The Dialectical Behavior Therapy Skills Workbook for Anxiety: Breaking Free from Worry, Panic, PTSD, and Other Anxiety Symptoms

196 Pages·2011·3.44 MB·English

by  Alexander L. Chapman

“Increasingly, research is showing that dialectical behavior therapy
(DBT) can be a useful treatment for a range of mental health problems.
In The Dialectical Behavior Therapy Skills Workbook for Anxiety,
Chapman, Gratz and Tull strip away the jargon and walk the reader
step-by-step through this treatment, showing the reader how to apply
DBT skills to anxiety. This workbook will provide many anxiety
sufferers with much-needed relief.”
—David F. Tolin, PhD, ABPP, director of the Anxiety
Disorders Center at the Institute of Living and author of
Face your Fears
“I strongly recommend this self-help book for people suffering from
various forms of anxiety. These authors effectively describe in lay
terms how mindfulness, distress tolerance, emotion regulation and
interpersonal effectiveness skills augment the more traditional
applications of cognitive behavioral therapy strategies in the treatment
of anxiety. In this book, the reader will find clinical vignettes,
diagrams, and useful worksheets in this book that enhance the process
of learning of these DBT tools.”
—Alec L. Miller, PsyD, professor of clinical psychiatry and
behavioral sciences at Albert Einstein College of
Medicine in Bronx, NY
“Symptoms of anxiety, worry, and panic are integral to the emotional
disorders and respond to a core set of psychological interventions. In
this outstanding workbook, the authors pull together some of the most
creative and scientifically-proven procedures for managing out-of-
control emotions, including anxiety. These dialectical behavior therapy
skills should benefit everyone suffering the ravages of anxiety
disorders.”
—David Barlow, PhD, professor of psychology and
psychiatry and founder and director emeritus of the Center
for Anxiety and Related Disorders at Boston University
“A clear, practical guide that combines evidence-based approaches
with rich clinical wisdom. Filled with innovative and practical advice
as well as lively metaphors and engaging case examples, this book is
sure to help readers struggling with anxiety find a balance between
acceptance and change. I highly recommend this book and these
authors.”
—Lizabeth Roemer, PhD, coauthor of The Mindful Way
Through Anxiety
“For many, the struggle to control anxiety can be an exhausting,
consuming, and seemingly endless challenge. Fortunately, The
Dialectical Behavior Therapy Skills Workbook for Anxiety offers a
number of well researched, easy to implement strategies that can help
readers to better understand, accept, and manage their anxiety,
improve their relationships, and engage more fully in their lives.“
—Susan M. Orsillo, PhD, psychology professor at Suffolk
University
“This is an excellent application of dialectical behavior therapy (DBT)
skills for people struggling with anxiety, panic attacks, and related
problems. Not only will readers gain a better understanding of what
these problems are, they’ll also learn some very practical and effective
skills to cope with them. Many thanks to the authors for bringing the
success of DBT to people suffering with anxiety.”
—John Forsyth, PhD, director of the Anxiety Disorders
Research Program at the University at Albany, SUNY and
author of The Mindfulness and Acceptance Workbook for
Anxiety
“To be relieved of anxiety is often a person’s highest priority for
therapy. This book allows access to the powerful DBT methods that
that can provide that relief. It is not always possible to join a DBT
skills training group, but it is possible to understand and use Marsha
Linehan’s transformative work by reading this practical
interpretation.”
—Kate Northcott, MA, MFT, DBT therapist in private
practice with Mindfulness Therapy Associates and
director of New Perspectives Center for Counseling in San
Francisco, CA
“Alexander Chapman and his colleagues have provided a much-
needed, thorough resource in The Dialectical Behavior Therapy Skills
Workbook for Anxiety. Offering DBT skills and emphasizing
mindfulness practice, this book provides helpful information and
practical worksheets, and will be a valuable tool for both people
experiencing anxiety and the clinicians treating them.”
