Comprehensive Dialectical

Behavior Skills Training for

Practical Applications
Muhammad Munib-ur-Rehman
Lecturer Government College University, Lahore
Clinical Psychologist/Certified Schema Therapist
Co-founder Manttaq
 When I teach my graduate students—who work with
complex, difficult-to-treat individuals at high risk for
suicide—I always remind them that they can choose
whether to look out for themselves or to look out for
their clients, but they cannot always do both. If they
want to look out for themselves at a possible cost to
their clients, I remind them that they are in the wrong
profession.
__Marsha M. Linehan
 DBT Skills Training

• DBT is a broad-based cognitive-behavioral treatment originally developed for

chronically suicidal individuals diagnosed with borderline personality disorder
(BPD).
• DBT was the first psychotherapy shown through controlled trials to be effective with
BPD.
• Multiple clinical trials have been conducted demonstrating the effectiveness of DBT
not only for BPD, but also for a wide range of other disorders and problems,
including both under-control and overcontrol of emotions and associated cognitive
and behavioral patterns.
Goal of DBT Skills Training
• DBT skills training, is based on a dialectical and biosocial theory of
psychological disorder that emphasizes the role of difficulties in
regulating emotions, both under and over control, and behavior.
• Emotion dysregulation has been linked to a variety of mental health
problems, stemming from patterns of instability in emotion regulation,
impulse control, interpersonal relationships, and self-image.
• DBT skills are aimed directly at these dysfunctional patterns.
• The overall goal of DBT skills training is to help individuals change
behavioral, emotional, thinking, and interpersonal patterns associated
with problems in living.
Historical Background
• DBT was developed by Marsha Linehan at the University of
Washington in 1970s.
• For years she had used standard CBT strategies to work with suicidal
and actively self-injurious patients.
• They discovered that cognitive-behavioral therapy alone did not work
as well as expected in patients with BPD.
• However, Linehan found that therapists’ unrelenting focus on trying to
help patients change their problematic behaviors often led patients to
feel invalidated.
• The first randomized controlled trial (RCT) for DBT was published in
1991
Effectiveness
DBT might be an effective treatment for:
• Borderline Personality Disorder
• Attention-deficit/hyperactivity disorder
• Bipolar disorder
• Eating disorders
• Generalized anxiety disorder
• Major depressive disorder
• Obsessive-compulsive disorder
• Post-traumatic stress disorder
• Substance use disorder
Borderline Personality Disorder
Borderline Personality Disorder
 Philosophical Background
• “Dialectics” is a term used to describe a method of philosophical
argument that involves some sort of contradictory process between
opposing sides.
• The ancient Greek philosopher, Plato, presented his philosophical
argument as a back-and-forth dialogue or debate.
• Generally between the character of Socrates, on one side, and some
person or group of people to whom Socrates was talking (his
interlocutors), on the other.
Hegel's Dialectics
• Thesis: A starting idea, statement, or belief. Represents the
initial position or viewpoint in a discussion or conflict.
• Humans are naturally selfish.
• Antithesis: A conflicting or opposing idea that challenges the
thesis.
• Creates tension or contradiction, highlighting the limitations
of the thesis.
• Humans are naturally altruistic.
• Synthesis: A resolution or integration of the thesis and
antithesis, combining elements of both to form a higher truth.
• Represents growth, understanding, or progress, transcending
the conflict.
• Humans have the capacity for both selfishness and
altruism depending on the situation.
The Dialectical World View and Basic Assumptions
Dialectics (basis of DBT)
• Two opposite ideas can be true at the same time, and
when considered together, can create a new truth and a
new way of viewing the situation.
• There is always more than one way to think about a
situation.
• Dialectics refers to two key ideas in DBT:
• Nature of reality: The world is interconnected, and
truths often hold contradictions.
• Therapist strategies: Using dialogue to help clients
find balance and change.
• DBT is rooted in this dialectical worldview, aiming to
help clients move away from extremes and find
workable solutions.
Balancing Opposites

• Therapists help clients navigate three polarities:

