DBT is a successful therapy that was created to relieve borderline personality disorder symptoms that make life unmanageable. However, others may also benefit from the therapy, and you don’t have to be at your doctors office to use it.
I designed this guide to be comprehensive, and customizable, so that it would suite each person’s individual needs. The idea to create it for myself came shortly after I searched every nook and cranny of the internet for one. I found a few reference sheets, but none of those provided explanations of how to use skills. While I am not a therapist by any means, the information found below came from a variety of credible sources. I simply broke it down into note cards and projects aid in the learning process.
The best advice I can give, based on the DBT blueprint, is to at least choose one or two from each category. Take into consideration your intentions for “on-the-go”, or to better explain, where you will be using it. Also, feel free to adapt the information in other ways. The important thing is to use them. I promise, you won’t be disappointed. I haven’t went to an actual therapist in months, but because I have my skills, I have actually be doing pretty well!
I hope you enjoy.
You Will Need:
- Scratch paper
- Note cards
- Craft objects like glitter, clue, markers, rhinestones, scissors
- A small and portable bag
- Various objects I will be listing throughout can be customized based on your own needs.
As you go through the following information, you will notice a note card for every almost every DBT acronym available. If it suits you to use some, and not others, that is fine. Just make sure that your kit contains at least one set of skills from each category because they work together to give you balanced therapy. Writing every single note is quite a bit of writing. Pick and choose the ones that call your name and then build a kit to go along with it. Once you have mastered those particular skills, create new cards that are based off skills you haven’t tried.
To begin, remember that DBT or dialectical behavioral therapy is composed of four skills.
- Interpersonal effectiveness
- Distress tolerance
- Emotional regulation
Studies show that DBT is effective in reducing a wide range of symptoms associated with Borderline Personality Disorder as well as other mental instabilities. From reducing suicidal behaviors, other forms of self-injury, psychiatric hospitalization, substance abuse, anger, drastic mood shifts, and has also aided many in developing deep and meaningful relationships.
Dr. Marsha Lineham developed the treatment herself after years of suffering from BPD. For more information regarding Ms. Lineham, you can watch the following video. In it, she explains the changes people have reported from her therapy. And if you don’t believe it, do a simple google seach or click on the embedded link here.
In this tutorial, I will explain how to put a kit together that will be small enough to go anywhere with you, however, I offer suggestions that allow you to decide what works best. For example, if your in a suit, and at a business function, it’s impossible to carry in a kit. Your “kit” can be entirely made up of note cards, a few hard candies, and a miniature, pocket sized object. It’s whatever you can use for the situations you encounter.
So Let’s Get Started!
Color a note card with a peaceful color. Now, write the following key words. You can simplify this part however you want as long as the words help you to remember the exercises.
Vision: Observe your surroundings and mentally take note of the textures of the wall, ceiling and floor. Mentally describe their colors and what they remind you of. Look at people and notice their demeanor.
Hearing: Whether outside or inside take note of all the sounds around you. Whether it’s the breeze outside rustling leaves, birds chirping, a noisy television or AC, observe and focus on it all.
Touch: If it’s plausible for you, you can take a tiny box, or cube of some sort. Blank all the surfaces out. Now, on each side, create a texture. You can glue glitter to it, use glitter to create a squishy effect, glue velvety fabric to one side, etc. Just make sure each side is different. You can also carry play dough in tiny tubs, or stress ball. If you can’t carry any of those, simply run your fingers over what you can. Just experience the true nature of touch. Focus. Be mindful of what it feels like.
Taste: Grab a cold or hot beverage, and slowly sip it. As it rolls around on your tongue describe every flavor in your mind. Accurately explain the temperature as well. If no drinks are available, pack a textured candy, or liquid filled candy. Chew some gum. Just experience it. Note the textures, flavors, and even the scents that help you to understand the flavor.
Smell: Breathe in through your nose. What do you smell? Is someone cooking? Are you outside? Do you smell rain? Or flowers? Or animals nearby? Note every detail.
On another card, once again, color it with a soothing color. Write “Meditation Card”. Keep in mind that I understand that you can’t always meditate on the go. However, meditation can be as simple as closing your eyes, focusing on nothing except breathing, and clearing your mind.
1. Find a quiet place, or block outside sounds. Ignore distractions or move away from them if possible.
3. Breathe in through your nose. Out through your mouth. As you do this, focus your entire mind on breathing.
4. Your thoughts will wonder, but that’s ok! Accept the thought without judgement. As an example of you think “what should I cook for dinner?” Don’t answer it or judge the thought, simply say to yourself well there’s a thought. Pull your attention back to breathing.
