DBT01. WHY DBT?

Here you can download the session PDF below by clicking on the button or continue scrolling to the online version. Watch the video playlist to help you learn the skill, the password is dbt.

Session Online Version

Theme song: Watch “Both Sides Now” video.

MINDFULNESS ACTIVITY “ATTENTION EXERCISE” ACTIVITY

Begin practicing mindfulness by noticing your attention and how it can wander. Gradually work on doing this practice for 30 seconds, 1 minute and 2 minutes at a time.

Step 1: Identify what you will focus on -- your breath, an object e.g., picture, burning candle, etc. or  activity e.g., brushing your hair, doing the dishes, reading, etc.

Step 2: Bring your attention to the object of focus.

Step 3: Your attention may wander to noises around you, worry thoughts, judgmental thoughts such as “this is stupid,” body sensations, urges to talk, and so on. Notice these thoughts and let them go.

Step 4: Gently bring your attention back to the object of focus.

Discuss: What was your experience like? What did you notice?

____________________________________________________________________________________________________________________________________________________________________________________________________________________

1. The general goal of Marsha M. Linehan’s Dialectical Behavior Therapy (DBT) is “to learn how to change your own behaviors, emotions and thoughts that are linked to problems in living and are causing misery and distress” (Linehan, 2015).) DBT has revolutionized treatment of mental health disorders with concepts such as mindfulness and acceptance. Dr. Linehan’s technology for treating complex problems of emotional and behavioral dysregulation has brought compassionate treatment to people who had been previously rejected by many therapists.

2. DBT helps people create a life worth living. It aims to replace maladaptive behaviors with skillful behaviors. Maladaptive behaviors are those that stop people from adapting to new or difficult circumstances. Skills listed on the “Weekly DBT Diary Card” help people experience a range of emotions without necessarily acting on those emotions while better navigating relationships in their social environment. A number of specific skills are referred to by acronyms or other mnemonics.

3. Dialectical means that opposing ideas like acceptance and change can both be true at the same time and when considered together create a new way of viewing the situation. DBT is all about looking at “both sides now”. To improve relationships and reduce conflict DBT suggests that we change BUT to AND and move away from either-or, black-or-white nondialectical ways of thinking and instead use both sides ways of thinking that honor other points of view. Instead of saying, “You’re not trying, you have to make an effort,” you could say, “You’re doing the best you can in this moment, and I hope you can do better moving forward.”

Watch: “Star Wars” video.

Discuss: Rey’s observation of “Life, death and decay – that feeds new life” is an example of dialectical thinking. Can you think of other examples of this kind of thinking?____________________________________________________________________________________________________________________________________________________________________________________________________________________

4. DBT is based on the following assumptions: .

1.     People are doing the best they can in the moment.

2.     People want to improve.

3.     People need to do better, try harder, and be more motivated in order to reach our goals and function better.

4.     People may not have caused all of their own problems and they have to solve them anyway.

5.     The lives of emotionally distressed people are painful as they are currently being lived.

6.     People must learn and practice new behaviors in all the different situations in their lives (e.g., home, school, work, neighborhood).

7.     People cannot fail in DBT. 

Discuss: Discuss: Do you have concerns about accepting any of the assumptions? If so, what are they and why?

__________________________________________________________________________________________________________

5. DBT recognizes that unwanted behaviors arise when we have a biological vulnerability to emotions; can’t effectively regulate them; are placed in an invalidating social environment. DBT’s Biosocial Theory tries to answer how these behaviors develop and how they are maintained or get “stuck.” Bio refers to our biological makeup—in particular, the wiring in our brain that contributes to how we experience and control emotions, act on urges, etc. Social environment refers to the people in our life—parents, spouses, siblings, children, friends, co-workers, members of the community and other Concerned Significant Others (CSOs). Biosocial Theory suggests that over time many of our behavioral difficulties are based on the combination of influences between our biological makeup and invalidating social environments Sometimes we are unable to understand where others are coming from. When this happens, we may experience social environments as “invalidating”.

Watch: “Home Alone” video.

Discuss: Sometimes there is a poor fit between our temperament and our family environment. We may be a “rose in a garden of tulips”. What was your validation versus invalidation experience like in your family of origin?

____________________________________________________________________________________________________________________________________________________________________________________________________________________

6. A validating environment communicates that what we are thinking, feeling, or doing makes sense. An invalidating environment communicates that what we are feeling, thinking, or doing doesn’t make sense or is considered inaccurate or an overreaction. The invalidating environment punishes or sometimes reinforces emotional displays and can contribute to the suppression or escalation of emotion. Being frequently invalidated can leave us feeling confused and unable to trust what we feel (self-invalidation). Here are three common types of invalidation to look out for:

a.     Thoughts, feelings, and behaviors are indiscriminately rejected

b.     Lower‐level expressions of emotion are ignored or punished and emotional escalation Is sometimes given greater attention (intermittently reinforced)

c.     The ease of problem solving and of meeting goals Is overstated and oversimplified

Watch: “Shrek: Onions” video.

