Dialectical Behavior Therapy (DBT) is an evidence-based therapy approach developed by psychologist Marsha Linehan in the late 1970s. DBT was originally created to support individuals experiencing chronic suicidal thoughts and behaviors associated with borderline personality disorder, but research has since supported its use with a wide range of mental health concerns involving emotional dysregulation, impulsive behaviors, self-harm, interpersonal difficulties, and challenges managing intense emotions. Keep reading to learn 15 DBT activities and exercises you can do with your clients in counseling sessions.
At its core, DBT focuses on helping clients develop practical skills to balance acceptance and change. Through DBT skills training, clients learn strategies related to mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness that can help them respond to difficult emotions, navigate relationships, and improve overall quality of life.
Comprehensive DBT programs typically include individual therapy, group skills training, between-session practice, and therapist consultation teams. However, many DBT activities and exercises can also be incorporated into individual counseling sessions to help clients practice specific skills, increase self-awareness, and apply therapeutic strategies to challenges they experience in everyday life.
Effective DBT treatment emphasizes helping clients build capabilities, generalize skills outside of therapy, increase motivation for change, and reduce behaviors that negatively impact their well-being. For clinicians, incorporating DBT-informed activities into sessions can provide structured opportunities to teach coping skills, strengthen emotional regulation, and support clients as they work toward meaningful goals.
For more valuable resources, view our DBT Tools and Resources hub
What Conditions Can DBT Help With?
Dialectical Behavior Therapy (DBT) was originally developed to support individuals experiencing borderline personality disorder (BPD) and chronic suicidal behaviors. Since its development, DBT has been adapted and researched for additional mental health concerns where clients may experience difficulties with emotional regulation, distress tolerance, impulsive behaviors, or interpersonal relationships.
DBT skills and activities may be incorporated into treatment with clients experiencing concerns such as:
- Borderline Personality Disorder (BPD): DBT has a strong evidence base for helping clients improve emotion regulation, reduce self-harm behaviors, and strengthen interpersonal effectiveness.
- Suicidal Behaviors and Self-Harm: DBT provides clients with coping strategies to manage intense emotional distress and develop alternatives to harmful behaviors.
- Eating Disorders: DBT-informed interventions may help clients build distress tolerance and emotion regulation skills related to eating-related challenges.
- Depression and Anxiety: DBT skills can support clients in managing difficult emotions, increasing awareness, and developing healthier coping strategies.
- Post-Traumatic Stress Disorder (PTSD): DBT-informed approaches may help clients strengthen emotional regulation and coping skills when managing trauma-related symptoms.
15 DBT Activities and Exercises
DBT activities provide practical ways to introduce clients to skills that enhance emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness. These exercises help clients practice new strategies in-session and apply them to real-life situations, fostering self-awareness, self-management, and healthier coping patterns. The following activities can be incorporated into both individual and group therapy sessions.
1. Self-Soothing with the Five Senses
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.
What It Is: Using your five senses to calm and center yourself in moments of distress.
How It Helps Clients: Encourages mindfulness, reduces emotional intensity, and promotes grounding.
How to Do It: Ask clients to identify ways to engage each sense (sight, sound, touch, taste, smell) for self-soothing. Provide a worksheet like the DBT Self-Sooth Worksheet from TherapyByPro for reference. Follow up in later sessions to assess effectiveness.
2. TIPP Skills
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.
What It Is: Distress tolerance skills focusing on Temperature, Intense exercise, Paced breathing, and Progressive muscle relaxation.
How It Helps Clients: Reduces emotional arousal during crises.
How to Do It: Practice each TIPP strategy in-session and discuss scenarios where it can be applied. Provide the TIPP Skill Worksheet for at-home practice.
3. Radical Acceptance Statements
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.
What It Is: Accepting reality fully without resistance to reduce suffering.
How It Helps Clients: Decreases distress from resisting circumstances outside of their control.