1. Acceptance vs. Change: Clients must accept themselves while
working on change.
2. Competence vs. Dependency: Clients may fear losing support if
they show progress, so therapists balance validation and
encouragement for growth.
3. Integrity vs. Learning: Clients may feel that learning new skills
validates others’ negative views. Therapists guide them to see skill-
building as self-empowerment, not weakness.
Change is Constant
• The world and people are always changing.
• Therapy encourages clients to embrace this change rather than resist it.
• Practical example: In group therapy, clients may be asked to change
seats regularly to build comfort with flexibility.
• Therapists and treatment methods also evolve, reflecting the dynamic
nature of therapy.
Biosocial Theory
• The Biosocial Theory explains the development of emotion dysregulation, central to
understanding Borderline Personality Disorder (BPD) and suicidal behavior.
• Emotion dysregulation is identified as the core issue in both BPD and suicide. Suicidal
behavior is conceptualized as a reaction to unbearable emotional suffering, while BPD is
viewed as a severe disorder stemming from affective system dysregulation.
• Individuals with BPD exhibit a characteristic pattern of instability in:
• Affect regulation: Struggles with managing and controlling intense emotions.
• Impulse control: Difficulty in resisting urges or acting thoughtfully.
• Interpersonal relationships: Conflicts and instability in social connections.
• Self-image: An unstable sense of identity and worth.
• Beyond BPD, emotion dysregulation is implicated in various other mental health
disorders including
• Substance Use Disorders, Eating Disorders, Major Depressive Disorder, Anxiety
Disorders, Schizophrenia, and Bipolar Disorders.
The DBT Model of Emotions
• To address emotion dysregulation, it is essential to understand the
nature of emotions.
• Defining "emotion" is challenging.
• DBT Definition of Emotions: Emotions are described as brief,
involuntary, full-system, and patterned responses to both internal and
external stimuli.
• Emotions have evolutionary adaptive value, meaning they serve a
purpose for survival by guiding behavior and decision-making.
Components of Emotional Responses
• Emotional vulnerability to cues: Some individuals are more sensitive to
emotional triggers.
• Prompting events: Internal or external events that draw attention and
trigger emotions.
• Appraisal and interpretation: How one perceives and interprets the cues.
• Response tendencies: These include:
• Neurochemical and physiological changes (e.g., increased heart rate).
• Experiential responses (subjective feeling states).
• Action urges (impulses to act in specific ways).
• Expressive responses: Verbal and nonverbal reactions that convey
emotions.
• Aftereffects: Secondary emotions or lingering impacts after the initial
emotional response.
Emotion Dysregulation
• It is the inability to regulate or change emotions, even with the best
efforts, under normal circumstances.
• It involves challenges in managing emotional cues, experiences,
behaviors, verbal and nonverbal expressions.
• Pervasive Emotion Dysregulation occurs across a wide range of
emotions, contexts, and adaptation problems.
• It results from Emotional vulnerability (increased sensitivity to
emotions).Inability to regulate intense, emotion-linked responses.
Emotional Vulnerability Characteristics
• High negative affectivity as a baseline (predisposition to experience
negative emotions).
• Sensitivity to emotional stimuli (easily triggered by emotions).
• Intense emotional responses to triggers.
• Slow return to emotional baseline after experiencing emotional
arousal.
 Emotion Regulation
The ability to manage emotional responses and behaviors effectively, even under strong
emotional influences.
Core Components of Emotion Regulation:
• Inhibiting impulsive and inappropriate behaviors triggered by intense positive or
negative emotions.
• Organizing and coordinating actions toward external goals, acting independently of
current mood when necessary.
• Self-soothing physiological arousal caused by strong emotions.
• Refocusing attention despite emotional distractions.
ØIt can be both automatic (instinctive, requiring no conscious effort) and consciously
controlled (deliberate).
ØThe initial focus is on increasing conscious control over emotions and behaviors.
Emphasis is placed on practicing emotion regulation skills to the point that they become
automatic over time.
Biological Vulnerabilities
(the “Bio” in the Biosocial Theory)
Core Biological Factors
• Negative Affectivity: A predisposition to experience high levels of
negative emotions like sadness, frustration, and discomfort.
• High Emotional Sensitivity: Increased sensitivity to emotional cues,
leading to heightened emotional reactions.
• Impulsivity: Difficulty controlling immediate emotional or behavioral
responses.
• Any disruption in the intricate emotion regulation system may lead to
initial emotional vulnerability and long-term modulation difficulties.
• These dysfunctions vary between individuals based on their unique
biological and experiential histories.
Sources of Biological Influences

