Dialectical Behavior Therapy

The integration of three modes of functioning: emotion mind (decisions out of feeling), reasonable mind (cold logic), and wise mind — the synthesis where emotion and reason meet and produce an organic decision. Wise mind is available to everyone and works like an inner compass. Practiced through meditation and exercises in noticing intuitive bodily signs: tension in the chest, warmth, release.

• 1. Recognize which mind you are in: emotion (decisions from feeling), reasonable (cold logic)?
• 2. Pause and turn inward
• 3. Ask yourself: what is the body saying? What do I feel in the chest, the belly?
• 4. Notice: behind the feeling there is something deeper than logic or emotion alone
• 5. Let an intuitive knowing come up — that is wise mind

When to use:

• At the start of a session, before an important decision
• When the client is stuck between logic and feelings
• In ambivalence about change
• Before commitment work

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not use it to suppress emotion: avoid the framing "use wise mind instead of feeling"
• ⚠️ In dissociation the link to the body may be hard
• ⚠️ Requires the concept to be explained beforehand

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder

Building the capacity to notice phenomena — thoughts, emotions, sensations, events — without trying to change them, stop them, or grab onto them. This is pure observing, like watching clouds in the sky: noticed and let go. The client learns to see thoughts as events of consciousness, not as facts of reality. Practiced through meditation, exercises in noticing without reacting, diary cards.

• 1. Bring attention to the phenomenon (a thought, an emotion, a sensation)
• 2. Notice it as a separate object of consciousness — without merging with it
• 3. Do not judge, do not try to change
• 4. Let it pass, like a cloud going by
• 5. Bring attention back to the present moment

When to use:

• With intrusive thoughts and OCD
• With rumination
• With suicidal thoughts — notice and let go, instead of grabbing on
• In panic disorder — observe sensations without trying to escape them
• In any crisis as a slowing-down move

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not use in acute suicidality, when immediate action is needed
• ⚠️ In marked dissociation it can deepen the detachment
• ⚠️ Requires teaching — clients often try to get rid of the thought instead of observing it

Linehan, M. M. (1993, 2015). Adapted from Buddhist mindfulness (Kabat-Zinn, 1994)

Building the capacity to put inner experience into words: emotions, sensations, events, thoughts. Moving from a vague state ("I feel bad") to a specific, accurate name ("I feel fear, starting with tightness in the chest, intensity 7 out of 10, triggered by a phone call from my mother"). Accurate description specifies the experience and creates distance from the affect, opening a foothold for further work.

• 1. Bring attention to the inner phenomenon
• 2. Find the precise word or description — without judgment, only observation
• 3. Add the intensity (1–10 scale)
• 4. Describe where in the body it is felt
• 5. Say it out loud or write it in the diary

When to use:

• At the psychoeducation stage — to help the client recognize emotions
• In alexithymia (difficulty naming emotions)
• In chain analysis, when describing each link
• In work with images and memories
• Before any emotional work — name first, then work

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ In full dissociation the contact with sensation may not be possible
• ⚠️ Do not impose words — the client must find the fitting description
• ⚠️ In trauma, detailed description can retraumatize

Linehan, M. M. (1993). DBT Skills Training Manual

Building the capacity to engage fully in the current activity, without scattering attention, without self-monitoring, without criticizing what is happening. It is immersion in the moment: dancing without thinking "how do I look", working without intrusive thoughts about the result. The opposite of self-watching and anxious self-control. It activates sources of pleasure and restores the link with life.

• 1. Choose an activity that used to engage you (a hobby, sport, art, contact with people)
• 2. Consciously let go of analysis and self-monitoring before you start
• 3. Immerse yourself in the process — just do it
• 4. If the mind drifts into thoughts — gently come back to the activity
• 5. Notice afterwards: how did this affect your state?

