DBT Skills Training Manual: (A Complete Guide)

DBT skill training manual was first introduced in the 1980’s to help the patients suffering from BPD.

DBT skill training manual equips individuals to deal with the swing of emotions and general troubles followed by BPD.

DBT skill training manual is a crucial part of dialectic behavioral therapy. In this article we will discuss DBT Skills Training Manual.

Dialectic Behavioral therapy (DBT) is a specialized type of cognitive behavior therapy aimed to treat clients with borderline personality disorder.

It was developed by Marsha M. Linehen in the 1980’s. Since its origin it has been used to treat other disorders too. 

Dialectical Behavior Therapy:

DBT is a form of psychotherapy also known as talk therapy which is built on the principles of cognitive behavior therapy.

It focuses on the psychosocial aspects of mental health problems. 

This therapy is based on the theory that some people get significantly higher arousal in stimulating situations than others.

Such situations might involve romantic relationships, workplace ties, family bonds and friend circles.

Emotional arousal for them is not only intense but they reach to peak earlier and take more time than usual to go back to the baseline of emotional arousal. 

People suffering from borderline personality disorder experience extreme mood swings, perceive the world from black and white outlook and switch from one crisis to another in a rapid manner.

They do not know how to deal with such intense and dynamic emotions and often experience invalidation from close ones.

DBT focuses on methods to teach them skills that will help them deal with such intense emotions. 

Components of DBT Skill Training Manual:

DBT skill training manual helps clients suffering from borderline personality disorder by focusing on following three aspects:

Support orientation:

It helps clients to recognize his or her strength and base their routine on those skills so that a person can have a positive self-image.

Cognition:

It helps clients to change their maladaptive and dysfunctional cognitions which make their life difficult and replace them with more functional cognitions that bring ease in the life of patients and make them feel good about themselves.

Collaboration:

DBT skill training manual works in a collaborative where clients sort out their problem with others with their therapist and therapist do the same.

Therapist’s major focus is to inculcate some skills in the client which he can use to deal with his everyday life problems.

Therapist asks the client to role play and figure out the new ways in which he can interact with others or give them certain home assignments to practice the skills such as calming oneself while upset. 

These skills constitute the core of the DBT skill training manual. 

DBT skill training can either be administered either in individual sessions or in group sessions.

Individual sessions:

Individual sessions of DBT take place on a weekly basis in which the main focus is on the behavior and thoughts which created trouble in an individual’s life in the previous week. 

Suicidal ideation and self-harming thought and behavior takes the top most priority and then behavior are discussed which causes trouble in interpersonal relationships.

In individual sessions quality of life of client and his journey towards well being is also considered.

Therapists might also focus on the past traumas that still cause emotional disturbance in an individual’s life. 

Group therapy session:

Group therapy session is led by a DBT specialist. It lasted for almost 2 and half hours.

In group sessions individuals learn skills from 4 modules of DBT skill training from other members.

These four modules of DBT skill training constitute interpersonal effectiveness, mindfulness, reality acceptance and emotional regulation. 

DBT skill training manual:

Two editions of the DBT skill training manual have been published by Marsha M. Linehen.

First DBT skill training manual was developed in 1993. First manual was solely based on research done in 1991 which compared the DBT skill training manual and other treatment for patients with suicidal ideation and who were diagnosed with borderline personality disorder.

After that series of researches were carried out on DBT skill training manual including DBT individual session, group session and telephonic session.

Researchers also focused on the DBT skill training manual and behavior pattern that combined formed DBT.

The second edition of DBT skill training manual was published in 2015 based on these researches. It has a rating of 4.5 on good reads.

DBT skill training manual is a comprehensive tool that can guide therapies to inculcate the DBT skills in clients.

This has been used for almost over two decades to provide the clients with skills and behavior that can help them make their lives better.

DBT skill training manual comes with access to worksheet and handouts necessary to improve the skill enhancing process.

It has complete instruction to orient their clients about how to treat a wide range of clinical problems with DBT and imparting skills of mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness.

The four skills imparted by the DBT skill training manual are discussed briefly here. 

Four skills in DBT SkillTraining Manual:

DBT skill training manual tries to equip the person with the following skill set:

Mindfulness:

 Mindfulness is described as being aware of what is going on in the current moment.

This makes a person accept his current emotions and thoughts with being judgmental.

Instead of holding oneself accountable for feeling or behaving in a particular way, a person becomes more accepting towards himself.

Mindfulness skill is broken down into ‘what’ and ‘how’ by DBT specialist:

What skill focuses on what a person needs to focus on. This includes 

• The present 
• Person’s awareness of present 
• Person’s awareness of his emotions, sensation and thoughts
• Distinction by person between emotion and sensation and thoughts

Observe, describe and participate constitute the core of what skills.

