TKC DBT Handbook

MIDDLE PATH PRACTICE EXERCISE

Shifting All Or Nothing Thinking to Middle Path thinking:

Try not to use all or nothing words like “always, “never”, “everything”, and “nothing”. Make a mindful effort to adjust each all or
nothing statement to more realistic phrases such as “often”, “usually”, “sometimes” or whatever is appropriate.

Examples of All Or Nothing thinking: Examples of Middle Path thinking:

• Good things never happen to me • Both good and bad things happen in my life
• I’m a bad person • I have flaws and strengths
• My family all treat me terribly • My family can be hurtful and they can also be loving
• I will never be loved • I know that all people deserve love
• I’m broken • I feel broken right now but I won’t always feel this way
• I’m a complete failure • I may have failed in the past but I am still a competent person
• Everybody hates me • Not all people will like me and that’s OK

Middle Path Practise Exercise:

List your all or nothing statements in the first column. Then create a Middle Path response in the second column.

ALL OR NOTHING STATEMENT MIDDLE PATH RESPONSE

51 Module IIMI:oEMduOlTeIOI:NMRINEGDUFLUALTNIOESNS

CREATING A MEANINGFUL LIFE

There are three critical factors in creating a meaningful life:

IDENTIFY YOUR CORE VALUES AND BELIEFS

Your values guide your decisions. Your beliefs determine whether or not you will attain your life goals. Knowing your values
and beliefs and living by them is the main pathway to achieving greater happiness. Clarify your values and prioritize them.

SET REALISTIC GOALS

Setting goals focuses your energy and allows you to accomplish more in your life. Aligning your goals with your values
and setting achievable goals will create a life with deeper fulfillment and meaning.

TAKE ACTION

To live by your values and beliefs, it is important to take action, begin to find ways to express your values. For example, if
you value family, find ways to do more positive activities with your loved ones. If fun is a value of yours, maybe spending

more time in the outdoors might bring you a sense of enjoyment.

52 Module III: EMOTION REGULATION

CREATING A MEANINGFUL LIFE PR ACTICE EXERCISE

Utilize this practice exercise to explore how you might use your values and set goals:

Identify what is truly important to you in life. Use this section to help build your own values list and choose five core values from
below, or create your own. Prioritize them in order of importance using the space below:

Acceptance Encouragement Justice Self-control
Adventure Enthusiasm Kindness Self-reliance
Appretiation Faith Leadership Serenity
Balance Family Love Spirituality
Belonging Fitness Loyalty Strength
Bravery Freedom Mindfulness Success
Commitment Fun Open-mindeness Trust
Compasion Generosity Power Truth
Confidence Gratitude Relaxation Wealth
Control Honesty Reliability Wisdom
Creativity Imagination Respect __________
Empathy Independence Sacrifice __________

Value 1: Value 2: Value 3:

Identify what you want to accomplish. A good way to create meaningful goals is to make them SMART: SPECIFIC, MEASURABLE,
ACHIEVABLE, REALISTIC and TIME-BASED. Start by identifying an ultimate goal, then create managable action steps you can
take to reach that goal, utilizing a realistic timeline.

Core Value: Adventure
Ultimate Goal: Visit Rome

Specific action: Research Rome, explore places I might visit Timeframe: By Monday
Specific action: Choose dates that I can travel to Rome Timeframe: Two weeks
Specific action: Timeframe: Four weeks
Book tickets (flights, hotel, transportation)

Core Value:
Ultimate Goal:

Specific action: Timeframe:
Specific action: Timeframe:
Specific action: Timeframe:

53 Module III: EMOTION REGULATION

BEHAVIOR CHAIN ANALYSIS

A Behavior Chain Analysis can help you identify why you are
engaging in problem behaviors