When to use:

• In depression and loss of pleasure (anhedonia)
• In social anxiety — full immersion lowers self-monitoring
• In emotional numbing — to restore contact with pleasure
• In rumination and intrusive thoughts — to fill awareness with the present
• As part of a daily self-regulation plan

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ In a manic episode it may amplify impulsivity
• ⚠️ Requires a sufficient level of physical and psychological safety
• ⚠️ In an eating disorder, choose the activity with care

Linehan, M. M. (1993). Adapted from Zen and mindfulness practices

Building the capacity to see facts without moral labels: not "I am terrible" but "I was late"; not "this is a catastrophe" but "this happened, and I need to find a solution". Non-judgmentalness is not indifference but a distinction between the fact and the interpretation. It reduces self-criticism, shame, and catastrophizing, and opens a place for real action.

• 1. Notice the judgment or label you are pinning on yourself
• 2. Ask yourself: is this a fact or an interpretation?
• 3. Formulate the situation only in observable facts
• 4. Drop the words "should", "awful", "always", "never"
• 5. Describe again — now without judgment

When to use:

• In self-criticism and self-blame
• In shame and guilt
• In catastrophizing
• In chain analysis — to describe the behavior objectively, without moral charge
• In interpersonal conflict — to see the fact, without expanding it into a verdict

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not use it in trauma as "just the facts" — it can be cold and alienating
• ⚠️ Validate the emotion first: hear the pain, then reframe
• ⚠️ In some forms of OCD, combine with other techniques

Linehan, M. M. (1993). Adapted from cognitive therapy and philosophy

Building the capacity to choose actions that work (even when they are not "right" or do not match the sense of fairness), instead of clinging to principles at any cost. It is a pragmatic choice: stepping back from a confrontation if the goal is to keep the relationship, even when the client was right. The focus shifts from "who is right" to "what helps reach the goal".

• 1. Decide what you want to achieve in this concrete situation
• 2. Set the question of fairness aside
• 3. Ask: which action is most likely to lead to the goal?
• 4. Do that action, even if it is not the most "right"
• 5. Evaluate the result: did it work?

When to use:

• In interpersonal conflict
• In pride and the inability to compromise
• In dyadic relationships with highly sensitive partners
• When the client is stuck in "I am right"
• As part of working on commitment to change

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not use it to justify giving up boundaries or submitting to abuse
• ⚠️ In trauma, take care — do not push compliance with a perpetrator
• ⚠️ Requires prior work with self-respect, otherwise it turns into mere submission

Linehan, M. M. (1993, 2015). Adapted from a dialectical approach

A four-component protocol for the rapid lowering of arousal and physiological stress. It works through direct activation of the parasympathetic nervous system. Cold water on the face triggers the dive reflex and lowers heart rate by 10–25% in 1–2 minutes. Intense exercise redirects energy. Paced breathing with a long exhale activates the vagus nerve. Progressive relaxation lowers muscle tension.

• 1. T — Temperature: lower the face into cold water (0–15°C) or apply ice to the neck for 30–60 seconds
• 2. I — Intense exercise: 20 minutes of fast running, push-ups, or jumps (if health allows)
• 3. P — Paced breathing: inhale on a 4-count, exhale on 8 (or longer); 5–10 minutes
• 4. P — Progressive muscle relaxation: tense the muscles for 5 sec, release for 10 sec; work through the body

When to use:

• In a panic attack or hyperarousal — first choice
• In a suicidal crisis — to lower arousal before further work
• In a self-harm urge — for an emergency drop in intensity
• In an aggressive impulse — physical discharge of energy
• In a session before emotional work, if the client is in panic

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Cold water is contraindicated in cardiac arrhythmias and pregnancy
• ⚠️ Intense exercise is contraindicated in injuries and cardiac conditions
• ⚠️ Breathing can cause hyperventilation if the technique is wrong — supervise it
• ⚠️ This is an emergency tool, not a substitute for long-term work

Linehan, M. M. (1993, 2015). Based on the physiology of the dive reflex

A four-step protocol for stopping an impulsive action in the gap between urge and behavior. It breaks the automatic chain: trigger → emotion → urge → action. It creates a micro-pause in which the client can choose a conscious action from wise mind, rather than from the automatism. A key skill in impulsivity, aggression, and suicidal crises.