Brain Genetic
Development Predispositions

Early
Intrauterine
Learning
Factors
Experiences

Physical Insults
Key Characteristics of Invalidating Environments

• Emotional Invalidation: Dismissing or trivializing a child’s

emotional experiences, leading to confusion and self-doubt about
emotions.
• Lack of Emotional Modeling: Failing to demonstrate healthy
emotional expression and regulation, leaving children without proper
examples to follow.
• Reinforcement of Emotional Arousal: Caregivers unintentionally
reward heightened emotional responses (e.g., giving in to tantrums or
overreacting), reinforcing dysregulated behavior.
Mismatch Between Child’s Temperament and
Caregiver’s Parenting Style
• A poor fit between the child’s natural emotional tendencies and the
caregiver’s approach to parenting can exacerbate difficulties in regulation.
• Even children with low biological vulnerabilities may face challenges if
the mismatch is extreme or if external family stresses are severe.
Biology × Environment Interactions
• Emotional and behavioral patterns are shaped by the interplay between a
child's biological predispositions and their social environment.
• For example:
• A child with low vulnerability but a chaotic caregiving environment (e.g., parental
substance abuse or chronic family stress) may still develop emotional dysregulation.
• Conversely, a biologically vulnerable child may thrive in a well-matched caregiving
environment with strong familial support.
Three Family Types That Increase Risk for
BPD
• Disorganized Families:
• Characterized by pervasive neglect, maltreatment, or chaos.
• Often fail to provide basic emotional and psychological support.
• Perfect Families:
• Emphasize maintaining appearances and suppressing negative emotions.
• Create an environment where emotional expression, particularly of negative feelings,
is seen as unacceptable or shameful.
• Normal Families:
• Primarily marked by a poor fit between child temperament and caregiver style.
• Parenting may be well-meaning but misaligned with the child’s emotional needs.
Protective Factors and Resilience
• A well-matched caregiving environment with emotionally attuned
and supportive caregivers can foster resilience even in biologically
vulnerable children.
• Support systems, emotional validation, and consistent parenting can
mitigate risks of emotional dysregulation and associated disorders.
The Role of the Invalidating Environment
• Emotions are a rapid communication system essential for survival and
connection. When invalidation occurs, it disrupts this process by
sending a message that the emotional communication was not received
or valued.
Cycle of Escalation:
• The sender (e.g., child) escalates emotional expression to ensure the message
is received.
• The receiver (e.g., caregiver) increases invalidation to suppress the emotion.
• This back-and-forth reinforces both emotional escalation in the child and
invalidation from the caregiver, cementing dysregulated patterns.
Characteristics of Invalidating Environments
• Erratic Responses: Responses to private experiences (e.g., feelings,
thoughts, sensations) are inconsistent, overly reactive, or dismissive.
• Trivialization of Emotions: Painful emotions are minimized or
attributed to personal flaws (e.g., laziness or lack of discipline).
• Over-Control of Emotional Expression: Negative emotions are
especially discouraged, while strong positive emotions may be
dismissed as impulsivity or poor judgment.
• Use of Punishment: Emotional expressions are often punished,
ranging from verbal criticism to physical or sexual abuse.
Outcomes of Invalidation
• Failure to Teach Emotional Skills:
• The child does not learn to label or modulate emotional arousal effectively.
• Tolerance for distress remains underdeveloped.
• The child struggles to trust their emotional responses as valid interpretations of events.
• Development of Self-Invalidation:
• The child becomes reliant on external cues to determine how to feel or act, diminishing
self-trust.
• Oversimplified problem-solving by caregivers hinders the child’s ability to set realistic
goals.
• Polarized Emotional Expression:
• Emotional responses alternate between extreme inhibition and extreme disinhibition.
• This undermines the communicative function of emotions, leading to further relational
and self-regulation difficulties.
Trauma and Invalidation
• High Rates of Trauma:
• Up to 60–75% of individuals with borderline personality disorder (BPD) have
histories of childhood trauma.