6. Practice as long as possible and open your eyes.
Emotional Regulation Skills
- Identify, label, functions of emotions
- Mindful to emotions
- Check the facts of emotion responses
- Behavior chain analysis
- Problem Solving
- Pros and Cons
- Opposite action to emotional urges
- Respecting emotions
- Managing extreme emotions
Grab a note card. Write Emotional Regulation at the top. List the following:
- Next, list emotions you battle with most under emotion. As an example, let’s say it’s anger.
- Under action, write your usual response. So, for me, when I get angry, I bottle it all up, and then blow up, or drop hints.
- Under opposite, write the opposite of your answer. Instead of bottling it up and exploding the opposite would be saying how I feel and why I feel that way calmly.
- This is the action you should take.
Distress Tolerance: Soothing
At the top of a note card,write Distress Tolerance: Soothing
- For each of the five senses, write down what you can do on the go to soothe yourself. Remember, they have to be things you can actually do wherever you are going. You can also list different things, for different on the go situations. That way the cards can be used at the supermarket, on vacation, or at work. While you can go for a brisk walk on vacation, or step outside for a break at work, you may be somewhere confined to a room (like a meeting) list skills that work for you.
- Also, you can pick one out of five, two out of five, or five out of five. The object is to soothe yourself in a situation in which you have become overwhelmed with your emotions and need to unwind before moving forward.
- Vision: If you can, carry something in your kit that is visually appealing to you. A trinket, a picture, something glittery, etc. For me, I love miniatures. So, I always have one in my kit, along with a crystal. If you can’t carry anything, if you can step outside, do it. Look at flowers, or the sky. If you are in a room and can’t leave, just keep a pleasing photograph with your note card, or come up with whatever will soothe you.
- Hearing: In a technological age, its likely you have a smartphone. Keep a small headphones set in your kit. When you can, pop them in, and play soothing music. Or, if your outside, listen to water flow, the wind blow, and birds chirp. If you can’t do anything else, go to the restroom, run some water, close your eyes and imagine a waterfall. Get creative.
- Scent: If you are able to, carry a small perfume bottle, note card sprayed with a comforting scent, or a scented marker. Sometimes, I carry chap stick in mine that smells like pumpkin pie. It comforts me.
- Touch: I always carry a small stuffed animal, a stress ball, something squishy, or something soft with me on the go. As long as it works for you, go with it. Cloth is also helpful, and if you can sew, make a tiny quilt to carry.
- Taste: Pack a favorite treat. When the moment strikes, take a moment to enjoy it. Whether its a rich chocolate candy, a banana, a comforting meal on the go, or just a nice (just one…lol) glass of wine. It’s up to you.
Distress Tolerance: Distraction
Distraction techniques are used in situations that leave you so overwhelmed that if you reacted you would risk making a bad decision. Due to this, distraction allows you to focus your attention elsewhere, until you are calm enough to face this situation.
Get a note card, and title it as the title of this section reads. Now begin listing, as you do it, the beginning letter of each word will vertically spell out the word accepts.
- Activities: A fun idea that can be used in many circumstances, is to carry a miniature activity with you. Bookstores, like Books a Million have racks where they have a mini-kit for nearly anything. I’ve seen Alice In Wonderland Tea Sets, miniature herb gardens, miniature origami kits, and miniature tarot card decks. They are pretty cheap, too. Most are $10 and under. However, you don’t have to buy one, you can even make one. Get a tupperwear bowl that’s small enough for you kit. Put some sand in it, and a small branch. Add a few stones. Viola’ you now have a Zen garden on the go.
- Another good idea, is to have a book with you, or a notebook to doodle or make lists.
- Contributing: If you are at a family event, help someone set up for clean up. If your in the store, and notice someone who needs help, or notice that the person keeps initiating conversation, begin socializing with them, and help. Call someone up that you love just to talk. Help a coworker who is buried in work. The idea is to focus your attention on the needs of others to distract yourself from your emotions momentarily.
- Comparisons: Take a moment to compare your current situation to a past situation that was much worse than your current one. Or, compare the situation to the fact that it could be worse.
- Emotions: Are you sad? Do something that will make you happy. Angry? Do something that calms you. I wrote down the most prevalent negative emotions I encounter day to day.Next to each one I wrote something I could do to combat it.
- Anger: When I am angry, laughing helps a lot. So, I write down funny memories that I can’t help but laugh out loud when remembering.
