DBT Skills List – The 4 Modules, Every Acronym, and 40 Activities to Practice Them

DBT skills are the practical tools taught in dialectical behavior therapy, grouped into four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Each module has a handful of named skills, many of them taught as acronyms, and each skill is something you practice rather than something you learn about.

This page lists every core skill by module, spells out the acronyms, and gives you 40 activities therapists use to practice them in groups. If you want the short version, the one-page cheat sheet below fits on a fridge.

Free download: DBT skills cheat sheet (PDF). All four modules and every acronym on one page.

At Rockland Recovery Behavioral Health in Sharon, MA, these skills are taught in weekly DBT skills groups paired with individual sessions as part of our DBT therapy in Massachusetts. Call 855.520.0531 if you would rather practice them with a clinician than from a list.

The four DBT skills modules at a glance

Marsha Linehan built DBT around a tension: accepting yourself as you are while working to change. Two modules lean toward acceptance (mindfulness and distress tolerance) and two toward change (emotion regulation and interpersonal effectiveness).¹

Mindfulness is taught first and then repeated between every other module, because the other three depend on noticing what you are feeling before you can do anything about it.

Mindfulness skills

Mindfulness in DBT is not meditation for its own sake. It is the skill of catching yourself in emotion mind or reasonable mind and finding the overlap between them, which Linehan called Wise Mind.

The “what” skills and the “how” skills

• Observe. Notice what is happening inside and around you without putting words on it yet.
• Describe. Put words on what you observed. “My chest is tight” rather than “I am falling apart.”
• Participate. Throw yourself into the current activity instead of watching yourself do it.
• Nonjudgmentally. Drop the “good” and “bad” labels. Stick to facts and consequences.
• One-mindfully. One thing at a time, with full attention.
• Effectively. Do what works in the situation, not what feels fair or proves a point.

Mindfulness activities for groups

1. Mindful breathing. Follow the breath, notice when attention wanders, bring it back without commentary.
2. 5-4-3-2-1 grounding. Name five things you can see, four you can touch, three you can hear, two you can smell, one you can taste.
3. Body scan. Move attention slowly from feet to head, noticing sensation without trying to change it.
4. Walking meditation. Walk slowly and attend to each footfall. Works well outdoors between group sessions.
5. Mindful eating. One raisin or one piece of chocolate, eaten over three minutes.
6. Observe-and-describe rounds. Pass an object around the circle. Each person observes for 30 seconds, then describes only facts.

Distress tolerance skills

Distress tolerance is for the moments when the problem cannot be solved right now and the urge is to do something that will make tomorrow worse. These are crisis survival skills, meant to be used briefly and then put down.

The acronyms

• STOP. Stop. Take a step back. Observe. Proceed mindfully. The first skill to reach for when an urge spikes.
• TIPP. Temperature (cold water on the face), Intense exercise, Paced breathing, Paired muscle relaxation. Each one changes body chemistry fast enough to interrupt a surge.
• ACCEPTS. Distract with Activities, Contributing, Comparisons, Emotions (opposite ones), Pushing away, Thoughts, Sensations.
• IMPROVE the moment. Imagery, Meaning, Prayer, Relaxation, One thing in the moment, Vacation (a short one), Encouragement.
• Self-soothe. Deliberately comfort each of the five senses.
• Pros and cons. Write out the pros and cons of acting on the urge and the pros and cons of tolerating it. Keep the card for next time.
• Radical acceptance and turning the mind. Acknowledging reality as it is, over and over, because acceptance is a choice you make repeatedly rather than once. We cover this in depth in our post on radical acceptance.

