DBT ®  Skill S Training Han DouTS an D Work SHeeTS


Also from Marsha M. Linehan
Books for Professionals
Cognitive-  B ehavioral Treatment of Borderline Personality Disorder
DBT Skills Training Manual, Second Edition
Dialectical Behavior Therapy with Suicidal Adolescents
Alec L. Miller, Jill H. Rathus, and Marsha M. Linehan
Mindfulness and Acceptance:
Expanding the Cognitive-
 B
ehavioral Tradition
Edited by Steven C. Hayes, Victoria M. Follette, and Marsha M. Linehan
Videos
Crisis Survival Skills, Part One: Distracting and Self-  S oothing
Crisis Survival Skills, Part Two: Improving the Moment and Pros and Cons
From Suffering to Freedom: Practicing Reality Acceptance
Getting a New Client Connected to DBT (Complete Series)
Opposite Action: Changing Emotions You Want to Change
This One Moment: Skills for Everyday Mindfulness
Treating Borderline Personality Disorder: The Dialectical Approach
Understanding Borderline Personality: The Dialectical Approach
For more information and for DBT skills updates from the author,
see her websites:
www.linehaninstitute.org , http://blogs.uw.edu/brtc,
and http://faculty.washington.edu/linehan/


DBT ® Skills
Training
Handouts
and Worksheets
Secon D eDiTion
Marsha M. Linehan
THe guil ForD PreSS
new York   l ondon


© 2015 Marsha M. Linehan
Published by The Guilford Press
A Division of Guilford Publications, Inc.72 Spring Street, New York, NY 10012www.guilford.com
All rights reservedExcept as indicated on page 4, no part of this book may be reproduced, translated, stored
in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the publisher.
Printed in the United States of AmericaThis book is printed on acid-free paper.Last digit is print number:

9

8

7

6

5

4

3

2

1
The author has checked with sources believed to be reliable in her efforts to provide
information that is complete and generally in accord with the standards of practice that are accepted at the time of publication. However, in view of the possibility of human error or changes in behavioral, mental health, or medical sciences, neither the author, nor the editor and publisher, nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or the results obtained from the use of such information. Readers are encouraged to confirm the information contained in this book with other sources.
Library of Congress Cataloging-in-
 P
ublication Data
Linehan, Marsha.
DBT skills training handouts and worksheets / Marsha M. Linehan. — Second edition.

pages
cm
Includes bibliographical references and index.
ISBN 978-1-57230-781-0 (paperback)1.
D
ialectical behavior therapy—Problems, exercises, etc. I


D
ialectical behavior therapy—Problems, exercises, etc. I
.
 T
itle.
RC489.B4L56 2015616.89'1420076—dc23
2014026331
DBT is a registered trademark of Marsha M. Linehan.Proudly sourced and uploaded by [StormRG]
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When I am on retreats, each afternoon I walk and
wring my hands, saying to all the mental health
patients of the world, “You don’t have to wring
your hands today. I am doing it for you.” Often
when I dance in the hallway of my house or with
groups, I invite all the mental health patients of the
world to come dance with me.
This book is dedicated to all the patients of the
world who think that no one is thinking of them.
I considered telling you that I would practice skills
for you so you don’t have to practice them. But then
I realized that if I did, you would not learn how to
be skillful yourself. So, instead, I wish you skillful
means, and I wish that you find these skills useful.


viabout the a uthor
Marsha M. Linehan, PhD, ABPP, is the developer of Dialectical Behavior Ther -
apy (DBT) and Professor of Psychology and of Psychiatry and Behavioral Sciences
and Director of the Behavioral Research and Therapy Clinics at the University of
Washington. Her primary research interest is in the development and evaluation of  evidence-based treatments for populations with high suicide risk and multiple,
severe mental disorders.
Dr. Linehan’s contributions to suicide research and clinical psychology research
have been recognized with numerous awards, including the Gold Medal Award for
Life Achievement in the Application of Psychology from the American Psychological Foundation and the James McKeen Cattell Award from the Association for Psy -
chological Science. In her honor, the American Association of Suicidology created the Marsha Linehan Award for Outstanding Research in the Treatment of Suicidal Behavior.
She is a Zen master and teaches mindfulness and contemplative practices via
workshops and retreats for health care providers.


v iiPreface
Since the publication of the original Dialectical Behavior Therapy (DBT) skills train -
ing manual in 1993, there has been an explosion of research on the applications of
DBT across disorders. My pilot and first DBT study focused on the treatment of highly suicidal adults. Now, we have research demonstrating the efficacy of DBT skills training with suicidal adolescents, as well as adults with borderline personal-ity disorder, eating disorders, treatment-resistant depression, substance use, and a variety of other disorders. A diagnosis of a mental disorder is not required, however, to benefit from DBT skills. Friends and family members of individuals with difficul -
ties will find these skills helpful; kids in elementary school through high school can gain from these skills. Businesses will find DBT skills useful in creating better work environments. All the DBT therapists I know practice these skills in their own lives on a routine basis. I myself am grateful for the skills because they have made my life a lot easier. As someone once said to me, “Aren’t these skills your mother was sup -
posed to teach you?” I always say yes, but for many people their mother just did not or was not able to get around to it.
I developed many of the skills by reading treatment manuals and treatment lit -
erature on evidence-based behavioral interventions. I reviewed what therapists told their patients to do and then repackaged those instructions in skills handouts and worksheets and wrote teaching notes for therapists. For example, the skill “oppo -
site action” is a set of instructions based on exposure-based treatments for anxiety disorders . The major change was to generalize the strategies to fit treatment of emo -
tions other than anxiety.  “Check the facts” is a core strategy in cognitive therapy


interventions. The mindfulness skills were a product of my 19 years in Catholic schools, my training in contemplative prayer practices through the Shalem Institute’s spiritual guidance program, and my 35 years as a Zen student—and now Zen mas -
ter. Mindfulness of current thoughts also draws from acceptance and commitment therapy. In general, DBT skills are what behavior therapists tell clients to do across many effective treatments. Some of the skills repurpose entire treatment programs now formulated as a series of steps. The new “nightmare protocol,” an emotion regulation skill, is an example of this. Other skills came from research in cognitive and social psychology. Still others came from colleagues developing new DBT skills


viii •  Preface
for new populations. As you can see, these skills came from many different sources
and disciplines.
I am happy to present this skills training manual for clients, which includes
all of the handouts and worksheets I have developed so far in DBT. (Stay tuned for more.) You are not likely to need to use all of the skills I have included. Every skill works for someone and no skill works for everyone. The skills in this book have
been tested with a huge variety of people: adults, adolescents, parents, friends, and
families, both high risk and low. I hope the skills are just what you need. Use your interpersonal skills (see the DEAR MAN GIVE FAST skills in the Interpersonal Effectiveness skills module) to talk your skills trainer or other teacher into teaching
you skills not ordinarily covered in skills training if you want to learn them. If you
should decide to venture forth on your own, I must tell you that we have no research on the effectiveness of this skills manual as a self-help workbook or self-treatment
manual. I am hoping to write a self-help treatment book in the future, so keep your
eyes open for that. Meanwhile, you might be interested in the skills videos avail -
able through The Guilford Press or The Linehan Institute and listed on page ii of this manual. They themselves do not constitute treatment, but we know that many
people have nonetheless found them useful, even though we have not collected data
on them. On your own or with the help of a skills teacher, I wish you skillful means.


ixac knowledgments
Developing, researching, testing, and organizing the behavioral skills in this book
has been a process that has unfolded over many years. Over these years many people made important contributions to what finally became this set of skills and work -
sheets. Here I want to thank a long line of teachers, colleagues, students, post
-
d
octoral fellows, and clients, who for many years have been in dialogue with me on
how to best develop, organize, explain, and disseminate behavioral skills to those in need of skillful means.
I want to acknowledge Rev. Pat Hawk and Rev. Willigis Yaeger, who were my
contemplative prayer and Zen teachers, and Anselm Romb, my Franciscan spiritual guide, who taught me to let go of words. Each of them listened to me for hours as I sorted out how to practice and how to teach mindfulness. My mentors, Gerald Davi -
son and Marvin Goldfried, taught me behavior therapy, and through them I was introduced to evidence-based treatments, where I found most of the skillful means that I condensed into the skills in this book. I extend my gratitude to Jon Kabat-Zinn, John Teasdale, Mark Williams, and Zindel Segal for inspiration. I especially want to thank my students and former students (in alphabetical order), Milton Brown, Anita Lungu, Andrada Neacsiu, Shireen Rizvi, Stephanie Thompson, Chelsey Wilks, Bri -


anna Woods; and my fellows and former fellows, Alex Chapman, Eunice Chen, Melanie Harned, Erin Miga, Marivi Navarro, and Nick Salsman. Many others have jumped in when asked, colleagues Seth Axelrod, Kate Comtois and her entire DBT team, Sona Dimidjian, Anthony Dubose, Thomas Lynch, and Suzanne Witterholt, as well as the Linehan Institute scientific advisory committee (Martin Bohus, Alan Fruzzetti, André Ivanoff, Kathryn Korslund, and Shelley McMain). I could not have written this book without the help of Elaine Franks, my fabulous administrative assistant, and Thao Truong, our office and financial manager, who made sure that our research clinic did not fall apart while everyone was waiting for me to finish this book. My family, Geraldine, Nate, Catalina, and Aline, made life easy at every turn no matter the stress—not a minor contribution to getting a book written.
Much of what is in this manual I learned from the many clients who partici -
pated in skills training groups that I have conducted over the years. I am grateful to all those who put up with the many versions that did not work or were not useful,


x • acknowledgments
and to those among them who gave enough feedback for me to make needed revi -
sions in the skills being taught.
The clients who gave feedback were, for the most part, individuals at high risk
for suicide. I thank the University of Washington Human Subjects Division, which
has never even once impeded my research treating individuals at extremely high risk for suicide. Their willingness to allow such high-risk research when other universi -
ties often do not sets an example and made this book possible.
Last, but certainly not least, I want to thank my copy editor, Marie Sprayberry,
Senior Editor Barbara Watkins, Executive Editor Kathyrn Moore, and the staff at The Guilford Press. In getting this manual out in a timely fashion they each had
occasion to practice all the distress tolerance skills in this book. Their concern for
this book and for this form of treatment was evident at every step.
Alas, it is likely that I have forgotten or accidently left out one or more individu -
als who have contributed to this book. If so, please let me know so I can include you in future editions.