How to Do It: Identify a recent challenging situation and create acceptance statements (e.g., “It is what it is”). Encourage clients to practice using these statements in daily life.
4. ABC PLEASE Skills
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.
What It Is: A self-care skill set addressing physical and emotional needs to prevent crises.
How It Helps Clients: Enhances emotional stability and decreases vulnerability to dysregulation.
How to Do It: Review and evaluate clients’ current routines. Encourage consistent practice of actions that satisfy physical and emotional needs. Use the ABC PLEASE Worksheet for guidance.
5. Positive Self-Talk
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.
What It Is: Mindfully identifying and modifying negative self-talk.
How It Helps Clients: Increases self-compassion and reduces internal criticism.
How to Do It: Explore current self-talk patterns and guide clients to create kinder, more encouraging statements. Encourage daily awareness and practice.
6. Wise Mind Practice
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.
What It Is: Integrating emotion and logic to make balanced decisions.
How It Helps Clients: Reduces impulsivity and promotes thoughtful, values-aligned actions.
How to Do It: Identify recent challenges and evaluate responses using emotional mind, logical mind, and wise mind. Use the Wise Mind Worksheet for support.
7. How Skill
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.
What It Is: Responding effectively without judgment about the situation being “right” or “wrong.”
How It Helps Clients: Enhances problem-solving and reduces emotional reactivity.
How to Do It: Guide clients to focus on practical steps that work, staying present without judgment. Practice in-session and encourage real-life application.
8. Meditation and Mindfulness Practices
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.
What It Is: Using techniques such as guided imagery, body scans, or progressive muscle relaxation to enhance awareness.
How It Helps Clients: Promotes calm, reduces stress, and improves attention regulation.
How to Do It: Introduce meditation methods suited to clients’ needs. Monitor responses, particularly with trauma histories. Encourage at-home practice.
9. DEARMAN Skill
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.
What It Is: A structured approach to assertive communication in relationships.
How It Helps Clients: Improves interpersonal effectiveness and clarity in expressing needs.
How to Do It: Walk through a recent challenging conversation using the DEARMAN framework. Use the DEARMAN Assertive Communication Worksheet for practice.
10. GIVE Skill
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.
What It Is: A relationship-focused skill to improve communication with empathy and respect.
How It Helps Clients: Supports healthy interactions and strengthens relationships.
How to Do It: Identify a past conversation that could be improved and roleplay the GIVE skill. Encourage application outside of sessions with a worksheet.
11. Boundaries Exploration and Roleplay
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.
What It Is: Learning to identify and enforce healthy boundaries in relationships.
How It Helps Clients: Increases self-respect and prevents relational conflict.
How to Do It: Discuss boundaries, identify relationships that need attention, and roleplay scenarios. Follow up to review real-life application.
12. Thought Challenging
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.
What It Is: Identifying and reframing unhelpful or distorted thoughts.
How It Helps Clients: Reduces cognitive distortions and promotes balanced thinking.
How to Do It: Use a recent challenge as a case study. Guide clients step-by-step, and provide a Thought Challenge Worksheet for independent practice.
13. Raisin Exercise (Mindful Eating)
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.
What It Is: A mindfulness exercise using a small food item to enhance present-moment awareness.
How It Helps Clients: Teaches focus, reduces mind wandering, and cultivates sensory awareness.
How to Do It: Instruct clients to examine a raisin using all five senses. Discuss experience and reflections.
14. Senses Exploration
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.
What It Is: Mindfulness practice emphasizing sensory engagement.
How It Helps Clients: Strengthens grounding skills and present-moment focus.
How to Do It: Use objects like a leaf, guiding clients to notice texture, color, smell, etc. Normalize distraction and encourage redirection.
15. Body Scan
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.
What It Is: Mindful awareness of bodily sensations from head to toe.
How It Helps Clients: Increases awareness of tension, emotion, and mind-body connection.
How to Do It: Guide clients through a full-body scan. Discuss observations and how sensations relate to emotions or stress.