• 1. Stop — literally freeze. Do not act in this second
• 2. Take a step back — physically or mentally step back, take the observer's position
• 3. Observe — ask yourself: what am I feeling? What is the urge? What is my real goal?
• 4. Proceed mindfully — choose an action from wise mind, not from automatism

When to use:

• In impulsive actions (a sharp reply in a conflict, self-harm, an impulsive purchase)
• In a conflict — before saying anything
• On receiving a provoking message, before replying
• In a suicidal impulse
• As a daily practice in impulsivity disorders

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Not effective in an acute suicidal crisis without other interventions
• ⚠️ Requires preliminary practice — for very fast impulses the skill must be drilled in advance
• ⚠️ With very low reflective capacity it needs adapting and simplifying

Linehan, M. M. (1993, 2015). Adapted from cognitive therapy and Eastern philosophy

A seven-element set of distraction techniques for an acute crisis. It is not a solution to the problem, but a way of getting through the moment without making things worse: redirecting attention, lowering intensity, and lasting until deeper work becomes possible. Each element is a separate switching strategy that the client picks for themselves.

• 1. A — Activities: a walk, cleaning, sport, a hobby — physical redirection
• 2. C — Contributing: help someone — shifting the focus from the self to others
• 3. C — Comparisons: recall the worst moment you have lived through — contextualization
• 4. E — Emotions (opposite): comedy when sad, energetic music when apathetic
• 5. P — Pushing away: mentally postpone the problem to a specific time
• 6. T — Thoughts: counting from 100 down, retelling a film plot, doing a puzzle
• 7. S — Sensations: ice in the hand, a cold shower, a sharp taste — intense physical stimulation

When to use:

• In an acute crisis (suicidality, self-harm, panic attack)
• When the client is not ready for deep work
• In the gap between a crisis and getting help
• As the first line of self-regulation
• To lower the intensity before deeper work

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ It does not replace a long-term solution
• ⚠️ It can be used for chronic avoidance — discuss the balance with the client
• ⚠️ In dissociation, Sensations and Emotions are often more effective than Activities
• ⚠️ Pushing away should not be used to repress important information

Linehan, M. M. (1993, 2015). Based on the principles of distraction and attention switching

A seven-element set of techniques for improving the subjective experience of the present moment without changing the situation itself. When the problem stays, but the quality of experiencing the moment can be raised. Includes imagery of a safe place, finding meaning, prayer, relaxation, attention to small pleasures, a strategic break from the problem, and self-encouragement.

• 1. I — Imagery: imagine a calm place in detail — sounds, smells, colors (5–10 minutes)
• 2. M — Meaning: find meaning in the current pain — for what? What will you learn?
• 3. P — Prayer: to a higher power, the universe — to release and ask for help
• 4. R — Relaxation: a warm bath, massage, relaxing music, yoga
• 5. O — One thing: focus on one small pleasure right now
• 6. V — Vion: strategically postpone the problem for a short time — "until tomorrow"
• 7. E — Encouragement: speak to yourself as you would to your best friend

When to use:

• In chronic pain or long-term stress that cannot be solved quickly
• In losses and uncontrollable circumstances
• As a daily practice for sustaining quality of life
• When despair is rising
• For the prevention of suicidality in prolonged crises

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not use in an acute crisis — more urgent interventions are needed (TIPP, STOP)
• ⚠️ Prayer requires respect for the client's beliefs — do not impose
• ⚠️ It can be heard as denial of real pain — validate first

Linehan, M. M. (1993, 2015). Based on positive psychology and coping techniques

Full acknowledgment and the end of the fight with what cannot be changed: the past, a loss, others' actions, uncontrollable circumstances. It is not approval of what happened, but the end of the war with reality. The formula: pain (unavoidable) + non-acceptance (a choice) = suffering. Radical acceptance removes the second term. Practiced through meditation, the half-smile, and willing hands.