EMOTIONAL VULNERABILITY ACTIVITY

Like onions and ogres, we too have layers. Increasing amounts of research suggest that powerfully emotional people may be wired differently. Pick someone you feel close too. On a scale of 0 to 10 (0 is normal and 10 is high) first rank you and then your loved ones’ emotional vulnerability.

·      Do you have high emotional sensitivity?____

o   Does your loved one have high emotional sensitivity?____

·      Do things get under your skin easily?____

o   Do things get under your loved ones’ skin easily?____

·      Do you feel emotions quickly?____

o   Does your loved ones’ feel emotions quickly?____

·      Do you have high emotional reactivity?____

o   Does your loved one have high emotional reactivity?____

·      Do you find that your emotions are more intense, more powerful?____

o   Do you find that your loved ones’ emotions are more intense, more powerful?____

·      Are your emotions slow to return to an emotional baseline? (Does it take hours or even a good portion of a day before they come back to “normal” again.)____

o   Are your loved ones’ emotions slow to return to an emotional baseline? (Does it take hours or even a good portion of a day before they come back to “normal” again.)____

Discuss: Share with the group what you learned about you and your loved ones’ vulnerabity to emotions. How does knowing what you two have in common and what is different help you and them?____________________________________________________________________________________________________________________________________________________________________________________________________________________

7. Strong, powerful emotions become a problem when you don’t know how to effectively regulate them. DBT wants you to experience and communicate these emotions in such a way that you control them rather than the emotions controlling you. Without Emotion Regulation skills, we are likely to end up engaging in maladaptive behaviors like abusing substances, avoiding school or work, self-harm, etc. Often acting impulsively to try and bring down anger, shame, fear, or whatever intense emotion we are experiencing.

Watch: “Malcolm in the Middle” video.

Discuss: What could these two have done to try and regulate their emotions?____________________________________________________________________________________________________________________________________________________________________________________________________________________

DBT BEHAVIOR & SKILLS GOALS ACTIVITY

Setting some personal behavior and skills goals may be helpful in deciding what you want to focus on during your DBT study.

Step 1: What unwanted behaviors do I want to decrease?

____________________________________________________________________________________________________________________________________________________________________________________________________________________

Step 2: What skills do I want to increase?

___________________________________________________________________________________________________________________________________________________________________________________________________________________

Watch: “Why DBT? End Credits” video.

As we roll the Why DBT? end credits think about what is the most important thing you learned in this session and what will you do differently because of what you learned. Write your thoughts below.

___________________________________________________________________________________________________________________________________________________________________________________________________________________

Session Commitments

While you are participating in this group commit to DBT’s treatment assumptions. 

Identify behaviors that that I would like to decrease and skills that I would like to increase.

Complete the Weekly DBT Diary. 

Come prepared to the next session to share your experience using DBT skills.

DBT SKILLS Session

The “DBT Goes to the Movies” group includes 24 sessions:

WHY DBT? -- Week 1

CORE MINDFULNESS -- Weeks 2 & 3.

For not being aware of what you feel, why you get upset, what your goals are, trouble staying focused.

·      Wise Mind (states of Mind)

·      What Skills (Observe, Describe, Participate)

·      How Skills (Don’t judge, Stay Focused, Do What Works)

DISTRESS TOLERANCE -- Weeks 4 to 9.

For crisis moments, acting without thinking it all through, escaping or avoiding painful emotional experiences.

·      TIPP (Temp, Intense exercise, Progressive relax, Paced breathing)

·      STOP

·      Wise Mind ACCEPTS

·      IMPROVE the Moment

·      Radical Acceptance

·      Turning the Mind

·      Willingness

·      Half Smiling

·      Willing Hands

·      Mindfulness of Current Thoughts

WALKING THE MIDDLE PATH -- Week 10.

For finding the balance between two opposites.

·      Think dialectically

·      Act dialectically

DBT ORIENTATION -- Week 11.

CORE MINDFULNESS -- Weeks 12 & 13.

For not being aware of what you feel, why you get upset, what your goals are, trouble staying focused.

·      Wise Mind (states of Mind)

·      What Skills (Observe, Describe, Participate)

·      How Skills (Don’t judge, Stay Focused, Do What Works)

EMOTION REGULATION -- Weeks 14 to 19.

For fast, intense mood changes with little control, steady negative emotional state, mood-dependent behaviors.