• Many continue to experience verbal, emotional, physical, or sexual abuse into
adulthood.
• Transactional View:
• Trauma may arise from the same invalidating family dynamics that contribute
to emotional dysregulation.
• It is unclear whether trauma directly causes dysregulation or whether it is
another result of familial dysfunction and invalidation.
 Development of Emotion Dysregulation in
Vulnerable Children
• Emotionally vulnerable children are particularly impacted by
invalidating environments, as their intense emotional responses elicit
even more invalidation.
• Over time, discrepancies between their private emotional experiences
and environmental feedback solidify patterns of dysregulation and
self-doubt.
• Invalidation teaches children that their emotions are not trustworthy,
forcing them to rely on external validation.
• Persistent invalidation fosters behavioral problems and intensifies
emotion dysregulation, creating a cycle that is difficult to break
without intervention.
The Consequences of Emotion Dysregulation
Disruption of Behavior:
• Emotion dysregulation disrupts goal-directed behavior and prosocial
actions.
• Strong emotions can dominate, redirecting actions away from less
emotionally driven behaviors.
Maladaptive Coping Mechanisms:
Impulsive behaviors, including self-injury and suicidal acts, often emerge as
emotion regulation strategies. While maladaptive, these behaviors can
temporarily alleviate intense emotional distress:
ØOverdosing induces prolonged sleep, reducing emotional arousal.
ØSelf-mutilation provides immediate relief from anxiety or other negative
emotions, though the mechanism is unclear.
ØSuicidal behaviors elicit help from others, altering painful circumstances
and providing distraction or relief through planning and imagining the act.
The Consequences of Emotion Dysregulation
Impact on Identity Formation:
• Emotion dysregulation affects the development of a stable sense of self:
• Emotional inconsistency leads to unpredictable behavior and cognitive conflicts.
• Inhibited emotional responses create a sense of numbness or emptiness, further
disrupting identity.
• Dependence on external validation arises when personal experiences and emotions
are invalidated.
Chaotic Relationships:
• Emotion dysregulation undermines effective interpersonal relationships:
• Lack of a stable identity and emotional spontaneity hampers meaningful
connections.
• Inability to self-regulate emotions and tolerate distress contributes to unstable and
chaotic relationships.
• Problems with anger expression, impulsivity, and extreme negative emotions
strain interpersonal bonds.
The Standard DBT Treatment Program
• DBT was originally created for high-risk, multiple diagnosis clients
with pervasive, severe emotion dysregulation; the clinical problems
presented by these clients were complicated.
• It was clear from the beginning that treatment had to be flexible and
based on principles, rather than tightly scripted with one protocol to fit
all clients.
• To give some clarity and structure to the inherent flexibility built into
the treatment, DBT was constructed as a modular intervention, with
components that can be dropped in and pulled out as the needs of each
client and the structure of the treatment dictate.
Treatment Functions
DBT clearly articulates the functions of treatment that it
is designed:
1) To enhance an individual’s capability by increasing
skillful behavior
2) To improve and maintain the client’s motivation to
change and to engage with treatment
3) To ensure that generalization of change occurs
through treatment
4) To enhance a therapist’s motivation to deliver
effective treatment
5) To assist the individual in restructuring or changing
his or her environment in such a way that it supports
and maintains progress and advancement toward
goals
Treatment Modes
Treatment is spread among a variety of modes:
ØIndividual therapy or case management,
ØGroup or individual skills training
ØBetween-session skills coaching,
ØA therapist consultation team
• Each of the modes has different treatment targets, and
also different strategies available for reaching those
targets.
 DBT Skills Modules
• The skills taught to clients reflect a key dialectic—the need for clients to accept
themselves as they are, and the need for them to change.
• Sets of acceptance skills as well as change skills. For any problem encountered,
effective approaches can include acceptance as well as change.
10 Key Differences from other Cognitive Therapies

