What is the DBT skills training Manual?

This blog post will explore what DBT skills training manual is as well as what DBT is.

We will also briefly discuss what DBT skills training is and what are the core techniques used in DBT.

What is the DBT skills training Manual?

The DBT skills training Manual was published in 1993, written by Marsha Linehand who is known as the developer of DBT- dialectical Behavioural therapy. 

This comprehensive manual and resource provides tools that allow therapists and practitioners to implement and learn DBT skills as well as use it for implementing DBT training. 

The original edition of this manual was written at a time when research on DBT in clinical settings was limited.

The only research conducted on Dialectical Behaviour Therapy (DBT) was in 1991- a clinical trial studying the application and use of DBT for the treatment of borderline personality disorder (BPD).

This particular manual consists of teaching notes, handouts, and worksheets which can be used to revee, reflect, and better teach the process and application of DBT skills in therapy. 

As of today, this particular manual has been used for over two decades by hundreds of thousands of practitioners and has been revised for the latest and second edition. 

The manual consists of the following and covers issues related to:

  • Orienting clients to DBT which involves introducing DBT to clients and groups as well as psycho educating them about the process of DBT. 
  • Teaching notes for development and cultivation of techniques and skills related to mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance skills. 

As of the new edition that has been published, much research and progress in the field of DBT has led to a few additions such as:

  • New DBT skills have been added based on the author’s experience and research using the original skills.
  • More research evidence related to emotions, emotion regulation, distress tolerance, and mindfulness.
  • New treatment strategies based within the cognitive-behavioural paradigm. 
  • The new edition also boasts Handouts and worksheets that have been completely revised. 
  • Multiple alternative worksheets have been added to help practitioners tailor treatment to each client.
  • More extensive reproducible teaching notes with clinical examples.
  • Curricula for running skills training groups for specific populations and problems. 

What Is DBT?

Dialectical Behaviour Therapy (DBT) is a type of cognitive-behavioural therapy that emphasises the importance of developing skills to deal with highly emotional situations. 

This form of therapy was created for the treatment of suicidal thoughts and is now considered as an effective treatment of emotional regulation dysfunction disorders such as Borderline disorder.

This form of therapy utilises a supportive and collaborative relationship between patient/client and therapist to address issues paying attention to self-destructive behaviours and focusing on learning social and coping skills. 

DBT also focuses on issues related to improving Quality of life and also coping with PTSD related problems. 

DBT as a form of psychotherapy was developed by Marsha Linehan when she noticed that the basic CBT approach did not work well for personality disorders- specifically Borderline Personality disorders.

Her DBT approach has been tailored to help clients accept their own ways of thinking, feeling, behaving, and also cultivate validations- internal validation towards their own emotional needs.

DBT utilises four skills:

  • Mindfulness
  • Distress tolerance
  • Interpersonal effectiveness
  • Emotional regulation

Using these four skills, the individual goes through four stages of treatment which include:

  • Moving to gain control by setting and building up positive relationships and help them understand their emotions better to understand it and be more aware of it.
  • Express emotions in an appropriate manner as opposed to avoiding, shutting out or shutting down, or by being explosive.
  • Learning to solve problems as a part of their effort to live a better life so clients are taught problem solving techniques as well as help them differentiate serious problems as opposed to normal day to day challenges. 
  • Feeling complete as a person where the client learns how to feel that sense of completeness by learning how to focus on building a sense of well being for themselves. 

What is DBT Skills Training?

DBT skills training involves teaching clients various skills to help cope with their problems and build better lives. 

These skills include:

  • Mindfulness
  • Distress tolerance
  • Interpersonal effectiveness
  • Emotional regulation

The form of training is typically delivered in a group format but can also be done one to one. 

The focus of this form of training is to help teach clients behaviours that bringpostive impact in their lives as well as sharpen their availability to use those skills in their day to day lives. 

It usually takes around 8 weeks- two months-24 weeks to get through the full curriculum that targets client’s to build these four skills because DBT assumes that many of the problems that clients bring about are caused by skills deficits. 

For example, the ability of the client in emotion regulation skills is believed to be the issue that is causing problems in individuals.

What are the core DBT techniques?

A Look at DBT Techniques

DBT is an accepted form of therapy, which has been registered and reviewed by the Substance Abuse and Mental Health Services Administration as an evidence-based treatment.

In addition to the unique structure of therapy, DBT also recognizes the fact that most people are doing the best they can possibly do with the types of skills they have.

If someone is not doing well they may simply be missing the necessary skills.

Dr. Linehan determined what skills needed to be stronger and then set about a method of correcting that. (Hoermann, Zupanik & Dombeck, n.d.).

Four skills that DBT utilises are:

Mindfulness

Mindfulness is a state of being and more proficiently a way of life where the individual actively imagines in the act of cultivating full awareness of the present. 

This awareness of the presence is related to both the world outside and around the individual and the world within the individual in terms of thoughts and feelings.