It will help you figure out all the things that you may be contributing to a problem behavior and in so doing,
a behavior chain analysis can give you insight into how to change that problem behavior.
1: The first step is to identify the behavior that you want to change. For example, do you want to stop engaging in deliberate self-harm
or self-medication through alcohol? Maybe binge eating? Try to identify a behavior that is causing problems in your life.
2: Next, think about what happened prior to engaging in the problem behavior. What were you doing? What was going on around
you? Were you in an argument? Did you remember a triggering traumatic event? The aim of this step is to identify the event or
situation that served as the starting point for your problem behavior.
3: Identify what kinds of thoughts accompanied the situation you identified in Step 2. How did you evaluate the situation or
yourself in that situation? Did you engage in catastrophic or all-or-nothing thinking?
4: Think about what emotions you were feeling as a result of that situation. Try your best to list as many emotions as you can (for
example; fear, sadness, anger, shame, guilt, embarrassment or dread).
5: Pay attention to what you felt in your body. Try to recognize and label all the sensations that you felt. For example, did you
experience shortness of breath? Muscle tension? An increased heart rate? Think about how your body reacted to the situation.
6: List what behaviors your thoughts, emotions and bodily sensations made you want to engage in. Did they make you want to
escape the situation or do something to make those feelings stop? Did you feel a need to engage in your problem behavior?
7: Finally, think about the consequences of engaging in your problem behavior. Did you feel better afterwards? Did you feel
disappointed in yourself or ashamed? List as many consequences, both positive and negative as you can.

TIPS FOR THIS EXERCISE

It can be helpful to go through a behavior chain analysis soon after engaging in a problem behavior. This way, your experience is fresh
in your mind and you will likely be able to remember more information about the factors that led up to your problem behavior.
Identify what may have made you more susceptible to responding to the situation as you did. For example, when people do not eat well
or get enough sleep, they may be more prone to experiencing negative moods or having more intense emotional experiences.
Behaviors can serve multiple functions. Therefore, it helps to go through a behavior chain analysis for a number of different situations
that may have led to a problem behavior and to try and identify all the functions that a problem behavior serves.
After you complete a behavior chain analysis, indentify different coping strategies that you could use at each stage.
In addition to identifying the function that a problem behavior serves, it is also important to figure out how to “break the chain”
through use of healthier coping strategies.

54 Module III: EMOTION REGULATION

BEHAVIOR CHAIN ANALYSIS PRACTICE EXERCISE

Problem behavior

Describe exactly what you did or said and try to be as specific and detailed as possible:

Links: Past Chain of Events Solutions: New Chain of Events

What were the feelings, thoughts and behaviors which led New suggestions for solving the problem. What could
up to the problem behavior? Try to write your thoughts as you have done differently to avoid the problem behavior?
direct quotes as they occur. Describe in specific detail how you could use each skill.
Solutions to
Vulnerabilities Vulnerabilities
Prompting Alternative
Event ways to think
Thoughts and act
before Alternative
behavior thoughts
Body Skills to cope
sensations with body
& changes sensations
Emotions Skills to cope
before the with emotions
behavior Alternative
Problem behavior
behavior Skills I can
Thoughts commit to
after behavior practicing
Emotions this week,
after behavior relating to
the problem
Consequences that make problem behaviors behavior
more likely to reoccur:
Obstacles to using the skills above:
Consequences that make problem behaviors
less likely to reoccur: (What makes it difficult for me to use my skills effectively?)

55 Module III: EMOTION REGULATION

MODULE IV: DISTRESS TOLER ANCE

S Slow your breathing
T Take note
O Open up
P Pick Crisis Survival skills

ACCEPTS: CRISIS SURVIVAL SKILL

Some emotions become so overwhelming that they cause you to lose control and act impulsively.
The distress tolerance survival skill “ACCEPTS” will help you to manage emotional crisis without
engaging in damaging behavior.

ctivities: Engage in exercise or hobbies, do some cleaning, go to events, call or visit a friend

Opposite ontributing: Help someone out or offer a favor, do volunteer work, give a gift, pray for someone
omparison: Refocus attention from yourself to others. Compare yourself to a time you have done less well. Use this to recast
Other ompassion: your situation in a more positive light
Other motions: Have compassion for other people; understand what they are going through; find things to appreciate about them
ushing Away: Do something which creates a different emotion - listen to music, read inspirational materials, watch a comedy,
ask someone to tell you a joke or tell a joke
Leave the situation mentally or physically; create a safe place mentally

houghts: Count to ten, look out the window, do puzzles, think to yourself "This too shall pass"

ensations: Take a cool or hot shower, hold ice, play with a rubber band

SELF-SOOTHE WITH THE FIVE SENSES:

VISION Lnoiogkhta,tloaosktraetama b, otroekesw, sitkhy,bleoaouktiaftutlhpeicsttuarressa.t

HEARING Listen to soothing music, pay attention to the sounds of
nature, the waves or rainfall.