·      Check the Facts

·      Opposite Action

·      ABC (Accumulate Positives, Build Mastery, Cope Ahead)

·      PLEASE

·      Ride the Wave (Let go of suffering)

·      Understanding Emotion

·      Self Sooth (5 senses, body scan, sensory awareness)

INTERPERSONAL EFFECTIVENESS -- Weeks 20 to 23.

For difficulty in keeping relationships steady, getting what you want, keeping self-respect, loneliness.

·      GIVE (be Gentle, act Interested, Validate, use an Easy Manner)

·      FAST (be Fair, no Apologies, Stick to your values, be Truthful)

·      DEARMAN

·      Validation (Kernel of truth)

BEHAVIOR CHAIN ANALYSIS -- Week 24.

For understanding why.

Mindfulness Practices Handout

The goal of mindfulness is not to empty your mind of thoughts. The purpose of mindfulness is the cultivation of awareness, not relaxation. People often confuse mindfulness with relaxation, because a common “side effect” of mindfulness is relaxation. Both secular and spiritual mindfulness practices have as an important part of their instructions simply noticing thoughts as they come and go while practicing mindfulness. Many people erroneously believe that when practicing mindfulness, they should suppress thoughts. Nothing could be further from the truth. Human brains generate thoughts, beliefs, assumptions and concepts of all sorts. The idea in mindfulness is to notice thoughts—while neither becoming attached to them nor pushing them away. Everyone, when learning to be mindful to the present moment, becomes distracted by thoughts at times. So, as you practice mindfulness you may notice your mind start to wander. That’s normal. Say “thinking” or “wandering” in your head softly will help you to gently redirect your attention right back to the exercise.

For most of the mindfulness exercises that follow sit in a comfortable position. Either close your eyes or focus on a point in front of you that will not be distracting. Cell phones and other potential distractors should be turned off, and objects (e.g., pens, notebooks) should be put down. Exercises can run for between 2 and 5 minutes. As you gain more experience, build up your mindfulness time to 10 minutes a day.

Exercises

A Good Life (FS05. How to Increase Wanted Behavior session)

Visualize a good life for your loved one.

Step 1: Imagine your loved one (child, partner, spouse, child, friend, parent, etc.) at whatever age you wish. Picture them doing well in whatever activity, job, relationship or situation is desired. Be specific. See your loved on in full detail. What are they wearing? Notice the hair, body position, the expression on the face.

Let at least 15 seconds pass before moving on to the next step.

Step 2: Observe your own feelings as you watch your loved one independently and successfully in harmony with their own surroundings.

Let at least 15 seconds pass before moving on to the next step.

Step 3: Fully experience releasing your loved one into their own self-reliant experience and bless them in your mind for the ability to live life fully and happily.

Let at least 15 seconds pass before moving on to the next step.

Step 4: Spend a few moments visualizing this scene in detail as if it were absolutely true.

Let at least 15 seconds pass before moving on to the next step.

Step 5: Now gradually allow the scene to move away from you and release it into the clear, blue sky. Watch as it disappears over the clouds, the horizon, up, up and out of view.

Let at least 15 seconds pass before moving on to the next step.

All the Worlds a Stage (FS06. Validate, Don’t Try to Fix session)

To give words to the unspoken

Step 1: Imagine a stage.

Let at least 15 seconds pass before moving on to the next step.

Step 2: Onto that stage let a scene appear from your past. One in which you felt that the reality that being acted out by others on the surface was very different from what was being felt on the inside. A time when you felt the outside and inside where out of synch.

Let at least 15 seconds pass before moving on to the next step.

Step 3: Try to remember how that made you feel?

Let at least 15 seconds pass before moving on to the next step.

Step 4: Look at the characters in your scene. Look at their faces and body posture and listen to what they are saying.

Let at least 15 seconds pass before moving on to the next step.

Step 5: In response to the scene, there is a small voice inside of you trying to speak. Listen to the voice and pay attention to what it is saying, whether or not it makes any sense.

Let at least 15 seconds pass before moving on to the next step.

Step 6: Listen to the voice as it comes to you, without trying to make it sound good or intelligent or correct.

Let at least 15 seconds pass before moving on to the next step.

Catch Your Breath (FS14. Anger Management session)

Calm down the conflict.

Step 1: As you focus on the breath, allow those unpleasant feelings of anger, fear, sadness, or whatever to come to mind. Allow them to come and go, naturally, with each passing breath. As you continue to do this, you may notice that the unpleasant feelings begin to subside.

Step 2: Ask yourself the following questions:

- How do I understand the situation?
- If I were to put myself in the other person’s shoes, how do they understand the situation?
- What do I really want or need in this situation?
- What does the other person really want or need in this situation?
- If I continue to act this way, will I really get what I want?
- What do I need to do differently in this conversation to have a better chance of getting what I want?
- Is there some way to make a compromise so that we both get what we want?

