DBT Problem Solving Worksheet: A Structured Dialectical Approach to Behavioral Change

The DBT Problem Solving Worksheet guides clients through a comprehensive 5-page clinical process. It begins with “Defining the Problem,” where clients separate the factual situation from their emotional responses, including the identification of primary and secondary emotions. This distinction is vital for determining whether the problem requires a change in the situation or a change in the emotional response (emotion regulation). The worksheet then moves into “Developing Solutions,” encouraging a broad brainstorming phase to bypass the rigid “all-or-nothing” thinking common in crisis states.

The middle phase of the worksheet focuses on “Evaluating Your Options” through a structured Pro/Con analysis and a ranking system. This ensures that the chosen solution is selected based on effectiveness rather than immediate emotional relief. The final sections, “Taking Action” and “Reviewing,” emphasize behavioral follow-through. By documenting specific implementation steps and warning signs, the client creates a “pre-planned response,” which significantly increases the likelihood of skillful behavior in the heat of the moment.

How This Worksheet Can Be Used

During sessions:
Clinicians use the worksheet to conduct a formal “Solution Analysis” after a Chain Analysis has been completed. It helps the therapist and client move from understanding why a behavior occurred to planning how to prevent it in the future.

Between sessions:
Clients use the worksheet as a homework assignment to manage real-world stressors. It serves as a “skills coach in a box,” guiding the client through the steps of effective problem-solving when the therapist is not present.

In Skills Training Groups:
This tool can be used to practice the “Interpersonal Effectiveness” and “Emotion Regulation” modules, specifically for situations where a client needs to change an environment or solve a conflict to reduce emotional vulnerability.

Benefits of the DBT Problem Solving Worksheet

• Shifts clients from emotional reactivity to a structured, “Wise Mind” problem-solving orientation.
• Differentiates between primary and secondary emotions to clarify the focus of the intervention.
• Uses Pro/Con analysis to evaluate the long-term effectiveness of potential solutions.
• Includes a detailed “Action Plan” with specific steps and triggers to improve behavioral follow-through.
• Features a “Review” section to facilitate experiential learning and refine future coping strategies.
• Supports the DBT “Change” strategies by providing a manageable pathway for situational modification.

Integrating This Tool into Clinical Work

Integrating the DBT Problem Solving Worksheet is most effective when the clinician helps the client distinguish between “solving the problem” and “accepting the problem.” In DBT, if the problem is a situation that can be changed, this worksheet is the primary tool. If the situation cannot be changed, the clinician should pivot to radical acceptance or distress tolerance. When using this worksheet, clinicians should encourage “brainstorming without judgment”—reminding the client that even “bad” ideas should be listed initially to open up cognitive flexibility. The “Reviewing” section is the most important for long-term growth; by analyzing why a solution did or did not work, the client develops a more sophisticated understanding of their environment and their own capabilities, which is foundational to building self-efficacy.

References

• Linehan, M. M. (2014). DBT Skills Training Manual (2nd ed.). Guilford Press.
• Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. Guilford Press.
• Koerner, K. (2012). Doing Dialectical Behavior Therapy: A Practical Guide. Guilford Press. (Focusing on the problem-solving and change strategies of DBT).
• D’Zurilla, T. J., & Nezu, A. M. (2007). Problem-Solving Therapy: A Positive Approach to Clinical Intervention. Springer Publishing Company.