- Depression: When I am sad, doing something to create order helps. I even write down my thoughts sometimes, to clear my mind. Like a therapist on paper. So for me, carrying a small notebook and pen would be perfect. Other good ideas are to carry inspirational quotes, letters from loved ones, and to even carry a favorite flower.
- Anxiety: To relieve anxiety, I usually just need to walk away, or separate myself from the situation. Many times, I walk to the bathroom, sit on the toilet, breathe, get up, wash my hands, splash my face with cool water, and remember that it’s not as bad as I think. Usually, my anxiety stems from social situations. I have to remind myself that worrying that people might be hostile, or judgmental is silly.
- Jittery Frustration:When I become stressed, I get shaky, and start rushing. I stumble words, sweat and begin feeling flushed. When this happens, cool air, and big breaths help a lot. I also have to implement mindfulness, and slow down. It doesn’t take long to regain my composure in this manner.
- Pushing Away: Pushing away is a visualization exercise that can be done anywhere. It is done by visualizing whatever uncomfortable emotion is plaguing you shifting away. If someone has angered you, imagine them shrinking away. If you are frustrated due to a work issue, imagine it becoming obtainable so that it is so easy, you finish it with no problem.
- Sensations: Distractions accomplished by physical sensations can be powerful. If you can sew, make yourself a small voodoo doll to carry around. When you become frustrated, poke it with pins. Wear a rubber band on your wrist and pop it. Go to the bathroom, and splash cool water on your face. Write a letter to someone that has bothered you, and tell them off just like you wish to do. Burn the letter.
Distress Tolerance: Improve the Moment
You know the drill, grab a new note card and slap a pretty title on it. This is another useful acronym, so make sure it spells “Improve” vertically after you have finished. It aids in memorizing the skills.
- Imagery: Use your imagination to imagine that you are in a better situation. Imaging a situation in which everything will go okay, or a situation that you encountered a crisis and were successfully able to resolve it.
- Meaning: In hindsight, many crises or conflicts that we have endured in the past teach a valuable lesson for the future. If you are religious, or simply believe in God, ask him how you can grow from this situation. Ask what he needs for you to experience because of this crisis.
- Prayer: Whether you believe in God, a spirit of the universe etc., take a moment to talk to that entity regarding your current situation. Ask for guidance, faith, strength, and wisdom. Get everything off of your mind off of it, and don’t forget to be thankful as well.
- Relaxation: When stressed, many people tighten up their muscles reflexively, or even hold their breath. Take a moment to release those muscles, and breathe.
- One thing in the moment: While it may be easy to look back at similar situations in the past, and think, “this always happens to me!” Or “why didn’t I do _____ so this wouldn’t have happened.” Don’t do that. Stay in the present.
- Encouragement: Encourage and motivate yourself. Positive thinking makes all the difference, and if you aren’t cheering for you, who is?
Get a separate card. Write Interpersonal Relationships: Express Desires Competently
List each word beginning with an acronym letter in a way in which is vertically spells DEARMAN
- Describe: Be specific about your wants and needs when expressing them.
As an example, instead of saying I need help. Replace with I need you to wash the dishes to help me.
- Express: Be clear when you express feelings. I feel _____ because _____.
I feel anxious because we haven’t spoken much lately.
- Assert: Don’t drop hints when you are explaining something to someone.
“It’s important that we go grocery shopping at 4:00 pm sharp, because I have an appointment.”
- Reinforce: When someone does what you want, or are considerate of you, be thankful! Say thank you!
- Mindful: Remember the point of the conversation, and stick to it. If you are discussing bills, don’t bounce to what you want for dinner. Digressing can become frustrating and prevent you from making important points in conversation.
- Appear: Check your posture, body language, tone of voice and eye contact.
- Negotiate: Offer to resolve issues by compromising. For example, “I’ll cook dinner tonight while you watch your favorite show, if you wash the dishes after dinner so I can watch mine.”
Interpersonal Effectiveness: Relationship Effectiveness
Title another note card exactly as the section is titled. Then, spell the acronym vertically, and write down the helpful phrase that follows for easy remembering or for quick reference.
- Gently: Don’t attack, threaten or judge.
- Interested: Give the other person your undivided attention. Instead of waiting for your moment to speak, listen to them entirely with no intention to respond and do not interrupt.
- Validate: Acknowledge that you understand what they are feeling and that what they are feeling is valid. Also, if you know that their feelings are based on how you are acting, acknowledge that as well.
- Easy: I have borderline personality disorder, and because of that, calming down isn’t my strong suit. However, everything is not so serious that I have to stay constantly wound up. Being that way would be unpleasant to others. Just let the moment pass, be easy about it, and breathe.
