14. Be respected by others.
15. Be seen by others as successful; become well known; obtain recognition and status.
16. Compete successfully with others.
17. Be popular and accepted.
 Other:
D. a chieve things in life.
18. Achieve significant goals; be involved in undertakings I believe are significant.
19. Be productive.
20. Work toward goals; work hard.
21. Be ambitious.
 Other:
(continued on next page )
Adapted from Schwartz, S. H. (1992). Universals in the content and structure of values: Theory and empirical tests in 20 countries. In M.
Zanna (Ed.), Advances in experimental social psychology (Vol. 25, pp. 1–65). New York: Academic Press. Copyright 1992 by Academic Press.
Adapted by permission of Elsevier B.V.


254eMotion r eGulation Handout 18  (p. 2 of 3)
e. live a life of pleasure and satisfaction.
22. Have a good time.
23. Seek fun and things that give pleasure.
24. Have free time.
25. Enjoy the work I do.
 Other:
f. keep life full of exciting events, relationships, and things.
26. Try new and different things in life.
27. Be daring and seek adventures.
28. Have an exciting life.
 Other:
G. Behave respectfully.
29. Be humble and modest; do not draw attention to myself.
30. Follow traditions and customs; behave properly.
31. Do what I am told and follow rules.
32. Treat others well.
 Other:
h. Be self-  directed.
33. Follow my own path in life.
34. Be innovative, think of new ideas, and be creative.
35. Make my own decisions and be free.
36. Be independent; take care of myself and those I am responsible for.
37. Have freedom of thought and action; be able to act in terms of my own priorities.
 Other:
i. Be a spiritual person.38. Make room in life for spirituality; live life according to spiritual principles.


39. Practice a religion or faith.
40. Grow in understanding of myself, my personal calling, and life’s real purpose.
41. Discern and do the will of God (or a higher power) and find lasting meaning in life.
 Other:
j. Be secure.42. Live in secure and safe surroundings.
43. Be physically healthy and fit.
44. Have a steady income that meets my own and my family’s basic needs.
 Other:
(continued on next page )


255eMotion r eGulation Handout 18  (p. 3 of 3)
k. recognize the universal good of all things.
45. Be fair, treat people equally, and provide equal opportunities.
46. Understand different people; be open-  minded.
47. Care for nature and the environment.
 Other:
l. contribute to the larger community.
48. Help people and those in need; care for others’ well-being; improve society.
49. Be loyal to friends and devoted to close people; be committed to a group that shares
my beliefs, values, and ethical principles.
50. Be committed to a cause or to a group that has a larger purpose beyond my own.
51. Make sacrifices for others.
 Other:
m. Work at self-  development.
52. Develop a personal philosophy of life.
53. Learn and do challenging things that help me grow and mature as a human being.
 Other:
n. have integrity.
54. Be honest, and acknowledge and stand up for my personal beliefs.
55. Be a responsible person; keep my word to others.
56. Be courageous in facing and living life.
57. Be a person who pays debts to others and repairs damage I have caused.
58. Be accepting of myself, others, and life as it is; live without resentment.
 Other:
o. other:


256
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details). eMotion r eGulation Handout 19  (Emotion Regulation Worksheets 12, 13)
Build m astery and c ope ahead
Build m astery
1. Plan on doing at least one thing each day to build a sense of accomplishment.
Example:
2. Plan for success, not failure.
••Do something difficult, but possible.
3. Gradually increase the difficulty over time.
••If the first task is too difficult, do something a little easier next time.
4. Look for a challenge.
••If the task is too easy , try something a little harder next time.
Cope ahead of Time with Difficult Situations
1. Describe the situation that is likely to prompt problem behavior.
••Check the facts. Be specific in describing the situation.
••Name the emotions and actions likely to interfere with using your skills.
2. Decide what coping or problem-  solving skills you want to use in the situation.
••Be specific. Write out in detail how you will cope with the situation and with your
emotions and action urges.
3. imagine the situation in your mind as vividly as possible.
••Imagine yourself IN  the situation NOW , not watching the situation.
4. rehearse in your mind coping effectively.
••Rehearse in your mind exactly what you can do to cope effectively.
••Rehearse your actions, your thoughts, what you say, and how to say it.
••Rehearse coping effectively with new problems that come up.


••Rehearse coping effectively with new problems that come up.
••Rehearse coping effectively with your most feared catastrophe.
5. practice relaxation after  rehearsing.


257
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details). eMotion r eGulation Handout 20  (Emotion Regulation Worksheets 9, 14)
Taking c are of y our m ind by Taking c are
of your Body
Remember these as plea Se skills.
P
L 1. Treat p hysica l illness. Take care of your body. See a doctor when
necessary. Take prescribed medication.
E 2. Balance e ating. Don’t eat too much or too little. Eat regularly and mindfully throughout the day. Stay away from foods that make you feel overly
emotional.
A 3. avoid m ood- altering Substances. Stay off illicit drugs, and use alcohol in
moderation (if at all).
S 4. Balance S leep. Try to get 7–9 hours of sleep a night, or at least the amount of sleep that helps you feel good. Keep to a consistent sleep schedule,
especially if you are having difficulty
sleeping.
E 5. Get e xercise. Do some sort of exercise every day. Try to build up to 20 minutes of daily exercise.


258
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details).eMotion r eGulation Handout 20a  (Emotion Regulation Worksheet 14a)
nightmare p rotocol, Step by Step
When  Nightmares Keep You from Sleeping
1. practice relaxation, pleasant imagery, and coping skills first, to be sure
you are ready to work on changing your nightmares.
Do progressive relaxation, paced breathing, and/or Wise Mind exercises;
listen to music or guided imagery; review the distress tolerance crisis survival skills.
2. choose a recurring nightmare you would like to work on.
This will be your target nightmare. Select a nightmare you can manage now.
Put off trauma nightmares until you are ready to work with them—or, if you
target a trauma nightmare, skip Step 3.
3. Write down your target nightmare.
Include sensory descriptions (sights, smells, sounds, tastes, etc.). Also
include any thoughts, feelings, and assumptions about yourself during the
dream.
4. choose a changed outcome for the nightmare.
The change should occur BEFORE  anything traumatic or bad happens to you
or others in the nightmare. Essentially, you want to come up with a change that will prevent the bad outcome of the usual nightmare from occurring. Write an ending that will give you a sense of peace when you wake up.
Note: Changes in the nightmare can be very unusual and out of the ordinary
(e.g., you might become a person with superhuman powers who is able
to escape to safety or fight off attackers). Changed outcomes can include changed thoughts, feelings, or assumptions about yourself.


5. Write down the full nightmare with the changes.
6. rehear Se and relax each night before going to sleep.
Rehearse the changed  nightmare by visualizing the entire dream with the
changes each night, before  practicing relaxation techniques.
7. rehear Se and relax during the day.
Visualize the entire dream with the change, and practice relaxation as often
as possible during the day.


259
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details).eMotion r eGulation Handout 20b  (Emotion Regulation Worksheet 14b)
Sleep h ygiene p rotocol
When You Can’t Sleep, What to Do Instead of Ruminating
To increa Se The likelihoo D of re STfulne SS/Sleep:
 1. Develop and follow a consistent sleep schedule even on weekends. Go to bed and get up
at the same times each day, and avoid anything longer than a 10-minute nap during the day.
 2. Do not use your bed in the daytime for things like watching TV, talking on the phone, or reading.
 3. avoid caffeine, nicotine, alcohol, heavy meals, and exercise late in the day before going to
sleep.
 4. When prepared to sleep, turn off the light, and keep the room quiet and the temperature comfortable and relatively cool.  Try an electric blanket if you are cold; putting
your feet outside of the blanket or turning on a fan directed toward your bed if you are hot; or wearing a sleeping mask, using earplugs, or turning on a “white noise” machine if needed.
 5. Give yourself half an hour to at most an hour to fall asleep. If it doesn’t work, evaluate whether you are calm, or anxious (even if only “background anxiety”), or ruminating.
 6. Do no T ca TaSTrophize . Remind yourself that you need rest, and aim for reverie (i.e.,


dreaminess) and resting your brain. Sell yourself on the idea that staying awake is not a catastrophe. Do not decide to give up on sleeping for the night and get up for the “day.”
if you are c alm B uT Wi De aW ake:
 7. Get out of bed; go to another room and read a book or do some other activity that will not wake you up further. As you begin to get tired and/or sleepy, go back to bed.
 8. Try a light snack (e.g., an apple).
if you are a nxiou S or r umina TinG
 9. use the cold water T ip skill. Get right back in bed and do the paced breathing T ip skill.
(See Distress Tolerance Handout 6: TIP Skills: Changing Your Body Chemistry.)
Remember, if you have any medical condition, get medical approval before using cold water.
10. Try the 9–0 meditation practice. Breathe in deeply and breathe out slowly, saying in your mind the number 9. On the next breath out, say 8; then say 7; and so on until you breathe out
saying 0. Then start over, but this time start with 8 (instead of 9) as you breathe out, followed
by 7, and so on until you reach 0. Next start with 6 as you breathe out, and so on to 0. Then start with 5, then with 4, and so on until you have gone all the way down to starting with 1. (If you get lost, start over with the last number you remember.) Continue until you fall asleep.
11. f ocus on the bodily sensation of the rumination (rumination is often escape from difficult
emotional sensations).


emotional sensations).
12. r eassure yourself that worries in the middle of the night are just “middle-of-the-night-
thinking,” and that in the morning you will think and feel differently.
13. r ead an emotionally engrossing novel for a few minutes until you feel somewhat tired. Then
stop reading, close your eyes, and try to continue the novel in your head.
14. if rumination doesn’t stop, follow these guidelines: “If it’s solvable, solve it. If it is insolvable,
go deep into the worry all the way to the “catastrophe”—the very worst outcome you can imagine—and then imagine coping ahead with the catastrophe.
(See Emotion Regulation Handout 19: Build Mastery and Cope Ahead.)
if nothing else works, with eyes closed, listen to public radio (BB c, npr , etc.) at low volume
(use headphones if necessary). Public radio is a good choice for this, because there is little fluctua -
tion in voice tone or volume.


