Dialectical behavior therapy combines cognitive-behavioral strategies & mindfulness to help manage intense emotions & improve relationships.
DBT worksheets helps clients focus on skills training to enhance coping mechanisms.
Practicing mindfulness can empower clients to navigate challenges more effectively, enhancing overall wellbeing.
Dialectical behavior therapy (DBT) is a structured, evidence-based approach designed to help individuals regulate emotions, build healthier relationships, and develop effective coping skills.
Originally developed for borderline personality disorder, DBT is now widely used for conditions like substance use, anxiety, and depression (Linehan, 2015).
In my clinical work with adolescents and adults in residential treatment, I’ve seen DBT’s impact firsthand. While some clients — especially younger ones — resist the structured feel of DBT worksheets, many come to value them as essential tools for building self-awareness and practicing real-world skills.
This article explores how DBT worksheets and techniques can be used effectively across different settings and populations, offering structure, insight, and flexibility to support meaningful therapeutic change.
Before you continue, we thought you might like to download our three Mindfulness Exercises for free. These science-based, comprehensive exercises will help you cultivate a sense of inner peace throughout your daily life, and will also give you the tools to enhance the mindfulness of your clients, students, or employees.
DBT worksheets offer practical tools for learning and applying core skills. However, their impact depends on how they’re introduced and tailored to each client.
While some clients appreciate the structure, others may find worksheets too rigid or reminiscent of school. Understanding a client’s learning style and engagement preferences is essential for making these tools meaningful and effective (Linehan, 2015).
Who benefits most from DBT worksheets?
Clients who value guidance and structure may find DBT therapy worksheets especially helpful. These individuals may struggle with organizing their thoughts and emotions, and worksheets offer a clear framework for reflection and skill building (Neacsiu et al., 2014).
Clients working on emotional regulation, distress tolerance, and behavioral tracking frequently benefit from a structured approach (Neacsiu et al., 2014).
Adapting worksheets for resistant clients
For clients, especially adolescents, who find worksheets too rigid, alternative approaches can make them more engaging (Rizvi et al., 2024).
Verbal processing
Instead of filling out a worksheet, discuss worksheet content in session and capture highlights through conversation.
Digital or creative adaptations
Use apps, journals, or drawing to reflect on emotions and behaviors.
Interactive learning
Practice DBT skills through role-play or real-life examples.
Gamification
Track skill usage as a weekly challenge to make learning feel more dynamic and rewarding.
Tracking progress and building consistency
When used regularly, DBT worksheets help clients recognize emotional and behavioral patterns over time (Linehan, 1993). One of the most valuable tools is the DBT diary card, which supports daily tracking of mood, behaviors, and skill use (Linehan, 1993).
Additionally, setting small, achievable goals around worksheet completion can improve engagement.
Final thoughts on using DBT worksheets effectively
The key to using DBT worksheets effectively is flexibility. They’re not universally applicable tools; they work best when adapted to individual preferences and paired with meaningful discussion or in-session practice. When therapists treat worksheets as tools for exploration rather than homework, clients are more likely to stay engaged and benefit from the process.
4 Best DBT Worksheets for BPD
Borderline personality disorder (BPD) is often characterized by intense emotions, impulsivity, unstable relationships, and difficulty with self-regulation (Linehan, 1993).
DBT has become the gold-standard treatment for BPD, providing structured strategies to help individuals develop emotional stability and improve interpersonal functioning (Linehan, 2015).
1. Mindfulness
Practicing mindfulness encourages observing thoughts without judgment, which can be especially beneficial for those who struggle with distressing emotions and identity instability (Neacsiu et al., 2014).
Guide clients in labeling their emotions without reacting impulsively
Build awareness of thought patterns that contribute to emotional distress
Track patterns and improve self-awareness
2. Distress tolerance
Individuals with BPD often experience overwhelming emotions that lead to impulsive actions, such as self-harm or substance use. Distress tolerance skills teach clients how to manage crises effectively without engaging in harmful behaviors (Linehan, 1993).