Interpersonal Effectiveness: Self Respect
- Fair: Be fair. Even to yourself. You are human, and you deserve to be treated fairly and to be understood for your ability to make mistakes, overreact and act irrationally at times. Understand that and move on.
- Apologies: Saying sorry when you are wrong is one thing, but don’t apologize when you haven’t done wrong, don’t apologize for asking, and don’t apologize for having a different opinion.
- Stick to Your Values: Never change your values or sacrifice them to fit in with others.
- Truth: Don’t exaggerate, act helpless in order to manipulate others, play the victim, or lie. Period.
The following skills are somewhat random, and belong to a sort of miscellaneous category. There are very valuable and will work nicely as a filler for your new DBT toolbox.
Miscellaneous DBT Skill Projects
On the next card, we will do another acronym spelling Please. I am sure you are tired by now, and that’s okay. Take a break, and split the project up. Once you finish this activity you will not only better understand DBT skills, but you will also have a portable tool box of flash cards and other therapeutic belongings that you can take anywhere.
Eat balanced meals
Avoid mind altering substances
Sleep enough to give your body adequate rest
Emotional Regulation: Vitals to Success
Title your note card, and begin writing the following on it.
- Validate: You don’t have feelings and emotions for no reason. Due to this, accept that you aren’t wrong for feeling the way you do. Explore the situation further in order to better understand how to handle the situation. Don’t judge or be too hard.
- Imagine: Imagine yourself accomplishing the task ahead peacefully and successfully. Take a moment to go through each step of the process in your mind through visualization.
- Take Small Steps: Break the project down into smaller steps. Make the goals achievable with time constraints that can be obtained. You don’t have to be perfect, just make progress.
- Applaud Yourself: Take a moment to celebrate your success in your endeavor before moving forward. You earned it!
- Lighten the Load: Once this project has been completed, how will it effect your life? Will you have less stress, better grades, a promotion at work, a new hobby mastered? Will accomplishing it remove some negativity currently residing in your life.
- Sweeten the Pot: Reward yourself during the project, and after. Reward your efforts, your progress, and your growth.
Reality Acceptance Skills
On this card, write the following:
- Radical Acceptance: Radical acceptance means that you accept reality for what it is, understand that everything has a cause, and realize that life is still good even in times of pain.
- Turning the Mind: Turning the mind is like going to a fork in the road, with one side accepting and the other rejecting, and choosing the accepting side time and time again.
- Allowing the world to be as it is
- Agreeing to participate in the world as it is
- Actively participating in reality
- What you need to overcome a threat
- Saying no, no, no
- Pushing away
On the back of the card, or starting on another, write:
Creating Smart Goals
Personally, I feel like this card is one of the best. Many have said that people suffering from personality disorders have a hard time setting goals and creating clear plans for their lives. I tend to disagree.
- Specific: What exactly will your goal accomplish?
- Measurable: How will you know when your goal has been completed?
- Achievable: Is it possible for your goal to be accomplished? Will it be worth the time, money and effort?
- Relevent: Is this goal significant to you?
- Timeline plan: When will this goal be achieved?
Behavior analysis is unique, as it provides you with the ability to understand your behaviors in a better light.
While it may be too much to put on a card, this is good information to print, and store with information regarding your treatment.
- Name the behavior
- Prompting event
- Rate intensity level
- Not the duration
- List vulnetabilities
- Behavior links: actions, body, sensations, thoughts, events, feelings.
- Short term positive effects
- Long term negative effects
- Replace problematic links with skills
- Apply skills until you find what works for you.
While there is quite a bit of information contained within this article, it won’t take long at all to begin the process of creating your own personal toolbox at home. During the process of creating the toolbox, even if you had very little knowledge regarding DBT before, you will walk away understanding an entire set of useful skills. Furthermore, because you were able to go through a comprehensive list of skills and their definitions, you are able to customize your toolbox to fit YOUR needs.
Why is that important?
There are nine symptoms for BDP and anyone who has at least five out of nine qualified for the diagnoses. Due to that, there is a limitless amount of combinations of traits that make up a BDP patient. While you may feel suicidal, self-harm, act spontaneously and fear abandonment, another patient may have an entirely different combination. And that isn’t a bad thing, either. We are human beings, that are unique in our very nature. Why should our illness and it’s treatment be any different? And this isn’t just ANY treatment, it’s a treatment that had actually brought patients to recovery time and time again. Please let me know if this helped you, I’d love to know that my viewers were able to benefit from my work.