xiContents
Introduction to This Book  1
General Skills: Orientation and Analyzing Behavior
General Handouts
Orientation Handouts
General Handout 1: Goals of Skills Training (General Worksheet 1) 9
General Handout 1a: Options for Solving Any Problem 10
General Handout 2: Overview—Introduction to Skills Training 11
General Handout 3: Guidelines for Skills Training 12
General Handout 4: Skills Training Assumptions 13
General Handout 5: Biosocial Theory 14
Handouts for Analyzing Behavior
General Handout 6: Overview—Analyzing Behavior
(General Worksheets 2, 3)19
General Handout 7: Chain Analysis (General Worksheets 2, 2a) 20
General Handout 7a: Chain Analysis, Step by Step
(General Worksheets 2, 2a)21
General Handout 8: Missing-Links Analysis (General Worksheet 3) 23
General Worksheets
Orientation Worksheet
General Worksheet 1: Pros and Cons of Using Skills (General Handout 1) 27
Worksheets for Analyzing Behavior
General Worksheet 2: Chain Analysis of Problem Behavior
(General Handouts 7, 7a)31
General Worksheet 2a: Example—Chain Analysis of Problem Behavior
(General Handouts 7, 7a)35
General Worksheet 3: Missing-Links Analysis (General Handout 8) 38


xii •  contents
Mindfulness Skills
Mindfulness Handouts
Handouts for Goals and Definitions
Mindfulness Handout 1: g oals of Mindfulness Practice
(Mindfulness Worksheet 1)45
Mindfulness Handout 1a: Mindfulness Definitions 46
Handouts for Core Mindfulness Skills
Mindfulness Handout 2: o verview— core Mindfulness Skills
(Mindfulness Worksheets 2–2c, 3)49
Mindfulness Handout 3: Wise Mind—States of Mind
(Mindfulness Worksheet 3)50
Mindfulness Handout 3a: i deas for Practicing Wise Mind
(Mindfulness Worksheet 3)51
Mindfulness Handout 4: Taking Hold of Your Mind—“What” Skills
(Mindfulness Worksheets 2–2c, 4–4b)53
Mindfulness Handout 4a: i deas for Practicing o bserving
(Mindfulness Worksheets 2–2c, 4–4b)54
Mindfulness Handout 4b: i deas for Practicing Describing
(Mindfulness Worksheets 2–2c, 4–4b)58
Mindfulness Handout 4c: i deas for Practicing Participating
(Mindfulness Worksheets 2–2c, 4–4b)59
Mindfulness Handout 5: Taking Hold of Your Mind—“How” Skills
(Mindfulness Worksheets 2–2c, 5–5c)60
Mindfulness Handout 5a: i deas for Practicing n onjudgmentalness
(Mindfulness Worksheets 2–2c, 5–5c)61


(Mindfulness Worksheets 2–2c, 5–5c)61
Mindfulness Handout 5b: i deas for Practicing o ne- Mindfulness
(Mindfulness Worksheets 2–2c, 5–5c)62
Mindfulness Handout 5c: i deas for Practicing e ffectiveness
(Mindfulness Worksheets 2–2c, 5–5c)63
Handouts for Other Perspectives on Mindfulness Skills
Mindfulness Handout 6: o verview— other Perspectives on Mindfulness
(Mindfulness Worksheets 6–10b)67
Mindfulness Handout 7: g oals of Mindfulness Practice— a Spiritual
Perspective (Mindfulness Worksheet 1)68
Mindfulness Handout 7a: Wise Mind from a Spiritual Perspective 69
Mindfulness Handout 8: Practicing l oving k indness to i ncrease
love and c ompassion (Mindfulness Worksheet 6)70
Mindfulness Handout 9: Skillful Means—Balancing Doing Mind
and Being Mind (Mindfulness Worksheets 7–9)71
Mindfulness Handout 9a: i deas for Practicing Balancing Doing Mind
and Being Mind (Mindfulness Worksheets 7–9)72
Mindfulness Handout 10: Walking the Middle Path—Finding the
Synthesis between o pposites (Mindfulness Worksheets 10–10b)74


c ontents • xiii
Mindfulness Worksheets
Worksheets for Core Mindfulness Skills
Mindfulness Worksheet 1: Pros and c ons of Practicing Mindfulness
(Mindfulness Handouts 1, 7)77
Mindfulness Worksheet 2: Mindfulness c ore Skills Practice
(Mindfulness Handouts 2–5c)78
Mindfulness Worksheet 2a: Mindfulness c ore Skills Practice
(Mindfulness Handouts 2–5c)79
Mindfulness Worksheet 2b: Mindfulness c ore Skills Practice
(Mindfulness Handouts 2–5c)80
Mindfulness Worksheet 2c: Mindfulness c ore Skills c alendar
(Mindfulness Handouts 2–5c)81
Mindfulness Worksheet 3: Wise Mind Practice
(Mindfulness Handouts 3, 3a)83
Mindfulness Worksheet 4: Mindfulness “What” Skills—
observing, Describing, Participating (Mindfulness Handouts 4–4c)84
Mindfulness Worksheet 4a: o bserving, Describing, Participating c hecklist
(Mindfulness Handouts 4–4c)85
Mindfulness Worksheet 4b: o bserving, Describing, Participating
calendar (Mindfulness Handouts 4–4c)86
Mindfulness Worksheet 5: Mindfulness “How” Skills—
nonjudgmentalness, o ne- Mindfulness, e ffectiveness
(Mindfulness Handouts 5–5c)88
Mindfulness Worksheet 5a: n onjudgmentalness, o ne- Mindfulness,
effectiveness c hecklist (Mindfulness Handouts 5–5c)89


effectiveness c hecklist (Mindfulness Handouts 5–5c)89
Mindfulness Worksheet 5b: n onjudgmentalness, o ne- Mindfulness,
effectiveness c alendar (Mindfulness Handouts 5–5c)90
Mindfulness Worksheet 5c: n onjudgmentalness c alendar
(Mindfulness Handouts 5–5c)92
Worksheets for Other Perspectives on Mindfulness Skills
Mindfulness Worksheet 6: l oving k indness (Mindfulness Handout 8) 97
Mindfulness Worksheet 7: Balancing Being Mind with Doing Mind
(Mindfulness Handouts 9, 9a)98
Mindfulness Worksheet 7a: Mindfulness of Being and Doing c alendar
(Mindfulness Handouts 9, 9a)99
Mindfulness Worksheet 8: Mindfulness of Pleasant e vents c alendar
(Mindfulness Handouts 9, 9a)101
Mindfulness Worksheet 9: Mindfulness of u npleasant e vents c alendar
(Mindfulness Handouts 9, 9a)103
Mindfulness Worksheet 10: Walking the Middle Path to Wise Mind
(Mindfulness Handouts 3, 10)105
Mindfulness Worksheet 10a: a nalyzing Yourself on the Middle Path
(Mindfulness Handout 10)106
Mindfulness Worksheet 10b: Walking the Middle Path c alendar
(Mindfulness Handout 10)107


xiv •  co ntents
Interpersonal Effectiveness Skills
Interpersonal Effectiveness Handouts
Handouts for Goals and Factors That Interfere
in terpersonal ef fectiveness Handout 1: go als of in terpersonal
ef
fectiveness ( in
terpersonal
ef
fectiveness Worksheet 1)117
in
terpersonal
ef
fectiveness Handout 2: Factors in the Way
of
in
terpersonal
ef
fectiveness118
in
terpersonal
ef
fectiveness Handout 2a: Myths in the Way
of
in
terpersonal
ef
fectiveness ( in
terpersonal
ef
fectiveness
Worksheet 2)119
Handouts for Obtaining Objectives Skillfully
in terpersonal ef fectiveness Handout 3: ov erview—
ob
taining  ob
jectives Skillfully123
in
terpersonal
ef
fectiveness Handout 4:
cl
arifying
go
als in
in
terpersonal
Situations ( in
terpersonal
ef
fectiveness Worksheet 3)124
in
terpersonal
ef
fectiveness Handout 5:
gu
idelines for
ob
jectives
ef
fectiveness— ge
tting What You Want (D e
ar
 Ma
n)

(in
terpersonal
ef
fectiveness Worksheets 4, 5)125
in
terpersonal
ef
fectiveness Handout 5a:
ap
plying D e
ar
 Ma
n
 Skills
to a Difficult
cu
rrent
in
teraction127
in
terpersonal
ef


cu
rrent
in
teraction127
in
terpersonal
ef
fectiveness Handout 6:
gu
idelines for
re
lationship
ef
fectiveness— ke
eping the
re
lationship ( g
iVe)

(in
terpersonal
ef
fectiveness Worksheets 4, 5)128
in
terpersonal
ef
fectiveness Handout 6a:
ex
panding the V in
giVe—
le
vels of Validation129
in
terpersonal
ef
fectiveness Handout 7:
gu
idelines for Self-
re
spect
ef
fectiveness— ke
eping
re
spect for Yourself (F aS
T)
(in
terpersonal
ef
fectiveness Worksheets 4, 5)130
in
terpersonal
ef
fectiveness Handout 8:
ev
aluating
op
tions
for Whether or How
in
tensely to
as
k for Something or Say
no

(in
terpersonal
ef
fectiveness Worksheet 6)131
in
terpersonal
ef
fectiveness Handout 9: Troubleshooting—When What
You
ar
e Doing
is
n’t Working ( in
terpersonal
ef
fectiveness
Worksheet 7)134
Handouts for Building Relationships and Ending Destructive Ones
in terpersonal ef fectiveness Handout 10: ov erview—
Building
re
lationships and
en
ding Destructive
on
es139
in
terpersonal
ef
fectiveness Handout 11: Finding and


in
terpersonal
ef
fectiveness Handout 11: Finding and
ge
tting People
to
li
ke You ( in
terpersonal
ef
fectiveness Worksheet 8)140
in
terpersonal
ef
fectiveness Handout 11a:
id
entifying Skills to Find People
and
ge
t Them to
li
ke You142
in
terpersonal
ef
fectiveness Handout 12: Mindfulness of
ot
hers
(in
terpersonal
ef
fectiveness Worksheet 9)143
in
terpersonal
ef
fectiveness Handout 12a:
id
entifying Mindfulness
of
ot
hers144


c ontents • xv
interpersonal e ffectiveness Handout 13: e nding r elationships
(interpersonal e ffectiveness Worksheet 10)145
interpersonal e ffectiveness Handout 13a: i dentifying How
to end relationships146
Handouts for Walking the Middle Path
interpersonal e ffectiveness Handout 14: o verview—Walking the Middle
Path ( interpersonal e ffectiveness Worksheets 11–15c)149
interpersonal e ffectiveness Handout 15: Dialectics
(interpersonal e ffectiveness Worksheets 11–11b)150
interpersonal e ffectiveness Handout 16: How to Think and a ct
Dialectically ( interpersonal e ffectiveness Worksheets 11–11b)151
interpersonal e ffectiveness Handout 16a: e xamples of o pposite Sides
That c an Both Be True152
interpersonal e ffectiveness Handout 16b: i mportant o pposites
to Balance153
interpersonal e ffectiveness Handout 16c: i dentifying Dialectics 154
interpersonal e ffectiveness Handout 17: Validation
(interpersonal e ffectiveness Worksheet 12)155
interpersonal e ffectiveness Handout 18: a “How To” g uide to Validation
(interpersonal e ffectiveness Worksheet 12)156
interpersonal e ffectiveness Handout 18a: i dentifying Validation 157
interpersonal e ffectiveness Handout 19: r ecovering from i nvalidation
(interpersonal e ffectiveness Worksheet 13)158
interpersonal e ffectiveness Handout 19a: i dentifying Self-  Validation 160