Handouts for Managing Really
Difficult Emotions


263
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details).eMotion re Gulation Handout 21   (Emotion Regulation Worksheets 15–16)
overview:
managing r eally Difficult emotions
minDfulne SS of c urren T emo TionS
Suppressing emotion increases suffering.
Mindfulness of current emotions is the path to emotional freedom.
mana GinG exTreme emo TionS
Sometimes emotional arousal is so high that you can’t use any skills,
particularly if the skills are complicated or take any thought on your part.
This is a skills breakdown point.
Crisis survival skills are needed.
Trou BleShoo TinG an D revie W
There are many ways to change emotions.
It can be helpful to have a list of the important skills
to look at when you can’t remember the skills you need to regulate
your emotions.


264
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details). eMotion r eGulation Handout 22  (Emotion Regulation Worksheet 15)
mindfulness of c urrent e motions:
letting Go of e motional Suffering
oBS erve y our e moTion
••Step back and just notice your emotion.
••Experience your emotion as a WAVE , coming and going.
••Now imagine surfing the emotion wave.
••Try not to BLOCK  or SUPPRESS  the emotion.
••Don’t try to GET  RID of or PUSH  away the emotion.
••Don’t try to KEEP  the emotion around.
••Don’t HOLD  ON to it.
••Don’t AMPLIFY it.
pracTice m inDfulne SS of Bo Dy SenS aTionS
••Notice WHERE  in your body you are feeling emotional sensations.
••Experience the SENSATIONS  as fully as you can.
••Observe how LONG  it takes before the emotion goes down.
remem Ber: y ou are n oT your e moTion
••Do not necessarily ACT  on your emotion.
••Remember times when you have felt DIFFERENT .
prac Tice l ovin G your e moTion
••RESPECT  your emotion.
••Do not JUDGE  your emotion.
••Practice WILLINGNESS .
••Radically ACCEPT  your emotion.


265
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details).eMotion re Gulation Handout 23
managing e xtreme e motions
Follow these suggestions when emotional arousal is very hiGh —so extreme that your ability to
use your skills breaks down.
First, observe and describe that you are at your Skill S Break DoWn poin T:
Your distress is extreme.
You are overwhelmed.
You cannot focus your mind on anything but the emotion itself.
Your mind shuts down; your brain stops processing information.
You cannot solve problems or use complicated skills.
now check the facts. Are you really “falling apart” at this level of distress?
If no, u Se your Skill S.
If yes, go to Step 1: You are at your Skill S Break DoWn poin T.
Step 1. Use crisis survival skills to bring down your arousal:
(See Distress Tolerance Handouts 6–9a.)
••TIP your body chemistry.
••DISTRACT  yourself from the emotional events.
••SELF- SOOTHE  through the five senses.
••IMPROVE  the moment you are in.
Step 2. Return to mindfulness of current emotions.
(See Emotion Regulation Handout 22.)
Step 3. Try other emotion regulation skills (if needed).


266
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details).eMotion r eGulation Handout 24  (Emotion Regulation Worksheet 16) (p. 1 of 2)
Troubleshooting e motion r egulation Skills: When What
you a re Doing i sn’t Working
1check y our Biolo Gical Sen SiTiviTy
••ASK: Am I biologically more vulnerable?
Do I have untreated physical illness or distress?
Am I out of balance on eating, use of drugs, sleep, exercise?
Have I taken medications as prescribed?
••WORK  on your PLEASE skills.
1. Take care of physical illness and distress.
2. Take medications as prescribed. Check if others are needed.
3. Try again.
2check y our Skill S
••REVIEW  what you have tried.
Did you try a skill likely to be effective?
Did you follow the skill instructions to the letter?
••WORK  on your skills.
1. Review and try other skills.
2. Get coaching if you need it.
3. Try again.
3check for reinforcer S
••ASK: Do my emotions . . .
COMMUNICATE  an important message or influence people to do things?
MOTIVATE  me to do things I think are important?
VALIDATE  my beliefs or my identity?
FEEL GOOD ?
••IF YES :
1. Practice interpersonal effectiveness skills to communicate.
2. Work to find new reinforcers to motivate yourself.
3. Practice self-  validation.


3. Practice self-  validation.
4. Do PROS AND CONS for changing emotions.
(See Emotion Regulation Worksheet 1.)
(continued on next page )


267eMotion r eGulation Handout 24  (p. 2 of 2)
4check y our m ooD
••ASK: Am I putting in the time and effort that solving my problem will take?
••IF NO:
1. Do PROS AND CONS for working hard on skills.
2. Practice RADICAL  ACCEPTANCE  and WILLINGNESS  skills.
3. Practice the mindfulness skills of PARTICIPATING  and EFFECTIVENESS
(See Mindfulness Handouts 4 and 5.)
5check for e moTional o verloaD
••ASK: Am I too upset to use complicated skills?
••IF YES , ask: Can the problems I am worrying about be easily solved now?
••IF YES , do PROBLEM  SOLVING .
(See Emotion Regulation Handouts 9, 12.)
••IF NO, practice mindfulness of CURRENT  EMOTIONS .
(See Emotion Regulation Handout 22.)
••IF your emotions are too high for you to think straight:
••Go to TIP skills.
(See Distress Tolerance Handout 5.)
6check for e moTion m yThS Ge TTinG in T he Way
••CHECK  FOR :
Judgmental myths about emotions (e.g., “Some emotions are stupid,” “There is a
right way to feel in every situation”)?
Beliefs that emotions and identity are the same (e.g., “My emotions are who I
am”)?
••IF YES :
1. Check the facts.
2. Challenge myths.
3. Practice thinking nonjudgmentally.


268
eMotion re Gulation Handout 25
review of Skills for e motion r egulation
Name Emotions
Describe Emotions1. Accumulate positive emotions
2. Build mastery
3. Cope ahead
4. PLEASE skillsReduce Emotional Vulnerability
Change Emotional
Thoughts and Interpretations
Check the Facts
Reduce Emotional Prompting Events
Problem Solving
Distraction
Manage Aftereffects
Repeat for Secondary Emotions
Distress Tolerance SkillsReduce
Emotional Reactions
and
High Arousal
Crisis Survival
Strategies
Mindfulness
of Current EmotionsChange
Emotional Reactions
Opposite Action
(all the way)
Opposite
Body Language
Opposite Words
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this handout is granted to purchasers of this
book for personal use only (see copyright page for details).


271
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may
download a larger version of this worksheet from www.guilford.com/dbt-
worksheets .eMotion re Gulation WorksHeet 1   (Emotion Regulation Handout 1)
pros and c ons of c hanging e motions
Due Date:       Name:                   Week Starting:
emoTion n ame:               i nTenSiTy (0–100) Before:      after:
Fill this worksheet out when you are experiencing difficulties with:
••Trying to decide whether to work on changing ineffective emotions.
••Feeling willful/saying no to letting go of emotion mind.
••Deciding whether to work on reducing your emotional reactions to specific events.
••Feeling threatened whenever you think of letting go of emotions.
••Not in the mood for being effective.
When filling out this worksheet, think about these questions:
••Is living in emotion mind in your best interest (i.e., effective) or not in your best interest (i.e.,
ineffective)?
••Will refusing to regulate your own emotions create a new problem for you?
••Is reducing immediate high emotions likely to increase your freedom or decrease it?
••Is being attached to your emotions about a situation useful or not?
••Is working to reduce your emotion really too much work?
Make a list of the pros and cons of changing the emotion you are having difficulty with.
Make another list of the pros and cons of not changing  your emotion.prosStay in emotion mind, acting emotionally


Regulate emotions and emotion actions

                    consStay in emotion mind, acting emotionally

                    Regulate emotions and emotion actions

What did you decide to do about your emotion?
is this the best decision (in Wise m ind)?


Worksheets for Understanding
and Naming Emotions


275
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may
download a larger version of this worksheet from www.guilford.com/dbt-
worksheets .eMotion re Gulation WorksHeet 2   (Emotion Regulation Handout 3)
figuring o ut What m y emotions a re Doing for m e
Due Date:       Name:                   Week Starting:
Select a current or recent emotional reaction and fill out as much of this sheet as you can. If the
prompting event for the emotion you are working on is another emotion that occurred first (for exam -
ple, feeling afraid prompted getting angry at yourself), then fill out a second worksheet for that first
emotion. Write on the back of the sheet if you need more room. Remember to use your describe
skills for each question.
emoTion n ame :                        inTenSiTy (0–100):
Describe p rompting e vent
What happened to prompt this emotion?
Describe m otivation to a ction
What action was my emotion motivating and preparing me to do? (Was there a problem my
emotion was getting me to solve, overcome, or avoid?) What function or goal did my emotion
serve?
Describe c ommunication to o thers
What was my facial expression? Posture? Gestures? Words? Actions?
What message did my emotion send to others (even if I didn’t intend to send the message)?
How did my emotion influence others (even if I didn’t intend to influence them)? What did others


do or say as a result of my emotional expression or actions?
Describe c ommunication to m yself
What did my emotion say to me?
What facts could I check out to be sure the message my emotions were sending to me was
correct?
What facts did I check out?


276
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may
download a larger version of this worksheet from www.guilford.com/dbt-
worksheets .eMotion re Gulation WorksHeet 2a   (Emotion Regulation Handout 3)
example: f iguring o ut What m y emotions a re Doing
for me
Due Date:       Name:                   Week Starting:
Select a current or recent emotional reaction and fill out as much of this sheet as you can. If the
prompting event for the emotion you are working on is another emotion that occurred first (for exam -
ple, feeling afraid prompted getting angry at yourself), then fill out a second worksheet for that first
emotion. Use the back of the sheet if necessary. Use describe skills for each question.
emoTion n ame:    Shame and Guilt              inTenSiTy (0–100):  80
prompting e vent
What happened to prompt this emotion?
 I left my roommate’s pot on the burner and forgot about it. I destroyed it. I then threw the pot away without telling my roommate.
motivation to a ction
What action was my emotion motivating and preparing me to do? (Was there a problem my emotion was getting me to solve, overcome, or avoid?) What function or goal did my emotion
serve?
 My emotion was motivating me to shrink away from my friend, to hide myself. It’s possible that the function was to get me to change that behavior. The emotion was also functioning to get me to try to hide that I destroyed the pot.