Encourage clients to pause before reacting to emotional triggers
Walk through five steps: Stop, take a breath, observe, pull back, proceed mindfully
Prevent impulsive decisions in high-stress situations
3. Emotional regulation
BPD is marked by difficulty managing emotional intensity, often leading to mood swings and prolonged distress. Emotional regulation skills focus on identifying, understanding, and shifting emotional responses (Rizvi et al., 2024).
Guide clients to identify an intense emotion and choose a better response
Reduce emotion-driven behaviors that can lead to negative outcomes
Focus attention on positive events that can increase positive emotions
4. Interpersonal effectiveness
Many individuals with BPD struggle with maintaining stable relationships due to fears of abandonment, difficulties with assertiveness, and emotional intensity (Linehan, 1993).
Interpersonal effectiveness skills teach clients how to communicate needs, set boundaries, and maintain self-respect in relationships (Linehan, 2015).
Help clients practice assertive communication without aggression or passivity
Encourage clear expression of needs while maintaining positive relationships
Practice assertiveness with difficult relationship conversations
Final thoughts
DBT worksheets are valuable tools for individuals with BPD, providing structured guidance to apply key DBT skills in daily life. By consistently practicing mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness, clients can build greater emotional resilience and stability over time (Linehan, 1993).
DBT’s effectiveness extends well beyond BPD. The following worksheets may also be helpful across a range of clinical concerns, from addiction to anxiety, depression, and trauma.
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Best DBT Worksheets for Addiction & Other Modalities
DBT has been widely adapted beyond BPD, demonstrating effectiveness in addiction recovery, anxiety and depression treatment, and trauma work (Rizvi et al., 2024).
While worksheets are not a complete solution on their own, they serve as a structured supplement to therapy, helping clients track behaviors, recognize patterns, and reinforce DBT skills in daily life (Linehan, 2015).
Addiction recovery
Addiction is often driven by emotional dysregulation and impulsivity, making DBT’s distress tolerance and mindfulness skills particularly useful in recovery (Axelrod et al., 2011).
Encourage clients to observe cravings without acting on them
Ride out urges like waves rather than resisting or indulging them
Assist in early recovery when cravings are strong
Anxiety & depression
For individuals with anxiety and depression, DBT helps by promoting emotional regulation, acceptance, and cognitive flexibility (Neacsiu et al., 2014). Worksheets in this area focus on reducing avoidance, identifying negative thought patterns, and engaging in behaviors that improve mood stability.
Help clients acknowledge painful realities without judgment or resistance
Distinguish between pain that can be changed and pain that must be accepted
Assist trauma survivors struggling with feelings of injustice, grief, or past harm
For some clients, completing worksheets offers a sense of accomplishment and a tangible way to track progress. Others benefit from a more flexible approach, using worksheets as a springboard for deeper reflection.
4 Essential DBT Therapy Skills for Effective Therapists
Therapists play a critical role in ensuring that worksheets are seen as not just another homework assignment, but rather as a meaningful part of the therapeutic process.
The following strategies can help therapists engage clients, reinforce learning, and adapt DBT worksheets to meet diverse needs (Linehan, 2015).
1. Encourage active engagement
In my experience, some clients resist worksheets when it feels like a forced, academic task (Rizvi et al., 2024). To increase engagement, therapists can try the following strategies.
Give clients autonomy in how they complete their worksheets, allowing them to use color, drawings, or different formats that make the process feel more personal and creative.
Let clients choose which worksheets feel most relevant to their current struggles, making them more invested in the process.
Use worksheets interactively, filling them out together in group settings or using them as discussion prompts in session.
2. Reinforce skill building through application
Therapists can maximize the impact of DBT worksheets by connecting them directly to real-world experiences. Worksheets should not be an isolated activity but rather a bridge between therapy sessions and daily life (Neacsiu et al., 2014). Strategies include the following:
Try role-play exercises where clients apply worksheet concepts in simulated situations.
Encourage clients to track progress by reviewing past worksheets, helping them identify growth and recurring patterns.
Assign small, manageable worksheet tasks rather than overwhelming clients with lengthy assignments.
3. Tailor worksheets to different populations
Different clients require different approaches when working with DBT worksheets (Rizvi et al., 2024).
Adolescents
Encourage creativity and personalization to increase engagement, such as using markers and keeping worksheets in a decorated binder.