interpersonal e ffectiveness Handout 20: Strategies for i ncreasing
the Probability of Behaviors You Want ( interpersonal e ffectiveness
Worksheet 14)161
interpersonal e ffectiveness Handout 21: Strategies for Decreasing
or Stopping u nwanted Behaviors ( interpersonal e ffectiveness
Worksheet 15)162
interpersonal e ffectiveness Handout 22: Tips for u sing Behavior c hange
Strategies e ffectively ( interpersonal e ffectiveness Worksheets 14, 15)163
interpersonal e ffectiveness Handout 22a: i dentifying e ffective Behavior
change Strategies164
Interpersonal Effectiveness Worksheets
Worksheets for Goals and Factors That Interfere
interpersonal e ffectiveness Worksheet 1: Pros and c ons of u sing
interpersonal e ffectiveness Skills ( interpersonal e ffectiveness
Handout 1)167
interpersonal e ffectiveness Worksheet 2: c hallenging Myths in the Way
of obtaining o bjectives ( interpersonal e ffectiveness Handout 2a)168
Worksheets for Obtaining Objectives Skillfully
interpersonal e ffectiveness Worksheet 3: c larifying Priorities
in interpersonal Situations ( interpersonal e ffectiveness Handout 4)173


xvi •  contents
interpersonal e ffectiveness Worksheet 4: Writing o ut interpersonal
effectiveness Scripts ( interpersonal e ffectiveness Handouts 5, 6, 7)174
interpersonal e ffectiveness Worksheet 5: Tracking i nterpersonal
effectiveness Skills use ( interpersonal e ffectiveness Handouts 5, 6, 7)175
interpersonal e ffectiveness Worksheet 6: The Dime g ame—Figuring o ut
How Strongly to a sk or Say n o (interpersonal e ffectiveness
Handout 8)176
interpersonal e ffectiveness Worksheet 7: Troubleshooting i nterpersonal
effectiveness Skills ( interpersonal e ffectiveness Handout 9)178
Worksheets for Building Relationships and Ending Destructive Ones
interpersonal e ffectiveness Worksheet 8: Finding and g etting People to
like You ( interpersonal e ffectiveness Handout 11)183
interpersonal e ffectiveness Worksheet 9: Mindfulness of o thers
(interpersonal e ffectiveness Handout 12)184
interpersonal e ffectiveness Worksheet 10: e nding r elationships
(interpersonal e ffectiveness Handout 13)185
Worksheets for Walking the Middle Path
interpersonal e ffectiveness Worksheet 11: Practicing Dialectics
(interpersonal e ffectiveness Handouts 15, 16)189
interpersonal e ffectiveness Worksheet 11a: Dialectics c hecklist
(interpersonal e ffectiveness Handouts 15, 16)190
interpersonal e ffectiveness Worksheet 11b: n oticing When You’re


interpersonal e ffectiveness Worksheet 11b: n oticing When You’re
not Dialectical ( interpersonal e ffectiveness Handouts 15, 16)191
interpersonal e ffectiveness Worksheet 12: Validating o thers
(interpersonal e ffectiveness Handouts 17, 18)192
interpersonal e ffectiveness Worksheet 13: Self-  Validation
and Self-  respect ( interpersonal e ffectiveness Handout 19)193
interpersonal e ffectiveness Worksheet 14: c hanging Behavior
with r einforcement ( interpersonal e ffectiveness Handouts 20, 22)194
interpersonal e ffectiveness Worksheet 15: c hanging Behavior
by extinguishing or Punishing i t (interpersonal e ffectiveness
Handouts 21–22)195
Emotion Regulation Skills
Emotion Regulation Handouts
emotion r egulation Handout 1: g oals of e motion r egulation
(emotion  regulation Worksheet 1)205
Handouts for Understanding and Naming Emotions
emotion r egulation Handout 2: o verview—
understanding and  naming e motions ( emotion r egulation
Worksheets 2–4a, 16)209


c ontents • xvii
emotion r egulation Handout 3: What e motions Do for You
(emotion r egulation Worksheets 2, 2a–c)210
emotion r egulation Handout 4: What Makes i t Hard to r egulate
Your e motions ( emotion r egulation Worksheets 3, 16)211
emotion r egulation Handout 4a: Myths about e motions
(emotion  regulation Worksheet 3)212
emotion r egulation Handout 5: Model for Describing e motions
(emotion r egulation Worksheets 4, 4a)213
emotion r egulation Handout 6: Ways to Describe e motions
(emotion r egulation Worksheets 4, 4a)214
Handouts for Changing Emotional Responses
emotion r egulation Handout 7: o verview— changing e motional
responses ( emotion r egulation Worksheets 5–8)227
emotion r egulation Handout 8: c heck the Facts ( emotion r egulation
Worksheet 5)228
emotion r egulation Handout 8a: e xamples of e motions That Fit the Facts
(emotion r egulation Worksheet 5)229
emotion r egulation Handout 9: o pposite a ction and Problem Solving—
Deciding Which to u se (emotion r egulation Worksheet 6)230
emotion r egulation Handout 10: o pposite a ction ( emotion r egulation
Worksheet 7)231
emotion r egulation Handout 11: Figuring o ut opposite a ctions
(emotion  regulation Worksheet 7)232
emotion r egulation Handout 12: Problem Solving ( emotion r egulation


emotion r egulation Handout 12: Problem Solving ( emotion r egulation
Worksheet 8)241
emotion r egulation Handout 13: r eviewing o pposite a ction
and Problem Solving ( emotion r egulation Worksheets 6–8)242
Handouts for Reducing Vulnerability to Emotion Mind
emotion r egulation Handout 14: o verview— reducing Vulnerability
to emotion Mind: Building a l ife Worth l iving ( emotion r egulation
Worksheets 9–14b)247
emotion r egulation Handout 15: a ccumulating Positive e motions—
Short Term ( emotion r egulation Worksheets 9, 10, 13)248
emotion r egulation Handout 16: Pleasant e vents l ist
(emotion r egulation Worksheets 9, 10, 13)249
emotion r egulation Handout 17: a ccumulating Positive e motions—
long Term ( emotion r egulation Worksheets 9, 11–11b, 13)252
emotion r egulation Handout 18: Values and Priorities l ist
(emotion r egulation Worksheets 10, 12, 13)253
emotion r egulation Handout 19: Build Mastery and c ope a head
(emotion r egulation Worksheets 12, 13)256
emotion r egulation Handout 20: Taking c are of Your Mind by Taking
care of Your Body ( emotion r egulation Worksheets 9, 14)257


xviii •  contents
emotion r egulation Handout 20a: n ightmare Protocol, Step by Step—
When n ightmares k eep You from Sleeping ( emotion r egulation
Worksheet 14a)258
emotion r egulation Handout 20b: Sleep Hygiene Protocol
(emotion  regulation Worksheet 14b)259
Handouts for Managing Really Difficult Emotions
emotion r egulation Handout 21: o verview—Managing r eally Difficult
emotions ( emotion r egulation Worksheets 15–16)263
emotion r egulation Handout 22: Mindfulness of c urrent e motions—
letting go of e motional Suffering ( emotion r egulation Worksheet
15)264
emotion r egulation Handout 23: Managing e xtreme e motions 265
emotion r egulation Handout 24: Troubleshooting e motion
regulation Skills—When What You a re Doing i sn’t Working
(emotion r egulation Worksheet 16)266
emotion r egulation Handout 25: r eview of Skills for e motion r egulation 268
Emotion Regulation Worksheets
emotion r egulation Worksheet 1: Pros and c ons of c hanging e motions
(emotion r egulation Handout 1)271
Worksheets for Understanding and Naming Emotions
emotion r egulation Worksheet 2: Figuring o ut What My e motions a re
Doing for Me ( emotion r egulation Handout 3)275
emotion r egulation Worksheet 2a: e xample—Figuring o ut What My
emotions a re Doing for Me ( emotion r egulation Handout 3)276
emotion r egulation Worksheet 2b: e motion Diary ( emotion  regulation


emotion r egulation Worksheet 2b: e motion Diary ( emotion  regulation
Handout 3)277
emotion r egulation Worksheet 2c: e xample— emotion Diary
(emotion r egulation Handout 3)278
emotion r egulation Worksheet 3: Myths about e motions
(emotion r egulation Handout 4a)279
emotion r egulation Worksheet 4: o bserving and Describing e motions
(emotion r egulation Handouts 5, 6)281
emotion r egulation Worksheet 4a: o bserving and Describing e motions
(emotion r egulation Handouts 5, 6)282
Worksheets for Changing Emotional Responses
emotion r egulation Worksheet 5: c heck the Facts ( emotion r egulation
Handouts 8, 8a)285
emotion r egulation Worksheet 6: Figuring o ut How to c hange
unwanted e motions ( emotion r egulation Handout 9)287
emotion r egulation Worksheet 7: o pposite a ction to c hange e motions
(emotion r egulation Handouts 10, 11)288
emotion r egulation Worksheet 8: Problem Solving to c hange e motions
(emotion r egulation Handout 12)289


c ontents • xix
Worksheets for Reducing Vulnerability to Emotion Mind
emotion r egulation Worksheet 9: Steps for r educing Vulnerability
to emotion Mind ( emotion r egulation Handouts 14–20)293
emotion r egulation Worksheet 10: Pleasant e vents Diary
(emotion r egulation Handouts 15, 16)295
emotion r egulation Worksheet 11: g etting from Values to Specific
action Steps ( emotion r egulation Handouts 17–18)296
emotion r egulation Worksheet 11a: g etting from Values to Specific
action Steps ( emotion r egulation Handouts 17–18)299
emotion r egulation Worksheet 11b: Diary of Daily a ctions on Values
and Priorities ( emotion r egulation Handouts 17–18)300
emotion r egulation Worksheet 12: Build Mastery and c ope a head
(emotion r egulation Handout 19)301
emotion r egulation Worksheet 13: Putting a Bc Skills Together
Day by Day ( emotion r egulation Handout 19)302
emotion r egulation Worksheet 14: Practicing P leaSe Skills
(emotion r egulation Handout 20)303
emotion r egulation Worksheet 14a: Target n ightmare e xperience Form
(emotion r egulation Handout 20a)304
emotion r egulation Worksheet 14b: Sleep Hygiene Practice Sheet 307
Worksheets for Managing Really Difficult Emotions
emotion r egulation Worksheet 15: Mindfulness of c urrent e motions
(emotion r egulation Handouts 21, 22)311
emotion r egulation Worksheet 16: Troubleshooting e motion


emotion r egulation Worksheet 16: Troubleshooting e motion
regulation Skills ( emotion r egulation Handout 24)312
Distress Tolerance Skills
Distress Tolerance Handouts
Distress Tolerance Handout 1: g oals of Distress Tolerance 321
Handouts for Crisis Survival Skills
Distress Tolerance Handout 2: o verview— crisis Survival Skills
(Distress Tolerance Worksheets 1–7b)325
Distress Tolerance Handout 3: When to u se crisis Survival Skills 326
Distress Tolerance Handout 4: The ST oP Skill (Distress Tolerance
Worksheets 2, 2a)327
Distress Tolerance Handout 5: Pros and c ons (Distress Tolerance
Worksheets 3, 3a)328
Distress Tolerance Handout 6: T iP Skills— changing Your Body c hemistry
(Distress Tolerance Worksheet 4)329
Distress Tolerance Handout 6a: u sing c old Water, Step by Step
(Distress Tolerance Worksheet 4)330
Distress Tolerance Handout 6b: Paired Muscle r elaxation, Step by Step
(Distress Tolerance Worksheet 4a)331


xx •  contents
Distress Tolerance Handout 6c: e ffective r ethinking and Paired
relaxation, Step by Step (Distress Tolerance Worksheet 4b)332
Distress Tolerance Handout 7: Distracting (Distress Tolerance
Worksheets 5–5b)333
Distress Tolerance Handout 8: Self-  Soothing (Distress Tolerance
Worksheet 6–6b)334
Distress Tolerance Handout 8a: Body Scan Meditation Step by Step
(Distress Tolerance Worksheet 6c)335
Distress Tolerance Handout 9: i mproving the Moment (Distress Tolerance
Worksheets 7–7b)336
Distress Tolerance Handout 9a: Sensory a wareness, Step by Step 337
Handouts for Reality Acceptance Skills
Distress Tolerance Handout 10: o verview— reality a cceptance Skills
(Distress Tolerance Worksheets 8–15a)341
Distress Tolerance Handout 11: r adical acceptance (Distress Tolerance
Worksheets 8–9a)342
Distress Tolerance Handout 11a: radical a cceptance—Factors That
interfere343
Distress Tolerance Handout 11b: Practicing radical a cceptance Step
by Step (Distress Tolerance Worksheets 9, 9a)344
Distress Tolerance Handout 12: Turning the Mind (Distress Tolerance
Worksheets 8, 8a, 10)345
Distress Tolerance Handout 13: Willingness (Distress Tolerance
Worksheets 8, 8a, 10)346