1. Synthesis of acceptance with change.

2. Inclusion of mindfulness as a practice for therapists and as a core
skill for clients.
3. Emphasis on treating therapy-interfering behaviors of both client and
therapist.
4. Emphasis on the therapeutic relationship and therapist self-disclosure
as essential to therapy.
5. Emphasis on dialectical processes.
10 Key Differences from other Cognitive Therapies

6. Emphasis on stages of treatment, and on targeting behaviors

according to severity and threat.
7. Inclusion of a specific suicide risk assessment
and management protocol.
8. Inclusion of behavioral skills drawn primarily from other evidence-
based interventions.
9. The treatment team as an integral component
of therapy.
10. Focus on continual assessment of multiple
outcomes via diary cards.
 Standard Core
DBT Skills
Training Schedule:
Cycling Twice
through All
Modules over 12
Months
 Skills Training Guidelines (Group)
1.Participants who drop out of skills training are NOT out of skills training. Participants
are considered to have dropped out only if they miss four consecutive sessions.
Otherwise, they remain enrolled in the program.
2.Participants who join the skills training group support each other by maintaining
confidentiality, attending regularly, practicing skills, offering validation, providing
noncritical feedback, and being open to help when needed.
3.Participants who are going to be late or miss a session call ahead of time, emphasizing
courtesy, accountability, and punctuality.
4.Participants do not tempt others to engage in problem behaviors. Clients should not
attend under the influence of drugs or alcohol but are encouraged to participate even
after substance use, provided they behave cleanly and soberly during sessions.
5.Participants do not form confidential relationships outside of skills training sessions.
Relationships are allowed but must be discussable within the group.
6.Participants who are suicidal and/or have severe disorders must be in ongoing regular
individual treatment to continue participating in skills training.
Assumptions of DBT
1. People are doing the best they can. The idea here is that all people at any given point in
time are doing the best they can, given the causes of behavior that have occurred up to this
moment.
2. People want to improve. The common characteristic of all people is that they want to
improve their lives.
3. People need to do better, try harder, and be more motivated to change. The fact that
someone is doing the best he or she can and wants to do even better does not mean that this
is enough to solve the problem.
4. People may not have caused all of their own problems, but they have to solve them
anyway. People have to change their own behavioral responses and alter their environment
for their lives to change.
Assumptions of DBT
5. New behavior has to be learned in all relevant contexts. New behavioral skills
have to be practiced in the situations where the skills are needed, not just in the
situation where the skills are first learned.
6. All behaviors (actions, thoughts, emotions) are caused. There is always a cause
or set of causes for actions, thoughts, and emotions, even if people do not know
what the causes are.
7. Figuring out and changing the causes of behavior is a more effective way to
change than judging and blaming. Judging and blaming are easier, but anyone
who wants to create change in the world has to change the chains of events that
cause unwanted behaviors and events.
 Module I:
General Skills
Orientation and Analyzing Behavior
 An Orientation to Skills Training
• Introductions (Client, Therapist, Participants )
• General Goal of Skills Training
The overall goal of skills training is to learn skills for changing unwanted behaviors,
emotions, thinking, and events that cause misery and distress.
• Behaviors to Decrease
Selecting the behaviors the client or participant want to decrease.
• Skills to Increase
1. Mindfulness Skills
2. Interpersonal Skills
3. Emotion Regulation Skills
4. Distress Tolerance Skills
• Format of Skills Training
• Skills Training Assumptions
• Biosocial Theory
Analyzing Behavior
• Rationale: The ability to analyze our own behavior allows us to
determine what causes it and what maintains it. Knowing this is
important for any of us if we want to change our own behavior.
• Chain Analysis of Problem Behavior
A “chain analysis” is a series of questions to guide clients through
figuring out what factors have led to problem behaviors and what
factors might be making it difficult to change those behaviors.
• Missing-Links Analysis
A “missing-links analysis” is a series of questions to guide clients
through analyzing the factors associated with not engaging in effective
behaviors that are needed or expected.
Chain Analysis
