handle conflict or crisis.
- Want to validate both your feelings and the facts of a situation.

---

## When *Not* to Use

---

Avoid relying on Wise Mind if:

- You are in immediate physical danger—safety first.
- You are severely dissociated or unable to stay grounded (seek stabilization first).
- You are using it as a way to avoid action or accountability.

---

## How-To

---

1. **Pause.** Take a moment to stop reacting.
2. **Notice your Emotion Mind.** What are you feeling? Where in your body?
3. **Notice your Reasonable Mind.** What are the facts and logical considerations?
4. **Visualize them meeting.** Imagine a Venn diagram where they overlap.
5. **Sit quietly and wait.** Often, a sense of “knowing” emerges.
6. **Name your Wise Mind decision.** What does your inner wisdom suggest?
7. **Act with intention.** Follow through mindfully.

---

## Tips & Variations

---

- **Visualization:** Picture a calm lake or a quiet center within your chest.
- **Mantra:** Repeat “Wise Mind” while breathing slowly.
- **Journal Prompt:** “What does my Wise Mind say about this?”
- **Watch out for:** Confusing impulse or avoidance with wisdom—true Wise Mind feels grounded, not frantic.

---

## Example

---

*Anna felt overwhelmed after a fight with her partner. Her Emotion Mind wanted to yell. Her Reasonable Mind said to ignore it completely. She closed her eyes, took deep breaths, and imagined a wise elder inside her. Her Wise Mind told her to wait until morning to have a calm conversation.*

---

## Inventor / Origin

---

Developed by **Marsha M. Linehan, PhD**, creator of Dialectical Behavior Therapy in the late 1980s. The Wise Mind concept draws from Zen Buddhist philosophy and Western psychology.

---

## Related Skills

---

- **Observe:** Noticing thoughts and feelings without judgment.
- **Describe:** Labeling internal experiences accurately.
- **Participate:** Engaging fully in the present moment.
- **Mindfulness of Current Emotion:** Allowing emotions to rise and fall naturally.

---

## Limitations

---

May not be effective if:

- You are actively under the influence of substances.
- You have untreated psychosis.
- You are in life-threatening crisis requiring immediate action.

---

## Evidence Base

---

Research shows that accessing Wise Mind as part of DBT mindfulness:

- Reduces emotional reactivity.
- Increases distress tolerance.
- Supports decision-making in BPD and other emotional dysregulation disorders.
- Linehan’s studies report improvements in emotion regulation and reduction in self-harm.

---

## Further Reading

---

- [Marsha Linehan's official DBT site](https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/)
- *DBT Skills Training Handouts and Worksheets, Second Edition* by Marsha M. Linehan
- [Wise Mind Guided Meditation](https://www.youtube.com/watch?v=Ksz5GZQh8uE)

---

## References

---

- Linehan, M.M. (1993). *Cognitive-Behavioral Treatment of Borderline Personality Disorder*. New York: Guilford Press.
- Linehan, M.M. (2015). *DBT Skills Training Manual, Second Edition*. New York: Guilford Press.

Explore the DBT Tools Library