Worksheets 8, 8a, 10)346
Distress Tolerance Handout 14: Half-  Smiling and Willing Hands
(Distress Tolerance Worksheets 8, 8a, 11)347
Distress Tolerance Handout 14a: Practicing Half-  Smiling
and Willing Hands (Distress Tolerance Worksheet 10)348
Distress Tolerance Handout 15: Mindfulness of c urrent Thoughts
(Distress Tolerance Worksheets 8, 8a, 12)350
Distress Tolerance Handout 15a: Practicing Mindfulness of Thoughts
(Distress Tolerance Worksheets 8, 8a, 12)351
Handouts for Skills When the Crisis Is Addiction
Distress Tolerance Handout 16: o verview—When the c risis i s addiction
(Distress Tolerance Worksheets 13–18)355
Distress Tolerance Handout 16a: c ommon a ddictions 356
Distress Tolerance Handout 17: Dialectical a bstinence (Distress Tolerance
Worksheet 14)357
Distress Tolerance Handout 17a: Planning for Dialectical a bstinence
(Distress Tolerance Worksheet 14)358
Distress Tolerance Handout 18: c lear Mind (Distress Tolerance
Worksheet 15)359
Distress Tolerance Handout 18a: Behavior Patterns c haracteristic
of addict Mind and of c lean Mind (Distress Tolerance Worksheet 16)360


c ontents • xxi
Distress Tolerance Handout 19: c ommunity r einforcement
(Distress Tolerance Worksheet 16)361
Distress Tolerance Handout 20: Burning Bridges and Building n ew o nes
(Distress Tolerance Worksheet 17)362
Distress Tolerance Handout 21: a lternate r ebellion and a daptive Denial
(Distress Tolerance Worksheet 18)363
Distress Tolerance Worksheets
Worksheets for Crisis Survival Skills
Distress Tolerance Worksheet 1: c risis Survival Skills (Distress Tolerance
Handouts 2–9a)369
Distress Tolerance Worksheet 1a: c risis Survival Skills (Distress Tolerance
Handouts 2–9a)370
Distress Tolerance Worksheet 1b: c risis Survival Skills (Distress Tolerance
Handouts 2–9a)371
Distress Tolerance Worksheet 2: Practicing the ST oP Skill
(Distress Tolerance Handout 4)372
Distress Tolerance Worksheet 2a: Practicing the ST oP Skill
(Distress Tolerance Handout 4)373
Distress Tolerance Worksheet 3: Pros and c ons of a cting on c risis u rges
(Distress Tolerance Handout 5)374
Distress Tolerance Worksheet 3a: Pros and c ons of a cting on c risis u rges
(Distress Tolerance Handout 5)375
Distress Tolerance Worksheet 4: c hanging Body c hemistry with T iP Skills
(Distress Tolerance Handouts 6–6b)376


(Distress Tolerance Handouts 6–6b)376
Distress Tolerance Worksheet 4a: Paired Muscle r elaxation
(Distress Tolerance Handout 6b)377
Distress Tolerance Worksheet 4b: e ffective r ethinking
and Paired r elaxation (Distress Tolerance Handouts 6c)378
Distress Tolerance Worksheet 5: Distracting with Wise Mind acce PTS
(Distress Tolerance Handout 7)379
Distress Tolerance Worksheet 5a: Distracting with Wise Mind acce PTS
(Distress Tolerance Handout 7)380
Distress Tolerance Worksheet 5b: Distracting with Wise Mind acce PTS
(Distress Tolerance Handout 7)381
Distress Tolerance Worksheet 6: Self-  Soothing (Distress Tolerance
Handout 8)382
Distress Tolerance Worksheet 6a: Self-  Soothing (Distress Tolerance
Handout 8)383
Distress Tolerance Worksheet 6b: Self-  Soothing (Distress Tolerance
Handout 8)384
Distress Tolerance Worksheet 6c: Body Scan Meditation, Step by Step
(Distress Tolerance Handout 8a)385
Distress Tolerance Worksheet 7: i MProVe the Moment
(Distress Tolerance Handout 9)386


xxii •  contents
Distress Tolerance Worksheet 7a: i MProVe the Moment
(Distress Tolerance Handout 9)387
Distress Tolerance Worksheet 7b: i MProVe the Moment
(Distress Tolerance Handout 9)388
Worksheets for Reality Acceptance Skills
Distress Tolerance Worksheet 8: r eality a cceptance Skills
(Distress Tolerance Handouts 10–15a)391
Distress Tolerance Worksheet 8a: r eality a cceptance Skills
(Distress Tolerance Handouts 10–15a)392
Distress Tolerance Worksheet 8b: r eality a cceptance Skills
(Distress Tolerance Handouts 10–15a)393
Distress Tolerance Worksheet 9: radical a cceptance (Distress Tolerance
Handouts 11–11b)394
Distress Tolerance Worksheet 9a: Practicing radical a cceptance
(Distress Tolerance Handouts 11–11b)395
Distress Tolerance Worksheet 10: Turning the Mind,
Willingness, Willfulness (Distress Tolerance Handouts 12, 13)396
Distress Tolerance Worksheet 11: Half-  Smiling and Willing Hands
(Distress Tolerance Handout 14, 14a)397
Distress Tolerance Worksheet 11a: Practicing Half-  Smiling
and Willing Hands (Distress Tolerance Handouts 14, 14a)398
Distress Tolerance Worksheet 12: Mindfulness of c urrent Thoughts
(Distress Tolerance Handouts 15, 15a)399


(Distress Tolerance Handouts 15, 15a)399
Distress Tolerance Worksheet 12a: Practicing Mindfulness of Thoughts
(Distress Tolerance Handouts 15, 15a)400
Worksheets for Skills When the Crisis Is Addiction
Distress Tolerance Worksheet 13: Skills When the c risis i s addiction
(Distress Tolerance Handouts 16–21)403
Distress Tolerance Worksheet 14: Planning for Dialectical a bstinence
(Distress Tolerance Handout 17)404
Distress Tolerance Worksheet 15: From c lean Mind to c lear Mind
(Distress Tolerance Handouts 18, 18a)407
Distress Tolerance Worksheet 16: r einforcing n onaddictive Behaviors
(Distress Tolerance Handout 19)408
Distress Tolerance Worksheet 17: Burning Bridges and Building n ew ones
(Distress Tolerance Handout 20)409
Distress Tolerance Worksheet 18: Practicing a lternate r ebellion
and a daptive Denial (Distress Tolerance Handout 21)410
Purchasers can download and print the worksheets
from this book at www.guilford.com/dbt-worksheets .


1introduction to This Book
This book contains informational handouts and worksheets for people learning
Dialectical Behavior Therapy (DBT) skills. The overall goal of DBT skills training
is to help you increase your resilience and build a life experienced as worth living.
DBT skills are aimed at teaching a synthesis of how to change what is and how to accept what is. Skills teach you both how to change unwanted behaviors, emotions,
thoughts, and events in your life that cause you misery and distress as well as how
to live in the moment, accepting what is. There are different sets of DBT skills, and no single training program will include all of the handouts and worksheets in this book. Your skills trainer or individual therapist/case manager will direct you to the
appropriate handouts and worksheets for your particular program.
How This Book Is Organized
There are five main sections in this book, and each begins with a brief introduc -
tion. Following a first section on General Skills, there is a section of handouts and worksheets for each of the four main DBT skills modules: Mindfulness Skills, Inter -
personal Effectiveness Skills, Emotion Regulation Skills, and Distress Tolerance
Skills. There are topical subsections of handouts and worksheets within each skills module, as described below. Every skill or set of skills has a corresponding handout
with instructions for practicing that skill. Nearly every handout has at least one
(often more than one) associated worksheet for recording your practice of the skill. The introductions to each section summarize the handouts, their purposes, and the worksheets that go with them.
General Skills: Orientation and Analyzing Behavior
During Orientation , you will be introduced to DBT and the goals of skills train -
ing, and will be encouraged to identify your own personal goals. You will also be


ing, and will be encouraged to identify your own personal goals. You will also be
oriented to the format, rules, and meeting times of your particular skills program.


2 • introduction to This Book
The handouts and worksheets for this portion of General Skills cover skills training
goals, guidelines, assumptions, and DBT’s biosocial theory. Biosocial theory is an
explanation of why some people find it challenging to manage their emotions and
actions. Also included in this section are handouts and worksheets for two skills for Analyzing Behavior : chain analysis and missing-links analysis. These skills are
often taught in individual DBT, but they may also be taught at any point during
skills training.
Mindfulness Skills
Following a brief presentation on Goals and Definitions , the handouts and work -
sheets for the Mindfulness module focus on Core Mindfulness Skills . These skills
are central in DBT: They teach how to observe and experience reality as it is, to
be less judgmental, and to live in the moment with effectiveness. They are the first skills taught, and they support all the other DBT skills. DBT mindfulness skills are translations of meditation practices from Eastern and Western spiritual traditions
into specific behaviors that you can practice. No spiritual or religious convictions
are expected or necessary for practicing and mastering these skills.
Other Perspectives on Mindfulness includes several subsets of handouts and
worksheets. A Spiritual Perspective (including Wise Mind from a Spiritual Perspec -
tive and Practicing Loving Kindness) is a set of handouts and worksheets included for those who consider spirituality an important part of their lives. The skills covered here focus  on experiencing ultimate reality, sensing our intimate connection with the
entire universe, and developing a sense of freedom. The Skillful Means: Balancing Doing Mind and Being Mind set focuses on balancing two seeming polarities: work -


ing to achieve goals, while at the same time letting go of attachment to achieving goals. The handouts and worksheets for Wise Mind: Walking the Middle Path cover
skills for finding a synthesis of extremes.
Interpersonal Effectiveness Skills
The handouts and worksheets in the Interpersonal Effectiveness module help you
manage interpersonal conflicts effectively and maintain and improve relationships
with other people (those you are close to, as well as strangers). After a short intro -
duction on Goals and Factors That Interfere, there are three main sets of these
forms. The first set is focused on Obtaining Objectives Skillfully . These are strate -
gies for asking for what you want, saying no to unwanted requests, and doing this
in a way that maintains your self- respect and keeps others liking you. The handouts
and worksheets for Building Relationships and Ending Destructive Ones help you
find potential friends, get people to like you, maintain positive relationships with others, and (when necessary) end destructive relationships. This module’s handouts
and worksheets for Walking the Middle Path are about walking a middle path in
your relationships, and balancing acceptance with change in yourself and in your relationships with others.