—Sheri Van Dijk, MSW, RSW, psychotherapist in Ontario,
Canada, and coauthor of The Dialectical Behavior
Therapy Skills Workbook for Bipolar Disorder
“The Dialectical Behavior Therapy Skills Workbook for Anxiety is a
welcome new tool for anyone who is burdened with anxiety, or who
works to help those who are. This is a clear, practical, and easy-to-use
workbook. It holds the promise of increased understanding, real relief,
and personal growth for anyone who is willing to take some time to
read the text and apply themselves to the exercises.”
—Jeffrey Brantley, MD, DFAPA, founder and director of
the mindfulness-based stress reduction program at Duke
Integrative Medicine and author of Calming Your Anxious
Mind
“The Dialectical Behavior Therapy Skills Workbook for Anxiety is
concise, well organized, easy to read, and will likely be a lifeline of
relief for many people. Chapman, Gratz, and Tull do a marvelous job
of detailing the specific tools of DBT that can truly help readers to
help themselves become more positive, able to cope, and successful in
their relationships.”
—Denise D. Davis, PhD, clinical psychologist and founding
fellow of the Academy of Cognitive Therapy
“This easy-to-read book provides practical and effective DBT
strategies for anyone struggling with anxiety. The authors guide
readers through a step-by-step process of dealing with stress and
anxiety by building DBT skills like mindfulness and distress tolerance.
A great resource for anxiety sufferers!”
—Pamela S. Wiegartz, PhD, author of The Pregnancy and
Postpartum Anxiety Workbook and The Worrier’s Guide
to Overcoming Procrastination
“Chapman, Gratz, and Tull have written a wonderfully helpful guide to
using the proven methods of DBT to overcome anxiety problems. In
this excellent workbook, the authors clearly describe the key tools of
DBT, then show you step by step how to apply these methods to
problems such as worry, panic attacks, and social anxiety. I highly
recommended this workbook for anyone seeking to conquer anxiety
once and for all.”
—Kevin L. Gyoerkoe, PsyD, director of The Anxiety and
OCD Treatment Center in Charlotte, NC, and author of 10
Simple Solutions to Worry and other books

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 professional services. If
expert assistance or counseling is needed, the services of a competent professional should be sought.
Distributed in Canada by Raincoast Books Copyright © 2011 by Alexander L. Chapman, Kim L. Gratz, and Matthew T. Tull New
Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
All Rights Reserved Acquired by Catharine Meyers; Cover design by Amy Shoup; Edited by Nelda Street epub ISBN: 9781608826148
___________
Library of Congress Cataloging-in-Publication Data Chapman, Alexander L. (Alexander Lawrence) The dialectical behavior therapy
skills workbook for anxiety : breaking free from worry, panic, PTSD, and other anxiety symptoms / Alexander L. Chapman, Kim L.
Gratz, and Matthew T. Tull ; foreword by Terence M. Keane.
p. cm.
Includes bibliographical references.
ISBN 978-1-57224-954-7 (pbk.) -- ISBN 978-1-57224-955-4 (pdf e-book) 1. Anxiety disorders--Treatment--Popular works. 2.
Dialectical behavior therapy--Popular works. I. Gratz, Kim L. II. Tull, Matthew T. III. Title.
RC531.C46 2011
616.85’220651--dc23
2011027693
To all the clients to whom I have taught DBT skills. You have taught and inspired me in many
ways. Also, to A. J., a major source of inspiration for this book.
—A. L. C.
To the clients in my DBT skills groups, past and present. You bring these skills to life and
inspire me to continue to engage with this material in new ways.
—K. L. G.
To all of my clients who struggle with anxiety and its disorders. I wish you peace and
compassion for your journey through the uncertainty of life.
—M. T. T.