Step 3: As you answer these questions in your head, you can feel upset leave the body, leaving you calmer and more able to choose how you want to act in the situation.

Step 4: Once you have decided on the best course of action, you can approach the other person and try again. Going through these steps can help you to break the negative pattern so that it becomes less and less possible for the other person to push your buttons. That way, you will be less likely to act in a way that you are ashamed of or embarrassed about later.

Step 5: If the other person wonders what you are doing, you can let them know that you just need to catch your breath for a minute to clear your head before you can continue the conversation. Then try to step aside and continue to focus on the breathing.

Contemplative (FS15. Spirituality session)

To focus attention and carry the contemplative practice into everyday life.

Step 1: Focus on either “opening your mind” to attend to all your sensations and thoughts as they arise and fall away OR “focusing your mind”.

Let at least 15 seconds pass before moving on to the next step.

Step 2: Select a word to focus on that is or could be part of your spiritual practice

Step 3: Observe nonjudgmentally, without attachment or avoidance your response to that word.

Let at least 15 seconds pass before moving on to the next step.
Step 4: Let go of intellectual analyses and logic, rambling thoughts, and distractions to gently bring oneself back to the word, over and over again.

Let at least 15 seconds pass before moving on to the next step.

Step 5: Let the word do the work, allowing oneself to go into the “cloud of unknowing” and leave behind the “cloud of forgetting.”

Let at least 15 seconds pass before moving on to the next step.

Get My Attention (FS01. CRAFT Connect Overview & DBT01. Acceptance & Change sessions)

Notice your attention and how it wanders.

Step 1: Identify what you will focus on -- your breath, an object e.g., picture, burning candle, etc. or activity e.g., brushing your hair, doing the dishes, reading, etc.
Step 2: Bring your attention to the object of focus.
Step 3: When your attention wanders away from the object of focus (and sometimes it will, so don’t judge yourself for it!) Notice that this has happened. Gently bring your attention back to the object of focus.

Gradually work on doing this practice for 30 seconds, 1 minute and 2 minutes at a time.

Grounding (FS03. Enrich Your Own Life & DBT10. Chain Analysis sessions)

Observe your surroundings.

Step 1: Pay attention to five things you are currently feeling, like the texture of your pants, breeze on your skin, or the smooth surface of a table you are resting your hands on.

Let at least 15 seconds pass before moving on to the next step.

Step 2: Bring your attention to four things that you can see. Pick things that you don’t normally notice like a shadow or a small crack.

Let at least 15 seconds pass before moving on to the next step.

Step 3: Listen, and note three things that you hear in the background. This can be the chirp of a bird, the hum of a refrigerator, or the faint sounds of traffic from a nearby road.

Let at least 15 seconds pass before moving on to the next step.

Step 4: Be aware of two smells you usually filter out, whether they’re pleasant or unpleasant.

Let at least 15 seconds pass before moving on to the next step.

Step 5: Focus on one thing that you can taste right now, at this moment. You can take a sip of a drink, chew a piece of gum, eat something, or notice the current taste in your mouth.

Let at least 15 seconds pass for this final step.

Imagery of a Recent Experience (FS07. Domestic Violence/Abuse Precautions session)

Step 1: Think of a time you were upset recently with someone. (Do not choose a scenario that will dysregulate you!)

Let at least 15 seconds pass before moving on to the next step.

Step 2: Try to conjure up the experience as though it were happening now—notice your thoughts, feelings, urges, body sensations, and so forth.

Let at least 15 seconds pass before moving on to the next step.

Step 3: Observe your experiences, let yourself experience them fully without judging them, and then silently put words on these experiences (e.g., ‘Tears are welling up in my eyes,’ ‘My shoulders feel tense,’ ‘My thoughts are racing’, etc.).

Let at least 15 seconds pass before moving on to the next step.

Step 4: Practice getting into Wise Mind as if you were in the situation right now.

Step 5: Think of one goal of yours in this situation.

Let at least 15 seconds pass before moving on to the next step.

Step 6: Focus on effectiveness. Think of something you could do or say to ‘that works.’

Let at least 15 seconds pass before moving on to the next step.

Leaves on a Stream (DBT 05.GIVE session)

Shift from looking from your thoughts, to looking at your thoughts. Notice you don’t need to control or change those thoughts in any way, thoughts will come and go naturally, without you having to do anything to control them.
Step 1: Visualize yourself sitting beside a gently flowing stream with leaves floating along the surface of the water.

Let at least 15 seconds pass before moving on to the next step.