To influence my friend to stop being mad at me.
communication to o thers
What was my facial expression? Posture? Gestures? Words? Actions? My eyes were looking down. My lips were turned down. I was slouched slightly and turned slightly away from my friend. I did not say anything. I put my hands on my forehead.
What message did my emotion send to others (even if I didn’t intend to send the message)? I think my friend realized that I felt bad.
How did my emotion influence others (even if I didn’t intend to influence them)? What did others do or say as a result of my emotional expression or actions? My friend tried to get me to talk. I think it influenced her to stop yelling at me and be more kind.
communication to m yself
What did my emotion say to me? It was wrong to do what I did. I feel badly about it because I disappointed my friend. I have really messed this up and now she will never trust or like me.
What facts could I check out to be sure the message my emotions were sending to me was correct? I could ask myself if what I did would get me kicked out of my house/friendship. I could try to figure out if what I did crossed my own wise/clear mind, moral code, values. I could ask her:
Have I destroyed the relationship? Is she going to kick me out? Stop spending time with me? I
could also ask what I can do that would help her to trust me again.
What facts did I check out?
 I felt bad about burning the pot—but it wasn’t a moral code or values issue yet until I tried to


hide that I had done it. That behavior did go against my Wise Mind. I asked my roommate if she hated me now and she said no. I asked if there was anything I could do to fix the situation, and
she asked me to buy a new pot, and I did.


277eMotion re Gulation WorksHeet 2b   (Emotion Regulation Handout 3)
emotion Diary
Name:                         Week Starting:
Record an emotion (either the strongest emotion of the day, the longest-  lasting one, or the one that was the most painful or gave you the
most trouble). Analyze that emotion. Fill out an Observing and Describing Emotions worksheet (Emotion Regulation Worksheet 4 or 4a) if
necessary, plus this diary sheet.
emotions motivate communicate to others communicate to me
Emotion
nameWhat did my
emotion motivate
me to do (i.e.,
what goal did my
emotion serve)?How was my emotion
expressed to others
(my nonverbal
appearance, my
words, my actions)?What message
did my emotion
express to others?What was
the effect of
my emotion
on others?What was my
emotion saying
to me?How did I check
the facts?
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this worksheet is granted to purchasers of
this book for personal use only (see copyright page for details). Purchasers may download a larger version of this worksheet from www.guilford.com/dbt-  worksheets .


278
eMotion re Gulation WorksHeet 2c   (Emotion Regulation Handout 3)
example: e motion Diary
Due Date:       Name:                   Week Starting:
Record an emotion (either the strongest emotion of the day, the longest-  lasting one, or the one that was the most painful or gave you the
most trouble). Analyze that emotion. Fill out an Observing and Describing Emotions worksheet (Emotion Regulation Worksheet 4 or 4a) if
necessary, plus this diary sheet.
emotions motivate communicate to others communicate to me
Emotion
nameWhat did my emotion
motivate me to do
(i.e., what goal did
my emotion serve)?How was my emotion
expressed to others (my
nonverbal appearance,
my words, my actions)?What message
did my emotion
express
to others?What was the
effect of my
emotion on others?What was
my emotion
saying to
me?How did I check the
facts?
Fear/anxietyNot to go to skills training group.I did not go to group. That group was not important
to me.(1) They called to
encourage me to
come.
(2) They wonder if I am committed.(3) They might be concerned.That group is unsafe.I didn’t.
I could have evaluated
if my life, health, or well-being was in danger. I could have
done pros and cons of
going to group.
Shame To keep to myself, to not draw attention to myself.
I wanted to go home
from the office party
at work.I didn’t make much
eye contact, I didn’t say much or initiate
conversation, or do


eye contact, I didn’t say much or initiate
conversation, or do
anything to attract attention.There are several possibilities:
(1) I want to be
left alone. (2) I
am feeling bad.Most everyone at
work left me alone. One person tried to
talk to me but gave
up.That I was uninteresting, a failure with
nothing to
contribute .I tried to recall times when people have listened to me. I tried
to talk to others and
notice if they seemed interested.
Sadness Withdraw. Isolate. Cry.My expression was downcast. My mouth turned down.
I was tearful. I told
someone I was sad.That I was sad. (1) My boyfriend approached me, soothed me, and invited me to sit
with him. (2) Some
people avoided me.I am so sad. I am alone.
No one cares.I reached out and noticed if someone responded. I thought about a time when I
did not feel sad.
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this worksheet is granted to purchasers of
this book for personal use only (see copyright page for details). Purchasers may download a larger version of this worksheet from www.guilford.com/dbt-  worksheets .


279
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may
download a larger version of this worksheet from www.guilford.com/dbt-
worksheets .Emotion R Eg ulation Wo R ksh EEt  3  (Emotion Regulation Handout 4a) (p. 1 of 2)
Myths about Emotions
Due Date:       Name:                   Week Starting:
F
or each myth, write down a challenge that makes sense to you. Although the one already
written

may make a lot of sense, try to come up with another one or rewrite the one there in your
own words.
 1. T
here is a right way to feel in every situation.

Challenge:  Every person responds differently to a situation. There is no correct or right way .
 M
y challenge:
 2. L
etting others know that I am feeling bad is a weakness.

Challenge:  Letting others know that I am feeling bad is a healthy form of communication .
 M
y challenge:
 3. N
egative feelings are bad and destructive.

Challenge:  Negative feelings are natural responses. They help me to create a better
understanding of the situation.
 M
y challenge:
 4.
Being emotional means being out of control.

Challenge:  Being emotional means being a normal human being.
 M
y challenge:
 5. So
me emotions are stupid.


M
y challenge:
 5. So
me emotions are stupid.

Challenge:  Every emotion indicates how I am feeling in a certain situation. All emotions are
useful to help me understand what I am experiencing .
 M
y challenge:
 6.
All painful emotions are a result of a bad attitude.

Challenge:  All painful emotions are natural responses to something.
 M
y challenge:
 7. I
f others don’t approve of my feelings, I obviously shouldn’t feel the way I do.

Challenge:  I have every right to feel the way I do, regardless of what other people think.
 M
y challenge:
 8. O
ther people are the best judges of how I am feeling.

Challenge:  I am the best judge of how I feel. Other people can only guess how I feel.
 M
y challenge:
 9. P
ainful emotions are not important and should be ignored.

Challenge:  Painful emotions can be warning signs telling me that a situation I am in is not
good.
 M
y challenge:
10
. E
xtreme emotions get you a lot further than trying to regulate your emotions.

Challenge:  Extreme emotions can often cause trouble for me and for other people. If an
emotion is not effective, emotion regulation is a good idea.
 M
y challenge:
(continued on next page )


280eMotion re Gulation WorksHeet 3   (p. 2 of 2)
11. Creativity requires intense, often out-of-  control emotions.
 Challenge:  I can be in control of my emotions and be creative.
 My challenge:
12. Drama is cool.
 Challenge:  I can be dramatic and regulate my emotions.
 My challenge:
13. It is inauthentic to try to change my emotions.
 Challenge:  Change is itself authentic; it is part of life.
 My challenge:
14. Emotional truth is what counts, not factual truth.
 Challenge:  Both emotional feeling and facts matter.
 My challenge:
15. People should do whatever they feel like doing.
 Challenge:  Doing what I feel like doing can be ineffective.
 My challenge:
16. Acting on your emotions is the mark of a truly free individual.
 Challenge:  The truly free person can regulate emotions.
 My challenge:
17. My emotions are who I am.
 Challenge:  Emotions are partly but not completely who I am.
 My challenge:
18. My emotions are why people love me.
 Challenge:  People will still love me if I regulate my emotions.
 My challenge:
19. Emotions can just happen for no reason.
 Challenge:  All things in the universe are caused.
 My challenge:
20. Emotions should always be trusted.
 Challenge:  Emotions should sometimes be trusted.
 My challenge:
21. Other myth:
 Challenge:
 My challenge:


281eMotion re Gulation WorksHeet 4   (Emotion Regulation Handouts 5, 6)
observing and Describing e motions
Due Date:       Name:                   Week Starting:
Select a current or recent emotional reaction, and fill out as much of this sheet as you can. If the prompting event for the emotion you
are working on is another emotion that occurred first (e.g., fear prompted anger at yourself), then fill out a second worksheet for the first
emotion. Use Emotion Regulation Handout 6 for ideas. Write on the back of this sheet if you need more room.
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this worksheet is granted to purchasers of
this book for personal use only (see copyright page for details). Purchasers may download a larger version of this worksheet from www.guilford.com/dbt-  worksheets .Aftereffects: Emotions, behavior, thoughts, etc.?
____________________________________
____________________________________Vulnerability Factors: What happened before to make me vulnerable to the prompting event? Tell the story up to the event.
Interpretation of Event:
Thoughts, beliefs, assumptions, appraisals?Biological Changes
Face and Body Changes
and Experiences:
What am I or was I feeling
in my face and body?
__________________________________________________________________________________________
Action Urges
What do I or did I feel like
doing? What do I or did I
want to say?
________________________________________________________________________Expressions
Face and Body Language:
What is or was my facial
expression? Posture? Gestures?
_______________________________________________________________
Expression with Words:
What I SAID
____________________________________________________________________________________
Actions: What I DID
_______________________________________________________________Emotion
Name:
_________


282
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may
download a larger version of this worksheet from www.guilford.com/dbt-
worksheets .Emotion R Eg ulation Wo R ksh EEt  4a  (Emotion Regulation Handouts 5, 6)
Observing and Describing Emotions
Due Date:       Name:                   Week Starting:
Sel
ect a current or recent emotional reaction, and fill out as much of this sheet as you can. If the
prompting event for the emotion you are working on is another emotion that occurred first (e.g., fear
prompted anger at yourself), then fill out a second worksheet for the first emotion. Use Emotion Regulation Handout 6 for ideas. Write on the back of this sheet if you need more room.
Em
Ot
iO
n
na
m
E:
 intEn
sity (0–100):
P
rO
m
Pt
ing Ev Ent
 for my emotion (who, what, when, where): What set off the emotion?

vulnE rability Fact Or s: What happened before that made me vulnerable to the prompting
event?

in tE r Pr Et atiOn s (beliefs, assumptions, appraisals) of the situation:

FacE a nd b ODy ch ang Es and ExP E riEn c Es: W hat was I feeling in my face and body?


actiOn  ur gEs: W hat did I feel like doing? What did I want to say?

FacE a nd bOD y  lan guag E: W hat was my facial expression? Posture? Gestures?

