If you are experiencing suicidal thoughts or urges, call the 988 Suicide & Crisis Lifeline at 988 or text 988 to talk to a crisis provider over SMS. They are available 24/7 to offer support. 988 also provides an online chat for those with an internet connection.
Dialectical behavior therapy (DBT) was developed in the 1960s to support individuals living with intense emotions, suicidal ideation, and self-injurious behaviors. This modality has since been adapted to treat multiple mental health conditions, including personality disorders, depression, and anxiety. Here, we’ll explore the benefits of DBT and outline the plethora of resources therapists can utilize to learn more about this evidence-based modality and support their clients.
What Is Dialectical Behavior Therapy?
Dialectical behavior therapy is a modality developed by Marsha M. Linehan, Ph.D. Its aim is to treat mental health conditions with intense emotional symptoms, specifically borderline personality disorder (BPD). However, DBT can manage and treat many other symptoms and challenges in either group or individual formats. Some therapists may also offer DBT for couples and families.
DBT is a structured modality that seeks to teach each client the skills within the DBT workbook, helping them cope with challenging symptoms, emotional pain, and difficult situations. It involves four distinct modules, including the following:
- Mindfulness
- Interpersonal effectiveness
- Emotional regulation
- Distress tolerance
The mindfulness module discusses how mindfulness can help individuals ground themselves in the present moment. Next, the interpersonal effectiveness module teaches individuals how to communicate more healthily with those they love, set boundaries, form healthy relationships, and ask for favors. Finally, the emotion regulation and distress modules are focused on reducing distressing emotions, chronic stress, and unhealthy urges, such as an urge to harm oneself.
The Best DBT Resources For Therapists
Below are some of the most influential and evidence based DBT resources for therapists and their clients.
The Dialectical Behavior Therapy Skills Training Manual By Marsha Linehan
The official DBT Skills Training Manual by Marsha M. Linehan outlines tips for therapists using the DBT modality, including recommendations for group sessions and guidance for peer collaboration. This guide outlines each step of the training process, allowing you to take notes and highlight important takeaways throughout each session. If you work with groups, the workbook offers tips for ensuring group harmony and focus. It also gives ideas for working through various challenges like when one group member is progressing less than other participants.
The main goal of DBT is for clients to graduate and become proficient in the skills taught, so it can be essential for therapists to become proficient themselves before teaching the modules. When your clients graduate, you can use the suggestions offered in the book to celebrate their victories and offer follow-up support as needed.
The DBT Skills Training Handouts And Worksheets
As a follow-up to the official DBT training manual for therapists, the DBT Skills Training Handouts and Worksheets book was developed to allow clients to complete worksheets, take notes, and follow the training modules as the therapist teaches them. Therapists can also use this workbook to photocopy and print multiple worksheets for the groups that they lead.
Some therapists may request that all clients buy their own copy of the workbook so they can use it in sessions. However, this step may not be necessary if you’re not offering an intensive DBT class.
DBT Group Activities
Group activities are just one way to teach DBT skills in an interactive environment, allowing all clients to work together to understand a specific skill. Below are 20 group activities to try in group DBT sessions:
- Gratitude journaling
- Practicing self-soothing together
- An emotion theater to act out different emotions
- Creating collages
- Coloring mandalas
- Outlining dream boards for end-of-treatment goals
- A DBT-themed “escape room”
- Connecting emotions with physical sensations
- Complimenting each other
- Listening to a guided meditation
- Practicing setting boundaries
- Practicing saying “no”
- Practicing DEARMAN (asking for a favor)
- Visualization
- Creative journaling to recognize creative abilities
- Practicing the “participation” skill by having a “talent show”
- Mindfully eating a snack
- Setting goals
- Partaking in art therapy
- Creating a group poster with motivational statements
Group activities can be beneficial because they allow each client to participate in their own healing process while gaining social interaction and learning interpersonal effectiveness.