Trauma survivors
Worksheets should be paced carefully to avoid emotional overwhelm. Gradual exposure and gentle processing can make difficult exercises more manageable.
Clients in addiction recovery
Worksheets on triggers, cravings, and distress tolerance should be paired with real-life action steps such as using the “Urge Surfing” worksheet during moments of craving.
4. Provide feedback and overcome resistance
For some clients, worksheets feel overwhelming or uncomfortable, leading to frustration or avoidance. Therapists can help by:
Reviewing worksheets together rather than expecting clients to complete them independently
Using nonjudgmental feedback to help clients explore their responses rather than feeling graded or evaluated
Normalizing resistance by discussing common challenges and helping clients reframe worksheets as a tool for growth rather than a chore
DBT worksheets are most effective when therapists integrate them into a dynamic, personalized approach rather than a rigid assignment (Rizvi et al., 2024). By fostering autonomy, creativity, and real-world application, therapists can help clients actively engage with DBT skills, leading to greater emotional awareness, regulation, and long-term change (Linehan, 2015).
5 DBT Therapy Techniques for Your Sessions
DBT sessions incorporate a variety of structured techniques designed to help clients regulate emotions, tolerate distress, and improve relationships.
While worksheets are an important tool, interactive techniques and in-session strategies bring DBT skills to life. Below are some of the most effective techniques therapists can use to reinforce learning and facilitate real-world application (Linehan, 2015).
1. The STOPP technique
The STOPP technique is a quick self-regulation strategy that helps clients interrupt impulsive reactions and make more mindful choices.
How it works:
Stop – Pause before reacting.
Take a deep breath – Create space between trigger and response.
Observe – Notice thoughts, emotions, and bodily sensations.
Pull back – Consider a bigger-picture perspective.
Proceed – Respond with intention rather than impulse.
Best used for:
Clients with impulsivity issues (BPD, addiction, anger management)
Teaching clients momentary distress tolerance skills in sessions
Helping clients reduce emotional reactivity in real time
2. Using diary cards in session
DBT diary cards track emotions, behaviors, and skill use over time. While some clients resist them, reviewing diary cards in session makes the process more meaningful (Linehan, 1993).
How it works:
Clients track daily emotions, urges, and DBT skills used.
Therapists review the cards in session, looking for patterns and triggers.
Clients can see their progress over time and adjust their coping strategies.
Best used for:
Clients with emotional dysregulation and self-destructive behaviors
Identifying high-risk situations for relapse or crisis
Encouraging accountability and self-awareness
3. Chain analysis
Chain analysis is a problem-solving tool that helps clients break down behaviors into triggers, thoughts, emotions, and consequences (Neacsiu et al., 2014).
How it works:
Identify the problem behavior.
Map out the chain of events leading up to the behavior.
Identify where a DBT intervention could have occurred and plan alternative responses.
Best used for:
Clients who repeat maladaptive behaviors despite negative consequences
Helping clients understand underlying patterns behind their actions
Teaching realistic problem-solving skills
4. Radical acceptance
Many clients struggle with resisting painful realities, leading to increased emotional suffering. Radical acceptance teaches clients to acknowledge reality without judgment or avoidance (Rizvi et al., 2024).
How it works:
Acknowledge the reality of a painful situation instead of fighting it.
Shift from “This shouldn’t be happening” to “This is happening, and I can choose how to respond.”
Use mindfulness and distress tolerance to reduce emotional resistance.
Best used for:
Clients struggling with grief, trauma, or unresolved pain
Teaching clients to separate pain from suffering
Helping clients focus on what they can control instead of ruminating on what they can’t
If you work with children, you may find this video helpful, as it’s geared toward helping children understand this concept and teaches them about distress tolerance skills.
Radical acceptance DBT coping skills for kids
5. Wise mind
“Wise mind” is a central concept in DBT that helps clients recognize the balance between “reasonable mind” and “emotion mind.” Wise mind is the calm, grounded place where logic and emotion meet, and decisions are made from a place of inner clarity and personal values (Linehan, 2015).
How it works:
Emotion mind is ruled by feelings, impulsivity, and urges.
