Table of Contents

I. An Introduction to DBT Skills Training
1. Rationale for Dialectical Behavior Therapy Skills Training
2. Planning to Conduct DBT Skills Training
3. Structuring Skills Training Sessions
4. Skills Training Treatment Targets and Procedures
5. Application of Fundamental DBT Strategies in Behavioral Skills Training
Part I Appendices
II. Teaching Notes for DBT Skills Modules
6. General Skills: Orientation and Analyzing Behavior
7. Mindfulness Skills
8. Interpersonal Effectiveness Skills
9. Emotion Regulation Skills
10. Distress Tolerance Skills
Index

About the Author

Marsha M. Linehan, PhD, ABPP, the developer of Dialectical Behavior Therapy (DBT), is Professor Emeritus of Psychology and Director Emeritus of the Behavioral Research and Therapy Clinics at the University of Washington. Before retiring in 2019, she devoted her career to developing and evaluating evidence-based treatments for populations with high suicide risk and multiple, severe mental disorders. Dr. Linehan is the 2025 recipient of the Lifetime Achievement Award from the American Foundation for Suicide Prevention. Her contributions to suicide research and clinical psychology research have also been recognized with the University of Louisville Grawemeyer Award for Psychology, the Career/Lifetime Achievement Award from the Association for Behavioral and Cognitive Therapies, the Gold Medal Award for Life Achievement in the Application of Psychology from the American Psychological Foundation, and the James McKeen Cattell Award from the Association for Psychological Science. In her honor, the American Association of Suicidology created the Marsha Linehan Award for Outstanding Research in the Treatment of Suicidal Behavior. Dr. Linehan was featured in TIME Great Scientists: The Geniuses and Visionaries Who Transformed Our World. She is founder of the Linehan Institute and is a Zen master.

Reviews

“DBT skills are useful not only for individuals who suffer from persistent emotion regulation difficulties, but also for individuals in extreme circumstances and people who have ordinary problems. This updated manual provides the ‘flexibility within fidelity’ in teaching these skills that practitioners and treatment adopters need. New, improved, expanded, and much clearer skills--they’re all here! Skills trainers and their clients will benefit from Linehan and her colleagues’ decades of systematic research and time spent developing, testing, and refining these skills, empowering practitioners to confidently offer multiple ways of understanding and practicing new behavior. Experienced skills trainers will notice the evolved richness and depth, while the explanations and teaching points will provide new trainers and students with an excellent foundation for skills training with both adults and adolescents. Providing a solid evidence-based foundation for core clinical training curricula, this manual and the accompanying volume of handouts and worksheets will be essential across the mental health disciplines.”--André Ivanoff, PhD, Columbia University School of Social Work

"Mental health professionals--whether or not they use DBT as their major therapeutic orientation--will find the second edition of Linehan's skills training manual and its companion volume of client worksheets and handouts invaluable. Skills such as mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance should be part and parcel of any therapist’s repertoire. The manual clearly spells out the theoretical basis and rationale for emphasizing these skills and provides a detailed account of how to use the patient material. Especially useful are descriptions of troubleshooting common problems. Therapists are sometimes at a loss to figure out how to help clients with complex problems; these books can significantly help us improve our effectiveness."--Judith S. Beck, PhD, President, Beck Institute for Cognitive Behavior Therapy

"Linehan's pioneering work has guided many--myself included--to incorporate mindfulness into compassionate clinical care in a structured format. The second edition of Linehan's DBT skills training manual and the companion volume of handouts and worksheets reflect two additional decades of wisdom and innovation, further bolstering these indispensable resources."--Zindel Segal, PhD, Distinguished Professor of Psychology in Mood Disorders, University of Toronto–Scarborough, Canada

"DBT is a proven evidence-based treatment that combines the best of our science with the knowledge and compassion of Marsha Linehan--an exceptional researcher and clinician whose innovative work has advanced the field and shifted many individuals from lives of suffering to lives of hope. These outstanding second editions offer guidance on how to implement DBT skills training, while providing the tools needed to deliver this state-of-the-art treatment. They will stand as the authoritative guides for teaching DBT skills, partnering with clients to build lives worth living, and helping us to address our national and international priorities of saving millions of lives lost to suicide worldwide. These 'must-have' books belong on the shelves of every clinician and will be valuable course texts."--Joan Rosenbaum Asarnow, PhD, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles

"I used DBT Skills Training Manual, Second Edition, as a text in my graduate course on cognitive-behavioral/empirically supported therapies. The inclusion in one volume of relevant theory, examples, and pragmatic instructions for implementation is most useful for the classroom. It is a state-of-the-art work that is affordable, well designed, and readable, and will be practical for students long after graduate school. I could also see it serving as an instrumental training resource for interns in outpatient, inpatient, and residential treatment settings."--Marla M. Sanzone, PhD, Adjunct Clinical Professor, Professional Psychology Graduate Program, George Washington University

"Since its introduction to the literature over two decades ago, Marsha M. Linehan's skills training manual has revolutionized the treatment of individuals with borderline personality disorder, and also the practice of psychotherapy in general. Now in a second edition, the manual and accompanying volume of handouts and worksheets provides clinicians, educators, students, and patients with a resource that can guide even novice clinicians to become more effective and knowledgeable in treating our field’s most challenging cases. Of interest to the psychoanalytically informed reader, the second edition has elaborated DBT’s attention to interpersonal concerns, with robust consideration of interpersonal dynamics replacing the approach to enhancing effectiveness presented in the prior edition."--Lois W. Choi-Kain, MD, MEd, Director, Adult Borderline Center and Training Institute, and Program and Medical Director, Gunderson Residence, McLean Hospital; Department of Psychiatry, Harvard Medical School -Marsha Linehan is a pioneering and well-respected researcher and clinician. Dialectical behavior therapy (DBT) has become a therapy of choice for BPD since the publication of her first manual in 1993. DBT has been recommended in guidelines of the English National Institute for Clinical Excellence (NICE)….Ideal for therapists, trainers, and students, the manual can now show the extent to which theory is underpinned by research on outcomes, quoting studies conducted since the publication of the first edition. The research base now includes core skills training for a variety of disorders and not only for those with a diagnosis of BPD and suicide risk. This makes the manual relevant to therapists treating varied clinical and non-clinical populations. The skills for helping clients with emotion regulation and distress tolerance should be in the repertoire of every mental health practitioner and addictions worker. There is a wealth of material in these manuals, now that over 20 years the skills have been tried, tested and refined by Linehan and her colleagues and made accessible to all. Trainers will find that the teaching points in the training manual are clear, with more practical examples citedan excellent foundation for students. The rationale for emphasizing particular behavioral skills is given as well as an explanation of how to use the material with clients….The training skills manual, along with the handout and worksheet volume are valuable resources for practicing clinicians in the field of mental health and addictions, whether or not DBT is their main orientation.--Alcohol and Alcoholism, 5/1/2015ƒƒThe book is well organized, progressing from a rationale for the use of DBT to specific session structures and skills training. It includes an incredible wealth of knowledge well beyond the scope of this short review to cover, but it is sufficient to say that therapists will find detailed instructions for a complete DBT course based on the latest research and clinical practice. This includes tips for therapists in side boxes, summaries of main points, and references to pertinent handouts. The companion workbook…is highly recommended along with this manual. *****--Doody's Review Service, 7/21/2015

“DBT skills are useful not only for individuals who suffer from persistent emotion regulation difficulties, but also for individuals in extreme circumstances and people who have ordinary problems. This updated manual provides the ‘flexibility within fidelity’ in teaching these skills that practitioners and treatment adopters need. New, improved, expanded, and much clearer skills--they’re all here! Skills trainers and their clients will benefit from Linehan and her colleagues’ decades of systematic research and time spent developing, testing, and refining these skills, empowering practitioners to confidently offer multiple ways of understanding and practicing new behavior. Experienced skills trainers will notice the evolved richness and depth, while the explanations and teaching points will provide new trainers and students with an excellent foundation for skills training with both adults and adolescents. Providing a solid evidence-based foundation for core clinical training curricula, this manual and the accompanying volume of handouts and worksheets will be essential across the mental health disciplines.”--André Ivanoff, PhD, Columbia University School of Social Work

"Mental health professionals--whether or not they use DBT as their major therapeutic orientation--will find the second edition of Linehan's skills training manual and its companion volume of client worksheets and handouts invaluable. Skills such as mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance should be part and parcel of any therapist’s repertoire. The manual clearly spells out the theoretical basis and rationale for emphasizing these skills and provides a detailed account of how to use the patient material. Especially useful are descriptions of troubleshooting common problems. Therapists are sometimes at a loss to figure out how to help clients with complex problems; these books can significantly help us improve our effectiveness."--Judith S. Beck, PhD, President, Beck Institute for Cognitive Behavior Therapy