Frequently Asked Questions About Dialectical Behavior Therapy (DBT) Activities
Below are the practical questions clinicians ask when facilitating Dialectical Behavior Therapy (DBT) exercises and skills-building activities to improve emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness.
How should a clinician select between a somatic TIPP exercise and a cognitive-focused Radical Acceptance statement during an acute emotional crisis?
The choice depends entirely on the client’s current level of autonomic nervous system arousal. When a client is experiencing intense emotional dysregulation or an active crisis that pushes them past their cognitive threshold, clinicians should prioritize somatic TIPP skills like temperature changes or paced breathing to rapidly down-regulate the nervous system. Once the client’s physiological arousal drops back into their window of tolerance, they regain the cognitive capacity required to effectively process and implement reflective tools like Radical Acceptance statements to manage reality without resisting it.
What clinical adjustments should a therapist make if a mindfulness activity like a body scan triggers severe trauma dissociation?
If an internal mindfulness exercise activates overwhelming survival responses or flashbacks, the therapist should immediately halt the internal tracking and pivot to external five-senses grounding. Intentionally directing close attention toward bodily sensations can be highly threatening for individuals carrying unprocessed traumatic stress. The clinician can modify the intervention by using objects like the raisin exercise or a leaf for senses exploration, which anchors the client to concrete, external stimuli while preserving nervous system safety within the clinical space.
How does introducing a Wise Mind practice fundamentally differ from standard cognitive thought challenging during interpersonal conflicts?
While standard thought challenging focuses heavily on logically analyzing, testing, and restructuring cognitive distortions, a Wise Mind practice emphasizes the synthesis of both the logical mind and the emotional mind. During intense relationship friction, trying to dispute thoughts can feel cold or invalidating to a highly sensitive client. Wise Mind exercises guide the client to acknowledge their valid emotional experiencing while simultaneously utilizing logical facts and intuitive awareness to choose balanced, values-aligned actions rather than responding impulsively.
How can a therapist effectively utilize a daily DBT diary card or ABC PLEASE tracking log to minimize behavioral avoidance between sessions?
A daily diary card or ABC PLEASE worksheet serves as a structured self-monitoring framework that captures real-time data on emotional vulnerabilities and active coping attempts outside the clinic. Clients who struggle with chronic dysregulation frequently find it difficult to track how lifestyle habits—such as poor sleep or skipped meals—increase their vulnerability to emotional crises. Reviewing these tracking parameters at the start of each session exposes subtle avoidant habits, reinforces skill generalization, and provides clear empirical proof of incremental behavioral changes.
When utilizing interpersonal effectiveness tools like DEARMAN or GIVE in a role-play, how can a clinician address a client’s fear that assertiveness will damage their relationships?
Clinicians can address this hesitation by conducting an objective boundary exploration and clear objective-setting analysis before starting the simulated interaction. Many clients confuse assertiveness with aggression and worry that expressing their needs will cause abandonment or conflict. By utilizing a DEARMAN worksheet to break down the dialogue into distinct elements, the therapist helps the client balance their objective effectiveness with relationship mindfulness (GIVE skills), providing a safe container to practice direct communication while maintaining mutual respect.
Final Thoughts on Selecting DBT Activities for Your Clients
Thank you for reading this resource on 15 Dialectical Behavior Therapy Exercises and Activities 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.
TherapyByPro is a trusted resource for mental health professionals worldwide. Our therapy tools are designed with one mission in mind: to save you time and help you focus on what truly matters-your clients. Every worksheet, counseling script, and therapy poster in our shop is professionally crafted to simplify your workflow, enhance your sessions, reduce stress, and most of all, help your clients.
Want to reach more clients? We can help! TherapyByPro is also a therapist directory designed to help you reach new clients, highlight your expertise, and make a meaningful impact in the lives of others.
- Add Product to WishlistSale!
- Add Product to WishlistSale!
- Add Product to WishlistSale!
View all of our Dialectical Behavior Therapy Worksheets
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/