What i saiD i n the situation (be specific):

What i DiD  in the situation (be specific):

What aFtE r EFFE c ts did the emotion have on me (my state of mind, other emotions, behavior,
thoughts, memory, body, etc.)?


Worksheets for Changing
Emotional Responses


285
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may
download a larger version of this worksheet from www.guilford.com/dbt-
worksheets .eMotion re Gulation WorksHeet 5   (Emotion Regulation Handouts 8, 8a) (p. 1 of 2)
check the f acts
Due Date:       Name:                   Week Starting:
It is hard to problem-solve an emotional situation if you don’t have your facts straight. You must
know what the problem is before you can solve it. This worksheet helps you figure out whether it is the event that is causing your emotion, your interpretation of the event, or both. Use your mindfulness skills of observing and describing. Observe the facts, and then describe the facts you have observed.
Step
1

ask: What emotion do i want to change?
emoTion n ame :           inTenSiTy (0–100) Before:     after:
Step
2
•
••

•ask: What is the promp TinG evenT  for my emotional reaction?
DeScriB e The promp TinG evenT : What happened that led you to have this


emotion? Who did what to whom? What led up to what? What is it about this event that
is a problem for you? Be very specific in your answers.

check T he f acTS!
Look for extremes and judgments in the way you are describing the prompting event .
reWriTe the facts, if necessary, to be more accurate.
facts                                                                                
Step
3

•••

•••ask: What are my in Terpre TaTionS (thoughts, beliefs, etc.) about the facts?
What am I assuming? Am I adding my own interpretations to the description of the
prompting event?

check T he f acTS!
List as many other  possible interpretations of the facts as you can.

reWriTe the facts, if necessary. Try to check the accuracy of your interpretations. If you
can’t check the facts, write out a likely or a useful (i.e., effective) interpretation.
facts

                                          
(continued on next page )


286eMotion re Gulation WorksHeet 5   (p. 2 of 2)
Step
4
•••
•
•••
•
•••ask: am i assuming a T hreaT ? What is the THREAT ? What about this event or
situation is threatening to me? What worrisome consequences or outcomes am I
expecting?

check T he f acTS!
List as many other  possible outcomes as you can, given the facts.

reWriTe the facts if needed. Try to check the accuracy of your expectations. If you
can’t check out probable outcomes, write out a likely noncatastrophic outcome to
expect.

                                          facts

Step
5
•

•ask: What’s the ca TaSTrophe , even if the outcome i am worrying about does
occur?  Describe in detail the worst outcome I can reasonably expect.

                                          DeScriBe W ayS To cope if the worst does happen.

Step
6

•



6

•





•




aSk: Does my emotion (or its intensity or duration) fi T The fac TS?
(0 = not at all to 5 = I am certain):
If you are unsure whether your emotion or your emotional intensity fits the facts (for
example, you give a score of 2, 3, or 4), keep checking the facts. Be as creative as you can be; ask others for their opinions; or do an experiment to see if your predictions or interpretations are correct.
Describe what you did to check the facts:


287
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may
download a larger version of this worksheet from www.guilford.com/dbt-
worksheets .Emotion R Eg ulation Wo R ksh EEt  6  (Emotion Regulation Handout 9)
Figuring Out How to Change Unwanted Emotions
Due Date:       Name:                   Week Starting:
O
nce you have checked the facts, use this worksheet to help you figure out what to do next.
Before you can figure out what to change, you have to decide whether acting on your emotion
is effective in the situation you are in (and whether the emotion is one you actually want to change). (If you are not sure whether you want to change it or not, go back to Emotion Regulation Worksheet 1 and do pros and cons.) In the flow chart below, circle Yes or No at each level, and
then select the skill that fits your situation best.
Describe what you did to manage the emotion:

 Ask:
Does this emotion
fit the facts?
Check the facts Ye s No
Ask:
Is acting on this
emotion effective?
Check Wise Mind
Be mindful
of current
emotions
(Emotion Regulation
Handout 22)
Act on
emotion/
action urge
Problem-solve
unwanted
emotions
(Emotion Regulation
Handout 12)Do not act on
emotion/
action urge
Consider
opposite action
(Emotion
Regulation


emotion/
action urge
Consider
opposite action
(Emotion
Regulation
Handouts 10–11)Do not act on
emotion/
action urge
Change thoughts
to fit the facts
(Emotion
Regulation
Handout 8)
Do
opposite action
(Emotion
Regulation
Handouts 10–11)Be mindful
of current
emotions
(Emotion
Regulation
Handout 22)
Act, but
accept the
consequences
gracefully
Reconsider
opposite actionYe s No Ye s NoAsk:
Is acting on this
emotion effective?
Check Wise MindEmotion
Name:
________________


288
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may
download a larger version of this worksheet from www.guilford.com/dbt-
worksheets .eMotion re Gulation WorksHeet 7   (Emotion Regulation Handouts 10, 11)
opposite a ction to c hange emotions
Due Date:       Name:                   Week Starting:
Select a current or recent emotional reaction that you find painful or want to change. Figure out
if the emotion fits the facts. If it does not, then notice your action urges; figure out what would be opposite actions; and then do the opposite actions. Remember to practice opposite action all the
way. Describe what happened.
emoTion n ame:               i nTenSiTy (0–100) Before:      after:
promp TinG evenT  for my emotion (who, what, when, where): What prompted the emotion.

iS my emo Tion (or its intensity or duration) juST ifieD? Does it fit the facts? i s it
effective?
List the facts that justify the emotion and those that do not. Check the answer that is mostly
correct.
justified

                     not justified

juST ifieD: Go to problem solving
(Emotion Regulation Worksheet 8)noT juST ifieD: continue
acTion ur GeS: What do I feel like doing or saying?


acTion ur GeS: What do I feel like doing or saying?

oppo SiTe ac Tion: What are the actions opposite to my urges? What am I not doing because
of my emotions? Describe both what  and how to act opposite all the way in the situation.

WhaT  i did:  Describe in detail.

hoW i did it: Describe body language, facial expression, posture, gestures, and thoughts.

What afTereffec T did the opposite action have on me (my state of mind, other emotions,
behavior, thoughts, memory, body, etc.)?


289
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may
download a larger version of this worksheet from www.guilford.com/dbt-
worksheets .eMotion re Gulation WorksHeet 8   (Emotion Regulation Handout 12) (p. 1 of 2)
problem Solving to c hange e motions
Due Date:       Name:                   Week Starting:
Select a prompting event that triggers a painful emotion. Select an event that can be changed. Turn
the event into a problem to be solved. Follow the steps below and describe what happened.
emoTion n ame:               i nTenSiTy (0–100) Before:      after:
1. Wha T iS The pro Blem ? Describe the problem prompting your emotions. What makes the
situation a problem?

2. check T he fac TS T o make S ure you have T he ri GhT pro Blem . Describe what
you did to be sure of your facts.
(See Emotion Regulation Worksheet 6 if you need help.)

 reWriTe the problem  if needed to stick with the facts.

3. Wha T iS a reali STic Shor T-Term G oal of your pro Blem S olvin G? What has to
happen for you to think you have made progress?

4. BrainST orm S oluTionS : List as many solutions and coping strategies as you can think of.


DON’T EVALUATE !

(continued on next page )


290eMotion re Gulation WorksHeet 8   (p. 2 of 2)
5. Which TW o iDeaS look Be ST (are most likely to meet your goal, are possible to do)?
1.                        2.  pro SSolution 1

                                       Solution 2

                                       con SSolution 1

                    Solution 2

6. choo Se the solution to try; list the steps needed; check the steps you do and how well they
work.
Step Describe  Done What happened?
1.
2.
3.
4.
5.
6.
7.
7. DiD you reach your G oal? If so, describe. If not, what can you do next?

 iS There no W a ne W pro Blem T o Be S olve D? If yes, describe, and problem-solve
again.


Worksheets for Reducing
Vulnerability to Emotion Mind


293
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may
download a larger version of this worksheet from www.guilford.com/dbt-
worksheets .eMotion re Gulation WorksHeet 9   (Emotion Regulation Handouts 14–20) (p. 1 of 2)
Steps for r educing v ulnerability to e motion m ind
Due Date:       Name:                   Week Starting:
For each emotion regulation skill, note whether you used it during the week, and describe what
you did. Write on the back of this sheet if you need more room.
A












accumula Te poSiTive e moTionS: Shor T Term
INCREASED  daily pleasant activities (circle): M T W Th F S Sun
Describe:

accumula Te poSiTive e moTionS: lonG Term; Buil DinG a l ife
Wor Th livinG
VALUES  considered in deciding what goals to work on (see Emotion Regulation Handout 18):

LONG -TERM  GOALS  worked on (describe):


LONG -TERM  GOALS  worked on (describe):

AVOIDED  AVOIDING  (describe):

minDfulne SS of p oSiTive e xperience S When They o ccurre D
Focused (and refocused) attention on positive experiences:
Distracted from worries if they showed up:
B
••
•
•••

BuilD maSTery
Scheduled activities to build a sense of accomplishment (circle): M  T  W  Th  F  S  Sun
Describe:

Actually did something difficult, Bu T possible (circle): M T W Th F S Sun
Describe:

C
••
•
•••
•
••••
•
cope aheaD
Describe a situation that prompts unwanted emotions (fill out Steps 1 and 2 of checking the
facts on Emotion Regulation Worksheet 5 if necessary):

Way that I imagined coping effectively (describe):

Way that I imagined coping with new problems that might arise (describe):

(continued on next page )


294eMotion re Gulation WorksHeet 9   (p. 2 of 2)
PLEASE  Skills

••
•
•••••

•••
•
•••••

Have I . . .
Treated physica l illness?

Balanced eating?
                                        avoided mood- altering substances?
                                        Balanced Sleep?
                                        exercised?


295eMotion re Gulation WorksHeet 10   (Emotion Regulation Handouts 15, 16)
pleasant e vents Diary
Due Date:       Name:                   Week Starting:
Accumulating pleasant events can take planning. For each day of the week, write down at least one pleasant activity or event that is possible
for you. In the next column, write down for each day the pleasant event or activity that you actually engaged in. Fill out an Observing and Describing Emotions worksheet (Emotion Regulation Worksheet 4 or 4a) if necessary, plus this diary sheet.
Day
of
week pleasant event(s) plannedpleasant event(s) i
actually  didmindfulness
of pleasant
event (0–5)letting go
of worries
(0–5)pleasant
experience
(0–100) comments
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this worksheet is granted to purchasers of
this book for personal use only (see copyright page for details). Purchasers may download a larger version of this worksheet from www.guilford.com/dbt-  worksheets .


