Developed by Marsha Linehan, dialectical behavior therapy (DBT) is a psychological intervention used to treat various mental health conditions, including depression, eating disorders, substance abuse, and borderline personality disorder. A primary focus of DBT is teaching patients the skills they need to create a “life worth living.” Core components of four major skillsets in DBT are described below:


To practice mindfulness, you need to work on the following three skill groups.

“What” skills: Observe (e.g., notice sensations, feelings, thoughts), describe what you have observed (“When X happens, I feel Y and think Z”), and participate (be present, become one with your activity).

“How” skills: Practice in a way that is nonjudgmental (observe but do not label as good or bad), one-mindful (stay fully focused on the activity), and effective (do what is needed to achieve your goal).

Wise mind skills: Get in touch with your wise mind, your intuitive way of knowing. The wise mind is the middle path—the integration of emotional mind (deciding based on feelings) and reasonable mind (deciding based on logic).

Emotion regulation

To change your emotional responses, first, check the facts of the situation: If your emotions do not agree with the facts (e.g., feeling afraid when, objectively, there is little to fear) or if acting based on your emotions will not work, engage in opposite action (e.g., go toward what you want to run away from).

What if your emotions agree with the facts (e.g., you are afraid because there is something to fear)? Problem-solve: Identify your goals, brainstorm solutions, choose a solution, and evaluate the results.

In general, to reduce vulnerability to thinking emotionally, use the acronym ABC PLEASE:

• Accumulate positive feelings (i.e. do enjoyable things).
• Build mastery: Do what makes you feel competent.
• Cope: Plan ahead.
• PhysicaL illness: Take care of your health.
• Eat right.
• Avoid mood-altering substances.
• Sleep sufficiently.
• Exercise regularly.

Distress tolerance

DBT offers a variety of skills (e.g., sensory awareness, self-soothing) for tolerating distress. Two such skills are described below.

1- Distract yourself with ACCEPTS.

• Activities (e.g., reading).
• Contributions (e.g., helping a friend).
• Comparisons: Think of people who are worse off.
• Emotions: Watch a funny movie.
• Pushing away: Leave the situation mentally or physically.
• Thoughts (e.g., count).
• Sensations: Take a hot/cold shower.

2- To IMPROVE the present moment, use...

• Imagery (e.g., recall a happy time).
• Meaning: Find meaning in the situation.
• Prayer.
• Relaxing activities.
• One thing in the moment (i.e. be one-mindful and focused).
• Vacation: Take a short break from your responsibilities to recharge yourself.
• Encouragement (e.g., “I can do this!”).

Interpersonal effectiveness

To be effective in relationships and interactions, consider the following three skill groups:

To get what you want, use DEAR MAN:

• Describe the situation.
• Express feelings/thoughts.
• Assert yourself (i.e. ask for what you need).
• Reinforce: Explain the advantages if the person agrees to your request (e.g., “I would be more productive if….”).
• Mindful (i.e. stay focused on your goal).
• Appear confident.
• Negotiate.

To maintain or improve your relationships, use GIVE:

• Gentle: Be nice.
• Interested: Listen and act interested.
• Validate: Show that you understand the person’s feelings and thoughts.
• Easy manner: Smile, use humor, etc.

Last, to maintain self-respect, use FAST:

• Fair: Be fair to yourself and others.
• Apologies: Do not apologize too much.
• Stick to your values.
• Truthful: Be honest.

To learn more about these and other techniques, see a therapist trained in DBT.