Reasonable mind is logical, fact driven, and emotionally detached.
Wise mind integrates both, offering a centered, intuitive sense of knowing what’s right.
Best used for:
Early treatment to build mindfulness and self-awareness
Clients struggling with emotional reactivity or indecision
Teaching the importance of balancing emotion and reason in daily life
Therapists often introduce the wise mind concept early in DBT to help clients understand how their state of mind influences decisions. Visual metaphors, guided meditations, and experiential exercises can make this concept more accessible.
Psychoeducation and chair work can help clients reflect on what it feels like to “sit” in each mind state, deepening awareness of how thoughts and emotions show up in different situations.
Final thoughts
DBT techniques bring worksheets and skill building into live therapeutic interactions, allowing clients to practice strategies in real time. These techniques provide practical, structured ways for clients to engage with DBT skills and apply them in daily life.
Top 17 Exercises for Mindfulness & Meditation
Use these 17 Mindfulness & Meditation Exercises [PDF] to help others build life-changing habits and enhance their wellbeing with the physical and psychological benefits of mindfulness.
Many of the foundational principles of DBT — such as mindfulness, emotion regulation, and value-based living — are echoed in the field of positive psychology.
If you’re looking to deepen your DBT practice or provide clients with science-based, practical tools to support their growth, the resources available through PositivePsychology.com can serve as a powerful complement.
To explore additional blog articles that have curated DBT worksheets, check out:
356+ science-based exercises, including tools that align with DBT’s focus on emotion regulation, distress tolerance, and interpersonal effectiveness
Mindfulness tools, guided meditations, and breathing exercises to support clients in grounding and present-moment awareness
Value clarification worksheets to help clients identify what matters most — essential for setting goals aligned with DBT’s wise mind and long-term vision
Self-compassion and resilience practices that pair well with radical acceptance and distress tolerance skills
Printable pdf and practitioner rights for use in clinical or coaching settings
A full train-the-trainer curriculum with video modules, guided meditations, presentation materials, and an instructional manual
A participant workbook and eight-pillar framework for teaching mindfulness in an accessible and comprehensive way
Lifetime updates, a marketing kit, and customizable materials for clinical or educational use
A flexible framework that can be seamlessly integrated into therapy or coaching settings
If you’re not ready for the full training but still want to explore mindfulness-based tools, you can also access a curated collection of 17 science-based mindfulness exercises to support clients in reducing stress and building present-moment awareness.
Whether you’re a therapist, coach, or someone using DBT independently, these resources can help reinforce skills outside of session and support long-term growth.
A Take-Home Message
DBT worksheets offer a structured yet flexible way to support growth in mindfulness, emotion regulation, distress tolerance, and interpersonal skills (Rizvi et al., 2024).
When used consistently and creatively, they empower clients to practice new behaviors, reflect on their experiences, and track progress over time.
Whether used in therapy or independently, worksheets become more than just paper tools; they become tools for insight and change. When paired with in-session DBT techniques, these worksheets can help individuals develop emotional resilience and healthier ways of navigating life’s challenges.
The key is using these tools flexibly, intentionally, and tailored to each client’s needs and learning style. With consistent use, DBT worksheets can become anchors in the therapeutic process, empowering individuals to build emotional resilience, self-awareness, and a life worth living.
Yes, many DBT skills can be practiced independently using worksheets, guided exercises, and self-help resources. However, working with a therapist can deepen your understanding, personalize the approach, and support long-term change.
Why is DBT criticized?
Criticism of DBT often relates to its structured format, the time commitment involved, and concerns about accessibility. Some clients may find it too rigid or academic in tone. That said, research consistently supports DBT’s effectiveness across a range of mental health conditions, including BPD, post-traumatic stress disorder, substance use disorders, and mood disorders (Linehan, 2015).
What is a DBT sheet?
A DBT sheet is a structured worksheet that helps individuals apply key DBT skills in daily life. It may guide users through mindfulness practice, emotion tracking, communication planning, or distress tolerance strategies. These tools help bring DBT concepts into real-world practice and reinforce learning over time.