How skill focuses on how a person can be more skilled in being mindful. This is done by:

• Maintaining balance between emotions and rational thought
• Rigorous acceptance of oneself, his thoughts and behavior as long as he is not hurting anyone 
• Taking actions in effective and efficient way
• Practicing mindfulness more often
• Avoiding the practices that make it difficult to practice mindfulness such as sleepiness, doubtfulness and restlessness

Effectively, one-mindfully and non-judgmentally constitute the how skill of mindfulness.

Interpersonal effectiveness:

The behavioral patterns taught by DBT skill training manual that dictate how you interact with people around you and with significant others share much resemblance with the skill set that is taught in interpersonal problem solving and some assertiveness classes.

These skills include asking effectively what person wants in a relationship, saying no to what he does not like in an assertive manner and learning strategies to cope with the inevitable conflicts in interpersonal relationships. 

Individuals suffering from borderline personality disorder may have skill sets to deal with the interpersonal problem and might be cognizant of what would be an effective behavioral pattern in which situation, but they particularly face difficulties in application of those skills and behavior during an interpersonal conflict.

Emotionally hyperactive situations renders them incapable of using those skills.

They might also be able to provide good advice to people on how to tackle their problem but they are unable to analyze their own situation and behave in a functional way. 

The major focus of this module is to provide the client with the skills which he can use in a situation where he needs to make change or need to stop the changes.

The objective is to achieve what the client wants in a situation without damaging interpersonal relation or self respect.

Interpersonal effectiveness constitutes the following skill set.

Objective effectiveness (DEAR MAN):

• D Describe
• E Express
• A Assert
• R Reinforce
• M Mindful
• A Appear Confident
• N Negotiate

Relationship Effectiveness (GIVE)

• G Gentle
• I Interested
• V Validate
• E Easy Manner

Self-respect effectiveness (FAST)

• F Fair
• A Apologies (no Apologies)
• S Stick to value
• T Truthful

Distress tolerance:

In most of the therapies, the focus is on changing or avoiding the distressing stimuli, situation or circumstances.

Not many therapies help clients to deal with distress in an effective way. It is usually done by religious or spiritual figures or public speakers.

DBT skill training manual focuses on accepting distress and dealing with pain in a functional way. 

Skill of distress tolerance emerges from the skill of mindfulness as it requires the person to be acceptant of reality.

A person is provided with skills to accept the present thoughts, emotions and situation.

It should be mentioned here that being acceptant of a situation in a non-judgmental way does not mean that a person approves of the situation too. 

Distress tolerance involves going through the crisis in a tolerating and accepting way.

Following four skills are taught which help in surviving the crisis 

• Thinking of pros and cons
• Distracting

Distraction can be achieved through following acronym:

• A Activities
• C Contributing
• C Comparisons
• E Emotions – use opposite
• P Pushing Away
• T Thoughts
• S Sensations
• Improving the moment 

Moment can be improved with the se of following acronym:

• I Imagery
• M Meaning
• P Prayer
• R Relaxation
• O One thing at a time
• V Vacation
• E Encouragement
• Self-soothing skills (This is done with the use of five senses that is sense of smell, touch, taste, sight and hearing)

Acceptance of situation involve following skills:

• Acceptance 
• Turning the thought pattern toward acceptance 
• Willingness vs. willfulness 

Emotional Regulation:

People suffering from borderline personality disorder are often suicidal and have intense emotions such as deeply frustrated, intensely angered or severely depressed or anxious.

This means that such clients are in dire need of skills which can help them in regulating their emotions. 

DBT skill training manual focuses on following skills for better emotional regulation:

• Identification and labeling of emotions
• Identifying hindrances in changing emotions 
• Being less vulnerable to emotional mind
• Enhancing stimuli that leads to positive emotions 
• Being mindful of current emotions 
• Initiating opposite action in response to stimuli causing negative emotions 
• Application of distress tolerance techniques

DBT and BPD:

DBT skill training manual was originally designed to treat patients with borderline personality disorder.

In 2014, 77 patients were treated with DBT who were diagnosed with BPD. All patients responded to treatment and 70% no longer fulfilled the criteria of BPD.

DBT skill training manual has also been effective in treating other disorder such as:

1. Substance abuse: DBT helped patients by reducing their urges and decreased the rate of relapses
2. Depression: Results of study conducted in 2003 showed that patients of depression who took DBT with antidepressant better responded to treatment who took antidepressants only. 
3. Eating disorder: A study was conducted in 2001 on women with binge eating disorder. Those women were treated with DBT. Results showed that 89% of women who received DBT stopped binge eating.

FAQs about DBT skills training

References:

contextualscience.org/publications/dbt_skills_training_manual_1

psycnet.apa.org/record/2015-05780-000

behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/skills-training/

behavioraltech.org/store/books/dbt-skills-training-manual-second-edition/

psychiatrictimes.com/special-reports/dialectical-behavior-therapy-skills-training-effective-intervention

dbtselfhelp.com/html/dbt_skills_list.html