• 1. Identify: what exactly cannot be changed in this situation?
• 2. Acknowledge the pain it carries — without minimizing
• 3. Ask: what does fighting this fact give you? What does it cost?
• 4. Make an active choice: "I acknowledge that this is so"
• 5. Ask: what can I do, given that this is reality?

When to use:

• In losses (death, divorce, a diagnosis)
• In past trauma that cannot be undone
• In uncontrollable circumstances
• When stuck in trying to redo the past
• After attempts to change the situation have failed

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not use during ongoing harm or abuse, when the client can still act
• ⚠️ It can be misheard as resignation to injustice
• ⚠️ Requires prior validation and grief work — acceptance only after grieving
• ⚠️ In trauma it requires sufficient safety

Linehan, M. M. (1993, 2015). Based on Buddhist philosophy and Stoicism (Epictetus)

A technique for distinguishing whether the intensity and the kind of an emotion fit the actual situation. If they do not — Opposite Action is applied. If they do — Problem Solving. The client learns to separate a real threat from a catastrophizing interpretation, which makes a precise intervention possible.

• 1. Describe what happened — facts only, no interpretation
• 2. Name your thoughts and interpretation of the situation
• 3. Record the prediction — what you think will happen
• 4. Find evidence for and against your interpretation
• 5. Rate the real likelihood and scale of the threat (in %)
• 6. Conclusion: does the emotion fit the facts? → Problem Solving. Does not fit? → Opposite Action

When to use:

• In catastrophizing (predicting the worst)
• In panic disorder
• In social anxiety (mind-reading others)
• In jealousy (suspicions without evidence)
• At the start of any emotion work — assess reality first

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ In an acute crisis it can be too cognitive — stabilize first
• ⚠️ In PTSD reviewing the facts can retraumatize
• ⚠️ Do not use as an accusation: "It is just in your head"

Linehan, M. M. (1993, 2015). Based on cognitive therapy (Beck, Ellis)

When the emotion does not fit the facts of the situation — do the action opposite to the urge that the emotion produces. Fear says "flee" — approach. Anger says "attack" — be gentle. Sadness says "isolate" — be active. The technique works only with unjustified emotions and requires a complete carry-out: not just the action, but facial expression, voice, and posture.

• 1. Recognize the emotion and check that it does NOT fit the real threat (via Check the Facts)
• 2. Identify the action urge the emotion carries
• 3. Choose the opposite action: fear → approach; anger → gentleness; sadness → activity; shame → disclose
• 4. Do it FULLY: action + facial expression + voice + posture
• 5. Hold for 15+ minutes, watching how the intensity of the emotion changes

When to use:

• In phobias and fears, when the emotion does not fit the real threat
• In unjustified anger in relationships
• In shame that is not linked to a real value violation
• In prolonged sadness and depressive stuckness
• In avoidant behavior

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ ONLY for unjustified emotions — if the fear matches a real danger, do not apply
• ⚠️ In trauma, observe safety — do not push approach to the traumatic without readiness
• ⚠️ You must actually DO the opposite, not only think about it

Linehan, M. M. (1993, 2015). Based on behavioral principles (exposure) and Buddhist philosophy

A combined skill: ABC accumulates positive experience and resources; PLEASE looks after the physiological base. Together they lower overall vulnerability to emotional breakdowns. ABC: accumulate positive emotions, build mastery, prepare for difficult situations in advance. PLEASE: treat physical illness, eat balanced, avoid substances, keep the sleep schedule, exercise.

• 1. A — Accumulate positives: one positive experience daily, 30 minutes to 2 hours
• 2. B — Build mastery: regularly do something that gives a sense of competence
• 3. C — Cope ahead: rehearse a difficult situation in advance, build a plan "if X — then Y"
• 4. P — PhysicaL illness: treat illness, take medication
• 5. L — Eat balanced: balanced food, regular meals
• 6. E — Avoid drugs/alcohol: minimize substances, especially in vulnerable periods
• 7. A — Sleep: 7–9 hours, regular timing, sleep hygiene
• 8. S — Exercise: 20–30 minutes of movement 3–4 times a week

When to use:

• Early in therapy as psychoeducation about vulnerability
• As prevention of breakdowns
• When the client notices the pattern: not sleeping / not eating / not moving → breakdowns
• Daily, not only in crisis situations
• As the basis of a daily self-regulation plan

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not use as a reproach: "It is your fault, you do not sleep"
• ⚠️ In medical conditions (cancer, autoimmune) it requires adaptation
• ⚠️ In an eating disorder, special caution with the food items
• ⚠️ It works more slowly than emergency techniques, but the effect is longer-lasting

Linehan, M. M. (1993, 2015). Based on the biopsychosocial model of vulnerability

When Check the Facts has shown that the emotion fits a real problem, that problem must be solved, rather than using emotion-regulation techniques. A step-by-step process: define the problem concretely, generate options through brainstorming, evaluate and choose the best, build a concrete plan of action, carry it out, and assess the result.

• 1. Define the problem concretely (not "I feel bad", but "I lost my job")
• 2. Brainstorm: any ideas without criticism, 5–10 minutes, the goal is volume
• 3. Evaluate the options: pros and cons, likelihood of working, cost
• 4. Choose one option or a combination
• 5. Build a concrete plan: step 1 — what, when, how; step 2.
• 6. Execute in order, adapting as needed
• 7. Assess the result: did it work? How much? What next?

When to use:

• When the emotion fits the real problem (after Check the Facts)
• In any life difficulty (work, study, relationships, money)
• As part of a chain analysis — what could have been done instead of the breakdown
• In session and as homework

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not use it instead of Opposite Action when the emotion does not fit reality
• ⚠️ In an acute crisis it can be too cognitive — stabilize first
• ⚠️ In severe depression it requires extra motivational support

Linehan, M. M. (1993, 2015). Adapted from D'Zurilla & Goldfried (1971)

A seven-step skill for effectively asserting your needs and getting the desired result. The focus is on the goal: when the result matters more than the relationship. It structures the request: an objective description of the situation, expression of feelings, a direct request, an explanation of the benefit, staying on topic, a confident appearance, and readiness to negotiate.

• 1. D — Describe: 1–2 sentences about the situation, only facts without judgment
• 2. E — Express: your feelings and view, using "I"-statements
• 3. A — Assert: state the request or refusal DIRECTLY, without hints
• 4. R — Reinforce: explain why this is good for both — briefly
• 5. M — Mindful: stay on topic, do not get sidetracked into other complaints
• 6. A — Appear confident: a steady voice, eye contact, an upright back
• 7. N — Negotiate: be ready to compromise on details while keeping the principle

When to use:

• When you need a concrete result
• When asking for help, time, resources
• When you have to say "no" or hold a boundary
• In work, family, and friendship relationships

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not apply it during physical violence or coercive control — safety first
• ⚠️ In social anxiety it requires preparation and rehearsal
• ⚠️ It requires a balance of confidence and safety

Linehan, M. M. (1993, 2015)

A four-step skill for keeping and strengthening the relationship. The focus is on connection: when the relationship matters more than the concrete result. It includes gentleness (no attacks or manipulation), active interest in the other's view, validation of their feelings, and an easy tone. Used together with DEAR MAN or FAST depending on the priority.

• 1. G — Gentle: no attacks, threats, manipulation, or sarcasm; soft voice, acknowledge the other's feelings
• 2. I — Interested: listen actively, ask questions, do not interrupt
• 3. V — Validate: acknowledge that their feelings make sense in their context
• 4. E — Easy manner: without unneeded tension, with humor where suitable

When to use:

• In conflicts, when the relationship matters
• With a partner, family, close friends
• When the relationship matters more than winning the argument
• When the client wants to keep the connection but does not know how

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ GIVE does not mean giving up your needs — it can be combined with DEAR MAN
• ⚠️ Do not use it under partner manipulation or violence
• ⚠️ It requires inner intent — the client will sense fake GIVE

Linehan, M. M. (1993, 2015)

A four-step skill for keeping self-respect in interpersonal situations. The focus is on the self: when self-respect matters more than the relationship. It includes fairness to oneself (not only to the other), refusing unnecessary apologies for one's own rights, fidelity to one's values, and honesty without exaggeration.