introduction to This Book • 3
Emotion Regulation Skills
The handouts and worksheets in the Emotion Regulation module help you to man -
age your emotions, even though complete emotional control cannot be achieved.
To a certain extent, we all are who we are, and emotionality is part of us; however,
we can learn to have more control. There are four sets of these forms. The first set covers Understanding and Naming Emotions. Emotions serve important functions,
and it can be hard to change an emotion if you don’t understand what it does for
you. The second set covers Changing Emotional Responses. These handouts and
worksheets help you reduce the intensity of painful or unwanted emotions, such as anger, sadness, shame, and so forth. They also tell you how to change situations that cause painful or unwanted emotions. Reducing Vulnerability to Emotion Mind
is the third set. The strategies covered here increase your emotional resilience and
make you less likely to become extremely or painfully emotional . The final set of
handouts and worksheets deals with Managing Really Difficult Emotions.
Distress Tolerance Skills
The handouts and worksheets in the Distress Tolerance module help you learn to tolerate and survive crisis situations without making things worse. There are two
main sets of these forms. The Crisis Survival Skills set covers techniques for tolerat -
ing painful events, urges, and emotions when you cannot make things better right
away. The Reality Acceptance Skills set shows you how to reduce suffering by help -
ing you accept and enter fully into a life even when it is not the life you want. This
module also includes a set of specialized handouts and worksheets for When the
Crisis Is Addiction.
Numbering of Handouts and Worksheets


Crisis Is Addiction.
Numbering of Handouts and Worksheets
Within each of this book’s five main sections, handouts for each module are grouped together first, followed by worksheets.
Every handout has a number; some also have a letter. The latter are supplements
to handouts with the same number. For example, Mindfulness Handout 3 is the main handout for the skill of Wise Mind. Mindfulness Handout 3a is supplementary and lists ways that Wise Mind can be practiced. (Worksheets are numbered in a sep -
arate sequence, as described below.) Most, but not all, handouts have corresponding worksheets that can be used for recording skills practice. Associated worksheets are listed by number next to the handouts in the table of contents, as well on the hand -
outs themselves.
There are multiple alternative worksheets associated with many of the hand -
outs. There are worksheets that cover all the skills in a section, as well as worksheets that cover individual skills. For example, Mindfulness Worksheets 2, 2a, 2b, and 2c
all cover the same core mindfulness skills, and so each carries the same number, 2.
However, each worksheet is formatted a bit differently, and the worksheets vary as


4 • introduction to This Book
to how many practices they can accommodate. The handouts associated with work -
sheets are listed by number next to the worksheets in the table of contents, as well
as on the worksheets themselves.
Not all DBT skills programs teach all the modules or all the skills in each
 module. Even those that do cover all the modules will not necessarily use every
handout and worksheet. You are, however, likely to use some worksheets multiple
times. For this reason, the author and publisher grant you, the book purchaser, per -
mission to make photocopies of handouts and worksheets in this volume for your personal use. You can also download and print out copies of the worksheets from
www.guilford.com/dbt-worksheets .


5general Skill S:
orienT aTion an D
anal Yzing Be HaVior
Introduction to Handouts and Worksheets
There are two sets of handouts and worksheets in this part of the book. The first
covers Orientation , which typically takes place during the first session of a new
skills group, or when new members join an ongoing skills group. The purpose of orientation is to introduce members to one another and to the skills trainers, and to orient members to the format, rules, and meeting times of the particular skills training program. As described below, General Handouts 1 through 5 cover these
issues, along with General Worksheet 1. General Handouts 6 through 8, and their
corresponding worksheets, cover two important general skills for Analyzing Behav -
ior: chain analysis and missing-links analysis. These are also described below.
Orientation
••General Handout 1: Goals of Skills Training. This handout lists the general
and the specific goals of DBT skills training. Use this handout to think how you could personally benefit from skills training. Which areas are you most interested
in? Use General Worksheet 1: Pros and Cons of Using Skills any time you aren’t sure
whether there are benefits to practicing DBT skills. Be sure to fill out the pros and cons for both the option of practicing skills and the option of not practicing.
••General Handout 1a: Options for Solving Any Problem. Although there are
many, many things that can cause us pain, our options for responding to pain are limited. We can solve the problem that is causing the pain. We can try to feel better
by changing our emotional response to the pain. Or we can accept and tolerate the


6 • general Skill S: orienT aTion anD  anal Yzing Be HaVior
problem and our response. Each of these options requires use of one or more DBT
skills. The final option is to stay miserable (or make things worse) and use no skills.*
••General Handout 3: Guidelines for Skills Training. This handout lists the
guidelines for most standard DBT skills programs. These are standards of behavior
that people in a group skills program are asked to follow. Some programs may have
somewhat modified guidelines.
••General Handout 4: Skills Training Assumptions. Assumptions are beliefs
that cannot be proved. In DBT skills training, all group members and skills trainers are asked to abide by these assumptions.
••General Handout 5: Biosocial Theory. Biosocial theory is an explanation of
how and why some people find it challenging to manage their emotions and actions. DBT skills are particularly useful for these people.
Analyzing Behavior
••General Handout 6: Overview: Analyzing Behavior. This handout previews
the two general skills for analyzing behavior—chain analysis and missing-links
analysis.
••General Handout 7: Chain Analysis. Any behavior can be understood as a
series of linked parts. These links are “chained” together because they follow each other—one link in the chain leads to another. Chain analysis is a way of determin -
ing what has caused a behavior and what maintains it. This handout provides a
series of questions (e.g., “What happened before that? What happened next?”) for
unlocking the links in a behavior chain that can feel stuck together. It guides you


unlocking the links in a behavior chain that can feel stuck together. It guides you
through figuring out what factors led to a problem behavior and what factors might be making it difficult to change that behavior. Knowing this is important if you want to change the behavior.
••General Handout 7a: Chain Analysis, Step by Step. This handout explains
in greater detail how to do a chain analysis. General Worksheet 2: Chain Analysis
of Problem Behavior is a worksheet for doing a chain analysis. Use it with Gen -
eral Handouts 7 and 7a, which have the same steps. General Worksheet 2a: Exam -
ple: Chain Analysis of Problem Behavior is a completed sample version of General
Worksheet 2.
••General Handout 8: Missing-Links Analysis. Missing-links analysis is a series
of questions to help you figure out what got in the way of behaving effectively. Use
it to identify why something did not happen that was needed and that you agreed
to do, planned to do, or hoped to do. General Worksheet 3: Missing-Links Analysis can be used with this handout.
*This last option was suggested to me in an e-mail. Unfortunately, I simply cannot find the message so
that I can properly credit the person here. Nevertheless, it was a fabulous addition.


9
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). General Handout 1   (General Worksheet 1)
Goals of Skills Training
General Goal
To learn how to change your own behaviors, emotions, and thoughts
that are linked to problems in living and are causing misery and distress.
Specific GoalS
Behaviors to Decrease:
Mindlessness; emptiness; being out of touch with self and others; judgmentalness.
Interpersonal conflict and stress; loneliness.
Absence of flexibility; difficulties with change.
Up-and-down and extreme emotions; mood-  dependent behavior; difficulties in regulating
emotions.
Impulsive behaviors; acting without thinking; difficulties accepting reality as it is; willfulness;
addiction.
Skills to i ncrease:
Mindfulness skills.
Interpersonal effectiveness skills.
Emotion regulation skills.
Distress tolerance skills.
perSonal Goal S
Behaviors to Decrease:
1.
2.
3.
Skills to i ncrease:
1.
2.
3.


10
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). General Handout 1a
options for Solving a ny problem
When life presents you with problems, what are your options?
1. Solve T he p roBlem
Change the situation . . . or avoid, leave, or get out of the situation for good.
2. feel Be TTer aB ouT The p roBlem
Change (or regulate) your emotional response to the problem.
3. Tolera Te The p roBlem
Accept and tolerate both the problem and your response to the problem.
4. STay m iSeraBle
Or possibly make it worse!
1. To p roBlem-Solve:
Use interpersonal effectiveness skills
Walking the Middle Path (from interpersonal effectiveness skills)
Use problem-  solving skills (from emotion regulation skills)
2. To f eel Be TTer aB ouT The p roBlem:
Use emotion regulation skills
3. To Tolera Te The p roBlem:
Use distress tolerance and mindfulness skills
4. To S Tay m iSeraBle:
Use no skills!


11
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).General Handout 2
overview:
introduction to Skills Training
GuiDeline S for Skill S Trainin G
SkillS  Trainin G aSS ump TionS
BioSocial Theory
of emo Tional an D
Behavioral Dy SreGulaTion


12
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). General Handout 3
Guidelines for Skills Training
1. participants who drop out of skills training are not out of skills training.
a. The only way out is to miss four scheduled sessions of skills training in a row.
2. participants who join the skills training group support each other and:
a. Keep names of other participants and information obtained during sessions confidential.
b. Come to each group session on time and stay until the end.
c. Make every effort to practice skills between sessions.
d. Validate each other, avoid judging each other, and assume the best about each other.
e. Give helpful, noncritical feedback when asked.
f. Are willing to accept help from a person they ask or call for help.
3. participants who join the skills training group:
a. Call ahead of time if they are going to be late or miss a session.
4. participants do not tempt others to engage in problem behaviors and:
a. Do not come to sessions under the influence of drugs or alcohol.
b. If drugs or alcohol have already been used, come to sessions acting and appearing clean
and sober.
c. Do not discuss, inside or outside sessions, current or past problem behaviors that could be contagious to others.
5. participants do not form confidential relationships with each other outside of skills
training sessions and:
a. Do not start a sexual or a private relationship that cannot be discussed in group.
b. Are not partners in risky behaviors, crime, or drug use.
other guidelines for this group/notes:


13
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). General Handout 4
Skills Training a ssumptions
an assumption is a belief that cannot be proved,
but we agree to abide by it anyway.
1. people are doing the best they can.
All people at any given point in time are doing the best they can.
2. people want to improve.
The common characteristic of all people is that they want to improve their lives and be happy.
3. people need to do better, try harder, and be more motivated to change. *
The fact that people are doing the best they can, and want to do even better, does not mean
that these things are enough to solve the problem.
4. people may not have caused all of our own problems, but they have to solve them
anyway. **
People have to change their own behavioral responses and alter their environment for their life to change.
5. new behavior has to be learned in all relevant contexts.
New behavioral skills have to be practiced in the situations where the skills are needed, not just
in the situation where the skills are first learned.
6. all behaviors (actions, thoughts, emotions) are caused.
There is always a cause or set of causes for our actions, thoughts, and emotions, even if we do
not know what the causes are.
7. figuring out and changing the causes of behavior work better than judging and blaming.
Judging and blaming are easier, but if we want to create change in the world, we have to change the chains of events that cause unwanted behaviors and events.