• What Is Chain Analysis?
Chain analysis is a method to dissect a behavior into its sequential components,
identifying how one link leads to the next. It involves asking questions to uncover
these links and understanding the underlying triggers, functions, and barriers to
resolution.
• How to Do a Chain Analysis (Example)
Understanding the Problem (Steps 1–5):
1.Identify the Problem Behavior: Yelling at a coworker.
2.Prompting Event: The coworker interrupted and criticized your idea during the
meeting.
3.Vulnerability Factors: Poor sleep the night before and skipped breakfast.
4.Chain of Events:
1. Felt criticized → Thought "They always undermine me."
2. Heart rate increased → Felt anger build up → Raised voice.
5.Consequences: The coworker appeared upset, and the meeting atmosphere became
tense.
Chain Analysis
• Changing the Problem (Steps 6–8):
6. Skillful Behaviors: Replace yelling with deep breathing and stating,
"Can we discuss this calmly?"
7. Prevention Plans: Get adequate sleep and eat before meetings to
reduce vulnerability.
8. Repair Damage: Apologize to the coworker and clarify intentions
in private.
• Note. When one is repairing negative consequences, it is extremely
important to first figure out what has actually been harmed.
 Module II:
Mindfulness Skill Training
Present moment awareness
What is Mindfulness?
• “Mindfulness” is the act of consciously focusing the mind in the present
moment without judgment and without attachment to the moment.
• When mindful, we are aware in and of the present moment. We can contrast
mindfulness with automatic, habitual, or rote behavior and activity.
• When mindful, we are alert and awake, like a sentry guarding a gate. We can
contrast mindfulness with rigidly clinging to the present moment, as if we
could keep a present moment from changing if we cling hard enough.
• We can contrast mindfulness with rejecting, suppressing, blocking, or
avoiding the present moment, as if “out of mind” really did mean “out of
existence” and “out of influence” upon us. When mindful, we enter into each
moment.
Goals of Mindfulness
1. Reduce Suffering and Increase Happiness
• Reduce pain, tension, and stress.
• Increase joy and happiness.
• Improve physical health, relationships, and distress tolerance.
• Other goals that participants might have can also be discussed and
written in the handout.
2. Increase Control of Your Mind:
“To a certain extent, being in control of your mind is being in control of
your attention—that is, what you pay attention to and how long you pay
attention to it.”
Goals of Mindfulness
• Increase your ability to focus your attention. “In many ways,
mindfulness practice is the practice of controlling your attention. With
a lot of practice, you get better at it.” Explain that mindfulness reduces
automaticity of attentional processes.
• Improve your ability to detach from thoughts, images, and
sensations. Explain that often we react to thoughts and images as if
they are facts. We get entangled in the events in the mind and cannot
tell the difference between a fact in the world and thoughts or images
of the world.
Universal Characteristics of Mindfulness
• Intentionally Living with Awareness in the Present Moment
Explain that this means waking up from automatic or rote behaviors to
participate and be present to our own lives.
• Without Judging or Rejecting the Moment
Point out that this means noticing consequences, as well as discerning
helpfulness and harmfulness—but letting go of evaluating, avoiding, suppressing,
or blocking the present moment.
• Without Attachment to the Moment
Emphasize that this means attending to the experience of each new moment,
rather than ignoring the present by clinging to the past or grasping for the future.
Example: “You can’t be attached to having a newborn baby in the house,
because quickly the baby will grow into a toddler.”
Core Mindfulness Skills
• Wise Mind; the “what” skills of observing, describing, and participating;
and the “how” skills of practicing nonjudgmentally, one-mindfully, and
effectively.
• Stone flake on the lake. Imagine that you are by a clear blue lake on a
beautiful sunny day. Then imagine that you are a small flake of stone, flat
and light. Imagine that you have been tossed out onto the lake and are now
gently, slowly, floating through the calm, clear blue water to the lake’s
smooth, sandy bottom. •• Notice what you see, what you feel as you float
down, perhaps in slow circles, floating toward the bottom. As you reach the
bottom of the lake, settle your attention there within yourself. •• Notice the
serenity of the lake; become aware of the calmness and quiet deep within. ••
As you reach the center of your self, settle your attention there.
 Module III:
Distress Tolerance Skills
Training