Step 2: For the next two minutes, take each thought that enters your mind and place it on a leaf... let it float by. Do this with each thought – pleasurable, painful, or neutral. Even if you have joyous or enthusiastic thoughts, place them on a leaf and let them float by.

Let at least 15 seconds pass before moving on to the next step.

Step 3: If your thoughts momentarily stop, continue to watch the stream. Sooner or later, your thoughts will start up again.

Let at least 15 seconds pass before moving on to the next step.

Step 5: Allow the stream to flow at its own pace. Don’t try to speed it up and rush your thoughts along. You’re not trying to rush the leaves along or “get rid” of your thoughts. You are allowing them to come and go at their own pace. If If your mind says “This is dumb,” “I’m bored,” or “I’m not doing this right” place those thoughts on leaves, too, and let them pass.

Let at least 15 seconds pass before moving on to the next step.

Step 7: If a leaf gets stuck, allow it to hang around until it’s ready to float by. If the thought comes up again, watch it float by another time.

Let at least 15 seconds pass before moving on to the next step.

Step 8: If a difficult or painful feeling arises, simply acknowledge it. Say to yourself, “I notice myself having a feeling of boredom/impatience/frustration.” Place those thoughts on leaves and allow them float along.

Listen to the Music (DBT09. FAST and Combat Worry Thoughts session)

Music can have a profound effect on both the emotions and the body.

Step 1: Listen to these three pieces of music.

Step 2: Observe difference in each piece --  Rhythm, Melody, Harmony, Timbre, Dynamics, Texture, and Form.

Step 3: Did these three pieces change your internal reactions? If so, think about how.

Movie Rehearsal (DBT14. Walking the Middle Path session)

Focus on dreams, goals or ambitions.

Step 1: Think about something you would like to do better.

Step 2: Imagine sitting in a movie theater, the lights dim and the movie starts. It is a movie of you doing perfectly whatever it is that you want to do. See as much detail as you can create, including your clothing, the expression on your face, small body movements, the environment and any other people that might be around. Add in any sounds you would be hearing — traffic, music, other people talking, cheering. And finally, create in your body any feelings you think you would be experiencing as you “perfectly” engage in this activity.

Let 15 seconds pass before moving on to the next step.

Step 3: Get out of your chair, walk up to the screen, open a door in the screen and step into the movie. Now experience the whole thing again from inside of yourself, looking out through your eyes. Again, see everything in vivid detail, hear the sounds you would hear, and feel the feelings you would feel.

Let 15 seconds pass before moving on to the next step.

Step 4: Walk back out of the screen that is still showing the picture of you performing perfectly and return to your seat in the theater. Reach out and grab the screen and shrink it down to the size of a cracker. Then, bring this miniature screen up to your mouth, chew it up and swallow it.

Let 15 seconds pass before moving on to the next step.

Step 5: Imagine that each tiny piece — just like a hologram — contains the full picture of you performing well. Imagine all these little screens traveling down into your stomach and out through the bloodstream into every cell of your body.

Let at least 15 seconds pass before moving on to the next step.

Step 6: Then imagine that every cell of your body is lit up with a movie of you performing perfectly. It’s like one of those appliance store windows where 50 televisions are all tuned to the same channel. (J. Canfield, Maximizing Your Potential)

Noticing Sensations (FS10. Supporting Treatment session)

Focusing on body sensations can bring you back into the present.

Step 1: Rate your current level of distress from 0 to 100, 0 being no stress 100 is lots of stress. Step 2: Listen to each question, and notice what occurs before I ask the next question. There are no right or wrong responses. Just notice your reaction.

“Can you feel your hair touching your head?”
“Can you feel your chest rising and falling as you breathe?”
“Can you feel the space between your eyes?”
“Can you feel the distance between your ears?”

“Can you notice your arms touching your body?”
“Can you feel the bottoms of your feet?”

“Can you notice the space within your mouth?”
“Can you notice the position of your tongue in your mouth?”

“Can you feel a breeze against your cheek?”
“Can you feel how one arm is heavier than the other?”
“Can you feel a tingling or numbness in one hand?”

“Can you feel a heaviness in your legs?”

“Can you notice your body hanging on your bones?”

“Can you feel your face getting soft?”

Step 3: Rate you level of distress now. One a scale of 0 to 100 did your arousal tolerance go down, stay the same, or go up?

Noticing Urges (FS13. Heathy Thinking session)

Don’t act on urges.

Step 1: Try to sit very still for two minutes.

Step 2: Notice any physical urges – whether to move, shift positions, scratch an itch, or do something else.

Step 3: Instead of acting on the urge, simply notice it, even when not acting on it may make you uncomfortable.

Practicing Loving Kindness (DBT12. ABC PLEASE session)

Step 1: Choose a person to send loving kindness toward. Do not select a person you do not want to relate to with kindness and compassion. Start with yourself, or, if this is too difficult, with a person you already love.