296
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may
download a larger version of this worksheet from www.guilford.com/dbt-
worksheets .eMotion re Gulation WorksHeet 11   (Emotion Regulation Handouts 17–18) (p. 1 of 3)
Getting from v alues to Specific a ction Steps
Due Date:       Name:                   Week Starting:
STep 1. avoiD  avoiD inG. Rate degree you have avoided working on building a life worth living:
In the past (  ) Now (  ) (0 = no avoidance, 100 = avoided completely even thinking about it)
Check reasons for avoiding:  Hopelessness Willfulness Too hard  Other:
Use your cope-ahead skills, and write out a plan for getting yourself to avoid avoiding.
STep 2. iD enTify value S ThaT are impor TanT To you . What is most important to you?
Review Emotion Regulation Handout 18 for ideas. Make a list of several of your most important
values.
my impor TanT value S:

STep 3. iD enTify one impor TanT life value or priori Ty To Work on no W.
Long-term goals depend on Wise Mind values and priorities. What values in your life need more
work now?
Make a list of two of the most important  values in your life that are important things for you to


work on right now.
Importance Priority
VALUE :                                ( ) ( )
VALUE :                                ( ) ( )
Rate the importance of each value for a “life worth living” to you (1 = a little important, 5 = extremely important). Then rate how important it is to work on this value NOW  (1 = low priority,
5 = very high priority).
refine your choice S. Review your list and ratings above and the value you have chosen
to work on now. c heck T he fac TS. Make sure that what you think are values and priorities
are in fact YOUR  values and priorities—not the values others have, the values others think
you should have, or old internal “tapes” of values you learned but no longer really believe in.
Rewrite your list if you need to.
choo Se a value T o Work on no W. Pick the value that is either the most important to
you or is your highest priority to work on right now. (If you have more than one value that is a
high priority to work on right now, fill out another worksheet for that value.)
VALUE TO WORK ON NOW :
(continued on next page )


297eMotion re Gulation WorksHeet 11   (p. 2 of 3)
STep 4. iD enTify a fe W GoalS rela TeD To ThiS value.
List two or three different goals  related to this value. Be specific. What can you do to make
this value a part of your life? (If you have trouble thinking of goals, brainstorm as many goals
as you can think of that might be related, and then choose those most related to your values.)
GOAL:
GOAL:
GOAL:
STep 5. c hoo Se one G oal T o Work on no W.
Select one goal that is reasonable to work on now.  If one goal has to be accomplished before
other goals can be worked on, choose that one as your working-on goal. Be specific. If you
want to work on more than one goal at a time, fill out two worksheets.
Goal to work on:
STep 6. iD enTify S mall ac Tion ST epS ToWarD your G oal.
Break down the goal into lots of small steps that you can do. Each small step is a subgoal on
the way to your overall goal. List action steps that will get you closer to your goal. If you can’t think of any steps, try brainstorming ideas. Write down whatever comes to your mind.
If you start to feel overwhelmed  because a step looks too big, erase it and break it down into
smaller steps you think you can actually do. Rewrite your list if you need to so that the steps
you think you can do are included. Put in the order that you think you should do them. If you start to feel overwhelmed  because there are too many steps, stop writing new steps and focus


on just one step.
action Step 1:
action Step 2:
action Step 3:
action Step 4:
STep 7. Take one ac Tion ST ep no W. Describe what you did:

Describe what happened next:

(continued on next page )


298eMotion re Gulation WorksHeet 11   (p. 3 of 3)
rememB er: aTT enD  To relaTionShipS
Attending to relationships (Group A on Emotion Regulation Handout 18) and being part of a group
(Group B) are important to just about everyone. If you did not choose a value from one of these groups, review them to see if one of these first 10 values is an important one for you to work on. If you choose one, write it down and then, after working on it, fill out the rest of the worksheet.
Describe the relationship or relationship problem you want to work on:

What goal can you work on now?

What small action steps will help you reach your goal?
action Step 1:
action Step 2:
action Step 3:
action Step 4:
Take one ac Tion ST ep no W. Describe what you did:

Describe what happened next:


299
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may
download a larger version of this worksheet from www.guilford.com/dbt-
worksheets .eMotion re Gulation WorksHeet 11a   (Emotion Regulation Handouts 17–18)
Getting from v alues to Specific a ction Steps
Due Date:       Name:                   Week Starting:
Once you have figured out your values, the next step is to decide on specific things you can do
or achieve (goals) that will make your life more in line with your values. Once you have goals, you can figure out what action steps are necessary to achieve the goal.
example: value : Be part of a group.
Possible GoalS:
••Reconnect with old friends.
••Get a more social job.
••Join a club.
Pick one G oal to work on right now.
••Join a club.
Figure out a few ac Tion ST epS that will move me toward my goal.
••Look for clubs on craigslist.
••Go to the bookstore by my house and ask about book groups.
••Join an interactive online game or chat room.
1. Pick one of your value S:

2. Identify three G oalS:

3. Circle one G oal to
work on right now.
4. Identify acTion ST epS you can take right now to move closer to this G oal.


5. Take one ac Tion ST ep now . Describe what you did:

Describe what happened next:


300
eMotion re Gulation WorksHeet 11b   (Emotion Regulation Handouts 17–18)
Diary of Daily a ctions on v alues and p riorities
Due Date:       Name:                   Week Starting:
This diary is for tracking your progress in reaching your goals and living according to your own values. You can either fill out one page for
each value or goal you are working on, or you can fill it out every day no matter what goal you are working on that day. Remember to be very specific. Check Emotion Regulation Worksheet 11 or 11a for your list of important values and goals.
Day value Goal value and p riority a ctions Today next Step
What value am
I working on?What is my goal
related to this value?What action did I do today to achieve this goal?
(Be specific.)What will my next action be to
achieve this goal? (Be specific.)
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this worksheet is granted to purchasers of
this book for personal use only (see copyright page for details). Purchasers may download a larger version of this worksheet from www.guilford.com/dbt-  worksheets .


301eMotion re Gulation WorksHeet 12   (Emotion Regulation Handout 19)
Build m astery and c ope ahead
Due Date:       Name:                   Week Starting:
In the far left column, put down the days of the week. Then write plans for practicing mastery in the first column under “Build Mastery.” At
the end of the day, write in the second column what you actually did to increase your sense of mastery. Under “Cope Ahead,” describe a problem situation in the first column, and then describe in the second column how you imagined coping skillfully. Also, check whether it helped.
DayBuild m astery cope a head
Activities planned
for building masteryActivities I actually did
for building mastery Future problem situationHow I imagined coping
effectively (describe)
1.
Helpful? YES NO
2.
Helpful? YES NO
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this worksheet is granted to purchasers of
this book for personal use only (see copyright page for details). Purchasers may download a larger version of this worksheet from www.guilford.com/dbt-  worksheets .


302
eMotion re Gulation WorksHeet 13   (Emotion Regulation Handout 19)
putting a Bc Skills Together Day by Day
Due Date:       Name:                   Week Starting:
This worksheet is for tracking your planned ABC tasks throughout each day. At night or first thing in the morning, write down what you plan
to do that day; as you go or at the end of the day, write down what you actually did. Over time, you will find that you can do more and more of what you plan, and as you do that you will find your vulnerability to negative emotions going down.
Rate your negative mood or emotions at start of day (0–100):    And negative mood or emotions at end of day (0–100):
Daytime
hoursplanne D acTivi TieS Wha T i a cTually Di D
accumulate p ositive
emotionsaction to B uild
mastery cope- ahead Taskaccumulate p ositive
emotionsaction to B uild
mastery cope- ahead Task
Before
8 a.m.
8 a.m.
to 12 noon
12 noon to 4
p.m.
4 p.m.
to 8 p.m.
After 8 p.m.
Total
number of
activities
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this worksheet is granted to purchasers of
this book for personal use only (see copyright page for details). Purchasers may download a larger version of this worksheet from www.guilford.com/dbt-  worksheets .


303eMotion re Gulation WorksHeet 14   (Emotion Regulation Handout 20)
practicing plea Se Skills
Due Date:       Name:                   Week Starting:
In the left column, put down the days of the week. Then write down what you did to practice each of the PLEASE skills. At the bottom of each
column, check whether practicing this skill was helpful during the week.
DayDescribe treating
physica l illnessDescribe balanced
eating  effortslist mood- altering
substances usedhours of S leep
(time to bed; time up)Describe exercise
(hours and/or minutes)
Helpful? YES NO Helpful? YES NO Helpful? YES NO Helpful? YES NO Helpful? YES NO
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this worksheet is granted to purchasers of
this book for personal use only (see copyright page for details). Purchasers may download a larger version of this worksheet from www.guilford.com/dbt-  worksheets .


