DBT Flash Cards: A Visual Guide to Dialectical Behavior Therapy Skills, Lecture notes of Psychology

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Dialectical Behavior Therapy: A Visual Review

Skills Flash Cards

These cards are helpful in familiarizing both clients and therapists with the Skills Modules within DBT and may be

used in conjunction with Skills Group or Individual Therapy. The cards are helpful for clients to use as a quick reference

while they are busy living their daily lives. The images found within are from the “Dialectical Behavior Therapy: A Visual

Review” presentation. The cards were created by Dr. Steve McCandless, Psy.D and Stephanie Johnston, LCSW of the Cen-

tral Arkansas Veterans Healthcare System in collaboration with artist Kevin Cates. The project was made possible through a

grant from the South Central MIRECC. Please feel free to use and distribute the cards as needed.

Instructions for Use

 Print the following pages then copy front and back onto one page.

 Make sure the numbers ‘1’ and ‘2’ are on opposite sides of the first page and in the same loca-

tion.

 Once printed cut along the dotted lines and put in sequential order.

 Blank cards are numbered 63-71 and are included for notes if desired.

 The cards can be stapled together or laminated with a hole punch in the top left corner and

placed on a key ring,

Borderline Personality

Disorder

BioSocial Theory

Sensitive Child

Invalidating Environment

Borderline Personality Disorder

1. Fear of Abandonment
2. Chaotic Relationships
3. Identity Disturbance
4. Impulsivity
5. Suicidal or Self Harm Behavior
6. Mood Instability
7. Feelings of Emptiness
8. Intense Anger
9. Stress related Paranoia

What is DBT?

DBT was developed in the mid-1990’s by Dr. Marsha Linehan. It combines both person-centered therapy based on acceptance with cognitive behavioral therapy based on change. This dialectic of change and acceptance remains core to the treatment. It is comprised of Skills Training in Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness as well as Individual Therapy. In Individual Therapy diary cards and a target hierarchy are used to organize sessions.

Dialectical Dilemma

Self Invalidation

Dialectical Dilemma

Inhibited Grief

Dialectical Dilemmas

Or Secondary Targets

 Unrelenting Crisis vs Inhibited Grief

 Emotional Vulnerability vs Self Invalidation

 Active Passivity vs Apparent Competence

Dialectical Dilemma

Active Passivity

Emotion

Regulation

Skills

Opposite Action Skill

Emotion:

Shame

Shame

Opposite Action Skill

Action Urge:

Hide

Opposite Action Skill 21

Emotion:

Anger

Anger

Opposite Action Skill

Action Urge:

Attack

Opposite Action Skill

Emotion:

Sadness

Opposite Action Skill 27

Sadness

Action Urge:

Isolate

Opposite Action Skill

Emotion:

Fear

Fear

Opposite Action Skill

Action Urge:

Avoid

Opposite Action Skill

Emotion:

Joy

Joy

Opposite Action Skill

Action Urge:

Repeat

Fear

Opposite Action Skill

Justified:

Danger

28 Opposite Action Skill

Sadness

Opposite Action:

Engage

26 Opposite Action Skill

Sadness

Justified:

Loss

Joy

Opposite Action Skill

Opposite Action:

Avoid

Joy

Opposite Action Skill

Justified:

Improves Life

Fear

Opposite Action Skill

Opposite Action:

Approach

42 Interpersonal Effectiveness

DEAR MAN Skill

Describe: the situation.

Express: your feelings.

Assert: what you want to happen.

Reinforce: the consequences both positive and negative.

Mindful: be a broken record, don’t get distracted.

Appear confident: Hold your ground.

Negotiate: Cooperate & be fair.

To Obtain Your Objective

40 Interpersonal Effectiveness

GIVE Skill

Gentle: No attacks, threats, judging, or non-

verbal cues of eye rolling or smirking.

Interested: Don’t interrupt, maintain good eye

contact.

Validating: Show that you understand the

other person. See the world from their point of view. Put yourself in their shoes.

Easy manner: Stay light hearted and smile.

To Keep Relationships

38 Goals of

Interpersonal Effectiveness

Be skillful in getting what you want and need from others. Get others to do things you would like them to do. Get oth- ers to take your opinions seriously. Say no to unwanted re- quests. Build relationships and end destructive ones. Strengthen current relationships. Don’t let hurts and prob- lems build up. Use relationship skills to head off problems. Repair relationships when needed. Resolve conflicts before they get overwhelming. Find and build new relationships. End hopeless relationships. Walk the middle path. Create and maintain balance in relationships. Balance acceptance and change in relationships.

Mindfulness Skill

Wise Mind

Emotional Mind Rational Mind

Goals of

Mindfulness

Reduce suffering and increase happiness. Reduce pain, tension, and stress

Increase control of your mind. Stop letting your mind be in control of you.

Experience reality as it is. Live life with your eyes wide open. Experience the reality of your connection to the universe, essential goodness, essential validity.

44 Interpersonal Effectiveness

FAST Skill

be Fair: to yourself and others.

no Apologies: don’t look ashamed, keep your

head and eyes up, no apologizing for being alive or for making a request.

Stick to values: don’t sell out your integrity.

Stick to your guns.

be Truthful: Don’t lie or act helpless when

you’re not.

To Keep Self Respect

Mindfulness Skill 49

Rational Mind

Excessive = Cold,

Over-regulated,

and Robotic

Distress

Tolerance

Skills

Distress Tolerance: TIPP Skill

T

Temperature

Distress Tolerance: TIPP Skill

I

Intense Exercise

Distress Tolerance: TIPP Skill

P

Paced Breathing:

In Through the Nose

Distress Tolerance: TIPP Skill

P

Progressive

Muscle Relaxation

Acknowledgments

Koerner, Kelly (2011). Doing Dialectical Behavior Therapy: A Practical Guide. New York: Guilford Press.

Linehan, M. M. (1993a). Cognitive Behavioral Treatment of Borderline Personality Disorder. New York: Guilford Press.

Linehan, M. M. (1993b). Skills Training Manual for Treating Borderline Personality Disorder. New York: Guilford Press.

Linehan, M.M. (2014a). DBT Skills Training Manual (2nd ed.). New York: Guilford Press.

Linehan, M.M. (2014b). DBT Skills Training Handouts and Worksheets (2nd ed.). New York: Guilford Press.