Let at least 15 seconds pass before moving on to the next step.

Step 2: Sitting, standing, or lying down, begin by breathing slowly and deeply. Opening the palms of your hands, Willing Hands, gently bring the person to mind.

Let at least 15 seconds pass before moving on to the next step.

Step 3: Radiate loving kindness by reciting a set of warm wishes, such as “May I be happy,” “May I be at peace,” “May I be healthy,” “May I be safe,” or another set of positive wishes of your own. Repeat the script slowly, and focus on the meaning of each word as you say it in your mind. (If you have distracting thoughts, just notice them as they come and go and gently bring your mind back to your script.)

Let at least 15 seconds pass before moving on to the next step.

Step 4: Continue until you feel yourself immersed in loving kindness.

Practice loving kindness each day, starting with yourself and then moving to others. Gradually work yourself up through loved ones, friends, those you are angry with or difficult people. For example, use a script such as “May John be happy,” “May John be at peace,” and so on (or “John, may you be happy,” “May you be at peace,” and so on), as you concentrate on radiating loving kindness to John.

Progressive Relaxation (DBT03. STOP & TIPP session)

Deep relaxation helps your body recover from stress.

Step 1: Lie or sit comfortably and close your eyes.
Step 2: Concentrating on one part of your body at a time, look for any tension. Consciously relax that part of your body. Feel all the tension draining away, like sand running through your fingers. Take your time. If you are not sure if there is still tension, tighten that part of your body for 10 seconds; then completely relax for 10 seconds before moving on to the next part.

Step 3: Focus on these parts, one at a time: 1. head and face; 2. eyes; 3. jaw; 4. neck; 5. shoulders and back; 6. arms; 7. hands and fingers; 8. chest and abdomen; 9. legs; 10. feet and toes.
Step 4: Mentally scan your body for any remaining tension. Completely relax.

Practice this at night before you sleep to train your body to relax. Do a shorter version of this exercise during the day any time you feel overstressed. (Anxiety Canada, How to Do Progressive Muscle Relaxation, 2019).

Relaxation Response (FS11. Aftercare Planning session)

Fill yourself up.

Step 1: Let your belly hang loose. Place your hands on your stomach to provide feedback on your breathing.
Step 2: Breathe in to a count of three, hold the breath for a count of three, breathe out to a count of three. Breath like this for one minute.
Step 3: Focus on the feeling of your breathing, either where the air flows into your nose or noticing the movement of the air deep in your belly.

Step 4: Now, imagine a warm, colored light – any color you like – flowing into your nose as you inhale.
Step 5: Imagine this warm, comfortable, relaxing light flowing into your body and filling up your body like water from a pitcher filling up a glass pushing any tension, stress, or anxiety out of your “glass”.

Step 6: Visualize any tension, stress, or anxiety dripping down through your head, neck, shoulders, chest, stomach, arms, hands, hips, legs and feet, through the floor and into the ground.

Ride the Wave (FS09. Invite Your Loved One to Enter Treatment & DBT04. Understanding Emotions & The Wave sessions)

Experience your emotions like waves in the ocean.

Step 1: In a non-judgmental mindful manner, recognize a feeling that you are currently experiencing. Name the feeling and think of it as part of you, but not all of you.

Let at least 15 seconds pass before moving on to the next step.
Step 2: Experience your feeling like a wave moving in the ocean. You can’t stop a strong wave from coming towards you. Try not to push the feeling away or take hold of it. Don’t try to control it too strongly or make the feeling bigger than it is either. Instead, ride out the wave of emotion in an appropriate manner.

Let at least 15 seconds pass before moving on to the next step.

Step 3: Float on your back with less intense feelings or ride the waves of stronger emotions on a surfboard - knowing that it will last only a little while and then will subtly subside.

Let at least 15 seconds pass before moving on to the next step.

Step 4: Remember, this feeling is only one part of you. This emotion should not force you to react in any certain way, especially in a way that is harmful to you. Recall moments when you experienced more positive emotions to remind yourself that they will return soon enough. Like a wave in the ocean, this feeling will take its course.

Let at least 15 seconds pass before moving on to the next step.
Step 5: Accept and tolerate your emotion. Try not to assign positive or negative thoughts to this feeling.

Let at least 15 seconds pass before moving on to the next step.
Step 6: Fully accept that this feeling is part of you right now, but it is only temporary. Try pretending that your feeling is a “guest” in your home, who you can tolerate “hosting” for the time being.

Savoring (FS15. Recovery is Life Worth Living session)

Step 1: Close your eyes taking a few moments to practice mindful breathing.

