Dialectical Behavior Therapy was developed by Marsha Linehan in the late 1970s to treat women struggling with multiple mental health issues, including suicidal risk. The framework for DBT usually involves a combination of weekly individual therapy, skill group therapy sessions, and team counseling. A DBT treatment plan can last from 6 months to a year. Read on to learn 15 Dialectical Behavior Therapy Exercises and Activities you can do with your clients.
View all our DBT Worksheets
Effective DBT treatment includes 5 characteristics (Chapman, AL, 2006). Chapman identified the following characteristics:
- Client Empowerment – This may include dialectical behavior therapy exercises that focus on emotion regulation skills, mindfulness practices, enhancing interpersonal effectiveness, and learning distress tolerance skills.
- Generalization of goals that can be applied to daily life – This can include skills training and homework to ensure that the skills covered in sessions can improve your client’s quality of life.
- Improving client motivation and reducing the presence of dysfunctional behaviors – This can be addressed in individual sessions and self-monitoring activities such as diary cards.
- Use structure to avoid reinforcing negative behaviors
- Providing therapists with support, validation, ongoing training, and skill building to promote effective counseling – DBT is often used for clients with a history of trauma and significant impairment from mental health problems. It is important to ensure that Counselors and Therapists receive the support they need to be able to provide effective therapeutic interventions.
What conditions can DBT treat?
Although DBT is widely accepted as an effective treatment for borderline personality disorder, research has shown that DBT is an effective treatment for a number of other mental health problems. Mental health problems that may benefit from DBT include:
- Eating disorders, including binge eating disorder
- Anxiety
- Depression
- Post-traumatic nerve disorder
- Self harm
- Suicidal behaviors
List of Dialectical Behavior Therapy Training and Activities
Dialectical behavior therapy activities can be an effective way to introduce your client to a variety of skills and encourage them to use the skills they learn outside of sessions.
Examples of DBT exercises you can include in your individual or group session include:
- Talk to your client about self-soothing skills that use the five senses. This can help your client incorporate mindfulness into coping skills. Providing your client with a worksheet such as the DBT self-soothing worksheet TherapyByPro, can serve as a reference for your client outside of the session. Allow time to observe your client’s ability to use self-soothing skills and evaluate their effectiveness in subsequent sessions.
- Introduce your client to the acronym TIPP. This is a distress tolerance skill that can help them cope with currently distressed or overwhelming emotions. In subsequent sessions, allow time to monitor the ability to use this challenge tolerance skill. Our TIPP Skill Worksheet can help your clients with this skill.
- Introduce your client to radical acceptance statements and discuss how they can be used to overcome adversity. Use their latest challenge to explore how radical acceptance statements can be applied. Encourage your client to use these expressions when they are worried and learn how they affect the level of distress.
- Introduce your customer to the ABC PLEASE skill. This skill focuses on self-care, which can reduce our chances of dealing with an emotional crisis. When introducing these skills, assess your client’s current behaviors regarding the actions discussed and how they think they can improve their current behaviors. At the next session, allow time to monitor the changes they implement. Check out our ABC PLEASE worksheet.
- Take time to talk about the role of self-talk in our well-being. Explore your client’s self-talk and explore changes they could make to show more kindness, compassion, and encouragement than they currently do. Encourage them to pay attention to their self-talk outside of the session and notice how they feel when they make positive changes to it.
- Introduce your customer to the three moods we have; emotional mind, logical mind and wise mind. A wise mind uses both our emotional and logical minds and adds to our intuition. Work through the last session by looking at the three minds in the session and how the problem was solved. Encourage your client to use their wisdom when they encounter challenges outside of the session. It can be beneficial to have some clients Wise Mind worksheet templateas available on TherapyByPro to serve as a guide.