304
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may
download a larger version of this worksheet from www.guilford.com/dbt-
worksheets .eMotion re Gulation WorksHeet 14a   (Emotion Regulation Handout 20a) (p. 1 of 3)
Target n ightmare e xperience f orms (Set of 3)
Due Date:       Name:                   Week Starting:
In the space provided below, describe the distressing dream in as many details as possible.
Include sensory descriptions (sights, smells, sounds, tastes, etc.). Note the feelings, images, and thoughts associated with this dream, including assumptions about yourself. Be as specific as possible. Note when the dream begins and when it ends. (Use the back of this sheet if necessary.)
In my dream,

(continued on next page )


305eMotion re Gulation WorksHeet 14a   (p. 2 of 3)
Changed Dream Experience Form
Due Date:       Name:                   Week Starting:
In the space provided below, describe the changed dream in as many details as possible. Include
sensory descriptions (sights, smells, sounds, tastes, etc.). Please note the feelings, images, and thoughts associated with this dream, including assumptions about yourself. Be as specific as possible. Be sure the change you put in occurs before  anything traumatic or bad happens to you
or others in the nightmare. Note when the dream begins and when it ends. (Use the back of this
sheet if necessary.)
In my dream,

(continued on next page )


306
eMotion re Gulation WorksHeet 14a   (p. 3 or 3)
Dream Rehearsal and Relaxation Record
Due Date:       Name:                   Week Starting:
In the left column, put down the days of the week. Then write down what you did to practice dream rehearsal and relaxation during the week.
In the morning write down the intensity of your nightmare. (Put a 0 if you did not have the nightmare.) Continue practicing until you do not have the nightmare again.
DayDescribe daytime visual
rehearsal and relaxationnegative
emotion
intensity
(0–100)Describe daytime visual
rehearsal and relaxationnegative
emotion
intensity
(0–100)Describe daytime visual
rehearsal and relaxationnightmare
intensity
(0–100)
Start:
End:     Start:
End:
Start:
End:     Start:
End:
Start:
End:     Start:
End:
Start:
End:     Start:
End:
Start:
End:     Start:
End:
Start:
End:     Start:
End:
Start:
End:     Start:
End:


307eMotion re Gulation WorksHeet 14b
Sleep h ygiene p ractice Sheet
Due Date:       Name:                   Week Starting:
In the far left column, put down the days of the week. Then put times/hours in bed, and what you did in the 4 hours before bed, in the next
three columns. Along with describing the strategies you used, please rate your degree of rumination before and after using skills. Write in 0 if you had no rumination. Finally, rate the overall usefulness of your strategies.
DayTime
to bed/
time uphours/
minutes
in bed
during the
dayfood, drink, exercise
within 4 hours of bedStarting
emotion/
rumination
intensity
(0–100)Describe strategies used to get to sleep (or
back to sleep)ending
emotion/
rumination
intensity
(0–100)usefulness
of
strategies
(0–100)

    Hrs:
Min:
        Hrs:
Min:
        Hrs:
Min:
        Hrs:
Min:
        Hrs:
Min:
        Hrs:
Min:
        Hrs:
Min:
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission to photocopy this worksheet is granted to purchasers of
this book for personal use only (see copyright page for details). Purchasers may download a larger version of this worksheet from www.guilford.com/dbt-  worksheets .


Worksheets for Managing Really
Difficult Emotions


311
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may
download a larger version of this worksheet from www.guilford.com/dbt-
worksheets .eMotion re Gulation WorksHeet 15   (Emotion Regulation Handouts 21, 22)
mindfulness of c urrent e motions
Due Date:       Name:                   Week Starting:
emoTion n ame:               i nTenSiTy (0–100) Before:      after:
Describe situation that prompts emotion. (Fill out Steps 1 and 2 on Emotion Regulation Worksheet
5, if necessary.)
When emotional intensity is extreme, go to cri SiS Survival Skill S first  and fill out Distress
Tolerance Worksheets 2–6. With any emotion, high or low, practice radical acceptance with minD -
fulne SS of curren T emo TionS.
Check off any of the following that you did:
Stepped back and just noticed the emotions I was experiencing.
Experienced the emotion as waves, coming and going on the beach.
Let go of judgments about my emotions.
Noticed where in my body I was feeling the emotional sensations.
Paid attention to the physical sensations of the emotions as much as I could.
Observed how long it took the emotion to go away.
Reminded myself that being critical of emotions does not work.
Practiced willingness to have unwelcome emotions.


Practiced willingness to have unwelcome emotions.
Imagined my emotions as clouds in the sky, coming and going.
Just noticed the action urge that went with my emotion.
Got myself to avoid acting on my emotion.
Reminded myself of times when I have felt different.
Practiced radically accepting my emotion.
Tried to love my emotions.
 Other:
Comments and descriptions of experiences:


312
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permis -
sion to photocopy this worksheet is granted to purchasers of this book for personal use only (see copyright page for details). Purchasers may
download a larger version of this worksheet from www.guilford.com/dbt-
worksheets .eMotion re Gulation WorksHeet 16   (Emotion Regulation Handout 24)
Troubleshooting e motion r egulation Skills
Due Date:       Name:                   Week Starting:
When you just can’t get your skills to work, try doing this worksheet to see if you can figure out what
is going wrong. Check off each box in order, follow the directions and keep going until you find a solution.
emoTion n ame:               i nTenSiTy (0–100) Before:      after:
List the skill you were trying to use that did not seem to help:
1. am i biologically more vulnerable?
no: Go to next question.
noT Sure : Review the PLEASE skills.
(See Emotion Regulation Handout 20.)
yeS: Work on PLEASE skills. (See Emotion Regulation Worksheet 14.)  Consider medication.
Did this help?   no (Go to next question)   yes (fabulous)   Didn’t do it
2. Did i use the skill correctly? c heck out the instructions.
yeS: Go to next question.
noT Sure : Reread the instructions or get coaching. T RY AGAIN .


Did this help?   no (Go to next question)   yes (fabulous)   Didn’t do it
3. are my emotions being reinforced (and maybe i don’t really want to change them)?
no: Go to next question.
noT Sure : Review Emotion Regulation Handout 3/Worksheets 2, 2a.
yeS: Do a PROS  and CONS  for changing emotions. (See Emotion Regulation Worksheet 1.)
Did this help?   no (Go to next question)   yes (fabulous)   Didn’t do it
4. am i putting in the time and effort that emotion regulation takes?
yeS: Continue practicing.
no: Practice radical acceptance and willingness. (See Distress Tolerance Handouts 11b
and 13.)
Practice participating and effectiveness. (See Mindfulness Handouts 4 and 5.)
Use problem solving to find the time to work on skills. (See Emotion Regulation Worksheet 8.)
Did this help?   no (Go to next question)   yes (fabulous)   Didn’t do it
5. are my emotions too extreme right now for skills? am i going around in so many circles
that i have fallen into the emotional sea of dyscontrol?
no: Go to next question.
yeS: If possible now , solve the problem. (See Emotion Regulation Handout 12, Worksheet 9.)
If not possible, attend to physical sensations. (See Emotion Regulation Handout 22.)
If too extreme for skills, go to TIP skills. (See Distress Tolerance Handout 5.)


Did this help?   no (Go to next question)   yes (fabulous)   Didn’t do it
6. are myths about emotions and emotion regulation getting in my way?
no.
yeS: Practice nonjudgmentalness. Check the facts and challenge the myths.
Did this help?   no  yes (fabulous)   Didn’t do it


313DiSTreSS Tolerance
Skill S
Introduction to Handouts and Worksheets
Distress tolerance is the ability to tolerate and survive crises without making things
worse. The ability to tolerate and accept distress is essential for two reasons. First,
pain and distress are part of life; they cannot be entirely avoided or removed. The
inability to accept this immutable fact increases pain and suffering. Second, distress tolerance, at least over the short run, is part of any attempt to change yourself. Oth -
erwise, efforts to escape pain and distress will interfere with your efforts to establish
desired changes. There are two main sets of handouts and worksheets for distress
tolerance skills: Crisis Survival Skills and Reality Acceptance Skills. There is an additional, specialized set of handouts and worksheets for Skills When the Crisis Is Addiction.  One introductory handout precedes the handouts and worksheets on
these skill sets:
••Distress Tolerance Handout 1: Goals of Distress Tolerance. The goals of dis -
tress tolerance are (1) to survive crisis situations without making them worse, (2) to accept reality as it is in the moment, and (3) to become free.
Crisis Survival Skills
••Distress Tolerance Handout 2: Overview: Crisis Survival Skills. The goal of
crisis survival skills is to get through crises without making things worse. Crisis situ -
ations are, by definition, short-term. Thus these skills are not to be used all the time.
••Distress Tolerance Worksheets 1, 1a, 1b: Crisis Survival Skills. These are three
different versions of worksheets that can be used with Handout 2 and throughout this portion of the module. Each worksheet covers all of the crisis survival skills.


••Distress Tolerance Handout 3: When to Use Crisis Survival Skills. This hand -
out defines what a crisis is, and explains when and when not to use these skills.


314 •  DiSTreSS Tolerance Skill S
••Distress Tolerance Handout 4: The STOP Skill. The STOP skill can keep you
from acting impulsively on your emotions in ways that make a difficult situation
worse. The term STOP is a way to remember how to do the skill: Stop, Take a step
back, Observe, and P roceed mindfully. Two different worksheets can be used to
track practice of the STOP skill— Distress Tolerance Worksheets 2 and 2a: Practic -
ing the STOP Skill. Worksheet 2 provides space for two practices during the week. Worksheet 2a gives space for tracking daily practice.
••Distress Tolerance Handout 5: Pros and Cons. Listing pros and cons allows
you to compare the advantages and disadvantages of different options. This par -
ticular handout asks you to compare the pros and cons of acting on your emotional urges in a crisis situation and of resisting those urges. Figure out and write down
your pros and cons when you are not in a crisis; then, when a crisis hits, pull out
your pros and cons and review them. You can also use Distress Tolerance Work -
sheets 3  and 3a: Pros and Cons of Acting on Crisis Urges. Both worksheets ask for
the same information, but they are set up differently. Some people find one format much easier to work with than the other, and vice versa. Whichever one you use, remember to fill out all four quadrants.
••Distress Tolerance Handout 6: TIP Skills: Changing Your Body Chemistry.
Very high emotion can make it impossible to use most skills. The TIP skills are designed as a quick way to reduce high emotional arousal. The TIP skills are T em-


perature (cold water), I ntense exercise, P aced breathing, and P aired muscle relax -
ation. (Note that there are two P skills, although there is only one P in TIP.) There are also handouts on individual TIP skills as listed below. Distress Tolerance Work -
sheet 4: Changing Body Chemistry with TIP Skills covers all the TIP skills and can be used to track your practice.
••Distress Tolerance Handout 6a: Using Cold Water, Step by Step. This hand -
out goes over how to use cold water to reduce emotional arousal quickly.
••Distress Tolerance Handout 6b: Paired Muscle Relaxation, Step by Step.
Paired muscle relaxation is the pairing of relaxing your muscles with breathing out.
The idea is to practice combining the two enough so that relaxing when highly emo -
tional becomes easier and sometimes even automatic as you breathe out. This hand -
out describes in detail how to practice paired muscle relaxation. To track your prac -
tice of this skill, use Distress Tolerance Worksheet 4a: Paired Muscle Relaxation.
••Distress Tolerance Handout 6c: Effective Rethinking and Paired Relaxation.
This is a method of combining rethinking what you are telling yourself with paired
relaxation to bring down emotion rapidly in moments of high stress. To track your practice of this skill, you can use Distress Tolerance Worksheet 4b: Effective
Rethinking and Paired Relaxation.
••Distress Tolerance Handout 7: Distracting. Distracting methods work
by reducing your contact with whatever set off the distress or its most painful
aspects. The methods are listed on this handout and can be remembered with the