*But trying harder and being more motivated may not be needed if progress is steady and at a realistic rate of improvement.
**Parents and caregivers must assist children in this task.


14
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).General Handout 5   (p. 1 of 2)
Biosocial Theory
Why do i have so much trouble controlling
my emotions and my actions?
emotional vulnerability is B iolo Gical :
it’s simply how some people are born.
They are more sensitive  to emotional stimuli; they can detect subtle
emotional information in the environment that others don’t even notice.
They experience emotions much more often  than others.
Their emotions seem to hit for no reason, from out of the blue.
They have more intense  emotions.
Their emotions hit like a ton of bricks .
And their emotions are long-  lasting .
impulsivity also has a B iolo Gical  basis:
regulating action is harder for some than for others.
They find it very hard to restrain impulsive behaviors.
Often, without thinking, they do things that get them in trouble.
Sometimes their behavior  seems to  come out of nowhere.
They find it very hard to be effective .
Their moods get in the way of organizing  to achieve their goals.
They cannot control  behaviors linked to their moods.
(continued on next page )


15General Handout 5   (p. 2 of 2)
an invalidating S ocial  environment
can make it very hard to regulate emotions.
An invalidating environment doesn’t seem to understand your emotions.
It tells you your emotions are  invalid, weird, wrong,  or bad.
It often ignores  your emotional reactions and does nothing to help you.
It may say things like “ Don’t be such a baby!” “Quit your blubbering.” “Quit
being such a chicken and just solve the problem.” or “Normal people don’t
get this frustrated. ”
People who invalidate are of Ten D oinG The Be ST T hey can .
They may not know  how to validate or how important it is to validate, or
they may be afraid  that if they validate your emotions, you will get more
emotional, not less.
They may be under high stress  or time pressure, or they may have too
few resources themselves.
There may be just a poor fit  between you and your social environment:
you may be a tulip in a rose garden.
an ineffective S ocial  environment
is a big problem when you want
to learn to regulate emotions and actions.
Your environment may reinforce out-of-  control emotions and actions.
If people give in when you get out of control, it will be hard for you to get in
control.
If others command you to change, but don’t coach you on how to do this, it will be hard to keep on trying to change.
it’s the T ranS acTionS  that count


it’s the T ranS acTionS  that count
between the person and the social environment.
Biology and the social environment influence the person.
The person reciprocates and influences his or her social environment.
The social environment reciprocates and influences the person.
And so on and on and on.


19
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).General Handout 6   (General Worksheets 2, 3)
Overview:
Analyzing Behavior
To figure out its causes
and plan for

problem solving.
Chain Analysis
is for when you engage in ineffective behavior.
A chain analysis examines the chain of events that leads to
ineffective behaviors, as well as the consequences of those behaviors that may be making it hard to change them. It also
helps you figure out how to repair the damage.
Missing-Links Analysis
is for when you fail to engage in effective behaviors.
A missing-links analysis helps you identify what got in the way of doing things you needed or hoped to do, things you agreed to do, or things others expected you to do. It also helps you problem-solve for the future.


20
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).General Handout 7   (General Worksheets 2, 2a)
chain a nalysis
To un DerSTanD Behavior, D o a chain analy SiS.
Step 1: Describe the pro Blem Behavior.
Step 2: Describe the promp TinG evenT  that started the chain of events leading to the problem
behavior.
Step 3: Describe the factors happening before the event that made you vulneraBle to starting
down the chain of events toward the problem behavior.
Step 4: Describe in excruciating detail the chain of even TS that led to the problem behavior.
Step 5: Describe the con Sequence S of the problem behavior.
To change behavior:
Step 6: Describe S killful  behaviors to replace problem links in the chain of events.
Step 7: Develop prevenT ion plan S to reduce vulnerability to stressful events.
Step 8: repair  important or significant consequences of the problem behavior.VULNERABILITY
PROMPTING EVENT
LINKSCONSEQUENCESPROBLEM BEHAVIOR


21
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).General Handout 7a   (General Worksheets 2, 2a) (p. 1 of 2)
chain a nalysis, Step by Step
1. Describe the specific pro Blem Behavior (overeating or overdrinking, yelling at your
kids, throwing a chair, having an overwhelming emotional outburst, dissociating, not coming or
coming late to skills training, putting off or refusing to do skills practice, etc.).
A. Be very specific and detailed. No vague terms.
B. Identify exactly what you did, said, thought, or felt (if feelings are the targeted problem
behavior). Identify what you did not do .
C. Describe the intensity of the behavior and other characteristics of the behavior that are important.
D. Describe the problem behavior in enough detail that an actor in a play or movie could recreate the behavior exactly.
E. If the behavior is something you did not do, ask yourself whether (a) you did not know you needed to do it (it did not get into short-term memory); (b) you forgot it and later it never
came into your mind to do it (it did not get into long-term memory); (c) you put it off when


you did think of it; (d) you refused to do it when you thought of it; or (e) you were willful and rejected doing it, or some other behavior, thoughts, or emotions interfered with doing it. If (a) or (b) is the case, skip from here to Step 6 below (working on solutions). Otherwise, keep going from here.
2. Describe the specific promp TinG evenT  that started the whole chain of behavior. Begin
with the environmental event that started the chain. Always begin with some event in your
environment, even if it doesn’t seem to you that the environmental event “caused” the problem
behavior. Otherwise, we could ask about any behavior, thought, feeling, or experience, “What prompted that?” Possible questions to help you get at this are:
A. What exact event precipitated the start of the chain reaction?
B. When did the sequence of events that led to the problem behavior begin? When did the
problem start?
C. What was going on right before the thought of or impulse for the problem behavior occurred?
D. What were you doing/thinking/feeling/imagining at that time?
E. Why did the problem behavior happen on that day instead of the day before?
3. Describe specific vulnera BiliTy fac TorS happening before the prompting event.
What factors or events made you more vulnerable to reacting to the prompting event with a
problematic chain? Areas to examine are:
A. Physical illness; unbalanced eating or sleeping; injury.
B. Use of drugs or alcohol; misuse of prescription drugs.
C. Stressful events in the environment (either positive or negative).
D. Intense emotions, such as sadness, anger, fear, loneliness.
E. Previous behaviors of your own that you found stressful coming into your mind.


E. Previous behaviors of your own that you found stressful coming into your mind.
(continued on next page )


22General Handout 7a   (p. 2 of 2)
4. Describe in excruciating detail the chain of even TS that led to the problem behavior.
Imagine that your problem behavior is chained to the precipitating event in the environment.
How long is the chain? Where does it go? What are the links? Write out all links  in the chain of
events, no matter how small. Be very specific, as if you are writing a script for a play. Links in the chain can be:
A. Actions or things you do.
B. Body sensations or feelings.
C. Cognitions (i.e., beliefs, expectations, or thoughts).
D. Events in the environment or things others do.
E. Feelings and emotions that you experience.
What exact thought (or belief), feeling, or action followed the prompting event? What thought,
feeling, or action followed that? What next? What next? And so forth.
••Look at each link in the chain after you write it. Was there another thought, feeling, or action that could have occurred? Could someone else have thought, felt, or acted differently at that point? If so, explain how that specific thought, feeling, or action came to be.
••For each link in the chain, ask whether there is a smaller link you could describe.
5. Describe the con Sequence S of this behavior. Be specific. (How did other people react
immediately and later? How did you feel immediately following the behavior? Later? What effect did the behavior have on you and your environment?)
6. Describe in detail at each point where you could have used a
skillful  behavior to head off the


skillful  behavior to head off the
problem behavior. What key links were most important in leading to the problem behavior? (In other words, if you had eliminated these behaviors, the problem behavior probably would not
have happened.)
A. Go back to the chain of behaviors following the prompting event. Circle each link where, if
you had done something different, you would have avoided the problem behavior.
B. What could you have done differently at each link in the chain of events to avoid the problem behavior? What coping behaviors or skillful behaviors could you have used?
7. Describe in detail a prevenT ion ST raTeGy for how you could have kept the chain from
starting by reducing your vulnerability to the chain.
8. Describe what you are going to do to repair  important or significant consequences of the
problem behavior.
A. Analyze: What did you really harm? What was the negative consequence you can repair?
B. Look at the harm or distress you actually caused others, and the harm or distress you
caused yourself. Repair what you damaged. (Don’t bring flowers to repair a window you broke: fix the window! Repair a betrayal of trust by being very trustworthy long enough to fit the betrayal, rather than trying to fix it with love letters and constant apologies. Repair failure
by succeeding, not by berating yourself.)


23
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).General Handout 8   (General Worksheet 3)
missing- links a nalysis
ask the following questions to understand how and why
effective behavior that is needed or expected did not occur.
1. Did you know what effective behavior was needed or expected (what skills
homework was given, what skills to use, etc.)?
if no  to q uestion 1, ask what got in the way of knowing what was needed or expected.
Ideas might include not paying attention, unclear instructions, never getting the instructions
in the first place, becoming too overwhelmed and couldn’t process the information, and so on.
proBlem- Solve what got in the way. For example, you might work on paying
attention, ask for clarification when you don’t understand instructions, call others, look up information, and so on.
2. if yeS  to q uestion 1, ask were you willing to do the needed or expected effective
behavior?
if no  to q uestion 2, ask what got in the way of willingness to do effective behaviors.
Ideas might include willfulness, feeling inadequate, or feeling demoralized.
proBlem- Solve what got in the way of willingness. For example, you might practice
radical acceptance, do pros and cons, practice opposite action, and so on.
3. if yeS  to q uestion 2, ask did the thought of doing the needed or expected effective
behavior ever enter your mind?if no  to q uestion 3,


behavior ever enter your mind?if no  to q uestion 3,
proBlem- Solve how to get the thought of doing effective behaviors into your mind.
For example, you might put it on your calendar, set your alarm to go off, put your skills
notebook next to your bed, practice coping ahead with difficult situations (see Emotion Regulation Handout 19), and so on.
4. if yeS  to q uestion 3, ask what got in the way of doing the needed or expected
effective behavior right away?  Ideas might include putting it off, continuing to
procrastinate, not being in the mood, forgetting how to do what was needed, thinking that
no one would care anyway (or no one would find out), and so on.
proBlem- Solve what got in the way. For example, you might set a reward for doing
what is expected, practice opposite action, do pros and cons, and so on.


general Worksheets
Orientation Worksheet


27
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 .General Worksheet 1   (General Handout 1)
Pros and Cons of Using Skills
Due Date:         Name:                 W eek Starting:
U
se this worksheet to figure out the advantages and disadvantages to you of using skills (i.e., acting
skillfully) to reach your goals. The idea here is to figure out what is the most effective way for you to
get what you want in life. Remember, this is about your goals, not someone else’s goals.
Describe the situation or problem:
Describe your goal in this situation:
Make a list of the Pros and Cons of practicing your skills in this situation.
Make another list of the Pros and Cons for not practicing your skills or of not practicing them
completely.
Check the facts to be sure that you are correct in your assessment of advantages and
disadvantages.
Write on the back if you need more space.
Pro SPracticing Skills

                                                              Not Practicing Skills
                                                                                CoN SPracticing Skills
                                                                                Not Practicing Skills

W
hat did you decide to do in this situation?

