DIALECTICAL

BEHAVIOR
THERAPY
BY JESSICA KATZ, LSW
DIALECTIC: THE IDEA
THAT TWO THINGS
CAN BE TRUE AT THE
SAME TIME

“I CAN LOVE MY
BROTHER, AND I’M
ANNOYED WITH HIM”

“I’M GLAD I CAME TO

THIS PARTY, BUT I FEEL
NERVOUS IN THIS
CROWD”

DIME: THE 4 PARTS OF DBT

DISTRESS TOLERANCE
INTERPERSONAL EFFECTIVENESS
MINDFULNESS
EMOTION REGULATION
 RESS TOLERAN
IST CE
D
INVOLVES GETTING THROUGH
UNCOMFORTABLE EMOTIONS

ACCEPTS TIPP

Use a healthy distraction. Reduce distress in the moment.

Engage in activities that require Change the temperature (i.e.,

thought and concentration. take a warm shower, splash
your face with cold water).
Contribute to someone or
something other than yourself. Engage in intense exercise (i.e.,
go on a walk or run, do jumping
Compare: Remember you’ve jacks, lift weights, dance in your
gotten through other hard room).
times.
Practice paced breathing.
Push away negative thoughts
for a moment. Schedule worry Try progressive muscle
time for later. relaxation: Start at the top of
your body and move down,
Occupy your mind with other tightening and letting go of one
thoughts (i.e., count to 100, muscle at a time.
read a book).

Find safe physical sensations.

 RESS TOLERAN
IST CE
D
INVOLVES GETTING THROUGH
UNCOMFORTABLE EMOTIONS

RIDE THE WAVE ABC

Identify your urge, and ride it Understand your impulses.

out.
Antecedent: What happens
Trigger: Identify stimuli that before?
might trigger you to act on your
urge. Behavior: What do I do?

Rise: Observe how you feel Consequences: What happens

(physically and emotionally) as as a result of my behavior?
the urge starts to intensify.
Peak
Peak: You’re about to act on
your urge — utilize your coping Rise
skills. Fall
Trigger

Fall: You coped. Observe how

you feel now that the urge has
fallen.

Fish: Remember your supports:

people, pets, and values.
 S ON A L E F F E C T
P E R IVE
E R N E
T SS
IN INVOLVES COMMUNICATING IN A HEALTHY
AND EFFECTIVE WAY

BOUNDARIES COMMUNICATION STYLES

Rigid boundaries: You’re Passive: not communicating your

guarded, keep others at a feelings, fear of speaking up; can
distance, and may seem lead to misunderstandings
detached. You’re unlikely to ask
for help and are very protective Aggressive: driven by anger and
of personal information. judgment; can create a hostile
environment
Porous boundaries: You tend
to overshare, are overinvolved in Passive-Aggressive: indirect
others’ problems, and have communication of feelings; holding
difficulty saying “no.” You want onto negative emotions; can cause
to please others and sacrifice conflict and resentment
your self-respect to do so.
Assertive: confident and respectful;
Healthy boundaries: You have creates space for open and honest
values and won’t compromise conversations; promotes healthy
them for others. You connections
communicate your wants and
needs. You can say “no” and
accept when others say “no.”
 S ON A L E F F E C T
P E R IVE
E R N E
T SS
IN INVOLVES COMMUNICATING IN A HEALTHY
AND EFFECTIVE WAY

DEARMAN GIVE/FAST

Describe the current situation. Be gentle. Avoid attacks,

threats, and manipulation.
Express your feelings and
thoughts. Act interested. Listen to the
other person’s point of view, and
Assert yourself by asking for don’t interrupt or talk over
what you want. them.

Reinforce the other person by Validate the other person’s

explaining positive effects of feelings and thoughts.
what you’re asking for.
Use an easy manner.
Be mindful and focus on your
goals. Maintain your position, Be fair to yourself and the other
and do not get off topic. person.

Appear confident. Don’t over-apologize.

Negotiate alternative solutions Stick to your values.

to the problem if necessary.
Be truthful.
 MINDFULNESS
INVOLVES BEING FULLY PRESENT IN THE
MOMENT WITHOUT JUDGMENT

THOUGHT DEFUSION ONE MINDFULLY

Let your thoughts come and go. Do one thing and focus your full
Notice them, acknowledge them, attention on it. Notice how it
then let them go. Picture your feels for even just 30 seconds.
thoughts as leaves floating Your mind may wander, but
down a stream or clouds drifting that’s okay — redirect it back to
in the sky. that one thing.

SQUARE BREATHING

Hold (4 secs)
Exhale (4 secs)
Inhale (4 secs)

Hold (4 secs)
 MINDFULNESS
INVOLVES BEING FULLY PRESENT IN THE
MOMENT WITHOUT JUDGMENT

5-4-3-2-1 RADICAL ACCEPTANCE

Bring your self back to the Accept things as they are, rather
present moment. What are 5 than ignoring, avoiding, or
things you see, 4 things you feel, ruminating. This does not mean
3 things you hear, 2 things you you agree, but you acknowledge
smell, and 1 thing you taste? that some things are out of your
control.
If you feel overwhelmed by your
current environment, you can “I don’t agree with my parents’
alter this exercise. Imagine political beliefs, and I know I can’t
yourself in a calm place. What persuade them.”
are 5 things you want to see, 4
things you want to feel, 3 things “I wish I didn’t have to go to that
you want to hear, 2 things you class everyday, and I know it’s
want to smell, and 1 thing you temporary.”
want to taste?
 TION REGULAT
MO ION
E
IDENTIFYING AND COPING WITH STRONG
EMOTIONS

WISE MIND

EMOTIONAL WISE REASONABLE

Emotional mind Wise mind Reasonable mind

relies on feelings. balances emotions relies on facts and
This mind is useful and reason. You are logic. This mind is
when comforting a able to recognize useful when taking
friend, but it may be and respect your tests or doing work,
harmful in serious feelings and but may be harmful
conversations. respond to them in when comforting a
a rational manner. friend.
 TION REGULAT
MO ION
E
IDENTIFYING AND COPING WITH STRONG
EMOTIONS

OPPOSITE ACTION CHECK THE FACTS

Just as emotions lead to When you notice your emotions

behaviors, behaviors lead to heightening, ask yourself the
emotions. Doing the opposite following questions:
action can change how you feel.
1. What triggered my emotion?
If you feel angry, you may want
to fight or yell. Instead, you can 2. What assumptions am I
calmly discuss the problem. making?

If you feel sad, you may want to 3. Does the intensity of my

self-isolate. Instead, you can emotion match the facts of the
spend time with loved ones. situation, or just my
assumptions?
 SOURCES
Brown, M. (2022, March 31). What it really means to
practice radical acceptance. Psych Central.
Reviewed by N. Simay Gokbayrak.
DBT Tools. (n.d.). DEAR MAN. DBT Tools.
DBT Tools. (n.d.). FAST Skill. DBT Tools.
DBT Tools. (n.d.). GIVE Skill. DBT Tools.
Palmer, Meg. (2023, November 7). Types of
communication styles. Southern New Hampshire
University.
Safilian-Hanif, Cimone. (2024, February 11). TIPP
skills for distress tolerance. Dialectical Behavior
Therapy.
Therapist Aid. (n.d.). Boundaries psychoeducation
printout. Therapist Aid.
Therapist Aid. (n.d.). DBT ACCEPTS skill worksheet.
Therapist Aid.
Therapist Aid. (n.d.). Emotion Regulation DBT skills.
Therapist Aid.
Therapist Aid. (n.d.). Wise mind worksheet.
Therapist Aid.