SMELL Breathe in the fresh smells of nature, notice the fragrance
of a flower, light a scented candle.

TASTE Have atgreoaotdyomuerasle,lfdtroindkehsseerrbta. lEtaetamorinhdoftuclhlyo. colate,

TOUCH Feel the texture of a tree, put your hand in running water, feel
the cold sensation of ice.
57
Module IV: DISTRESSS TOLERANCE

ACCEPTS PRACTICE EXERCISE

Think of a time when you acted on a problem behavior (i.e. using drugs or alcohol, cursing or
yelling at others, engaging in self-injury, or acting in a manipulative way):

Triggering event:

Interpretation of the event:

Emotions you experienced:

Body experiences:

Action urges:

Rate your level of distress: 4.
(0 = no distress, 10 = max distress)

Which crisis survival strategies could you have used and in what order?

1. 2. 3.

Now rate your level of distress after
using your crisis survival skills:

Homework: Practice using your crisis survival skills today and describe how you used them:

Skill: How I used the skill:

Skill: How I used the skill:

Skill: How I used the skill:

58 Module IV: DISTRESSS TOLERANCE

IMPROVE THE MOMENT

magery Imagine relaxing scenes; see yourself as having accomplished your goals

eaning Find some purpose, meaning or value in your life struggles and pain; focus on the positives

rayer Be open to a higher power, ask for strength to manage pain in the moment; try to let go and trust the universe

elaxation Practice deep breathing and just noticing your breath; tense and relax your muscles; shower, bathe or do yoga and tai chi

ne thing Focus your entire attention on what you are doing right in this moment

acation Have a picnic in the park; go for a walk on the beach or take a hike in nature

ncouragement Remind yourself that you are doing the best that you can in this moment

59 Module I: MINDFULNESS

PROS AND CONS

UTILIZING PROS AND CONS:

The secret to a good Pros and Cons list is to write it when you are calm and secure, not in desperation or in crisis. Pros and Cons can help you to
acces your WISE mind. Don’t throw away your lists and remember that they can help you in a moment of despair or uncertainty.

Begin by listing the pros and cons of the problem behavior or situation
Rate the short term effects as a 5 and the long term effects as a 10.

This helps to keep you motivated and to stop any impulsive urges you may have that may harm you in the long term
Review the Pros and Cons before going into a difficult situation in order to keep your emotions regulated. See if anything

particular stands out to you, are there any patterns that you notice? Does your review change the urges you have?
Review the Pros and Cons before going into a difficult situation in order to keep your emotions regulated. See if anything

particular stands out to you, are there any patterns that you notice? Does this change the urges you have?

60 ModMuolde uMIVlo:eDdIIuVS:TlDeREIIS:STMSSRITNEOSDSLFETUROLALNNEERCSAES NCE

PROS AND CONS PR ACTICE EXERCISE

Mary is nineteen years old. She left college in the middle of the semester to go to chemical dependency rehabilitation. Her therapist
recommended she go directly to a sober house as a transition back to a healthy lifestyle. Mary weighs the pros and cons of going to the
sober house versus going back to live with her parents immediately upon finishing treatment. Notice how in this example, the pros greatly
outweigh the cons. This method gives us greater insight into how we might deal with problems effectively on a long term basis Explore
Mary’s Pros and Cons list below and use the blank chart to give your own example.

Problem: Should I live at a sober house for a few months?

