The Dialectical Behavior Therapy Skills Workbook

243 Pages·2007·4.87 MB·English

by  Matthew McKay

The individual struggling with overwhelming emotions and DBT therapists will benefit significantly from
this workbook. McKay, Wood and Brantley have expanded and translated DBT Skills, making Linehan’s
iconic work on emotional skill building even more accessible and easy to apply to everyday life.
—Kate Northcott, MA, MFT, is a DBT therapist in private practice with
Mindfulness Therapy Associates and is director of New Perspectives Center
for Counseling, a non-profit counseling center, in San Francisco, CA

The Dialectical
Behavior Therapy
Skills Workbook
Practical DBT Exercises for
Learning Mindfulness, Interpersonal
Effectiveness, Emotion Regulation
&
Distress Tolerance
MATTHEW MCKAY, PH.D. • JEFFREY C. WOOD, PSY.D.
JEFFREY BRANTLEY, MD
New Harbinger Publications, Inc.
Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It
is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other pro-
fessional services. If expert assistance or counseling is needed, the services of a competent professional should be sought.
Distributed in Canada by Raincoast Books
Copyright © 2007 by Matthew McKay, Jeffrey C. Wood, and Jeffrey Brantley
New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
All Rights Reserved
Printed in the United States of America
Acquired by Catharine Sutker; Cover design by Amy Shoup;
Edited by Elisabeth Beller; Text design by Tracy Carlson
Library of Congress Cataloging-in-Publication Data
The dialectical behavior therapy skills workbook : practical DBT exercises for learning mindfulness, interpersonal
effectiveness, emotion regulation, and distress tolerance / Matthew McKay ... [et al.].
p. cm.
ISBN-13: 978-1-57224-513-6
ISBN-10: 1-57224-513-1
1. Dialectical behavior therapy--Problems, exercises, etc. I. McKay, Matthew.
RC489.B4D52 2007
616.89’142--dc22
2007013007
09 08 07
10 9 8 7 6 5 4 3 2 1
First printing
In memory of my mother, Louise Long LaBrash, who was always there for me in the hard times.
—Matthew McKay
To my students and clients at Fresno City College and Reedley College, 2005–2006, whose
strength, hope, and resilience inspired me while writing this book.
—Jeffrey C. Wood
This work is dedicated to all who struggle with intense and unpredictable emotions in their
inner and outer lives. May you find peace and happiness, and may all living beings benefit from
your efforts.
—Jeffrey Brantley

Contents
IntroductIon
Dialectical Behavior Therapy: An Overview of the Treatment . . . . . . . . . . . . . 1
chapter 1
Basic Distress Tolerance Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
chapter 2
Advanced Distress Tolerance Skills: Improve the Moment . . . . . . . . . . . . . . . 31
chapter 3
Basic Mindfulness Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
chapter 4
Advanced Mindfulness Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .85
chapter 5
Exploring Mindfulness Further . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .115
chapter 6
Basic Emotion Regulation Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
chapter 7
Advanced Emotion Regulation Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
chapter 8
Basic Interpersonal Effectiveness Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
chapter 9
Advanced Interpersonal Effectiveness Skills . . . . . . . . . . . . . . . . . . . . . . . . . . 199
chapter 10
Putting It All Together . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .225

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .229
vi The Dialectical Behavior Therapy Skills Workbook
IntroductIon
Dialectical Behavior Therapy:
An Overview of the Treatment
Dialectical behavior therapy, developed by Marsha Linehan (1993a, 1993b), is extraordinarily
effective at helping people manage overwhelming emotions. Research shows that dialectical
behavior therapy strengthens a person’s ability to handle distress without losing control or acting
destructively.
A lot of people struggle with overwhelming emotions. It’s as if the knob is turned to maximum
volume on much of what they feel. When they get angry or sad or scared, it shows up as a big,
powerful wave that can sweep them off their feet.
If you’ve faced overwhelming emotions in your life, you know what we’re talking about. There
are days when your feelings hit you with the force of a tsunami. And when that happens, it makes
you—understandably—afraid to feel things because you don’t want to get swept away by your
emotions. The trouble is, the more you try to suppress or put a lid on your emotions, the more
overwhelming they can get. We’ll talk about that in chapters 6 and 7 on emotional regulation.
What’s important to know right now is that trying to stop your feelings doesn’t work.
There’s a fair amount of research to suggest that the likelihood of developing intense, over-
whelming emotions may be hardwired from birth. But it can also be greatly affected by trauma
or neglect during childhood. Trauma at critical points in our development can literally alter our
brain structure in ways that make us more vulnerable to intense, negative emotions. However, the
fact that a propensity to intense emotions is often rooted in genetics or trauma doesn’t mean the
problem can’t be overcome. Thousands of people have used the skills you’ll learn in this book to
achieve better emotional control. They have changed their lives—and you can too.
So what are these skills, and how will they help you? Dialectical behavior therapy teaches
four critically important skills that can both reduce the size of emotional waves and help you keep
your balance when those emotions overwhelm you.