Step 2: Open your eyes and allow them to settle on an object in front of you. Not staring or focusing hard on that object, but instead, allowing your gaze to soften, your eyes to un-focus slightly. Not paying attention to the sharp outlines of the object,  instead allowing them to blur and merge and fade into the background.

Let 15 seconds pass before moving on to the next step.

Step 3: Experience a closeness with the object, as if there was no separation between yourself and what you are looking at. Use your senses as the gate to pleasure and enjoyment as if you could drink in the joy from the beauty of that object enjoying its color, texture, shape, and shadow of the object,

Let 15 seconds pass before moving on to the next step.

Step 4: Let the object as a whole nourish you becoming aware of the positive feelings in your mind and body as you savor your experience.

Let at least 15 seconds pass before moving on to the next step.

Step 5: Focus your attention on these positive feelings. Really absorb yourself in them, without holding on to them too tightly, or trying to make them last. Just allow yourself to be open to and appreciate this positive experience in this moment.

Small Flake (DBT07. Radical Acceptance session)

Step 1: As you sit, focus your mind on your breath. Attend to your breath coming in and your breath going out.
Step 2: As you breathe naturally imagine you are by a mountain lake on a warm sunny day. It is a large, clear, very blue lake. The sun is shining warmly on the lake.
Step 3: Imagine you are a small stone flake from a piece of stone near the lake. Imagine being picked up and gently tossed out to the middle of the lake, skimming across the cool clear water. Step 4: Now imagine that you are slowly, very slowly floating down in the lake, noticing all that is in the lake as you gently float down, floating down in the cool, clear blue waters, gazing at what is around you, and now settling on the clear bottom of the lake, at the center of the lake, gazing at the clear waters and what is nearby.
Step 5:When you are ready, open your eyes, come back to the room, trying to maintain your awareness of that clear center that is within you .

Spiral Staircase (DBT11. Turning the Mind & Willingness session)

Step 1: As you sit, focus your mind on your breath. Attend to your breath coming in and your breath going out.
Step 2: As you breathe naturally imagine there is an inner spiral staircase within you and that you are walking down that staircase. Going at your own pace, making the staircase as light or as dark as you wish with as many windows as you wish, walking slowly down.
Step 3: As you walk, notice if you are tired or afraid , sit down on the steps if you wish, walk down the stairs as steep or as shallow as you wish, as light or dark as you wish.
Step 4: Notice as you walk down you are moving toward your very center, toward your own wise mind, toward wisdom. Simply walking down at your own pace, stopping and sitting when you arrive at a still point.
Step 5: When you are ready, open your eyes, come back to the room, trying to maintain your awareness of that clear center that is within you.

Square Breathing (FS02. Effective Communication & DBT02. Core Mindfulness sessions)

Repeat steps one through four for a total of at least three minutes.
Step 1: Start by getting into a comfortable seated position in a chair or on the floor
Step 2: Once all of the air has been expelled from your lungs, start by inhaling to a count of four through your nose. Say the numbers to yourself in your head. By the time you reach four, your lungs should be completely full of air. As you inhale, imagine the air pouring into your lungs and making them and your abdomen expand. Make sure that you are practicing abdominal breathing when you do this. When you inhale, your abdomen protrudes out; your
shoulders should not rise up. If you notice yourself breathing with your shoulders, this means that you are taking shallow breaths and are not practicing deep abdominal breathing.
Step 3: Hold the air in your lungs for a count of four. Again, say the numbers to yourself in your head, and count slowly. Picture the air filling up your lungs in your mind's eye.
Step 4: Breathe out slowly to a count of four through your mouth. By the time you are at four, all of the air should be out of your lungs. Picture it moving up and out of your lungs, through your windpipe and finally mixing with the air in front of you.
Step 5: Hold your lungs in an empty state for a count of four. Focus on the emptiness of your lungs and the smallness of your abdomen. (Anahan Wellness, Square Breathing, 2019)

Visualization (DBT13. DEAR MAN session)

Form mental images to take a visual journey to a peaceful, calming place or situation.
Step 1: Sit in a quiet spot and loosen any tight clothing. Imagine your favorite place where you have happy memories.

Let at least 15 seconds pass before moving on to the next step.

Step 2: Think about smells, sounds, touch and sights – use as many senses as you can.

Let at least 15 seconds pass before moving on to the next step.

Step 3: Walk around that place or situation in your mind remembering everything that you relate to it.

Let at least 15 seconds pass before moving on to the next step.

Walkabout (DBT15. ACCEPTS, IMPROVE session)

Mindfulness movement -- dance, martial arts, ritual music making and walking.

Step 1: Find an unobstructed area with enough space for you to walk least 5–10 paces in a straight line.