Rate the intensity: Short term effects = 5 Long term effects = 10

PROS (ADVANTAGES) CONS (DISADVANTAGES)
I might have less autonomy
Help me to remain sober 10 I will be further from my friends 5
I’ll miss home comforts 5
Fellowship with other women in recovery 10 I really miss my mom’s cooking 5
I won’t be able to see my dog 5
I can focus more on my step work 10 It could be awkward to meet new people 5
I’ll miss my friend’s graduation party 5
I’ll have less chances to isolate 10 5
TOTAL: 35
My parents won’t be upset with me 5

I’ll make new sober friends 10

I can practice willingness and surrender 5

TOTAL: 60

Choose a problem or write your own:
Rate the intensity: Short term effects = 5 Long term effects = 10

• Sinking into depression • Driving dangerously • Using drugs • Raging • Lying
• Binge eating/purging • Reckless spending • Self-injury • Stealing • Infidelity

ADVANTAGES (PROS) DISADVANTAGES (CONS)

TOTAL: TOTAL:

What are the advantages of not acting on your problem behavior? For example: gaining greater self-esteem, strength and confidence, more
money, better relationships, health, better decision making, job security, greater peace of mind, a sense of meaning and fulfillment

61 Module MIVo: DdIuSTlRe EIS: SMSITNODLFEURLANNECSES

R ADICAL ACCEPTANCE

Defining Radical Acceptance:

Radical acceptance is a general approach to life. It is about stopping the exhaustion that comes from fighting reality, so that you have more
energy to tolerate what’s actually happening with more grace. Remember; what you resist will always persist, your identity gets hitched to
whatever you are not accepting. The more you push something away or run from it, the more your sense of self becomes linked with that
experience. Acceptance does not mean approval; you can accept something and still want to change it. It is never a final resting place. Once

you’ve fully accepted reality for what it is, there is still work to be done.

What Radical Acceptance is:

• It is letting go of fighting reality and accepting your situation for exactly what it is
• Acceptance is knowing that everything has a cause, even if you don’t know what that cause is

• It is the ability to recognize that life is worth living even when you experience pain

What Radical Acceptance is not:

• Acceptance does not mean that you are resigned to always feeling this way
• It doesn’t mean that the your feelings are right or wrong, good or bad

• Radical Acceptance doesn’t ask you to be passive and not to take actions that might help your situation

How Radical Acceptance feels:

• Like a weight has been lifted from your mind and heart
• A deep sense of peace and relief

• As though you have let go of a painful struggle
• You can breathe more easily and more fully

Hitting the pause button:

Choose a time when you are involved in a goal oriented activity, such as reading, working on the computer, cleaning or eating, and explore
pausing for a moment. Begin this exercise by stopping your activity and sitting comfortably, allowing your eyes to close. Take a few deep
breaths and with each exhale let go of any thoughts or worries about what you are going to do next and let go of any tightness in the body.
Now, notice what you are experiencing as you inhabit this moment. What sensations are you aware of in your body? Do you feel anxious or
restless as you try to step out of your usual mental process? Do you feel pulled to resume your activity? Can you simply allow this present

moment to just be, and accept what is happening, just as it is?

62 Module IV: DISTRESSS TOLERANCE

R ADICAL ACCEPTANCE PRACTICE EXERCISE

List five things you are having trouble accepting in your life right now:
1
2
3
4
5
Describe a difficult situation which you cannot change and which is causing you suffering:

Rate your level of distress on a scale of 0-10 (0 = no distress, 10 = max distress):
What is the hardest aspect for you to accept about this situation:

Describe how your life would be different if you accepted this situation:

Can you make an inner commitment to radically accept the situation just as it is?
YES Yes, but with these reservations
NO No, but I could if this happened
Do you find yourself resisting accepting the situation and if you are, explain how:

Now rate your level of distress on a scale of 0-10 (0 = no distress, 10 = max distress):

63 Module MIVo: DdIuSTlRe EIS: SMSITNODLFEURLANNECSES

WILLINGNESS VS. WILlFULNESS

Understanding willingness vs. willfulness:

Attempt to culivate a WILLING response to each situation:

• Willingness is doing just what is needed in each situation
• Willingness is listening very carefully to your WISE MIND and acting from a centered inner place
• Willingness brings you a sense of connection to your environment, to other people and to the universe
• Willingness allows a mindful awareness and a joyful appreciation of those connections

Try to avoid engaging in WILLFUL behavior:

• Willfulness is giving up on a problem when in reality, you need to act more skillfully
• Willfulness is doing the opposite of what is effective or giving up trying at all
• Willfulness is trying to fix, manipulate or control every situation for your benefit
• Willfulness is refusing to tolerate the moment, choosing instead to escape or avoid

Transforming your behavior from willful to willing:

NOTICE Observe, describe and label your willful stance for what it is

ACCEPT Accept that your behavior is stubborn and willful, and commit to turning to willingness

ASK YOURSELF “What am I afraid of?” Usually, a willful stance is because of the fear of what may happen if you become willing.
“Will I feel more exhausted, more in pain or more helpless?”