Contents
Acknowledgments
Foreword
CHAPTER 1: ANXIETY AND ANXIETY DISORDERS
• What Is Anxiety? • Anxiety vs. Anxiety Disorders • The Anxiety Disorders • Anxiety and Avoidance •
Conditions That Commonly Accompany Anxiety Disorders • Moving Forward Chapter 2: Overview of
Cognitive Behavioral Therapy and Dialectical Behavior Therapy
• The Nuts and Bolts of CBT for Anxiety Disorders • Why DBT? • A Brief History of DBT • What
Happens in DBT? DBT in a Nutshell • Moving Forward Chapter 3: DBT Mindfulness and Distress
Tolerance Skills
• DBT Mindfulness Skills • DBT Distress Tolerance Skills • Moving Forward
CHAPTER 4: DBT EMOTION REGULATION AND INTERPERSONAL
EFFECTIVENESS SKILLS
• DBT Emotion Regulation Skills and Emotions • The Basics of DBT Emotion Regulation Skills • DBT
Interpersonal Effectiveness Skills • Moving Forward Chapter 5: Stress
• What Is Stress? • Stress in Anxiety Disorders • Managing Stress with DBT Skills • Moving Forward
Chapter 6: Worry
• Why Worry? • Worry in GAD and Other Anxiety Disorders • Features and Consequences of Worry •
Moving Forward Chapter 7: Flashbacks, Nightmares, and Other Traumatic Stress Symptoms
• Post-Traumatic Stress Symptoms • Is It Post-Traumatic Stress Disorder? • DBT Skills to Deal with
Post-Traumatic Stress Symptoms • Moving Forward Chapter 8: Panic Attacks
• What Are Panic Attacks? • Panic Attacks in Anxiety Disorders • Where Do Panic Attacks Come
From? • Features and Consequences of Panic Attacks • Moving Forward Chapter 9: Obsessions and
Compulsive Behaviors
• Obsessions and Compulsions • Obsessive-Compulsive Disorder • Is It an Obsession, Worry, or
Reexperiencing? • Why Do Obsessions and Compulsions Develop? • Features and Consequences of
Obsessions and Compulsions • Moving Forward Chapter 10: Social Anxiety
• Situations That Can Bring on Social Anxiety • What Drives Social Anxiety? • Consequences of
Fearing Evaluation • Moving Forward References
Acknowledgments
I am grateful to so many people who have helped me to step onto and stay on
this path I’ve taken, without whom this type of book would not be possible. I
would like to thank all of my clients, who have taught me so much about how
these skills work (and sometimes how they don’t) to enhance their daily lives
and bring them freedom and fulfillment. I got into DBT work back in graduate
school, when I saw in one of my very first clients how powerful these skills can
be and how much change is possible even in the midst of misery and despair.
Since then, I have been compelled (somewhat obsessively and compulsively) to
devote my career and much of my life to this work. One of my very favorite
activities each week is the teaching of my DBT skills groups, and the best
reward for this work occurs when I hear that people are using these skills to
make meaningful changes in their lives. Each person I’ve worked with has
taught me so much, and I thank you all for helping me to be in the best position
to help others.
I am also grateful to my coauthors for taking this journey with me. I feel very
fortunate to have Kim as a friend, colleague, and coauthor. You are one of the
most skilled and compassionate people I’ve ever met, and these writing projects
with you are a delight. I’d also like to thank Matt, without whom this book
simply wouldn’t exist. His expertise in anxiety disorders and clear,
compassionate writing have been invaluable. I also have greatly appreciated the
feedback and support (even when I have asked for deadline extensions for this
book, which I must admit that I did twice!) of the editorial staff at New
Harbinger, especially Catharine Meyers, Jess Beebe, and Kayla Sussell.
My parents, family, and mentors also have contributed so much to my life
and work. I would like to thank my friend and colleague, Dr. Richard Farmer,
for his guidance while I was a graduate student learning about treatments for
anxiety and other disorders. I may not have appreciated those biweekly essays in
your class at the time, but I sure do now. Dr. Marsha Linehan’s wisdom has been
essential to this work (I often hear her voice in my head whenever I write about,
teach, or practice DBT), and I greatly appreciate her ongoing friendship and
support of my work. I also would like to thank Dr. Tony Cellucci for his support,
friendship, and guidance over the years. My parents have stuck with me and
showed an unusual degree of acceptance and tolerance over the years, even years
ago, when I tried to convince them that there was no point in my going to
university. My wife, Katherine, has been a saint for supporting me throughout