Marsha Linehan pioneered Dialectical Behavioral Therapy (DBT) in the late 1970s, aiming to address the complex mental health challenges faced by women, often involving multiple concerns such as suicidal risk. DBT encompasses various components, including individual therapy, skills group therapy sessions, and weekly team consultations. A typical DBT treatment plan can span from six months to a year. Discover below 15 DBT activities and exercises that can be incorporated into therapy sessions with your clients.

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Effective DBT treatment includes 5 characteristics (Chapman, A.L., 2006). Chapman identified the following characteristics:

• Enhancing the client’s capabilities- This can include dialectical behavior therapy exercises focusing on emotion regulation skills, mindfulness practices, improving interpersonal effectiveness, and learning distress tolerance skills
• Generalizing goals that can apply to day-to-day 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.
• Using structure to avoid reinforcing negative behaviors
• Providing therapists with support, validation, continued training, and skills building to promote effective counseling- DBT is often used with clients who have a history of trauma and significant impairment from their mental health concerns. It is important to make sure that Counselors and Therapists are receiving the support they need so that they can provide effective therapeutic interventions.

Why DBT?

Dialectical Behavioral Therapy (DBT) is a specialized form of cognitive-behavioral therapy that is particularly well-suited for individuals who experience emotional dysregulation, self-destructive behaviors, and difficulty managing intense emotions. There are several compelling reasons why DBT may be chosen as a preferred treatment option:

1. Effective for Emotion Regulation: DBT is specifically designed to help individuals better understand, tolerate, and regulate their emotions. It provides practical skills for managing intense emotional states, which is particularly valuable for conditions like borderline personality disorder (BPD).
2. Evidence-Based: DBT is backed by substantial research and clinical evidence supporting its effectiveness for a range of conditions, including BPD, self-harm, suicidal ideation, substance use disorders, and eating disorders.
3. Comprehensive Approach: DBT offers a comprehensive approach to therapy, encompassing individual therapy sessions, group skills training, phone coaching between sessions, and therapist consultation teams. This multifaceted approach provides ongoing support and skill-building opportunities.
4. Mindfulness Emphasis: DBT incorporates mindfulness techniques, which help individuals stay grounded in the present moment, reduce reactivity to emotions, and make healthier choices in challenging situations.
5. Dialectical Thinking: DBT introduces dialectical thinking, which encourages individuals to find a balance between seemingly opposing ideas or perspectives. This can lead to more adaptive problem-solving and decision-making.
6. Suicide Prevention: DBT includes a strong focus on suicide prevention. It equips individuals with skills to reduce self-destructive behaviors and suicidal thoughts and provides a safety net through phone coaching with therapists.
7. Acceptance and Change: DBT emphasizes the importance of both acceptance and change. Clients learn to accept themselves and their current circumstances while also working toward positive changes in their lives.
8. Customized Treatment: DBT is highly adaptable and can be tailored to address a wide range of mental health issues, making it suitable for clients with complex and comorbid conditions.
9. Enhanced Interpersonal Skills: DBT includes modules on interpersonal effectiveness, helping individuals improve their communication and relationships with others.
10. Long-Term Benefits: Research indicates that DBT can lead to long-lasting improvements in emotional well-being and overall functioning, even after the completion of therapy.
11. Empowerment: DBT empowers individuals to take control of their lives and make informed choices that align with their values and goals.
12. Holistic Approach: DBT recognizes the interconnectedness of thoughts, emotions, behaviors, and relationships and addresses these aspects in a holistic manner.

While DBT is highly effective for many individuals, it is important to note that therapy is a personal journey, and the choice of DBT or another therapeutic approach should be based on the individual’s unique needs and preferences, as well as the expertise of the therapist. DBT may be particularly beneficial for those who struggle with emotional dysregulation and self-destructive behaviors. Keep reading to learn 15 DBT activities and exercises you can do with your clients.

What Conditions Can DBT Treat?

While DBT has been widely accepted as an effective treatment for borderline personality disorder, research has shown that DBT is an effective treatment for a variety of other mental health concerns. Mental health concerns that can benefit from DBT include:

• Anxiety
• Depression
• Eating Disorders, including binge eating disorder
• Post-traumatic stress disorder
• Self-harm
• Suicidal behaviors

List of DBT Activities and Exercises to do With Your Clients

Dialectical behavior therapy activities can be an effective way to introduce various skills to your client, and encourage them to use the skills they learn outside of sessions.

Examples of DBT exercises that you can incorporate into your individual or group session include:

1. The GIVE skill is an additional interpersonal effectiveness skill that can help your client improve their communication. You can use a recent conversation that your client feels could have gone better and see where they could make changes based on the GIVE skill. Allow time to explore any situations where your client was able to apply this skill outside of the session. Our GIVE Skill worksheet can help your clients with this skill.
2. Introduce your client to the How Skill. This skill encourages your client to not judge the situation as “bad” or “good” or have a “right” or “wrong” response. Clients are encouraged to be present at the moment, and not to worry about how the future would be impacted. Lastly, the client should be encouraged to do what works, without worrying if it is “right”. Encourage your client to focus on their desired outcome. Allow for time to follow up regarding their ability to use the How Skill outside of the session.
3. Spend time exploring the use of our senses. Bring a leaf into 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 happened and come back to the leaf. After the five minutes, process their experience. Based on their engagement in the exercise, provide them with feedback about how they can further engage their senses in mindfulness exercises.
4. Introduce your client to the acronym TIPP. This is a distress tolerance skill that can help them cope with distressing or overwhelming emotions at the moment. Allow for time to follow up about their ability to utilize this distress tolerance skill in later sessions. Our TIPP Skill Worksheet can help your clients with this skill.
5. Introduce your client to radical acceptance statements and discuss how they can be used to cope with distress. Use a recent challenge of theirs to explore how radical acceptance statements can be applied. Encourage your client to try using these statements when they become distressed and be aware of how they impact their level of distress.
6. Introduce your client to the idea of meditation, and explore their current understanding of what meditation entails. Clients may not have a full, or correct, understanding of meditation and what to expect. You can discuss different forms of meditations including guided imagery and progressive muscle relaxation. Be mindful of your client’s mental health before introducing mindfulness- individuals with trauma may not benefit from the use of meditations. Follow up with your client about their ability to engage in a mindfulness practice outside of the session and how it impacted them.
7. Boundaries are a vital part of healthy relationships. Spend time exploring components of healthy boundaries and ask your client to identify a relationship that they feel could benefit from new or enforced boundaries. Roleplaying can be an effective tool that allows clients to practice difficult conversations and situations they may experience regarding healthy boundaries. Follow up regarding their ability to improve the boundaries they choose to work on.
8. Spend time talking about the role that self-talk can have on our well-being. Explore your client’s self-talk, and explore changes that they could make to show themselves more kindness, compassion, and encouragement than they may be doing at this time. Encourage them to be mindful of their self-talk outside of the session, and notice how they feel when they make positive shifts to it.
9. Introduce your client to the concept of a thought challenge. Using a recent challenge, they have experienced, walk them through the process of a thought challenge, taking your time to ensure that they understand the steps. Encourage your client to practice thought challenges outside of the session and use a thought challenge worksheet to document their experience to review in their next session.
10. Talk with your client about self-soothing skills that use their five senses. This can help your client incorporate mindfulness into their coping skills. Providing your client with a worksheet, such as the DBT self sooth worksheet one available at TherapyByPro, can serve as a reference for your client outside of the session. Allow for time to follow up about your client’s ability to use their self-soothing skills and evaluate their effectiveness in later sessions.
11. While in session, ask your client to eat a raisin (or another similar food item) which requires your client to stay focused on the present moment. Ask them to explore the raisin using their five senses. When the exercise is complete, ask them if their mind was wandering, and how they felt throughout the exercise. This can help reinforce the benefits of being in the present moment.
12. Introduce your client to the three states of mind that we have; the emotional mind, the logical mind, and the wise mind. The wise mind uses both, our emotional and logical mind, and adds in our intuition. In the session, work through a recent session by looking at the three minds, and the way the challenge unfolded. Encourage your client to try and use their wise mind when they experience challenges outside of the session. Some clients may benefit from having a Wise Mind worksheet template, like the one available at TherapyByPro, to serve as a guide.
13. Introduce your client to the ABC PLEASE skill. This skill focuses on taking care of ourselves which can decrease our chances of struggling with an emotional crisis. When you introduce these skills, evaluate your client’s current behaviors regarding the actions discussed, and how they think they could improve their current behaviors. Allow for time to follow up on their applied changes in a later session. Check out our ABC PLEASE worksheet.
14. Introduce your client to the DEARMAN skill. This skill would be beneficial for individuals who can benefit from focusing on their interpersonal effectiveness, and improving their communication patterns. Use a recent challenge to walk through the skill as an example in the session. If your client would benefit from having a handout to walk them through the skill, TherapyByPro offers a thorough DEARMAN Assertive Communication worksheet. Allow time to follow up with your client’s ability to practice this skill outside of the session.
15. Spend time engaging in a body scan exercise. You can begin with their toes, and work your way up to the top of their head. Ask the client to be aware of how their clothes feel, what their body is touching, how their clothes feel, if they feel warm, etc. When the body scan is complete, allow time to process their experience. Ask your client what they learned about their body at that moment that they were unaware of before. As an example, maybe they noticed that they were holding tension in their shoulders or jaw that they were unaware of before. Explore how their physical sensations relate to their emotions and thoughts.

Final Thoughts on Selecting DBT Activities for Your Clients

Thank you for reading this resource on 15 DBT Activities and Exercises to do with your Clients in Therapy. With the proper training and experience, DBT activities can be an effective treatment for clients who are living with a range of mental health concerns. There are many aspects of DBT that can be applied to individuals with an array of mental health concerns and challenges. Being able to tailor DBT exercises to your individual client, or group of clients can help you provide a customized approach to your work.

If you are able to practice using these skills yourself, you would likely be able to improve the way that you introduce, explore, and talk about the DBT exercises you share. This can include breathing exercises and meditations. Supervision can be a wonderful time to explore your experiences with DBT skills and to practice your approach to introducing skills in sessions. 

TherapyPatron.com helps mental health professionals better serve their clients. Our (editable, fillable, printable PDF) therapy worksheets can help you streamline your practice, effectively deliver different types of therapy, and support your clients be the best version of themselves.

Resources:

• Chapman, A.L. (2006). Dialectical behavior therapy: Current indications and unique elements.
• Psychiatry,3 (9), 62-68. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963469/

Author: Kayla VanGuilder, MA, LCMHC

Kayla is a Mental Health Counselor who earned her degree from Niagara University in Lewiston, New York. She has provided psychotherapy in a residential treatment program and an outpatient addiction treatment facility in New York as well as an inpatient addiction rehab in Ontario, Canada. She has experience working with individuals living with a variety of mental health concerns including depression, anxiety, bipolar disorder, borderline personality disorder, and trauma.