YOUR BODY Try to relax your face and neck and sit up straight. Attempt to let go of any tension. Breathe and adopt a half smile

“YES” Imagine yourself doing something willingly, while telling yourself “yes” over and over again
64
Module IV: DISTRESSS TOLERANCE

WILLINGNESS VS. WILlFULNESS PR ACTICE EXERCISE

List five ways you are engaging in willful behavior, either presently or in the past:
1
2
3
4
5
Describe a past situation where you have been willing. If you can’t think of one, describe a
situation where you might have used willingness to better effect:

Describe the willing actions you utilized or could have used:

Describe a past situation where you have acted willfully or with stubbornness:

Describe the impact your willful behavior had on yourself or others:

65 Module MIVo: DdIuSTleREI:SMSSITNODLFEURLANNECSES

TURNING THE MIND

Acceptance is a choice you make every single moment:

Acceptance of reality requires an act of choice. It’s a little bit like walking down a path that keeps forking in different directions. One
direction means accepting events just as they are, and the other direction means pushing away reality and avoiding situations that may
be more challenging. Turning your mind requires you to keep travelling the path to acceptance.

The experience of turning your mind: COMMITTING TO ACCEPTANCE

DEVELOPING AWARENESS When you acknowledge your lack of acceptance of reality, try to make
an inner commitment to change your approach:
Become aware when you're not accepting a situation. Some clues that • Acknowledge to yourself that you are resisting acceptance
you are choosing not to accept are: • Challenge old ways of thinking and feeling by committing to a
• Feelings of anger, bitterness or annoyance
• Asking yourself “Why me?” or “Why is this happening?” new approach
• Attempting to block experiences or numb yourself • Try to face challenging experiences with an attitude of gentle
• Hiding or covering up how you’re honestly feeling
acceptance

REPEATING THE CHOICE TO ACCEPT

In order to retrain your mind, body and emotions to function in a healthy and balanced manner, you must repeatedly turn your mind, over and over,
towards acceptance of what is. Fighting, rejecting or pushing away reality only serves to increase your sense of internal struggle and pain.

Turning your mind: becoming aware of the five senses

• Touch: Shift your awareness to your body’s position in this moment; are your feet firmly planted on the floor? Are you comfortable?
• Sight: Acknowledge how your surroundings appear. Are others present? Try not to judge what you see, just take it in and accept.
• Smell: Bring your awareness to the odors and aromas in your environment. Whether soothing or stressful, simply acknowledge.
• Taste: Notice any flavors you might experience. Simply name them and try to avoid judgmental descriptions.
• Sound: Become aware of all the sensory information around you. Try to become aware of the full spectrum of sounds you may hear.

66 Module IV: DISTRESSS TOLERANCE

TURNING THE MIND PRACTICE EXERCISE

Commit to turning your mind today. Try to accept a difficult situation or person for what or who
they are, and begin to notice how using this skill is positively affecting you. Describe below:

Describe a situation you cannot change and how radical acceptance might benefit you:

Describe what is most difficult for you about accepting this situation:

What do you gain by refusing to accept and how does resistance or avoidance benefit you:

Describe how your life could be different if you simply accepted the situation for what it was:

Can you make an inner commitment to turn your mind and accept the situation just as it is?
YES Yes, but with these reservations
NO No, but I could if this happened

67 Module IV: DISTRESSS TOLERANCE

BEHAVIOR CHAIN ANALYSIS

A Behavior Chain Analysis can help you identify why you are
engaging in problem behaviors