I
s this the best decision (in Wise Mind)?


31
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 .General WorksHeet 2   (General Handouts 7, 7a) (p. 1 of 4)
chain a nalysis of p roblem Behavior
Due Date:         Name:                   Date:
VULNERABILITY
PROMPTING EVENT
LINKSCONSEQUENCESPROBLEM BEHAVIOR
1. What exactly is the major pro Blem Behavior that I am analyzing?
2. What promp TinG evenT  in the environment started me on the chain to my problem
behavior? Include what happened ri GhT Before the urge or thought came into my
mind.
Day prompting event occurred:
3. Describe what things in myself and in my environment made me vulneraBle.
Day the events making me vulnerable started:
(continued on next page )


32General WorksHeet 2   (p. 2 of 4)
linkS in T he chain of even TS: Behaviors ( Actions, Body sensations,
Cognitions/Thoughts, Feelings) and E vents (in the environment)
possible Types of l inks
a. Actions
B. Body sensations
c. Cognitions/thoughts
e. Events
f.  Feelings
4. List the chain of events  (specific
behaviors and environmental events that
actually did happen). Use the ABC-EF list
above.
1st.

2nd.

3rd.
  4th.

5th.

6th.
  7th.
  8th.

9th.
  6. List new, more skillful  behaviors to
replace ineffective behaviors. Use the
ABC-EF list.
1st.

2nd.
  3rd.

4th.
  5th.

6th.
  7th.

8th.

9th.

(continued on next page )


33General WorksHeet 2   (p. 3 of 4)
linkS in T he chain of even TS: Behaviors ( Actions, Body sensations,
Cognitions/Thoughts, Feelings) and E vents (in the environment)
possible Types of l inks
a. Actions
B. Body sensations
c. Cognitions/thoughts
e. Events
f.  Feelings
4. List the chain of events  (specific
behaviors and environmental events that
actually did happen). Use the ABC-EF list
above.
10th.

11th.

12th.
  13th.

14th.

15th.
  16th.
  17th.
  6. List new, more skillful  behaviors to
replace ineffective behaviors. Use the
ABC-EF list.
10th.

11th.

12th.
  13th.

14th.
  15th.

16th.

17th.

(continued on next page )


34General WorksHeet 2   (p. 4 of 4)
5. What exactly were the consequences  in the environment?
and in myself?
What  harm  did my problem behavior cause?
7. prevention plans:
Ways to reduce my vulnerability  in the future:
Ways to prevent  precipitating event  from happening again:
8. plans to repair,  correct, and overcorrect the harm:


35
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 .General WorksHeet 2a   (General Handouts 7, 7a) (p. 1 of 3)
example: c hain a nalysis of p roblem Behavior
Due Date:         Name:                   Date:
Problem Behavior:
VULNERABILITY
PROMPTING EVENT
LINKSCONSEQUENCESPROBLEM BEHAVIOR
1. What exactly is the major pro Blem Behavior that I am analyzing?
Drinking too much and driving drunk
2. What promp TinG evenT  in the environment started me on the chain to my problem
behavior? Include what happened ri GhT Before the urge or thought came into my
mind.
Day prompting event occurred:   Monday
My sister from out of town called me and said she was not going to come visit me the next
week like she had said she would, because her husband had an important business party he wanted her to attend with him.
3. Describe what things in myself and in my environment made me vulneraBle.
Day the events making me vulnerable started:   Sunday
My boyfriend said he had to take a business trip sometime in the next month.
(continued on next page )


36General WorksHeet 2 a  (p. 2 of 3)
linkS in T he chain of even TS: Behaviors ( Actions, Body sensations,
Cognitions/Thoughts, Feelings) and E vents (in the environment)
possible Types of l inks
a. Actions
B. Body sensations
c. Cognitions/thoughts
e. Events
f.  Feelings
4. List the chain of events  (specific
behaviors and environmental events that
actually did happen). Use the ABC-EF list
above.
1st.  I felt hurt and started sobbing on the
phone with my sister and was angry with her.
2nd.  I thought, “I can’t stand it. No one
loves me.”3rd.  I felt very ashamed once I hung up
from talking to my sister.
4th.  I thought “My life is useless; no one
will ever be here for me.”5th.  Tried watching TV, but nothing was on
I liked.6th.  I started feeling agitated and thought,
“I can’t stand this.”7th.  I decided to drink a glass of wine to
feel better, but ended up drinking two whole
bottles.
8th.  Got in my car to drive to a late-night
concert.9th.  While I was bending down to pick up a
piece of paper, car swerved. I was stopped
by a cop and taken in on a DUI.6. List new, more
skillful  behaviors to
replace ineffective behaviors. Use the ABC-EF list.
1st.  Listen to why my sister could not
come.
2nd.  Remember that my sister and my


come.
2nd.  Remember that my sister and my
boyfriend love me.3rd.  Check the facts; is my sister going to
reject me over this?
4th.  Call my sister back and apologize for
being angry (since I know she will validate
how I feel).
5th.  Download a movie, work on a puzzle,
or call a friend instead.
6th.  Try my TIP skills to bring down arousal.
7th.  Walk down the street and have a
dinner out, because I won’t drink too much
in public.
8th.  Call my boyfriend and ask him to come
over for a while.
9th.  Take a long bath, try TIP skills again;
Keep checking the facts; remember these
emotions will pass; call my therapist for help.
(continued on next page )


37General WorksHeet 2 a  (p. 3 of 3)
5. What exactly were the consequences  in the environment?
Short-term: I had to spend the night in jail.
Long-term: My boyfriend has less trust in me; my sister is upset about it.
and in myself?
Short-term: I am ashamed and furious with myself.Long-term: I will have to pay more for car insurance and may have trouble getting a job.
What
harm  did my problem behavior cause?
It hurt me by giving me a DUI record. My sister feels guilty because she upset me.
7. prevention plans:
Ways to reduce my vulnerability  in the future:
Make plans for how to cope whenever my boyfriend is out of town.
Ways to prevent  precipitating event  from happening again:
I can’t keep the precipitating event from happening, so I need to practice coping ahead and
have plans for how to manage when I am at home alone.
8. plans to repair,  correct, and overcorrect the harm:
Apologize to my sister and reassure her that she has a perfect right to change her plans. Work with her to plan a new time for a visit. Ask if it would be easier for her if I came to visit her.


38
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 .General Works Heet 3   (General Handout 8)
mis sing- li nks an alysis
To understand missing effective behavior, do a missing-links analysis.
Due Date:

Name:

Date:
M
issing Behavior:
U
se this sheet to first figure out what got in the way of doing things you needed or hoped to do, or
things you agreed to do or others expected you to do. Then use that information to problem-solve,
so that you will be more likely to do what is needed, hoped for, or expected next time.
1.D
id
i
 know what effective behavior was needed or expected? Yes
 No
i
f no  to Question 1, what got in the way of knowing?
D
escribe problem solving:
 S
TOP
2.if
 ye
S t
o Question 1, was I willing to do what was needed? Yes

 No
i
f no  to Question 2, what got in the way of wanting to do what was needed?
D
escribe problem solving:
 S
TOP
3.if
 ye
S t
o Question 2, did the thought of doing what was needed or expected ever enter my
mind? Yes

 No
i
f no  to Question 3, describe problem solving:
4
.if


i
f no  to Question 3, describe problem solving:
4
.if
 ye
S t
o Question 3, what got in the way of doing what was needed or expected right away?
 S
TOP
Describe problem solving:
 S
TOP


39MinDFulne SS Skill S
Introduction to Handouts and Worksheets
Mindfulness is the act of consciously focusing the mind in the present moment,
without judgment and without attachment to the moment. A person who is mind -
ful is aware in and of the present moment. Mindfulness is the opposite of being on “automatic pilot,” or being lost in habit. Mindfulness has to do with the quality of awareness that a person brings to everyday living. It’s a way of living awake, with
eyes wide open. As a set of skills, mindfulness practice is the intentional process of
observing, describing, and participating in reality nonjudgmentally, in the moment, and with effectiveness (i.e., using skillful means). We can contrast mindfulness with rigidly clinging to the present moment, as if we could keep a present moment from
changing if we cling hard enough. When we are mindful, we are open to the fluidity
of each moment as it arises and falls away.
Goals and Definitions
••Mindfulness Handout 1: Goals of Mindfulness Practice. The goals of practic -
ing mindfulness skills, for most people, are to reduce suffering, increase happiness,
and increase control of the mind. For some, a goal of mindfulness is to experience
reality as it is . Mindfulness skills require practice, practice, practice.
••Mindfulness Handout 2: Mindfulness Definitions. This handout offers basic
definitions of mindfulness, mindfulness skills, and mindfulness practice.
••Mindfulness Worksheet 1: Pros and Cons of Practicing Mindfulness. This
worksheet is designed to help you decide whether you have anything to gain from
practicing mindfulness.
Core Mindfulness Skills
The handouts and worksheets for Core Mindfulness Skills cover seven skills in three


The handouts and worksheets for Core Mindfulness Skills cover seven skills in three
sets: Wise Mind; the “what” skills of observing, describing, and participating; and
the “how” skills of practicing nonjudgmentally, one-  mindfully, and effectively.


40 •  MinDFulne SS Skill S
••Mindfulness Worksheets 2, 2a, 2b, and 2c: Mindfulness Core Skills Practice
offer four variations for recording practice of all seven core mindfulness skills. They
can be useful for recording practice after you have learned all of the core skills.
Mindfulness Worksheet 2c: Mindfulness Core Skills Calendar offers a calendar for -
mat for recording practice of all these skills.
WIsE MInD
••Mindfulness Handout 3: Wise Mind: States of Mind. Wise Mind is the inner
wisdom that each one of us has. When we access our inner wisdom, we say we are
in Wise Mind. When we enter the state of Wise Mind, we integrate opposites—
including our reasonable and emotional states of mind—and we are open to experi -
encing reality as it is.
••You can record your practice efforts on Mindfulness Worksheet 3: Wise Mind
Practice. (Mindfulness Handout 3a: Ideas for Practicing Wise Mind offers practice
ideas.) Worksheet 3 asks you to rate how effective your practice was in accessing
your own Wise Mind. Note that the rating is not about whether the practice calmed
you or made you feel better.
MInDfulnE ss “W HaT” skIlls
••Mindfulness Handout 4: Taking Hold of Your Mind: “What” Skills. “What”
skills are what you do when practicing mindfulness—  observe, describe, or partici -
pate. Do only one of these activities at a time. To observe is to pay attention on


purpose to the present moment. To describe is to put into words what you have observed. To participate is to enter into an activity fully and wholly, becoming one with whatever you are doing.
••Mindfulness Handout 4a: Ideas for Practicing Observing, Mindfulness
Handout 4b: Ideas for Practicing Describing , and  Mindfulness Handout 4c: Ideas
for Practicing Participating  offer ideas for how to practice each of the mindfulness
“what” skills. If you are just learning these skills, your skills trainer is likely to assign a specific exercise or two after you first practice each skill in a session.
••Mindfulness Worksheets 4, 4a, and 4b offer three different formats for
recording practice of mindfulness “what” skills. Worksheet 4 provides space for practice of the “what” skills only twice between sessions. Worksheet 4a  gives space
for multiple practices for each “what” skill in a checklist format. Worksheet 4b  is
aimed at those who like to write describing their practice.
MInDfuln Ess “Ho W” skIlls
••Mindfulness Handout 5: Taking Hold of Your Mind: “How” Skills. The
“how” skills are how you observe, describe, or participate—  nonjudgmentally, one-
mindfully, and effectively. Although the “what” skills should only be done one at a
time, the “how” skills can be done together.