A person who practises mindfulness may begin with putting effort to bring about all of their senses to focu on what they’re experiencing right now however, over time, it becomes a way of life- done without much effort and with a greater understanding of one’s self. 

Mindfulness is the experience of being present with the here and now. The state of Mindfulness is an experience of your present feelings, thoughts, and behaviour. It is the act of paying attention to yourself, your body, and the world around you.

It is the complete opposite of living in an autopilot mode of existence which can cause various problems, mental health related issues, stress, and an overall poor sense of well being. 

Being mindful requires you to let go of the past, and the worries of the future and simply focus on the present and the things you can do in the present. This can help you move past unnecessary anxious and depressive thoughts that are unnecessary and often causing dysfunction. 

The various techniques and skills used to cultivate Mindfulness in DBT are:

What Skills:

  • Observe
  • Describe
  • Participate

Emotional regulation

James Gross in the Handbook of Emotional Regulation defines emotional regulation as a process where an individual influences the emotions they have, even impacts when they have them, and also includes the experience of how they feel and express their emotions. 

According to this definition, emotional regulation includes the processing of both positive and negative emotions and it is both an automatic and controlled process.

According to Gross, the process might also be controlled by the unconscious or could be a conscious process and often impacts an individual’s ability to produce or express emotions. 

Emotional regulation has three steps to the process (Chowdhury, 2021)

  • It has an Initiating behaviour triggered by emotions.
  • As well as behaviours that are inhibited by emotions.
  • And responses triggered by emotions.

Some of the techniques and skills used in DBT for emotional regulation include:

Using Reduce Vulnerability: (Please)

  • P & L Treat Physical Illness
  • E eating
  • A Altering Drugs (no drugs unless it is medication to be taken as prescribed by your doctor)
  • S Sleep
  • E Exercise

Using Build Mastery over situation, emotions, and self behaviours. 

Build Positive experiences by allowing oneself to engage with positive experiences, emotions, relationships. 

Be mindful of current emotion by being aware and non-judgemental. 

Distress tolerance

Distress tolerance is understood as a person’s ability to manage emotional distress in actual or perceived distressing situations. 

People with low distress tolerance tend to become overwhelmed by stress and stress inducing situations and oftentimes, when they do not know how to manage these situations effectively, turn to unhealthy patterns of behaviour to cope.

Whether the stress is immense or your tolerance level is high or low, your ability to tolerate distress can play a major role in how you manage your daily life. Learning distress tolerance coping skills can improve your ability to handle negative emotions and improve well-being. 

Some of the techniques and skills used in DBT for distress tolerance include:

Wise Mind Accepts

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

Using Self Soothe with five senses:

  • Taste
  • Smell
  • See
  • Hear
  • Touch

Using Improve the moment:

  • I Imagery
  • M Meaning
  • P Prayer
  • R Relaxation
  • O One thing at a time
  • V Vacation
  • E Encouragement

Interpersonal Effectiveness

Interpersonal effectiveness is very important because it helps us maintain various goals. Thes goals include maintaining our relationship, considering ourselves with respect, as well as attaining our personal, career objectives and goals. 

Each goal requires interpersonal skills that allow us to clarify what we want from others, our lives, and also our interactions with the outside world. It also helps us to maintain our relationships in healthy ways as well as help us to stick to our values so as to maintain our self respect.

Some of the techniques and skills used in DBT for interpersonal effectiveness include:

Using Objectiveness effectiveness: (Dear Man)

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

Using Relationship Effectiveness: (Give)

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

Self-respect effectiveness: (Fast)

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

Conclusion

This blog post has explored what DBT skills training manual is as well as what DBT is.

We have also briefly discussed what DBT skills training is and what are the core techniques used in DBT.

References

DBT Skills Training Manual, Second Edition. GoogleBooks. Retrieved on 7th January 2022. https://books.google.co.in/books/about/DBT_Skills_Training_Manual_Second_Editio.html?id=HoEaBQAAQBAJ&source=kp_book_description&redir_esc=y

DBT® skills training manual, 2nd ed. APA Psycnet. Retrieved on 7th January 2022. https://psycnet.apa.org/record/2015-05780-000

Linehan, M. M. (2015). DBT® skills training manual (2nd ed.). Guilford Press.

Dbt Skills List. DBT Self Help. Retrieved on 7th January 2022. https://www.dbtselfhelp.com/html/dbt_skills_list.html\

Harned.M., Botanov, Y. Dialectical Behaviour Therapy Skills Training Is Effective Intervention.

Psychiatric Times, March 31, 2016. Vol 33 No 3, Volume 33, Issue 3. Retrieved on 7th January 2022. https://www.psychiatrictimes.com/view/dialectical-behavior-therapy-skills-training-effective-intervention

Riopel, L.What is Dialectical Behaviour Therapy (DBT)? Positive Psychology. Retrieved on 7th January 2022. 

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