aspects. The methods are listed on this handout and can be remembered with the
term “Wise Mind ACCEPTS.” There are three different worksheets for tracking


introduction to Handouts and Worksheets • 3 1 5
practice— Distress Tolerance Worksheets 5, 5a, and 5b: Distracting with Wise Mind
ACCEPTS.  Worksheet 5 provides space for two practices between sessions. Work -
sheet 5a provides space for practicing every ACCEPTS skill twice. Worksheet 5b
gives space for multiple practices of each skill.
••Distress Tolerance Handout 8: Self-  Soothing. Self-  soothing means doing
things that feel pleasant and comforting, and that provide relief from stress or pain.
It is being gentle and mindfully kind to yourself. This handout lists a number of ways to self-  soothe through each of your five senses. There are three different worksheets
you can use to track your self-  soothing practice— Distress Tolerance Worksheets 6,
6a, and 6b: Self-  Soothing.  Each worksheet increases the number of practices, from
two practices between sessions (Worksheet 6) to practice of each skill twice between
sessions (Worksheet 6a) to multiple daily practices (Worksheet 6b).
••Distress Tolerance Handout 8a: Body Scan Meditation, Step by Step. This
handout gives instructions for body scan meditation as a special form of self-
soothing. Practice of the body scan can be recorded on Distress Tolerance Work -
sheet 6c: Body Scan Meditation, Step by Step.
••Distress Tolerance Handout 9: Improving the Moment. This handout lists a
number of different strategies that can be used to improve the quality of the pres -
ent moment, making it easier to survive a crisis without making it worse. The term


ent moment, making it easier to survive a crisis without making it worse. The term
IMPROVE is a way to remember the strategies. Any of three worksheets— Distress
Tolerance Worksheets 7, 7a,  and 7b: IMPROVE the Moment —can be used to track
practice of this skill. Each worksheet increases the number of practices that can be recorded, from two practices during the week (Worksheet 7) to practice of every skill twice (Worksheet 7a) to multiple daily practices (Worksheet 7b).
••Distress Tolerance Handout 9a: Sensory Awareness, Step by Step. The R in
IMPROVE stands for Relaxing actions, and sensory awareness is a relaxing action
you can take to improve the moment. This handout can be used as a guide to this
exercise.
Reality Acceptance Skills
••Distress Tolerance Handout 10: Overview: Reality Acceptance Skills. The
goal of reality acceptance is to reduce suffering and increase a sense of freedom by
finding ways to accept the facts of your life. This handout briefly lists the six reality
acceptance skills.
••Distress Tolerance Worksheets 8, 8a, 8b: Reality Acceptance Skills. These
three worksheets cover practice of all the reality acceptance skills. They can be used to track practice of any of the skills in this section. There are also worksheets for specific reality acceptance skills, as mentioned below.
••Distress Tolerance Handout 11: Radical Acceptance. Radical acceptance is a
complete and total openness to the facts of reality as they are, without fighting the facts or being willful and ineffective. This handout outlines what has to be accepted


316 •  DiSTreSS Tolerance Skill S
and why radical acceptance is better than nonacceptance. It is helpful to use this
handout with  Distress Tolerance Worksheet 9: Radical Acceptance which helps you
figure out what you might need to radically accept.
••Distress Tolerance Handout 11a: Radical Acceptance: Factors That Interfere.
This handout clarifies what radical acceptance is not and outlines factors that inter -
fere with it.
••Distress Tolerance Handout 11b: Practicing Radical Acceptance, Step by
Step.  This handout gives instructions for practicing radical acceptance. Practice can
be recorded on Distress Tolerance Worksheet 9 as mentioned above, or on Distress Tolerance Worksheet 9a: Practicing Radical Acceptance.
••Distress Tolerance Handout 12: Turning the Mind. In order to accept reality
that feels unacceptable, you usually have to make an effort more than once. You sometimes have to keep choosing to accept reality over and over for a very long time.
Turning the mind is choosing to accept. This handout explains turning the mind and
how to do it. Practice of this skill can be tracked on Distress Tolerance Worksheet 10: Turning the Mind, Willingness, Willfulness.
••Distress Tolerance Handout 13: Willingness. Willingness is the readiness to
respond to life’s situations wisely, as needed, voluntarily, and without grudge. It is the opposite of willfulness. This handout describes how to practice willingness. As
with Handout 12, practice can be recorded on Distress Tolerance Worksheet 10.
••Distress Tolerance Handout 14: Half-  Smiling and Willing Hands. Half smil -


ing and willing hands are two ways to accept reality with your body. This handout
describes how to practice each skill. Distress Tolerance Handout 14a: Practicing Half-  Smiling and Willing Hands  describes several specific ways to practice these
skills. Practice of these skills can be tracked on either Distress Tolerance Work -
sheet 11: Half-  Smiling and Willing Hands  or 11a: Practicing Half-  Smiling and
Willing Hands.  The two worksheets are similar, but Worksheet 11 requires more
writing.
••Distress Tolerance Handout 15: Mindfulness of Current Thoughts. Mind -
fulness of current thoughts is observing thoughts as thoughts, as sensations of the
brain, rather than as facts about the world. You simply let thoughts come and go—
noticing them, but not trying to control or change them. Observing thoughts is
similar to observing any other behavior. Handout 15 describes this skill. Distress Tolerance Handout 15a: Practicing Mindfulness of Thoughts lists examples of how to practice this skill. To record practice, you can use either of two worksheets— Dis-
tress Tolerance Worksheet 12: Mindfulness of Current Thoughts or Distress Toler -
ance Worksheet 12a: Practicing Mindfulness of Thoughts.
Skills When the Crisis Is Addiction
••Distress Tolerance Handout 16: Overview: When the Crisis Is Addiction. The
skills in this special part of the module are specifically designed for dealing with


introduction to Handouts and Worksheets • 3 1 7
various addictions. This handout lists these skills. Distress Tolerance Worksheet 13:
Skills When the Crisis Is Addiction covers all these skills and can be used instead of
worksheets for the specific skills mentioned below.
••Distress Tolerance Handout 16a: Common Addictions. This handout defines
addiction and lists common behaviors that can become addictions when you are
unable to stop them, despite your best efforts to stop and despite negative conse -
quences.
••Distress Tolerance Handout 17: Dialectical Abstinence. Dialectical absti -
nence is the synthesis of absolute abstinence (total commitment to abstinence) and harm reduction (planning for slips into the addictive behavior so they don’t become relapses).
••Distress Tolerance Handout 17a: Planning for Dialectical Abstinence. This
handout lists ways to plan for both abstinence and harm reduction. The items under “Plan for Abstinence” are shorthand for the skills described on Distress Tolerance Handouts 18–21. To track your practice of dialectical abstinence, use Distress Toler -
ance Worksheet 14: Planning for Dialectical Abstinence.
••Distress Tolerance Handout 18: Clear Mind. “Clear mind” is the middle
ground between the extremes of “addict mind” (when you are governed by your addiction) and “clean mind” (when you think your problems are behind you and you don’t need to be careful of a potential relapse). Clear mind is the safest place to
be, since it involves not engaging in the addictive behavior while remaining vigilant
of the temptation to do so.


of the temptation to do so.
••Distress Tolerance Handout 18a: Behavior Patterns Characteristic of Addict
Mind and of Clean Mind. This handout lists typical behaviors of addict mind and
clean mind and can help you identify when you are in one or the other. In particular,
check the behaviors you engage in while you are in clean mind. Use Distress Toler -
ance Worksheet 15: From Clean Mind to Clear Mind to practice replacing clean mind behaviors you’ve marked on Handout 18a with clear mind behaviors.
••Distress Tolerance Handout 19: Community Reinforcement. Community
reinforcement means restructuring your environment so that it will reinforce absti -
nence instead of addiction. This handout explains why this is important and lists steps you can take to make it happen. Use Distress Tolerance Worksheet 16: Rein -
forcing Nonaddictive Behaviors to track your practice of community reinforcement.
••Distress Tolerance Handout 20: Burning Bridges and Building New Ones.
“Burning bridges” here means actively eliminating from your life any and every con -
nection to potential triggers for addictive behaviors. “Building new bridges” means
creating new visual images and smells in your mind to compete with addiction urges.
Use Distress Tolerance Worksheet 17: Burning Bridges and Building New Ones to
track your practice of this skill.
••Distress Tolerance Handout 21: Alternate Rebellion and Adaptive Denial.
When addiction functions as rebellion, you can use some type of alternate rebellion
to satisfy your wish to rebel without destroying yourself or blocking your way to


318 •  DiSTreSS Tolerance Skill S
achieving important goals. Adaptive denial consists of convincing yourself that you
actually don’t crave the addictive behavior (denial). The first half of this handout
lists possible forms of alternate rebellion. The second half of the handout describes
steps for adaptive denial. Use Distress Tolerance Worksheet 18: Practicing Alternate Rebellion and Adaptive Denial to track your practice of these skills.


321
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details). distress tolerance Handout 1
Goals of Distress Tolerance
Survive c riSiS SiTuaTionS
Without m aking Them Worse
accep T reali Ty
replace Suffering and Being “Stuck”
with o rdinary p ain and the p ossibility of m oving f orward
Become f ree
of having to Satisfy
the Demands of y our o wn
Desires, u rges, and i ntense emotions
oTher:


325
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details).distress tolerance Handout 2   (Distress Tolerance Worksheets 1–7b)
overview:
crisis Survival Skills
These are skills for tolerating painful events, urges, and emotions when you cannot make
things better right away.
The ST op Skill
pros and c ons
Tip your Body c hemistry
Distract with Wise m ind accep TS
Self-  Soothe with the f ive Senses
improve the m oment


326
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details). distress tolerance Handout 3
When to u se crisis Survival Skills
you are in a cri SiS when the situation is:
••Highly stressful.
••Short-term (that is, it won’t last a long time).
••Creates intense pressure to resolve the crisis now .
uSe cri SiS Survival Skill S when:
1. You have intense pain that cannot be helped quickly.
2. You want to act on your emotions, but it will only make things worse.
3. Emotion mind threatens to overwhelm you, and you need to stay skillful.
4. You are overwhelmed, yet demands must be met.
5. Arousal is extreme, but problems can’t be solved immediately.
Don’ T uSe cri SiS Survival Skill S for:
••Everyday problems.
••Solving all your life problems.
••Making your life worth living.