in troduction to Handouts and Worksheets • 4 1
• •Mindfulness Handout 5a: Ideas for Practicing Nonjudgmentalness , Mind  ful-
n
ess Handout 5b: Ideas for Practicing One-  M
indfulness , and  Mindfulness Handout
5c: Ideas for Practicing Effectiveness offer ideas for how to practice each of the
mindfulness “how” skills. If you are just learning these skills, your skills trainer is likely to assign a specific exercise or two after you practice each one in a session.
• •Mindfulness Worksheet 5: Mindfulness “How” Skills: Nonjudgmentalness,
One-Mindfulness, Effectiveness  provides space for recording only two practices
of a “how” skill for the week. Mindfulness Worksheet 5a: Nonjudgmentalness, One-
 M
indfulness, Effectiveness Checklist  offers a checklist format for recording
“how” skills practice, and Mindfulness Worksheet 5b: Nonjudgmentalness, One-

M
indfulness, Effectiveness Calendar offers a calendar format for this purpose.
Mindfulness Worksheet 5c: Nonjudgmentalness Calendar is an advanced worksheet for the single skill of nonjudgmentalness.
Other Perspectives on Mindfulness Skills
There are three sets of handouts and worksheets for mindfulness skills  that give
a different perspective on mindfulness. These are Mindfulness Practice: A Spiri -
tual Perspective; Skillful Means: Balancing Doing Mind and Being Mind; and Wise Mind: Walking the Middle Path. Some DBT skills training programs may include one or more of these sets of skills.
• •Mindfulness Handout 6: Overview: Other Perspectives on Mindfulness. This
handout briefly previews the three supplementary mindfulness skills.


handout briefly previews the three supplementary mindfulness skills.
MInDf uln E ss PRa cT IcE: a  sPIRIT u al PE RsP EcT IvE
• •Mindfulness Handout 7: Goals of Mindfulness Practice: A Spiritual Perspec -
tive. Mindfulness can be practiced for psychological reasons or spiritual reasons. A
spiritual perspective on mindfulness is included for those for whom spirituality is an important part of their life. Mindfulness practice is very old, arising initially from spiritual practices across many cultures, and it has a modern-day presence in many contemplative prayer and meditation practices.
• •Mindfulness Handout 7a: Wise Mind from a Spiritual Perspective . This
handout outlines different types of spiritual practices and includes some of the many terms used to reference the transcendent. Many spiritual and religious practices share elements in common with mindfulness practices, including silence, quieting the mind, attentiveness, inwardness, and receptivity. These are characteristics of deep spiritual experiences.
• •Mindfulness Handout 8: Practicing Loving Kindness to Increase Love and
Compassion. Anger, hate, hostility, and ill will toward ourselves and toward others
can be very painful. The practice of loving kindness is a form of meditation in which specific positive words and phrases are repeatedly recited, to cultivate compassion and loving feelings as an antidote to negativity. Loving kindness is an ancient spiri -
tual meditation practice. In some ways it is similar to praying for the welfare of


42 •  MinDFulne SS Skill S
ourselves and others. To record practice of loving kindness, use Mindfulness Work -
sheet 6: Loving Kindness , which provides space for describing two occasions of
practicing loving kindness.
skIllful M Eans: Balanc InG Do InG MInD an D BEInG MInD
••Mindfulness Handout 9: Skillful Means: Balancing Doing Mind and Being
Mind . “Skillful means” is a term in Zen that refers to any effective method that aids
you to experience reality as it is—or, in DBT terms, to enter fully into Wise Mind.
Doing mind and being mind are states of mind that, in their extreme forms, can get in the way of skillful means and of Wise Mind. Doing mind focuses on achieving goals; being mind focuses on experiencing. The polarity between them is similar
to that between reasonable mind and emotion mind. In everyday life, wise living
requires us to balance working to achieve goals (on the one hand), and at the very same time to let go of attachment to achieving goals (on the other hand).
••Mindfulness Handout 9a: Ideas for Practicing Balancing Doing Mind and
Being Mind. This handout lists practice exercises. It is useful when you have already gone through mindfulness training several times.
••Mindfulness Worksheet 7a: Mindfulness of Being and Doing Calendar,
Mindfulness Worksheet 8: Mindfulness of Pleasant Events Calendar , and Mindful -
ness Worksheet 9: Mindfulness of Unpleasant Events Calendar are all worksheets in calendar format that ask participants to record their mindfulness practice each day. The calendars focus on mindfulness during frazzled moments (Worksheet 7a), pleasant events (Worksheet 8), and unpleasant events (Worksheet 9).


WIsE MInD: Walk InG THE  MIDDlE PaTH
••Mindfulness Handout 10: Walking the Middle Path: Finding the Synthesis
between Opposites. Wise Mind is the middle path between extremes. In Wise Mind,
we replace “either–or” with “both–and” thinking in an effort to find a synthesis
between oppositions. Ordinarily, when we are at an extreme on any continuum, we are in danger of distorting reality. This handout is useful if you have already gone through mindfulness training one or more times.
••Mindfulness Worksheet 10: Walking the Middle Path to Wise Mind . This
worksheet lists several polarities that could be out of balance, and provides space for
recording practice aimed at balancing them.
••Mindfulness Worksheet 10a: Analyzing Yourself on the Middle Path . Use this
worksheet to think through whether you are out of balance on each of the polarities listed. “Out of balance” here means a living style that knocks you off your center,
out of Wise Mind.
••Mindfulness Worksheet 10b: Walking the Middle Path Calendar . This work -
sheet offers opportunities for recording daily practice in a different format than in Worksheet 10. It can also be used in conjunction with Worksheet 10a.


Mindfulness Handouts
Handouts for Goals and Definitions


45
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). Mindfulness Handout 1   (Mindfulness Worksheet 1)
Goals of m indfulness p ractice
reDuce Sufferin G anD increa Se happine SS
Reduce pain, tension, and stress.
Other:
increa Se con Trol of y our m inD
Stop letting your mind be in control of you.
Other:
experience r eali Ty aS iT iS
Live life with your eyes wide open.
Experience the reality of your . . .
••connection to the universe.
••essential “goodness.”
••essential validity.
Other:


46
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).Mindfulness Handout 1a
mindfulness Definitions
Wha T iS minDfulneSS ?
••intentionally living with awareness in the present moment.
(Waking up from automatic or rote behaviors to participate and be present to our own lives.)
••Without judging or rejecting the moment.
(Noticing consequences, discerning helpfulness and harmfulness—but letting go of evaluating,
avoiding, suppressing, or blocking the present moment.)
••Without attachment to the moment.
(Attending to the experience of each new moment, rather than ignoring the present by clinging to the past or grabbing for the future.)
Wha T are m inDfulne SS Skill S?
••Mindfulness skills are the specific behaviors to practice that, when put together, make up mindfulness.
Wha T iS minDfulne SS pracTice?
••mindfulness and mindfulness skills  can be practiced at any time, anywhere, while doing
anything. Intentionally paying attention to the moment, without judging it or holding on to it, is all that is needed.
••meditation  is practicing mindfulness and mindfulness skills while sitting, standing, or lying
quietly for a predetermined period of time. When meditating, we focus  the mind (for example,
we focus  on body sensations, emotions, thoughts, or our breath), or we open  the mind (paying


attention to whatever comes into our awareness). There are many forms of meditation that differ mostly by whether we are opening the mind or focusing the mind—and, if focusing, depending
on what is the focus of our attention.
••contemplative prayer (such as Christian centering prayer, the rosary, Jewish Shema, Islamic
Sufi practice, or Hindu raja yoga) is a spiritual mindfulness practice.
••mindfulness movement  also has many forms. Examples include yoga, martial arts (such as
Qigong, tai chi, akido, and karate), and spiritual dancing. Hiking, horseback riding, and walking can also be ways to practice mindfulness.


49
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).Mindfulness Handout 2   (Mindfulness Worksheets 2–2c, 3)
overview:
core m indfulness Skills
WiSe minD:
STaTeS of m inD
“Wha T” SkillS
(what you do when practicing mindfulness):
observing, Describing, p articipating
“hoW” Skill S
(how you practice when practicing mindfulness):
nonjudgmentally, o ne- mindfully, e ffectively


50
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). Mindfulness Handout 3   (Mindfulness Worksheet 3)
Wise m ind:
States of m ind
EMOTION
MINDREASONABLE
MINDWISE
MIND
Reasonable Mind Is:
 Cool Rational Task-Focused
When in reasonable mind,
you are ruled by facts, reason,
logic, and pragmatics. Values and feelings are not important.        Emotion Mind Is:
         Hot Mood-DependentEmotion-Focused
When in emotion mind,
you are ruled by your
moods, feelings, and urges
to do or say things. Facts, reason, and logic are not important.Wise Mind Is:
 The wisdom within
 each person
 Seeing the value of
 both reason and
 emotion
 Bringing left brain and
 right brain together
 The middle path


51
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).Mindfulness Handout 3a   (Mindfulness Worksheet 3) (p. 1 of 2)
ideas for p racticing Wise m ind
The mindfulness skills often require a lot  of practice. As with any new skill, it is important to first
practice when you don’t need the skill. If you practice in easier situations, the skill will become
automatic, and you will have the skill when you need it. Practice with your eyes closed and with
your eyes open.
1.  Stone flake on the lake. Imagine that you are by a clear blue lake on a beautiful sunny day.
Then imagine that you are a small flake of stone, flat and light. Imagine that you have been tossed out onto the lake and are now gently, slowly, floating through the calm, clear blue
water to the lake’s smooth, sandy bottom.
••Notice what you see, what you feel as you float down, perhaps in slow circles, floating
toward the bottom. As you reach the bottom of the lake, settle your attention there within yourself.
••Notice the serenity of the lake; become aware of the calmness and quiet deep within.
••As you reach the center of your self, settle your attention there.
2. Walking down the spiral stairs. Imagine that within you is a spiral staircase, winding down to your very center. Starting at the top walk very slowly down the staircase, going deeper and deeper within yourself.


••Notice the sensations. Rest by sitting on a step, or turn on lights on the way down if you wish. Do not force yourself further than you want to go. Notice the quiet. As you reach the center of your self, settle your attention there—  perhaps in your gut or your abdomen.
3. Breathing “Wise” in, “ mind” out. Breathing in, say to yourself, “Wise”; breathing out, say
“Mind.”
••Focus your entire attention on the word “wise,” then, focus it again entirely on the word
“mind.”
••Continue until you sense that you have settled into Wise Mind.
4. asking Wise m ind a question. Breathing in, silently ask Wise Mind a question.
••Breathing out, listen for the answer.
••Listen, but do not give yourself the answer. Do not tell yourself the answer; listen for it.
••Continue asking on each in-  breath for some time. If no answer comes, try again another
time.
(continued on next page )