"Linehan's pioneering work has guided many--myself included--to incorporate mindfulness into compassionate clinical care in a structured format. The second edition of Linehan's DBT skills training manual and the companion volume of handouts and worksheets reflect two additional decades of wisdom and innovation, further bolstering these indispensable resources."--Zindel Segal, PhD, Distinguished Professor of Psychology in Mood Disorders, University of Toronto–Scarborough, Canada

"DBT is a proven evidence-based treatment that combines the best of our science with the knowledge and compassion of Marsha Linehan--an exceptional researcher and clinician whose innovative work has advanced the field and shifted many individuals from lives of suffering to lives of hope. These outstanding second editions offer guidance on how to implement DBT skills training, while providing the tools needed to deliver this state-of-the-art treatment. They will stand as the authoritative guides for teaching DBT skills, partnering with clients to build lives worth living, and helping us to address our national and international priorities of saving millions of lives lost to suicide worldwide. These 'must-have' books belong on the shelves of every clinician and will be valuable course texts."--Joan Rosenbaum Asarnow, PhD, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles

"I used DBT Skills Training Manual, Second Edition, as a text in my graduate course on cognitive-behavioral/empirically supported therapies. The inclusion in one volume of relevant theory, examples, and pragmatic instructions for implementation is most useful for the classroom. It is a state-of-the-art work that is affordable, well designed, and readable, and will be practical for students long after graduate school. I could also see it serving as an instrumental training resource for interns in outpatient, inpatient, and residential treatment settings."--Marla M. Sanzone, PhD, Adjunct Clinical Professor, Professional Psychology Graduate Program, George Washington University

"Since its introduction to the literature over two decades ago, Marsha M. Linehan's skills training manual has revolutionized the treatment of individuals with borderline personality disorder, and also the practice of psychotherapy in general. Now in a second edition, the manual and accompanying volume of handouts and worksheets provides clinicians, educators, students, and patients with a resource that can guide even novice clinicians to become more effective and knowledgeable in treating our field’s most challenging cases. Of interest to the psychoanalytically informed reader, the second edition has elaborated DBT’s attention to interpersonal concerns, with robust consideration of interpersonal dynamics replacing the approach to enhancing effectiveness presented in the prior edition."--Lois W. Choi-Kain, MD, MEd, Director, Adult Borderline Center and Training Institute, and Program and Medical Director, Gunderson Residence, McLean Hospital; Department of Psychiatry, Harvard Medical School -Marsha Linehan is a pioneering and well-respected researcher and clinician. Dialectical behavior therapy (DBT) has become a therapy of choice for BPD since the publication of her first manual in 1993. DBT has been recommended in guidelines of the English National Institute for Clinical Excellence (NICE)….Ideal for therapists, trainers, and students, the manual can now show the extent to which theory is underpinned by research on outcomes, quoting studies conducted since the publication of the first edition. The research base now includes core skills training for a variety of disorders and not only for those with a diagnosis of BPD and suicide risk. This makes the manual relevant to therapists treating varied clinical and non-clinical populations. The skills for helping clients with emotion regulation and distress tolerance should be in the repertoire of every mental health practitioner and addictions worker. There is a wealth of material in these manuals, now that over 20 years the skills have been tried, tested and refined by Linehan and her colleagues and made accessible to all. Trainers will find that the teaching points in the training manual are clear, with more practical examples citedan excellent foundation for students. The rationale for emphasizing particular behavioral skills is given as well as an explanation of how to use the material with clients….The training skills manual, along with the handout and worksheet volume are valuable resources for practicing clinicians in the field of mental health and addictions, whether or not DBT is their main orientation.--Alcohol and Alcoholism, 5/1/2015Æ’Æ’ The book is well organized, progressing from a rationale for the use of DBT to specific session structures and skills training. It includes an incredible wealth of knowledge well beyond the scope of this short review to cover, but it is sufficient to say that therapists will find detailed instructions for a complete DBT course based on the latest research and clinical practice. This includes tips for therapists in side boxes, summaries of main points, and references to pertinent handouts. The companion workbook…is highly recommended along with this manual. *****--Doody's Review Service, 7/21/2015