• 1. F — Fair: be fair to yourself and to the other — equal respect
• 2. A — Apologies (no excess): do not apologize for what you have a right to
• 3. S — Stick to values: do not sacrifice values for approval
• 4. T — Truthful: speak the truth, do not exaggerate or minimize

When to use:

• When you risk losing yourself in the relationship
• When you are being manipulated or pressured
• In low self-esteem and a tendency to endless concession
• In boundary violations

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not confuse FAST with harshness — it is about respect, not opposition
• ⚠️ In combination with GIVE and DEAR MAN it lets you balance goal, relationship, and self-respect
• ⚠️ With strong dependence on approval, prior values work is needed

Linehan, M. M. (1993, 2015)

A detailed walk-through of a concrete problem behavior along the entire chain: vulnerability → prompting event → thoughts → emotions → sensations → urge → problem behavior → consequences. This is the main analytic tool in individual DBT. After the walk-through, for every link a question is asked: which skill could have broken the chain at this point?

• 1. Vulnerability: what weakened the client that day? (lack of sleep, hunger, stress, breaking PLEASE)
• 2. Prompting event: a specific trigger — a call, a message, a meeting, a thought
• 3. The chain of links: thoughts → emotions (name + intensity) → body sensations → urge
• 4. Problem behavior: what exactly happened
• 5. Consequences: short-term and long-term
• 6. Solution analysis: for each link — which skill could have broken the chain?

When to use:

• After every target behavior (self-harm, crisis, breakdown) in an individual session
• When there is a repeating pattern of behavior
• For learning: how the chain works, not as punishment
• In Stage 1 of DBT (behavioral control)

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Not as punishment, but as learning — neutral, exploratory tone
• ⚠️ Validate first: hear the pain, then analyze
• ⚠️ Do not run it in the moment of an acute crisis — stabilize first
• ⚠️ Requires enough time: 20–30 minutes in session

Linehan, M. M. (1993, 2015)

Six levels of validation — from basic listening to radical genuineness. Validation is the "wing of acceptance" in DBT. Without it, change strategies trigger resistance. Key principle: validation does not equal approval — the therapist validates the emotion, not the behavior. Six levels: attentive listening, accurate reflection, articulating the unspoken, validation through the client's history, normalization in the present context, radical genuineness.

• 1. Level 1: attentive listening — presence, eye contact, nodding
• 2. Level 2: accurate reflection — repeat the gist without interpretation
• 3. Level 3: articulate the unspoken — name what is behind the words
• 4. Level 4: validation through history — the reaction makes sense given the client's past
• 5. Level 5: normalization — anyone would react this way in this situation
• 6. Level 6: radical genuineness — relate as an equal, with appropriate self-disclosure

When to use:

• In every session before change strategies
• With strong client emotion
• When the client feels "wrong" or criticizes themselves
• With therapy-interfering behavior — before naming it

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Validation does not equal approval — validate the emotion, not the behavior
• ⚠️ Do not over-elaborate — the client may feel "analyzed"
• ⚠️ It requires sincerity — the client senses fake
• ⚠️ In manipulation: validate the emotion, but hold the therapeutic limits

Linehan, M. M. (1993, 2015)

A set of tactics for strengthening the client's commitment to therapy and to change. Commitment is not a one-off signature, but a recurring process in which the therapist actively takes part. It includes: starting small (foot-in-the-door), the contrast effect (door-in-the-face), devil's advocate, freedom of choice, a pros-and-cons table, sincere support, and acknowledgment of the client's responsibility.