References
Axelrod, S. R., Perepletchikova, F., Holtzman, K., & Sinha, R. (2011). Emotion regulation and substance use frequency in women with substance dependence. Behaviour Research and Therapy, 49(12), 775–783.
Harned, M. S., Korslund, K. E., & Linehan, M. M. (2012). A pilot randomized controlled trial of dialectical behavior therapy with and without the skills training component for suicidal women meeting criteria for borderline personality disorder. Behaviour Research and Therapy, 50(6), 330–339.
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.
Neacsiu, A. D., Bohus, M., & Linehan, M. M. (2014). Dialectical behavior therapy: An intervention for emotion dysregulation. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 491–507). Guilford Press.
Rizvi, S. L., Bitran, A. M., Oshin, L. A., Yin, Q., & Ruork, A. K. (2024). The state of the science: Dialectical behavior therapy. Behavior Therapy, 55(6), 1233–1248. https://doi.org/10.1016/j.beth.2024.02.006
About the author
Andrea Lein, Ph.D. is a professional speaker, author, and psychologist on a mission to inspire others to lead healthy, flourishing lives. She holds a Ph.D. in Clinical & School Psychology and an M.Ed. in Educational Psychology, specializing in giftedness, from the University of Virginia.
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What our readers think
Brain Leree
on January 15, 2024 at 08:59
I appreciate you giving this information.
In our online treatment, dialectical behavioral therapy is used. It works incredibly well for depression, substance abuse, and borderline personality disorder. Even the most serious cases respond very well to DBT, and we treat a wide range of clients.
I wish DBT was more available in standard mental health services.
In the UK, it’s thin on the ground.
BPD is prolific and causes so much suffering. Yet still much ignorance and stigma remains.
I hate the way so many blame and shame such lonely and fragile people.
We want love, but are terrified of our vulnerability being abused.
I wish I could’ve got this treatment. My partners would not have had to put up with so much, maybe.
Thank you for sharing your thoughts on the availability of Dialectical Behavior Therapy (DBT) and the challenges faced by individuals with Borderline Personality Disorder (BPD). It is indeed disheartening to hear that access to this valuable treatment is limited in the UK and that stigma continues to surround BPD.
The importance of raising awareness about mental health conditions and advocating for better access to evidence-based treatments, such as DBT, cannot be overstated. It is essential to create a more understanding and compassionate society that supports individuals with mental health challenges instead of perpetuating shame and blame.
I encourage you to check out Psychology Today! It has a great directory you can use to find therapists in your local area. Usually, the therapists provide a summary in their profile with their areas of expertise and types of issues they are used to working with.
Please know that your voice matters and your experiences can contribute to raising awareness, challenging stigmas, and ultimately improving mental health care for those who need it most.
What our readers think
I appreciate you giving this information.
In our online treatment, dialectical behavioral therapy is used. It works incredibly well for depression, substance abuse, and borderline personality disorder. Even the most serious cases respond very well to DBT, and we treat a wide range of clients.
I wish DBT was more available in standard mental health services.
In the UK, it’s thin on the ground.
BPD is prolific and causes so much suffering. Yet still much ignorance and stigma remains.
I hate the way so many blame and shame such lonely and fragile people.
We want love, but are terrified of our vulnerability being abused.
I wish I could’ve got this treatment. My partners would not have had to put up with so much, maybe.
Damaged people damage people.
Hi Josh,
Thank you for sharing your thoughts on the availability of Dialectical Behavior Therapy (DBT) and the challenges faced by individuals with Borderline Personality Disorder (BPD). It is indeed disheartening to hear that access to this valuable treatment is limited in the UK and that stigma continues to surround BPD.
The importance of raising awareness about mental health conditions and advocating for better access to evidence-based treatments, such as DBT, cannot be overstated. It is essential to create a more understanding and compassionate society that supports individuals with mental health challenges instead of perpetuating shame and blame.
I encourage you to check out Psychology Today! It has a great directory you can use to find therapists in your local area. Usually, the therapists provide a summary in their profile with their areas of expertise and types of issues they are used to working with.
Please know that your voice matters and your experiences can contribute to raising awareness, challenging stigmas, and ultimately improving mental health care for those who need it most.
Warm regards,
Julia | Community Manager