- Introduce your customer to How Skill. This skill encourages your client not to judge a situation as “bad” or “good” or to give a “right” or “wrong” answer. Customers are advised to be prepared in the moment and not worry about how the future will affect them. Finally, the client should be encouraged to do what works without worrying about whether it is “right”. Encourage your client to focus on the desired outcome. Allow time to follow up on the ability to use the How To Skills outside of the session.
- Introduce your client to the idea of meditation and explore their understanding of what meditation means. Clients may not have a complete or correct understanding of meditation and what to expect. You can discuss different forms of meditation, including guided imagery and progressive muscle relaxation. Consider your client’s mental health before introducing mindfulness—individuals with trauma may not benefit from meditation. Follow up with your client about their ability to engage in mindfulness practice outside of the session and how it has affected them.
- Introduce your customer to the DEARMAN skill. This skill would benefit individuals who could benefit from focusing on interpersonal effectiveness and improving their communication patterns. Use the last problem to go over the skill as an example in the session. If your client would benefit from having a distribution document to move them efficiently, TherapyByPro offers a comprehensive DEARMAN Assertive Communication worksheet. Allow time to observe your client’s ability to practice this skill outside of the session.
- The GIVE skill is an additional interpersonal effectiveness skill that can help your client improve their communication. You can use the last conversation your customer thought could have been better and see where they can make changes based on the GIVE skill. Allow time to explore situations where your client can apply this skill outside of the session. Our GIVE Skill worksheet can help your clients with this skill.
- Boundaries are an important part of a healthy relationship. Spend time exploring the components of healthy boundaries and ask your client to identify relationships they feel could benefit from new or enforced boundaries. Role-playing can be an effective tool for allowing clients to practice difficult conversations and situations they may encounter regarding healthy boundaries. Track their skills to improve the boundaries they choose to work on.
- Introduce your client to the concept of a thought problem. Using one last prompt, they practiced, take your time to make sure they understand the steps, and walk them through the thought process. Encourage your client to engage in thinking problems outside of the session and a thinking problem worksheet to document their experiences for review in their next session.
- Ask your client to eat a raisin (or other similar food item) during the session, which requires your client to focus on the present moment. Ask them to explore the raisin using their five senses. After the exercise is over, ask them if their mind wandered and how they felt throughout the exercise. This can help reinforce the benefits of being in the present moment.
- Take time to explore the use of our senses. Bring a leaf to the session and ask your client to describe the leaf using their senses for a full five minutes. Normalize that if their mind wanders, accept that it’s happening and go back to the leaf. Process their experience after five minutes. Based on their participation in the practice, give them feedback on how they can further engage their senses in the mindfulness practice.
- Take time to practice the body scan. You can start at their toes and work your way up to the top of their head. Ask the client how their clothes feel, what their body is touching, how their clothes feel, whether they feel warm, etc. ask to be notified. After the body scan is complete, give them time to process their experience. Ask your client what they learned about their body in that moment that they didn’t know before. For example, they may notice that they are holding a tension in their shoulders or jaw that they were previously unaware of. Explore how their physical sensations relate to their emotions and thoughts.
Final thoughts on selecting DBT activities for your clients
Thanks for reading this resource about 15 Dialectical Behavior Therapy Exercises and Activities for Therapy with Your Clients. With appropriate training and experience, DBT activities can be an effective treatment for clients living with a range of mental health problems. There are many aspects of DBT that can be applied to individuals with a range of mental health issues and problems. Being able to tailor DBT exercises to your individual client or group of clients can help bring a personalized approach to your work.
If you can use these skills yourself, you will be able to improve the way you present, research, and communicate the DBT exercises you share. This may include breathing exercises and meditations. Supervision can be a great time to explore your experience with DBT skills and practice your approach to applying the skills in sessions.
TherapyByPro is a program online mental health directory connecting mental health professionals with clients in need. If you are a mental health professional, you can Join our community and add your experience listing here. We have templates for assessments, practice forms, and worksheets that mental health professionals can use to facilitate their practice. Look at all of us mental health worksheets here.
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