Step 2: Start at one end. Stand for a moment in an attentive position. Your arms can be held in any way that is comfortable. Then, while breathing in, lift one foot and bring it forward. While breathing out, bring the foot down and touch the floor. Repeat this with the other foot.

Step 3: Walk slowly to the opposite end, then turn around slowly and stand there for a moment before you walk back. Then repeat the process. Keep your eyes open to maintain balance, but don’t look at anything in particular.

Step 4: Walk naturally. Place your full attention on this experience of walking. Watch for tensions building in the body; put all of your attention on the sensations coming from the feet and legs. Experience every tiny change in tactile sensation as the feet press against the floor and then lift again, so that the feet become your whole universe.

Step 5: If your mind wanders note the distractions then return your attention to walking. Try not to look at your feet while you are doing all of this.

Step 6: Now get up from your computer and go for a walkabout.

What’s in a Face? (FS04. All Behavior is Caused session)

The window to the soul.

Step 1: Notice how your face feels. Start with the forehead, then move to your eyes, cheeks, mouth and jaw. Are they relaxed or tensed? Are there other physical sensations?

Let at least 15 seconds pass before moving on to the next step.

Step 2: What is your facial expression? Try to notice without changing your expression or experience.

Let at least 15 seconds pass before moving on to the next step.

Step 4: Identify the emotions you are currently feeling.

Let at least 15 seconds pass before moving on to the next step.

Step 5: Now relax your face. Start with the forehead, then move to your eyes, cheeks, mouth and jaw.

Let at least 15 seconds pass before moving on to the next step.

Step 6: What are you feeling now?

What’s Stopping You? (FS08. Plan to Change session)

Get in touch with what’s in the way of being successful.

Step 1: For this exercise you are going to mill around for 2 minutes in a room away from your device.

Step 2: Once you enter that space walk slowly and all to come to mind whatever feels in the way of your feeling empowered and letting yourself succeed.

Step 3: As you mill around speak out (if you can) words and phrases from your past or messages from family, friends or society that nag at you as you walk.

Step 4: At the end of 2 minutes come back to the group and share your thought about how these voices keep you from moving forward.

Wise Mind (DBT06. Steps to Wise Mind session)

Step 1: Keeping your eyes open, find a good place to rest your eyes. Bring to mind something you want to do, are doing right now or don’t want to do in the future. Focus on that “something" (if it helps write it down).

Let at least 15 seconds pass before moving on to the next step.

Step 2: Notice your breath coming in and going out as you breathe naturally.

Step 3: As you inhale ask yourself, “Is doing or not doing this something Wise Mind?” As you exhale, listen -- don’t talk. Keep asking with each breath in and listening with each breath out.

Let at least 15 seconds pass before moving on to the next step.

Step 4: See if an answer comes to you. If not, perhaps there is no answer now, you need to learn more about the situation or perhaps you are too ambivalent to know the answer.

Words in the Sand (DBT08. Check Facts, Opposite Action & Problem Solve session)

Create a space between ourselves and our thoughts.

Step 1: Close your eyes. Imagine a vast desert with lot of sand. You can see the dunes expanding all across the horizon.

Step 2: Calm your mind, and try to become aware of your thoughts. What are you thinking the most about today? Are your thoughts neutral? Are they negative? Without judgment just notice what your mind is thinking about.

Step 3: Try to imagine your thoughts written across the sand as words.

Step 4: Imagine how the wind is blowing off the words and as that happens you let the thoughts go. Thought by thought, you notice how your mind becomes calmer and clearer.

Step 5: As you notice the sand around you become smooth again, you witness that your thoughts are just products of the mind that don't have power over you.

Self-Compassion Break

Evoke the three aspects of self-compassion when you need it most

Step 1: Think of a difficult situation in your life that is causing you stress. Call the situation to mind, and see if you can actually feel the stress and emotional discomfort in your body.

Let at least 15 seconds pass before moving on to the next step.

Step 2: Now, say to yourself -- This is a moment of suffering. This hurts. This is stress.

Let at least 15 seconds pass before moving on to the next step.

Step 3: Say to yourself -- Suffering is a part of life. Other people feel this way. I’m not alone. We all struggle in our lives.

Let at least 15 seconds pass before moving on to the next step.

Step 4: Put your hands over your heart, feel the warmth of your hands and the gentle touch of your hands on your chest. Say to yourself -- May I be kind to myself. Think about what you also need to hear right now to express kindness to yourself in the situation.

Let at least 15 seconds pass before moving on to the next step.

Step 5: With your hands still over your heart say -- May I:

·      Give myself the compassion that I need,

·      Learn to accept myself as I am,

·      Forgive myself,

·      Be strong,

·      Be patient,

Let at least 15 seconds pass for this final step.

(adapted from https://self-compassion.org/, Neff 2022)