DBT Worksheets for Teaching Core Skills to Clients

By Veronica West, Registered Psychologist BPsychSc(Hons), MPH, MPsych

Most clinicians who use DBT skills with individual clients find the skills straightforward to explain, and find the harder part is getting clients to use them when they're overwhelmed. Good DBT worksheets give each skill a clear structure that clients can practise when they're calm and reach for when they're not. This article walks through the core DBT skills across the four modules, with more than 30 skills, questions and exercises I use to teach them, plus how to sequence them in individual therapy.

What Is DBT Skills Training?

Dialectical behaviour therapy (DBT): a cognitive behavioural treatment developed by Marsha Linehan for people with chronic suicidal behaviour and borderline personality disorder, which balances acceptance and change. It's now used more widely for emotional dysregulation, self-harm, and impulsive behaviour.

Comprehensive DBT includes individual therapy, a skills training group, phone coaching, and a consultation team for the therapist, and it's the comprehensive program that the research evidence mostly describes, including a randomised trial by Linehan and colleagues (2006) with women with borderline personality disorder. Many clinicians use DBT skills within individual therapy without delivering the full program. That's a legitimate way to use them, though it's worth being clear with clients and referrers that it isn't the same as comprehensive DBT. The skills sit in four modules:

Module	What it helps with	Core skills
Mindfulness	Noticing thoughts, feelings and urges without acting on them	Wise mind, what skills, how skills
Distress tolerance	Getting through a crisis without making it worse	TIP, STOP, self-soothe, ACCEPTS, radical acceptance
Emotion regulation	Reducing vulnerability to intense emotions, and changing emotions that don't fit the facts	Check the facts, opposite action, ABC PLEASE
Interpersonal effectiveness	Asking for what you need while keeping the relationship and your self-respect	DEAR MAN, GIVE, FAST

Mindfulness Skills Worksheets

Mindfulness is the foundation for the other modules, as clients need to notice an emotion or urge before they can do anything different with it.

Wise mind: the overlap between emotion mind, where feelings drive decisions, and reasonable mind, where logic drives them. Most clients recognise both states quickly once they're described, and wise mind gives them a way to talk about the middle ground.

• What skills: observe, describe, and participate.
• How skills: non-judgementally, one-mindfully, and effectively.

A simple first worksheet asks the client to observe and describe one routine activity each day, such as making a coffee, noting what they see, hear, and feel without judging it. It's low stakes, and it builds the noticing that every other skill depends on.

Distress Tolerance Worksheets

Distress tolerance skills are for getting through a crisis without making it worse, and they're usually the first skills clients with self-harm or crisis behaviours need. The core skills are:

• TIP: change body chemistry quickly with Temperature (cold water on the face), Intense exercise, Paced breathing, and Paired muscle relaxation.
• STOP: Stop, Take a step back, Observe, and Proceed mindfully.
• Self-soothe: use each of the five senses to find calm, for example a favourite song, a warm drink, or a soft blanket.
• ACCEPTS: distract with Activities, Contributing, Comparisons, opposite Emotions, Pushing away, Thoughts, and Sensations.
• Radical acceptance: fully accepting a painful reality that can't be changed right now, so the client stops adding to their suffering by fighting it.

The temperature part of TIP can slow the heart rate quickly, so check for heart conditions, eating disorders, or other medical concerns before recommending it, and suggest the client checks with their GP if you're unsure. Single-sheet handouts for TIP, self-soothing and radical acceptance are in our subscription library, which is useful when you want one skill for one client rather than a whole bundle.

Emotion Regulation Worksheets

Emotion regulation skills help clients feel overwhelmed less often, and change emotions that don't fit the situation. Checking the facts comes first, with questions like these:

• What event prompted my emotion?
• What am I interpreting or assuming about the event?
• Am I assuming a threat, and how likely is it really?
• Does my emotion, and its intensity, fit the facts?

When an emotion doesn't fit the facts, or acting on it won't help, opposite action asks the client to act against the urge, for example approaching instead of avoiding when anxiety doesn't fit the situation. ABC PLEASE then reduces vulnerability over time:

• Accumulate positive emotions, in the short term and the long term.
• Build mastery with activities that give a sense of achievement.
• Cope ahead by rehearsing a plan for a difficult situation.
• PLEASE: treat PhysicaL illness, balance Eating, avoid mood-Altering substances, balance Sleep, and get Exercise.

Interpersonal Effectiveness Worksheets

Interpersonal effectiveness skills balance three goals, getting what you need, keeping the relationship, and keeping your self-respect, and there's a skill for each:

• DEAR MAN, for asking for something or saying no: Describe, Express, Assert, Reinforce, stay Mindful, Appear confident, and Negotiate.
• GIVE, for keeping the relationship: be Gentle, act Interested, Validate, and use an Easy manner.
• FAST, for keeping self-respect: be Fair, no unnecessary Apologies, Stick to your values, and be Truthful.

Clients find these much easier once they've written out a real script. A DEAR MAN script for a client whose housemate is always late with the bills might start with "The electricity bill was due last Friday and your half hasn't come through" (describe) and "I feel stressed when I have to cover it" (express), before asking clearly for the payment by Wednesday (assert).

Chain Analysis Worksheets

Chain analysis breaks a problem behaviour down into the links that led to it, so the client can see where a skill could have changed the outcome. A chain analysis worksheet usually covers:

1. Vulnerability factors, such as poor sleep, illness, or stress earlier that day.
2. The prompting event that started the chain.
3. The links, meaning each thought, feeling, body sensation, and action that followed.
4. The problem behaviour itself.
5. The consequences, in the short term and the longer term.
6. The points in the chain where a different skill could have been used.

Missing links analysis is a shorter companion for when something the client agreed to, like homework, didn't happen. It asks whether they knew what was needed, whether they were willing, whether it occurred to them at the time, and what got in the way. Both are included in our DBT Worksheets Mega Bundle, alongside the four core modules.

How to Sequence DBT Worksheets in Individual Therapy

When a client is in frequent crisis, I start with distress tolerance alongside basic mindfulness, as they need a way to get through the next week before the other skills will stick. Once things are more settled, emotion regulation and interpersonal effectiveness follow. A few principles make the worksheets more useful:

• Teach one skill at a time, and practise it in session before setting it as homework.
• Practise skills when the client is calm, so they're familiar when they're needed.
• Use a diary card to track urges, emotions, and skills used each day.
• Review homework at the start of every session, with curiosity rather than judgement.
• Use chain analysis on real incidents rather than hypothetical ones.

There's no single right order for every client, and it's fine to move between modules as situations come up. For the questions that sit around the skills work, our guide to cognitive behavioural therapy questions to ask clients pairs well with DBT.

DBT worksheets give clients a concrete version of each skill that they can practise between sessions and reach for in the moment. Teaching the four modules in a sensible order, with chain analysis to connect them to real situations, helps clients build skills they'll actually use.

Veronica West is a registered psychologist (BPsychSc(Hons), MPH, MPsych) and the founder of My Thriving Mind, a digital resource library for psychologists, counsellors, and allied mental health professionals. The range includes the DBT worksheets collection, the DBT Worksheets Mega Bundle with 45 worksheets, the DBT for BPD Worksheet Bundle with 50 pages across the four modules, and the DBT Skills Flashcards Bundle with 46 cards. For clinicians who want everything in one purchase, the Whole Shop Bundle includes the full library of 1,000+ therapy resources.

Browse the DBT worksheets collection here: https://mythrivingmind.io/collections/dbt-worksheets