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1. DBT Made Simple
Facilitator: Dr. Dawn-Elise Snipes

2. Objectives
 The Basics of DBT
 The B in DBT: What You Need to Know About Behavior
 Mindfulness
 Reducing Emotional Reactivity
 Distress Tolerance Skills
 What Clients Need to Know About Emotions
 Regulating Painful
 Increasing Positive
 Helping Clients Become More Effective In
Relationships

3. The Clients
 Emotional Vulnerability
 React to things others wouldn’t react to
 Reaction is more intense than others
 Recovery time is longer than for others
 Inability to Regulate Emotion
 Difficulty identifying/labeling emotions
 Difficulty understanding why they feel that way
 Difficulty expressing the emotion in an effective way

4. Dialectical Theory
 Everything is interconnected (Action/reaction)
 Examine examples of action/reaction
 Addiction
 Anger
 Depression
 Social Interactions
 Reality is in a constant process of change
 How you perceive something now may be different than how
you perceive it in an hour?
 What changes perceptions?
 What does the emotional mind say? The reasonable mind?
The wise mind?

5. Dialectical Theory
 The truth (always evolving) can be found by integrating
multiple perspectives, and tolerating that two opposite
things may co-exist
 Simultaneous (understanding things differently by taking
multiple people’s perspectives of the same event)
 Example: Crime scene
 Example: Interpersonal disagreement
 Longitudinal (understanding things differently as knowledge is
gained)
 Example: Mommy had no use for us and that is why she left.
 Example: Mommy loves me, but she beats me, so I must be bad.

6. Skills Training Groups
 Core Mindfulness
 Increase self-awareness of thoughts, feelings and urges
 Develop an understanding of emotions as things that do
not have to be acted upon
 Interpersonal Effectiveness
 Develop assertiveness skills
 Identify the goals of relationships and skills/activities
needed to achieve those goals

7. Skills Training Groups
 Emotion Regulation Skills
 Label and effectively communicate feeling states
 Understand the function of emotions and why we don’t
want to eliminate them
 Learn the connection between thoughts, feelings and
behaviors and how to break the chain
 Distress Tolerance Skills
 Survival skills/alternatives to self-harm

8. DBT Assumptions
 Clients are doing their best
 They want to get better
 They need to work harder/smarter and be more
motivated
 Even if clients didn’t create their problems, they
have to fix them
 Clients need to learn to act skillfully in EVERY
area of their lives
 Clients cannot fail in therapy

9. Treatment Priorities in DBT
 Suicidal or self-harming behaviors
 Behaviors that interfere with therapy (including
clinician)
 Suicidal or self-harm ideation and misery
 Maintaining treatment gains
 Other goals identified by the client
Mindfulness
Emotion Regulation
Interpersonal Effectiveness
Distress Tolerance

10. Stages of Treatment
 Stage 1: Attaining Basic Capacities
 Identify behaviors that pose a direct threat to the clients (or
other’s) safety
 Monitor the frequency, intensity of behaviors using a
Behavior Tracking Form
 Address
 Suicidal/self-harming behaviors
 Behaviors that interfere with therapy
 Suicidal ideation and “misery”
 Maintaining treatment gains
 Client initiated goals

11. Stages cont…
 Stage 2 Reducing Traumatic Stress
 Subgoals
Negative relationships experiences related to emotional
dysregulation
Lack of interpersonal skills
 Stage 3 Increasing Self-Respect and Achieving
Individual Goals

12. The “B” in DBT
 Benefits--Positive and Negative Reinforcement
 Punishment – Positive and Negative
 Consequences
 Negative
 Positive
 Neutral
 Intermittent reinforcement (variable interval or
ratio)
 Modeling

13. The B In DBT
 Reinforcers: Increase the likelihood of a behavior
 Punishments: Reduce the likelihood of a behavior
 Vulnerabilities: Increase the likelihood of fight or
flight responding
 Backward Chaining
 Outburst Co-Worker said something insensitive 
Felt drained upon awakening Had to put cat down
the day before

14. The B In DBT
 Triggers (+/-)
 Cause a reaction
 Remind the person of a prior situation in which a
behavior was:
Rewarded—Lashing out makes gave client control
Punished– Lashing out did no good increasing client’s
sense of helplessness
 Communicate to the person there is a threat
 Prompt feelings of wellbeing

15. The “B” in DBT
 Shaping
 Rewarding/reinforcing “successive approximations”
 Example: Anger
Level 1: Not throwing things or being physically
aggressive
Level 2: Disengaging until the urge to be verbally or
physically aggressive was gone
Level 3: Being able to calmly discuss issues/problems

16. The “B” in DBT
 Shaping
 Example: Addiction or other self-harm
Level 1: Engaging in secondary coping behavior (smoking,
walking, eating, listening to music, drawing)
Level 2: Taking a mindfulness minute to evaluate the
situation, then choosing a behavior consistent with goals

17. Mindfulness
 Developing an in-the-moment awareness of how
you are:
 Emotionally
 Mentally
 Physically
 Exploring the interconnection of thoughts,
feelings and physical sensations
 Distress in one leads to distress in others
 Becoming aware of the emotional wave

18. Reducing Emotional Reactivity
 Reduce Vulnerability: (Please)
 P & L Treat Physical Illness
 Eating
 Altering Drugs
 Sleep
 Exercise
 Build Positive experiences
 Be mindful of current emotion

19. Distress Tolerance
 Activities: Do hobbies, watch a video, go for a walk
 Contribute. Do volunteer work
 Compare yourself to people coping the same as or
less well than you
 Emotions. Distract with opposite (i.e. Comedy)
 Push away a distressing situation by leaving it
mentally for awhile.
 Thoughts. Think about something else (Puzzles, book)
 Sensations. Distract with intense sensations

20. What Clients Need To Know About Emotions
 Increasing the Positive
 Decreasing the Negative

21. Interpersonal Effectiveness
 Assertiveness
 Distress tolerance
 Emotion identification and communication
 Understanding
 Your needs
 The needs of others
 Exploring situations using dialectical theory

22. Interpersonal Effectiveness
 DEARMAN - Getting what we want/need:
 Describe our situation.
 Express why this is an issue or need and how we feel about
it.
 Assert: Sharing clearly what we feel and asking directly for
what we want/need.
 Reinforce our position by offering a positive outcome
(win/win)
 Mindful focusing on what we are requesting
 Appear Confident
 Negotiate

23. Summary
 DBT is a great tool to help clients
 Become more aware of emotions
 Identify the thoughts, feelings and urges associated
with emotions
 Develop a greater sense of self-awareness regarding
The whys of emotions
Vulnerabilities which make them more likely to be
emotionally reactive or sensitive
 Provide a framework for teaching skills groups that
benefit an array of clients who have difficulty with
emotionality.

24. Available at New Harbinger Publications
(https://newharbinger.com).
Use Promocode 1168SNIPES to get 25%
off your entire order.
The book contains
• Step-by-step guide to DBT skills
• Excellent worksheet examples for
clinicians
• A user-friendly explanation of DBT
and how it works.