Guided Mindfulness Practices
Guided mindfulness practice can be an essential resource for offering DBT. Because a significant portion of the DBT modality is focused on mindfulness, it may be helpful to use mindfulness resources like books, apps, and guided audios to offer in session. Consider listening to new mindfulness audio recordings daily with your clients or suggesting certain apps so they can practice mindfulness on their own at home. You can use mindfulness printouts like worksheets and mandalas to help your clients become motivated to practice this skill outside of sessions.
DBT Workbooks For Specific Mental Health Conditions
The primary DBT workbook is not the only book available for training in DBT. Alexander Chapman wrote the Dialectical Behavior Therapy Skills Workbook for Anxiety, which targets specific symptoms of anxiety disorders. Another author, Ellen Strachan-Fletcher, created the Dialectical Behavior Therapy Skills Workbook for Bulimia, and other authors have created similar guides for conditions like bipolar disorder and depression. You may consider using these guides when you want to take a more specialized approach to treating specific mental health conditions.
Diary Cards
Diary cards are often a critical part of DBT engagement for clients. A diary card is a sheet that clients can use to track their mood daily using a scale. They can also make note of behaviors they would like to change. By tracking behaviors alongside mood, clients may be able to see which moods are connected to which behaviors. If your clients don’t like printouts, you can recommend an app like Daylio, a mood-tracking app that allows clients to customize their daily behaviors and moods and see them tracked on a graph throughout the month.
At the end of each session with your clients, you can go through their diary cards with them and point out which skills they excelled in and how their moods and behaviors have changed since they began therapy. Seeing their progress may remind them of the power of DBT and help them feel more capable of continuing the work after graduating from the modality.
Apps And Software
Several apps have been developed to support therapists and clients in practicing DBT skills, remembering details from the DBT workbook, and engaging in daily practices like diary card tracking. You can find these apps on the iOS and Android app stores for any smart device. If you’re a virtual therapist, these apps may especially come in handy, particularly if you’re working with clients who are short on time or feel more comfortable engaging with resources online.
DBT Crisis Plans
Outlining a crisis plan with each of your clients may help you and them avoid any mental health emergencies during treatment. Because DBT is often used to treat conditions that cause intense emotional reactions, clients attending DBT sessions may be at risk of experiencing a crisis. When forming a crisis plan, outline the following with the support of your client:
- A list of three emergency contacts
- A list of local and national crisis hotlines they can call
- Three coping skills they can use in extreme distress
- Three resources they can use to remind themselves of coping skills
- Three goals for treatment
A crisis plan can be useful when you need to get in touch with one of the client’s emergency contacts. Further, it can help the client stay regulated in times when their emotions feel out of their control. If a crisis occurs, some DBT therapists offer an after-hours emergency line the client can call to ask questions about local resources.
Remote Support Platforms For Therapists
DBT can be offered remotely as well as in person. Some therapists may prefer to have online clients for flexibility and convenience, as well as to offer cost-effective services to the individuals they see. In these cases, platforms like BetterHelp can be useful as they allow providers to become contracted and match with as many or as few clients as needed to grow their practice.
Through an online platform, you can match with clients looking for a DBT therapist and offer DBT-oriented worksheets that the clients can work on from home. In addition, you can work from any location with an internet connection, whether a home office or a physical private practice. Your clients can choose between phone, video, or live chat sessions, offering some variance in how you provide support.
Studies also back up the effectiveness of online therapy. One study assessed the efficacy of DBT delivered virtually vs. in person and found that each intervention had similar outcomes. Researchers concluded that “delivering dialectical behavioral therapy with email may provide a more accessible alternative to treatment for individuals with borderline personality disorder without sacrificing the quality of care.”
Takeaway
DBT is a complex evidence-based modality for clients living with various mental health conditions and challenges. Because of DBT’s extensive list of coping strategies, worksheets, and skills to learn, some providers may find it valuable to use pre-made resources, such as books, guides, and audio to support their clients and learn the ins and outs of the modality. To learn more about DBT or to offer your services to clients around the country, consider signing up to work with an online platform like BetterHelp or as a DBT specialist in your area.
