DBT therapy techniques to try: An overview for mental health providers

DBT focuses on four core modules: mindfulness skills, distress tolerance skills, interpersonal effectiveness skills, and emotional regulation. Together, the four modules equip clients with the skills to manage emotions, navigate relationships, tolerate distress, and stay present.

Mindfulness DBT techniques 

Mindfulness teaches clients how to ground in the present moment and accept things as they are. In DBT, mindful awareness is crucial for emotional regulation. Acceptance helps clients respond instead of react to their distress. It also moves clients away from seeing the world, themselves, and others as “all good” or “all bad,” which can reduce the intensity of negative emotions. 

• Mindful acceptance: This skill teaches clients to accept their experiences, thoughts, and feelings as they are without labeling them “good” or “bad.” Acceptance doesn’t mean we need to “like” the experience or the emotion; it simply puts non-judgmental language on what’s happening in the “now” moment. 
• Mindful breathing: There are many ways to practice mindful breathing. Tools include box breathing and 4-7-8 breathing. Taking deep breaths helps calm down the nervous system, which can help the body relax. 
• Mindful observation: This skill teaches clients how to observe a single thought, feeling, or experience without trying to change it.

For more information and guidance, you can also explore Headway’s mindfulness therapy techniques.

Distress tolerance DBT techniques

In DBT, distress tolerance skills are one cornerstone of emotional regulation. These skills can help clients navigate crises, such as self-harm behaviors, impulsive tendencies, and suicidal ideation. As an extension of mindfulness, distress tolerance teaches clients to accept their reality rather than fight against it. It also shows clients how to engage the mind and body to temper upsetting emotions and tough situations. Research shows that distress tolerance skills can produce beneficial results, even with short-term therapy. 

• TIPP skills: TIPP stands for “temperature, intense exercise, paced breathing, and progressive muscle relaxation.” For example, during an intense moment, a client can place ice on the back of their neck or go for a long run. Taking deep breaths and tensing and relaxing one’s muscles can also provide relief. 
• Engaging the 5 senses: With this technique, clients are encouraged to name one thing that they can hear, see, touch, taste, and smell. Engaging the senses provides a helpful sensory distraction. 
• IMPROVE skill: IMPROVE stands for “imagery, meaning, prayer, relaxation, one, vacation, and encouragement.” Clients are encouraged to choose one of these tools to improve the moment by replacing the negative experience with a positive one. For example, imagery could include looking at a beautiful sunset or a cute animal video.

Interpersonal effectiveness DBT techniques

Interpersonal skills are the nuts and bolts of effective communication. In DBT, clients learn how to navigate their relationships in healthier ways. This skill begins with helping clients identify their needs. Then, they learn how to communicate their wants to others. Interpersonal skills address topics such as assertiveness, boundary-setting, taking responsibility, and conflict resolution. Research shows that interpersonal effectiveness helps clients take active steps towards problem-solving, equipping them with active solutions. 

• Boundary setting: This skill teaches clients how to set limits with others by helping them identify what is acceptable in their relationships and what is not. Appropriate boundary setting can prevent resentment and misunderstandings from festering. 
• GIVE: This acronym stands for “be Gentle, act Interested, Validate, and use an Easy manner. GIVE directs clients how to respond to others, especially during times of conflict. Interpersonal interactions are smoother when we are gentle, express interest, validate another person’s emotions, and stay calm. 
• FAST skill: This skill teaches clients how to maintain their self-respect and express the truth, even when it’s challenging. FAST stands for “be Fair, no Apologies, Stick to values, and be Truthful.

Emotion regulation DBT techniques

Emotional regulation is a crucial part of DBT. This skill teaches clients how to manage and regulate their emotions. Emotional regulation can help reduce a client’s self-harm behaviors and interpersonal difficulties. For example, a client who was emotionally neglected during childhood may feel abandoned whenever a friend cancels plans. Learning to modulate one’s emotions can help these clients cope with stressful situations and interpersonal misunderstandings without reacting negatively.

• Opposite action: Emotions come with biological signals that are wired for action. For example, hunger pangs tell us we’re famished, prompting us to eat. When emotions feel larger than life, however, they can drive clients to act in ways that don’t serve them well. One example is yelling when feeling angry. Opposite action teaches clients how to do the “opposite” of what they feel like doing. In the anger example, a client would walk away. 
• Emotion naming: Putting language on our emotions is called “affect labeling.” With this skill, clients learn how to “use their words” and say “I feel…” Naming one’s emotions can calm the amygdala, which instills a sense of calm. 
• Cope ahead: Coping ahead helps clients feel more in control of stressful situations. It includes identifying the situation, naming the facts, identifying ways to handle the experience, and rehearsing the plan. 

DBT techniques for specific conditions

While DBT was developed to help treat borderline personality disorder, therapists can modify these techniques to help treat specific conditions.

DBT techniques for borderline personality disorder

Here are some modified DBT techniques that can support treatment plans for personality disorders.

• Boundary setting: Symptoms of BPD can cause clients to end relationships prematurely, especially when conflict arises. One boundary-setting technique that can help is teaching them how to say “no” when people place inappropriate demands or make them feel unsafe. 
• Problem-solving: This emotion regulation strategy helps clients identify what they “can” control when they feel distressed. Knowing what can be done empowers them to take action with confidence. 
• Increasing positive emotions: Increasing one’s experience of positive emotions can help temper negative ones. With this skill, clients are encouraged to engage in joyful activities, such as spending time outdoors, exercising, or watching a funny movie.

DBT techniques for depression 

Here are some modified DBT techniques that can support treatment plans for depression.

• Opposite action: Depression can cause clients to isolate, thus opposite actions can help them connect. For example, if a client feels like isolating or cancelling plans, doing the opposite by reaching out to a friend or getting out of the house can help. 
• Self-compassion: This mindfulness technique teaches clients to treat themselves the way they’d treat a friend. Research shows self-compassion can help reduce depressive symptoms, such as rumination and avoidance. 
• Labeling emotions: Helping depressed clients identify and name their emotions, like sadness and anger, can help reduce the intensity of the feeling. In addition, naming emotions can prevent clients from stuffing down their feelings, which can make symptoms of depression worse.