• 1. Foot-in-the-door: start with a small commitment — "Let us try 4 weeks?"
• 2. Devil's advocate: argue against change, so the client argues for it
• 3. Pros and cons: jointly draw a table of the pros and cons of change
• 4. Free choice: "It is your choice. I will not force you" — the paradox of freedom strengthens the choice
• 5. Cheerleading: sincere support — "I believe you can"
• 6. Acknowledging responsibility: the client acknowledges that this is their choice and their life

When to use:

• In the pre-treatment phase (orientation and initial commitment)
• At the start of every new stage or after a break
• When motivation drops
• In therapy-interfering behavior

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Devil's advocate requires a strong alliance — without it, it sounds like mockery
• ⚠️ Cheerleading must be sincere — fake support breaks trust
• ⚠️ Renew commitment regularly, not only at the start

Linehan, M. M. (1993, 2015). Based on social psychology (Cialdini, Festinger)

The core of DBT: dialectics means that opposites can be true at the same time. The client is ill AND can change. Their pain is real AND life can improve. The therapist accepts the client AND demands change. Includes work with polarized thinking through the metaphor of the pendulum, devil's advocate, extending, finding the opportunity in a crisis, and two styles of communication — warm (reciprocal) and irreverent.

• 1. Identify the polarity the client is stuck in ("all or nothing")
• 2. Name both extremes without judgment
• 3. Use a metaphor: a pendulum looking for the center
• 4. Ask an integration question: how can both truths exist at the same time?
• 5. If stuck — devil's advocate or extending (gently)
• 6. Balance the warm style (reciprocal) and the irreverent

When to use:

• When the client is in "either/or" mode
• When stuck in one position and unable to move
• In resistance to change
• In every session — this is not a technique but the philosophy of DBT

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Irreverent requires established trust — without it, it sounds like harshness
• ⚠️ It can be misheard as mockery
• ⚠️ It requires sincerity and good contact with the client

Linehan, M. M. (1993, 2015). Based on dialectical philosophy (Hegel)

A six-step model showing how an emotion arises and develops: trigger → interpretation → emotion (name + intensity) → action urge → behavior → consequences. It is the basis for all emotion-regulation work in DBT. The model normalizes emotions (they are the result of logic, not enemies) and creates points for intervention at each step.

• 1. Identify the trigger — an external event or an inner phenomenon (a memory, a thought)
• 2. Name the interpretation — what does this mean? (a fast appraisal, often outside awareness)
• 3. Name the emotion — name + intensity on a 1–10 scale
• 4. Identify the action urge — what did you want to do? (run, attack, hide)
• 5. Describe the behavior — what was done or not done
• 6. Mark the consequences — short-term and long-term

When to use:

• In psychoeducation — to help the client understand where emotions come from
• In chain analysis — to look at a specific emotion and behavior
• To normalize emotions
• As a basis for all other emotion-regulation techniques

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not use it for self-blame — "it is your interpretation, your fault"
• ⚠️ In an acute emotion, the model can be too cognitive — stabilize first
• ⚠️ It takes time and practice to integrate

Linehan, M. M. (1993, 2015). Based on the cognitive model of emotion (Beck, Ekman)

A six-step model showing how an emotion arises and develops: trigger → interpretation → emotion (name + intensity) → action urge → behavior → consequences. It is the basis for all emotion-regulation work in DBT. The model normalizes emotions (they are the result of logic, not enemies) and creates points for intervention at each step.

• 1. Identify the trigger — an external event or an inner phenomenon (a memory, a thought)
• 2. Name the interpretation — what does this mean? (a fast appraisal, often outside awareness)
• 3. Name the emotion — name + intensity on a 1–10 scale
• 4. Identify the action urge — what did you want to do? (run, attack, hide)
• 5. Describe the behavior — what was done or not done
• 6. Mark the consequences — short-term and long-term

When to use:

• In psychoeducation — to help the client understand where emotions come from
• In chain analysis — to look at a specific emotion and behavior
• To normalize emotions
• As a basis for all other emotion-regulation techniques

Key phrases:

Follow-up questions:

Warnings:

• ⚠️ Do not use it for self-blame — "it is your interpretation, your fault"
• ⚠️ In an acute emotion, the model can be too cognitive — stabilize first
• ⚠️ It takes time and practice to integrate

Linehan, M. M. (1993, 2015). Based on the cognitive model of emotion (Beck, Ekman)