It will help you figure out all the things that you may be contributing to a problem behavior and in so doing,
a behavior chain analysis can give you insight into how to change that problem behavior.
1: The first step is to identify the behavior that you want to change. For example, do you want to stop engaging in deliberate self-harm
or self-medication through alcohol? Maybe binge eating? Try to identify a behavior that is causing problems in your life.
2: Next, think about what happened prior to engaging in the problem behavior. What were you doing? What was going on around
you? Were you in an argument? Did you remember a triggering traumatic event? The aim of this step is to identify the event or
situation that served as the starting point for your problem behavior.
3: Identify what kinds of thoughts accompanied the situation you identified in Step 2. How did you evaluate the situation or
yourself in that situation? Did you engage in catastrophic or all-or-nothing thinking?
4: Think about what emotions you were feeling as a result of that situation. Try your best to list as many emotions as you can (for
example; fear, sadness, anger, shame, guilt, embarrassment or dread).
5: Pay attention to what you felt in your body. Try to recognize and label all the sensations that you felt. For example, did you
experience shortness of breath? Muscle tension? An increased heart rate? Think about how your body reacted to the situation.
6: List what behaviors your thoughts, emotions and bodily sensations made you want to engage in. Did they make you want to
escape the situation or do something to make those feelings stop? Did you feel a need to engage in your problem behavior?
7: Finally, think about the consequences of engaging in your problem behavior. Did you feel better afterwards? Did you feel
disappointed in yourself or ashamed? List as many consequences, both positive and negative as you can.

TIPS FOR THIS EXERCISE

It can be helpful to go through a behavior chain analysis soon after engaging in a problem behavior. This way, your experience is fresh
in your mind and you will likely be able to remember more information about the factors that led up to your problem behavior.
Identify what may have made you more susceptible to responding to the situation as you did. For example, when people do not eat well
or get enough sleep, they may be more prone to experiencing negative moods or having more intense emotional experiences.
Behaviors can serve multiple functions. Therefore, it helps to go through a behavior chain analysis for a number of different situations
that may have led to a problem behavior and to try and identify all the functions that a problem behavior serves.
After you complete a behavior chain analysis, indentify different coping strategies that you could use at each stage.
In addition to identifying the function that a problem behavior serves, it is also important to figure out how to “break the chain”
through use of healthier coping strategies.

68 Module IV: DISTRESS TOLERANCE

BEHAVIOR CHAIN ANALYSIS PRACTICE EXERCISE

Problem behavior

Describe exactly what you did or said and try to be as specific and detailed as possible:

Links: Past Chain of Events Solutions: New Chain of Events

What were the feelings, thoughts and behaviors which led New suggestions for solving the problem. What could
up to the problem behavior? Try to write your thoughts as you have done differently to avoid the problem behavior?
direct quotes as they occur. Describe in specific detail how you could use each skill.
Solutions to
Vulnerabilities Vulnerabilities
Prompting Alternative
Event ways to think
Thoughts and act
before Alternative
behavior thoughts
Body Skills to cope
sensations with body
& changes sensations
Emotions Skills to cope
before the with emotions
behavior Alternative
Problem behavior
behavior Skills I can
Thoughts commit to
after behavior practicing
Emotions this week,
after behavior relating to
the problem
Consequences that make problem behaviors behavior
more likely to reoccur:
Obstacles to using the skills above:
Consequences that make problem behaviors
less likely to reoccur: (What makes it difficult for me to use my skills effectively?)

69 Module IV: DISTRESS TOLERANCE

V: APPENDIX

Daily DBT Exploration

NAME: Did well = Need to improve =

Ways that I took care of myself today:

Connected with Took prescribed Ate healthy Exercised Got balanced Participated in
supportive people medication food sleep treatment

What situation triggered me the most, recently (even a little bit):

What were my vulnerabilities? (Please check where applicable):

Diet Isolation Lack of exercise Financial Illness
Career
Self Image Willfulness Losses Relationship issues

Other

What feelings did I experience in this situation:

What thoughts were the most difficult:

What urges did I have:

What cognitive distortions are connected to my thought? (Please check where applicable):

All or nothing thinking Labeling (myself as flawed) Justification

Predicting the future Disqualifying the positive Minimizing

Catastrophizing Euphoric recall Other

What my Wise Mind says relating to this situation:

“Even though I

I

What I learned from this Wise Mind thought: Used = Could have used =

How you used or could have used your skills: How:

Skill:

Skill: How:

71 Module I: MVI:NADppFeUnLNdEixSS

Diary Card Week I

Emotional Intensity (0 = no intensity, 10 = most intense)

Day Sadness Fear Shame Guilt Anger Loneliness Emptiness

MON
TUES
WEDS
THUR
FRI
SAT
SUN

Urges (0 = no intensity, 10 = most intense)

Day T.I.B Drink or Isolation Impulsivity Self-harm Devaluation Suicidal
(see * page two) Drugs thoughts

MON

TUES

WEDS

THUR

FRI

SAT

SUN

Skills Attempted Skill worked = Skill did not work = Could have tried skill =

DBT Skills MON TUES WEDS THUR FRI SAT SUN Total

WISE MIND
WHAT AM I FEELING?
NON-JUDGMENTAL

ONE MINDFUL
EFFECTIVE

TEFLON MIND

COGNITIVE DISTORTIONS
ABC

PLEASE
OPPOSITE TO EMOTION ACTION

RIDE THE WAVE
MIDDLE PATH

DEAR MAN
GIVE
FAST

DISTRACT/SELF-SOOTHE/IMPROVE
PROS AND CONS

RADICAL ACCEPTANCE
TURNING THE MIND

72 V: Appendix

Diary Card Week I

Day Significant Events of the Day

MON
TUES
WEDS
THUR
FRI
SAT
SUN

Day Assignments This Week
* Therapy Interfering Behaviors (T.I.B)
MON
TUES
WEDS
THUR
FRI
SAT
SUN

A: Showing up late or leaving groups early F: Skipping groups or meetings
B: Not completing Diary Card or homework G: Not putting forth my best effort
C: Being critical of myself, other people or the program H: Getting up and down during groups
D: Not paying attention/falling asleep during groups I: Focusing on leaving the program
E: Not being honest in treatment J: Minimizing my problem behaviors

73 V: Appendix

Diary Card Week II

Emotional Intensity (0 = no intensity, 10 = most intense)

Day Sadness Fear Shame Guilt Anger Loneliness Emptiness

MON
TUES
WEDS
THUR
FRI
SAT
SUN

Urges (0 = no intensity, 10 = most intense)

Day T.I.B Drink or Isolation Impulsivity Self-harm Devaluation Suicidal
(see * page two) Drugs thoughts

MON

TUES

WEDS

THUR

FRI

SAT

SUN

Skills Attempted Skill worked = Skill did not work = Could have tried skill =

DBT Skills MON TUES WEDS THUR FRI SAT SUN Total

WISE MIND
WHAT AM I FEELING?
NON-JUDGMENTAL

ONE MINDFUL
EFFECTIVE

TEFLON MIND

COGNITIVE DISTORTIONS
ABC

PLEASE
OPPOSITE TO EMOTION ACTION

RIDE THE WAVE
MIDDLE PATH

DEAR MAN
GIVE
FAST

DISTRACT/SELF-SOOTHE/IMPROVE
PROS AND CONS

RADICAL ACCEPTANCE
TURNING THE MIND

74 V: Appendix

Diary Card Week II

Day Significant Events of the Day

MON
TUES
WEDS
THUR
FRI
SAT
SUN

Day Assignments This Week
* Therapy Interfering Behaviors (T.I.B)
MON
TUES
WEDS
THUR
FRI
SAT
SUN

A: Showing up late or leaving groups early F: Skipping groups or meetings
B: Not completing Diary Card or homework G: Not putting forth my best effort
C: Being critical of myself, other people or the program H: Getting up and down during groups
D: Not paying attention/falling asleep during groups I: Focusing on leaving the program
E: Not being honest in treatment J: Minimizing my problem behaviors

75 V: Appendix

Diary Card Week III

Emotional Intensity (0 = no intensity, 10 = most intense)

Day Sadness Fear Shame Guilt Anger Loneliness Emptiness

MON
TUES
WEDS
THUR
FRI
SAT
SUN

Urges (0 = no intensity, 10 = most intense)

Day T.I.B Drink or Isolation Impulsivity Self-harm Devaluation Suicidal
(see * page two) Drugs thoughts

