DBT® Skills Training Handouts and Worksheets, Second Edition

Book Preface

Since the publication of the original Dialectical Behavior Therapy (DBT) skills train-ing manual in 1993, there has been an explosion of research on the applications of DBT across disorders. My pilot and first DBT study focused on the treatment of highly suicidal adults. Now, we have research demonstrating the efficacy of DBT skills training with suicidal adolescents, as well as adults with borderline personal-ity disorder, eating disorders, treatment-resistant depression, substance use, and a variety of other disorders. A diagnosis of a mental disorder is not required, however, to benefit from DBT skills. Friends and family members of individuals with difficul-ties will find these skills helpful; kids in elementary school through high school can gain from these skills. Businesses will find DBT skills useful in creating better work environments. All the DBT therapists I know practice these skills in their own lives on a routine basis. I myself am grateful for the skills because they have made my life a lot easier. As someone once said to me, “Aren’t these skills your mother was sup-posed to teach you?” I always say yes, but for many people their mother just did not or was not able to get around to it.

I developed many of the skills by reading treatment manuals and treatment lit-erature on evidence-based behavioral interventions. I reviewed what therapists told their patients to do and then repackaged those instructions in skills handouts and worksheets and wrote teaching notes for therapists. For example, the skill “oppo-site action” is a set of instructions based on exposure-based treatments for anxiety disorders. The major change was to generalize the strategies to fit treatment of emo-tions other than anxiety. “Check the facts” is a core strategy in cognitive therapy interventions. The mindfulness skills were a product of my 19 years in Catholic schools, my training in contemplative prayer practices through the Shalem Institute’s spiritual guidance program, and my 35 years as a Zen student—and now Zen mas-ter. Mindfulness of current thoughts also draws from acceptance and commitment therapy. In general, DBT skills are what behavior therapists tell clients to do across many effective treatments. Some of the skills repurpose entire treatment programs now formulated as a series of steps. The new “nightmare protocol,” an emotion regulation skill, is an example of this. Other skills came from research in cognitive and social psychology. Still others came from colleagues developing new DBT skills for new populations. As you can see, these skills came from many different sources and disciplines.

I am happy to present this skills training manual for clients, which includes all of the handouts and worksheets I have developed so far in DBT. (Stay tuned for more.) You are not likely to need to use all of the skills I have included. Every skill works for someone and no skill works for everyone. The skills in this book have been tested with a huge variety of people: adults, adolescents, parents, friends, and families, both high risk and low. I hope the skills are just what you need. Use your interpersonal skills (see the DEAR MAN GIVE FAST skills in the Interpersonal Effectiveness skills module) to talk your skills trainer or other teacher into teaching you skills not ordinarily covered in skills training if you want to learn them. If you should decide to venture forth on your own, I must tell you that we have no research on the effectiveness of this skills manual as a self-help workbook or self-treatment manual. I am hoping to write a self-help treatment book in the future, so keep your eyes open for that. Meanwhile, you might be interested in the skills videos avail-able through The Guilford Press or The Linehan Institute and listed on page ii of this manual. They themselves do not constitute treatment, but we know that many people have nonetheless found them useful, even though we have not collected data on them. On your own or with the help of a skills teacher, I wish you skillful means.