The 4 Main Skill Modules of Dialectical Behavior Therapy (DBT)

By Lulu Lyle, Taproot Therapy Clinical Trainee

Dialectical Behavior Therapy (DBT) is based on the idea of radical acceptance, which means that people can both accept that “it is what it is,” but also work to change their behaviors for a desired outcome. In other words, one can validate the thought or feeling and still make change. It aims to arrive at the truth by exchange and synthesis of logical yet opposing arguments. Simply put, it is holding two truths at once. DBT was originally developed as the gold-standard treatment for individuals with Borderline Personality Disorder (BPD); however, it can also be effective for a broader range of clients, including those experiencing anxiety, depression, substance use issues, emotional dysregulation without high risk. 

There are four main skill modules of DBT: mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. These main areas help to manage emotions, behaviors, and relationships. 

Mindfulness
Mindfulness is “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally" (Kabat-Zinn, 1994). DBT aims to teach clients the skills to build awareness and respond thoughtfully to their internal and external worlds. Some key skills to build include how to observe, describe, and participate intentionally. 

Distress tolerance 
Distress tolerance is “an individual’s perceived or actual ability to withstand negative emotional and/or other aversive states”(Simons & Gaher, 2005). In DBT, the client will learn skills to remember what to do in emotionally distressing situations. For example, one can focus on building skills to calm their nervous system down, like self-soothing techniques. Distress tolerance focuses on the importance of practicing radical acceptance through saying things to yourself like: I accept it as it is. I can’t change the past. I can only control the present.

Interpersonal effectiveness
Interpersonal effectiveness is how to “attend to relationships, balance priorities versus demands, balance the 'wants' and the 'shoulds,' and build a sense of mastery and self-respect in relationships” (Linehan, 2015). The interpersonal effectiveness skill module focuses on developing skills to build and maintain healthy relationships. DBT includes skills that teach clients how to assert themselves in terms of asking for something or saying no. Additionally, it includes skills for how to maintain and take care of relationships. 
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Emotion regulation 
Emotion regulation refers to “the processes by which individuals influence which emotions they have, when they have them, and how they experience and express these emotions” (Gross, 1998). The emotion regulation aspect helps clients understand and manage their emotional responses. There are DBT skills that help clients focus on the foundational parts of health that have to do with one’s own body because it is hard to help the mind when the body is also not functioning properly. Additionally there are tools such as “opposite action,” which explains how sometimes clients should respond to an emotion with a behavior opposite to its impulse. Lastly, the client will learn skills to reduce the tendency to vacillate between extreme expression and complete suppression.


If you find yourself wanting to improve your mindfulness, distress tolerance, emotional regulation, and/or interpersonal effectiveness, DBT may be the best type of therapy for you! Overall you will learn to: 

• Stay present and aware without judgement.  
• Get through intense emotional situations without making things worse.
• Understand and manage emotions instead of being overwhelmed by them.
• Build and maintain healthy relationships while respecting self and others.