15 Dialectical Behavior Therapy (DBT) Exercises & Activities to do with your Clients in Therapy

Dialectical Behavioral Therapy was developed by Marsha Linehan in the late 1970s with the intention of treating women who were struggling with more than one mental health concern, often including suicidal risk. The framework for DBT typically includes a combination of individual therapy, skills group therapy sessions, and team consultations each week. A DBT treatment plan can last from 6 months to a year. keep reading to learn 15 Dialectical Behavior Therapy Exercises and Activities you can do 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.

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:

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

List of Dialectical Behavior Therapy Exercises & Activities

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. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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. 
  7. 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.
  8. 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.
  9. 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. 
  10. 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.
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  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 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 an online mental health directory that connects mental health pros with clients in need. If you’re a mental health professional, you can Join our community and add your practice listing here. We have assessments, practice forms, and worksheet templates mental health professionals can use to streamline their practice. View all of our mental health worksheets here.

View all of our Dialectical Behavior Therapy Worksheets

Resources:

DBT Activities for Clients FAQs

What is the most effective DBT skill?

It's difficult to say which DBT skill is the most effective as different skills may be more helpful for different individuals depending on their unique circumstances and challenges. However, some of the most commonly used and effective DBT skills include: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness. Ultimately, the most effective DBT skill will vary from person to person based on their individual needs and goals in therapy. It's important to work closely with a trained DBT therapist to determine which skills will be most helpful for you.

What order should I teach DBT skills?

When working with clients in DBT, the therapist will typically start by addressing the most urgent and problematic behaviors first, before moving on to less severe behaviors. This means that if the client is engaging in life-threatening behaviors, such as suicidal or self-injurious behavior, the therapist will prioritize addressing these behaviors first and foremost. Once the individual is safe and stable, the therapist will work with the individual to address therapy-interfering behaviors and improve their engagement in the therapy process. From there, the therapist will work with the individual to address quality of life behaviors and teach them DBT skills that will help them manage their emotions, regulate their behavior, and improve their relationships with others. It's important to note that the hierarchy of treatment priorities in DBT may need to be adjusted based on the individual's unique circumstances and needs. It's important to work closely with a trained DBT therapist to determine the best course of treatment for your unique situation.

What DBT skills work for anxiety?

Dialectical Behavior Therapy (DBT) includes several skills that can be helpful for managing anxiety. Here are some examples: Mindfulness skills, Distress tolerance skills, Emotion regulation skills, Interpersonal effectiveness skills. It's important to note that the specific DBT skills that are most helpful for managing anxiety can vary depending on the individual's unique circumstances and needs. It's important to work closely with a trained DBT therapist to determine which skills will be most helpful for you and to receive guidance on how to effectively implement these skills in your life.

What DBT skills are used for depression?

DBT therapy employs four techniques to aid with emotional dysregulation, which is a common symptom in depression. These four techniques include mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. By utilizing these techniques, DBT therapy aims to help individuals develop effective strategies for managing difficult emotions and improving their overall emotional well-being.

Kayla Loibl, MA, LMHC
Author: Kayla Loibl, MA, LMHC

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.

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