327
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details). distress tolerance Handout 4   (Distress Tolerance Worksheets 2, 2a)
STop Skill
Stop Do not just react. Stop! Freeze! Do not move a
muscle! Your emotions may try to make you act without thinking. Stay in control!
Take a step back Take a step back from the situation. Take a break. Let go. Take a deep breath. Do not let your feelings make you act impulsively.
Observe Notice what is going on inside and outside you. What is the situation? What are your thoughts and feelings? What are others saying or doing?
Proceed mindfully Act with awareness. In deciding what to do, consider your thoughts and feelings, the situation, and other people’s thoughts and feelings. Think about your
goals. Ask Wise Mind: Which actions will make it
better or worse?
Note . Adapted from an unpublished worksheet by Francheska Perepletchikova and Seth Axelrod, with their permission.


328
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details). distress tolerance Handout 5   (Distress Tolerance Worksheets 3, 3a)
pros and c ons
Use pros and cons any time you have to decide between two courses of action.
An urge is a crisis when it is very strong and when acting on the urge will make things worse  in
the long term.
Make a list of the pros and  cons of acting on your crisis urges. These might be to engage in
dangerous, addictive, or harmful behaviors, or they might be to give in, give up, or avoid doing
what is necessary to build a life you want to live.
Make another list of the pros and cons of resisting crisis urges—that is, tolerating the distress and not giving in to the urges.
Use the grid below to evaluate both sets of pros and cons (this type of grid is also used in Distress Tolerance Worksheet 3). Or you can use the type of grid seen in Distress Tolerance Worksheet 3a and in the pros-and-cons worksheets for other modules.
pro S con S
acting on crisis urgespros  of acting on impulsive urges,
giving in, giving up, or avoiding what needs to be done.

                    cons of acting on impulsive urges,
giving in, giving up, or avoiding what
needs to be done.

resisting
crisis
urgespros  of resisting impulsive urges,


crisis
urgespros  of resisting impulsive urges,
doing what needs to be done, and not giving up.

                   cons of resisting impulsive urges,
doing what needs to be done, and
not giving up.

Before an overwhelming crisis urge hits:
Write out your pros and cons; carry them with you.
Rehearse your pros and cons over and over.
When an overwhelming crisis urge hits:
Review your pros and cons. Get out your list and read it over again.
••Imagine the positive consequences of resisting the urge.
••Think of the negative consequences of giving in to crisis behaviors.
••Remember past consequences when you have acted on crisis urges.


329
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details).« Distress tolerance Han Do ut 6  (Distress Tolerance Worksheet 4)
TIP Skills: Changing Your Body Chemistry
To reduce extreme emotion mind fast.
Remember these as TIP  skills:
TTI P Th e T emPer aTu re of your face with C old wa T er*
(to calm down fast)
• •Holding your breath, put your face in a bowl of cold water,
or hold a cold pack (or zip-lock bag of cold water) on your eyes and cheeks.
• •Hold for 30 seconds. Keep water above 50°F.
IInTenSe  exer C ISe*
(to calm down your body when it is revved up by emotion)
• •Engage in intense exercise, if only for a short while.
• •Expend your body’s stored up physical energy by running, walking fast, jumping,
playing basketball, lifting weights, etc.
P

PaCed Bre aThIn g
(pace your breathing by slowing it down)
• •Breathe deeply into your belly.


• •Breathe deeply into your belly.
• •Slow your pace of inhaling and exhaling way down (on average, five to six breaths
per minute).
• •Breathe out more slowly than you breathe in  (for example, 5 seconds in and 7
seconds out).
PaIred  mu SC le relaxa T Io n
(to calm down by pairing muscle relaxation with breathing out)
• •While breathing into your belly deeply tense your body muscles ( not so much as
to cause a cramp).
• •Notice the tension in your body.
• •While breathing out, say the word “Relax” in your mind.
• •Let go of the tension.
• •Notice the difference in your body.
*Caution:  Very cold water decreases your heart rate rapidly. Intense exercise will increase heart rate. Consult your health care provider before
using these skills if you have a heart or medical condition, a lowered base heart rate due to medications, take a beta-  b
locker, are allergic to
cold, or have an eating disorder.


330
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details).Distress tolerance Han Do ut 6a   (Distress Tolerance Worksheet 4)
Using Cold Water, Step by Step
Cold Wa ter Can  Wor k Wo nder S*
When you put your full face into cold water .  . . or y ou put a zip-lock bag
with cold water on your eyes and upper cheeks, and hold your breath, it
tells your brain you are diving underwater.
This causes the “dive response”  to occur. (It may take 15–30 seconds to
start.)Your heart slows down, blood flow to nonessential organs is reduced, and
blood flow is redirected to the brain and heart.
This response can actually help regulate your emotions.This will be useful as a distress tolerance strategy when you are having
a very strong, distressing emotion,  or when you are having very strong
urges to engage in dangerous behaviors .
(This strategy works best when you are sitting quietly—
 a
ctivity and
distraction may make it less effective.)
tr y it o U t!
*Caution:  Very cold water decreases your heart rate. If you have any heart or medical condition, have a lowered base heart rate due to medica -
tions, or are on a beta-  b
locker, consult your health care provider before using these skills. Avoid ice water if you are allergic to the cold.


331
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details).distress tolerance Handout 6b   (Distress Tolerance Worksheet 4a)
paired m uscle r elaxation, Step by Step
If you have decided to practice paired muscle relaxation, it can be very helpful to practice
relaxing each of your muscles first.
When you are starting, practice in a quiet place to reduce distractions, and make sure that you
have enough time. As you improve with practice, you will want to practice in many different kinds of
places, so that you can relax effectively when you most need to.
remember that effectiveness improves with practice. If judgments arise, observe them, let
them go, and return to your practice. If you become anxious, try focusing on breathing in  to the
count of 5 and out  to the count of 7 (or the counts you have already determined for paced breathing),
breathing all the while into your belly until you can return to relaxation exercises.now that you are ready to begin . . .
1. Get your body into a comfortable position in which you can relax. Loosen tight clothing. Lie or
sit down, with all body parts uncrossed and no body part supporting any others.
2. For each area of the body listed below, gather tension by tightening muscles. Focus on the sensation of tightness in and around that area. Hold the tension as you inhale for 5–6 seconds, then release and breathe out.
3. As you release, say in your mind very slowly the word “Relax.”


3. As you release, say in your mind very slowly the word “Relax.”
4. Observe the changes in sensations as you relax for 10–15 seconds then move on to the next
muscle.
Start first with each of the 16 muscle groups.
Once you can do that, practice with medium groups of muscles and then large groups.
Once you are good at that, practice tensing your entire body at once.
When you tense your entire body, you are like a robot—stiff, nothing moving.
When you relax your entire body, you are like a rag doll—all muscles drooping down.
Once you can relax all your muscles, practice three or four times a day until you can routinely
relax your entire body rapidly.
By practicing pairing exhaling and the word “Relax” with relaxing your muscles, you will
eventually be able to relax just by letting go and saying the word “Relax.”Large
Medium
Small
• 1. Hands and wrists: Make fists with both hands and pull fists up on the wrists.
 2. Lower and upper arms: Make fists and bend both arms up to touch your shoulders.
 3. Shoulders: Pull both shoulders up to your ears.

••
 4. Forehead: Pull eyebrows close together, wrinkling forehead.
 5. Eyes: Shut eyes tightly.
 6. Nose and upper cheeks: Scrunch up nose; bring upper lips and cheeks up toward eyes.


 7. Lips and lower face: Press lips together; bring edges of lips back toward ears.
 8. Tongue and mouth: Teeth together; tongue pushing on upper mouth.
• 9. Neck: Push head back into chair, floor, or bed, or push chin down to chest.
10. Chest: Take deep breath and hold it.
11. Back: Arch back, bringing shoulder blades together.

•
12. Stomach: Hold stomach in tightly.
13. Buttocks: Squeeze buttocks together.
•14. Upper legs and thighs: Legs out; tense thighs.
15. Calves: Legs out; point toes down.
16. Ankles: Legs out; point toes together, heels out, toes curled under.
remember,  paired relaxation is a skill. It takes time to develop. With practice, you will notice the benefits.
Note.  Adapted from Smith, R. E. (1980). Development of an integrated coping response through cognitive–  affective stress management train -
ing. In I. G. Sarason & C. D. Spielberger (Eds.), Stress and anxiety (Vol. 7, pp. 265–280). Washington, DC: Hemisphere. Copyright 1980 by
Hemisphere Publishing Corporation. Adapted by permission.


332
From DBT Skills Training Handouts and Worksheets, Second Edition  by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan. Permission
to photocopy this handout is granted to purchasers of this book for personal use only (see copyright page for details).Distress tolerance Han Do ut 6c   (Distress Tolerance Worksheet 4b)
Effective Rethinking and Paired Relaxation,
Step by Step
Step 1. Write down the prompting event that is often related to distressing emotions and that you
want to work on reducing your emotional reactions to.
Step 2. Ask:  “What must I be telling myself (that is, what are my interpretations and thoughts )
about the event that causes such distress and arousal?” Write these down. Examples:
“He hates me,” “I can’t stand this!” “I can’t do this,” “I’ll never make it,” “I’m out of control!”
Step 3. Rethink  the situation and its meaning in a way that counteracts the thoughts and interpreta -
tions producing stress and distressing emotions. As you rethink the situation, write down as many
effective thoughts  as you can to replace the stressful thoughts.
Step 4. When you are not  in the stressful prompting event, practice imagining  the stressful event:
a. A
t the same time, while breathing in,  say to yourself an effective self-  s
tatement.
b.
When breathing out, say  “Relax” while intentionally relaxing all your muscles.
Step 5. Keep practicing every chance you get until you have mastered the strategy.
Step 6. When a stressful situation occurs, practice effective rethinking and paired relaxation.