MON

TUES

WEDS

THUR

FRI

SAT

SUN

Skills Attempted Skill worked = Skill did not work = Could have tried skill =

DBT Skills MON TUES WEDS THUR FRI SAT SUN Total

WISE MIND
WHAT AM I FEELING?
NON-JUDGMENTAL

ONE MINDFUL
EFFECTIVE

TEFLON MIND

COGNITIVE DISTORTIONS
ABC

PLEASE
OPPOSITE TO EMOTION ACTION

RIDE THE WAVE
MIDDLE PATH

DEAR MAN
GIVE
FAST

DISTRACT/SELF-SOOTHE/IMPROVE
PROS AND CONS

RADICAL ACCEPTANCE
TURNING THE MIND

76 V: Appendix

Diary Card Week III

Day Significant Events of the Day

MON
TUES
WEDS
THUR
FRI
SAT
SUN

Day Assignments This Week
* Therapy Interfering Behaviors (T.I.B)
MON
TUES
WEDS
THUR
FRI
SAT
SUN

A: Showing up late or leaving groups early F: Skipping groups or meetings
B: Not completing Diary Card or homework G: Not putting forth my best effort
C: Being critical of myself, other people or the program H: Getting up and down during groups
D: Not paying attention/falling asleep during groups I: Focusing on leaving the program
E: Not being honest in treatment J: Minimizing my problem behaviors

77 V: Appendix

Diary Card Week IV

Emotional Intensity (0 = no intensity, 10 = most intense)

Day Sadness Fear Shame Guilt Anger Loneliness Emptiness

MON
TUES
WEDS
THUR
FRI
SAT
SUN

Urges (0 = no intensity, 10 = most intense)

Day T.I.B Drink or Isolation Impulsivity Self-harm Devaluation Suicidal
(see * page two) Drugs thoughts

MON

TUES

WEDS

THUR

FRI

SAT

SUN

Skills Attempted Skill worked = Skill did not work = Could have tried skill =

DBT Skills MON TUES WEDS THUR FRI SAT SUN Total

WISE MIND
WHAT AM I FEELING?
NON-JUDGMENTAL

ONE MINDFUL
EFFECTIVE

TEFLON MIND

COGNITIVE DISTORTIONS
ABC

PLEASE
OPPOSITE TO EMOTION ACTION

RIDE THE WAVE
MIDDLE PATH

DEAR MAN
GIVE
FAST

DISTRACT/SELF-SOOTHE/IMPROVE
PROS AND CONS

RADICAL ACCEPTANCE
TURNING THE MIND

78 V: Appendix

Diary Card Week IV

Day Significant Events of the Day

MON
TUES
WEDS
THUR
FRI
SAT
SUN

Day Assignments This Week
* Therapy Interfering Behaviors (T.I.B)
MON
TUES
WEDS
THUR
FRI
SAT
SUN

A: Showing up late or leaving groups early F: Skipping groups or meetings
B: Not completing Diary Card or homework G: Not putting forth my best effort
C: Being critical of myself, other people or the program H: Getting up and down during groups
D: Not paying attention/falling asleep during groups I: Focusing on leaving the program
E: Not being honest in treatment J: Minimizing my problem behaviors

79 V: Appendix

DBT SKILLS CHEAT SHEET

WISE MIND MODULE I: MINDFULNESS
WHAT AM I FEELING? ONE MINDFUL
NON JUDGMENTAL EFFECTIVE
TEFLON MIND

DEAR MAN MODULE II: INTERPERSONAL EFFECTIVENESS
GIVE FAST
VALIDATION

COGNITIVE DISTORTIONS MODULE III: EMOTION REGULATION
ABC STRONG
PLEASE OPPOSITE TO EMOTION ACTION
MIDDLE PATH

ACCEPTS ~ SELF-SOOTHE MODULE IV: DISTRESS TOLERANCE
PROS AND CONS OPPOSITE TO EMOTION ACTION
RADICAL ACCEPTANCE MIDDLE PATH

80 Module I: MINDFVU: LANppEeSnS dix

“The expert at anything was
once a beginner.”

~ Helen Hayes

Telephone: (845) 637- 6021
Fa x: (845) 469-1000

Email: [email protected]
W W W.THEK NIGHTCENTER DBT.COM

Module I: MINDFULNESS