Tolerate and survive crises without making things worse
Goals of Distress Tolerance
• Survive crisis situations without making them worse.
• Accept reality replace suffering and being “stuck” with ordinary pain
and the possibility of moving forward.
• Become free of having to satisfy the demands of your own desires,
urges, and intense emotions
1. Crisis Survival Skills
• Crisis survival skills are short-term solutions to painful situations.
Their purpose is to make a painful situation more tolerable, so that it is
possible to refrain from impulsive actions that can make the situation
worse.
1. The STOP Skill
2. Pros and Cons
3. TIP Skills
4. Distracting with Wise Mind ACCEPTS
5. Self-Soothing
6. Improving the Moment IMPROVE
P
2. Reality Acceptance Skills
• The goal of reality acceptance skills is to reduce suffering and increase
freedom when painful facts cannot be changed immediately, if ever.
1. Radical Acceptance
2. Turning the Mind
3. Willingness
4. Half-Smiling and Willing Hands
5. Mindfulness of Current Thoughts
Radical Acceptance
When you cannot keep painful events and emotions from coming your way
• What Is Radical Acceptance?
1. Radical means all the way, complete and total.
2. It is accepting in your mind, your heart, and your body.
3. It’s when you stop fighting reality, stop throwing tantrums because reality is not
the way you want it, and let go of bitterness.
• What Has to Be Accepted?
1. Reality is as it is (the facts about the past and the present are the facts, even if
you don’t like them).
2. There are limitations on the future for everyone (but only realistic limitations
need to be accepted).
3. Everything has a cause (including events and situations that cause you pain and
suffering).
4. Life can be worth living even with painful events in it.
Radical Acceptance
• Why Accept Reality?
1. Rejecting reality does not change reality.
2. Changing reality requires first accepting reality.
3. Pain can’t be avoided; it is nature’s way of signaling that something is
wrong.
4. Rejecting reality turns pain into suffering.
5. Refusing to accept reality can keep you stuck in unhappiness, bitterness,
anger, sadness, shame, or other painful emotions.
6. Acceptance may lead to sadness, but deep calmness usually follows.
7. The path out of hell is through misery. By refusing to accept the misery
that is part of climbing out of hell, you fall back into hell.
 Module IV:
Emotional Regulation Skills
Training
To reduce emotional suffering
Emotional Regulation
• The goal of emotion regulation is to reduce emotional suffering.
• The goal is not to get rid of emotions; emotions have important functions in
our lives.
• It helps client to change emotions that the client (not other people) want to
change, or to reduce the intensity of their emotions.
• It can also reduce the vulnerability to becoming extremely or painfully
emotional and increase emotional resilience.
• Emotion regulation requires use of mindfulness skills, particularly
nonjudgmental observation and description of own current emotions.
• You have to know what an emotion is and what it does for you before you
can effectively regulate it.
Emotional Regulation Skills
1. Understanding and Naming Emotions
2. Changing Emotional Responses
3. Reducing Vulnerability to Emotion Mind
4. Managing Really Difficult Emotions.
 Understanding and Naming Emotions
What Emotions Do for You
• There are reasons why we have emotions. We need them!
Factors That Make Regulating Emotions Hard
• Lack of skills, reinforcing consequences, moodiness, rumination/ worrying,
myths about emotions, and biology can interfere with changing emotions.
A Model for Describing Emotions
• Emotions are complex responses. Changing any part of the system can change
the entire response.
Ways to Describe Emotions
• Learning to observe, describe, and name your emotion can help you regulate
your emotions.
 Module V:
Interpersonal Effectiveness
Skill Training
Goals of Interpersonal Effectiveness
• Be Skillful in Getting What You Want and Need from Others
ØGet others to do things you would like them to do.
ØGet others to take your opinions seriously.
ØSay no to unwanted requests effectively
• Build Relationships and End Destructive Ones
• Strengthen current relationships.
• Don’t let hurts and problems 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.
Interpersonal Effectiveness Skills
• Objectives Effectiveness: DEAR MAN
Be effective in asserting your rights and wishes.
• Relationship Effectiveness: GIVE
Act in such a way that you maintain positive relationships and that others feel
good about themselves and about you.
• Self--Respect Effectiveness: FAST
Act in such a way that you keep your self-respect.
• Walk the Middle Path
Create and maintain balance in relationships. ‰ Balance acceptance and change
in relationships