Distress tolerance activities for groups

1. TIPP practice with ice. Hold ice or splash cold water, then rate distress before and after on a 0 to 10 scale.
2. Build a self-soothe kit. Each member assembles one item per sense and explains the choice.
3. Pros-and-cons cards. Fill a four-square grid for a real recurring urge and keep the card in a wallet.
4. ACCEPTS menu. Brainstorm two options per letter as a group, then each person picks the three they would actually use.
5. Safe-place visualization. A guided image of a calm place, then describe it in enough detail to return to it alone.
6. Half-smile and willing hands. Practice the posture of acceptance for two minutes while holding a mildly frustrating thought.

Emotion regulation skills

Where distress tolerance gets you through a spike, emotion regulation lowers the baseline. These skills work on understanding what an emotion is doing for you, checking whether it fits the facts, and reducing how vulnerable you are to begin with.

The core skills

• Identify and label the emotion. Name it, notice the prompting event, the body sensations, the urge, and what the emotion is trying to communicate.
• Check the facts. Does the intensity of the emotion fit the actual situation, or the story about the situation?
• Opposite action. When the emotion does not fit the facts, act opposite to its urge. Approach what anxiety says to avoid. Get up when depression says to stay down.
• Problem solving. When the emotion does fit the facts, solve the problem that is causing it.
• ABC PLEASE. Accumulate positive experiences, Build mastery, Cope ahead. Then reduce vulnerability: treat PhysicaL illness, balance Eating, Avoid mood-altering substances, balance Sleep, get Exercise.
• Cope ahead. Rehearse a hard situation in detail, including the skills you will use, before it happens.

Our post on DBT for depression walks through how opposite action and ABC PLEASE apply when the dominant emotion is flat rather than intense.

Emotion regulation activities for groups

1. Emotion wheel round. Each person picks the most specific word for what they felt this week and locates it on the wheel.
2. Pleasant activities list. Build a personal list of 20 small things that reliably produce a positive emotion, then schedule three for the coming week.
3. Opposite action role-play. Pair up. One person names an emotion and its urge; the partner acts out the opposite.
4. Mood and sleep log review. Bring a week of diary cards and look for the link between sleep and emotional intensity.
5. Build mastery challenge. Everyone commits to one slightly hard, doable task before the next group and reports back.
6. Cope-ahead script. Write the scene, the likely emotion, and the exact skills, then read it aloud to the group.

Interpersonal effectiveness skills

These skills answer three questions in any hard conversation: what do I want, how do I want the relationship to be afterward, and how do I want to feel about myself when it is over. Each question has its own acronym.

The acronyms

• DEAR MAN (getting what you want). Describe, Express, Assert, Reinforce. Stay Mindful, Appear confident, Negotiate.
• GIVE (keeping the relationship). Be Gentle, act Interested, Validate, use an Easy manner.
• FAST (keeping your self-respect). Be Fair, no Apologies for existing, Stick to your values, be Truthful.

Interpersonal effectiveness activities for groups

1. DEAR MAN scripting. Write a real request line by line, then deliver it to a partner who plays the other person.
2. Saying no practice. Decline three escalating requests using FAST without over-explaining.
3. Validation ladder. Practice validation on a partner’s real complaint, starting with full attention and reflecting back, then naming what makes the feeling understandable.
4. Boundary mapping. Draw concentric circles for the people in your life and name one boundary per circle.
5. Mindful listening. Two minutes of listening with no response, then reflect back only what was said.
6. Intensity dial. Rate how firmly to ask or how firmly to say no in a sample scenario using the factors Linehan lists (priorities, capability, timing, authority, the relationship).

DBT group activities that tie the modules together

Skills groups are more than acronym drills. Therapists use these to review homework, keep the room engaged, and connect skills to real weeks.

Review and generalization

1. Homework review circle. Each member reports one skill they tried, what happened, and what they would change.
2. Behavior chain analysis. Walk one problem behavior backward link by link, from the prompting event through each thought and urge, and mark where a skill could have gone.
3. Skills generalization. Take one skill and list where it applies at work, at home, and alone.
4. Crisis plan drafting. Triggers, early warning signs, the skills in order, and who to call.
5. Diary card walkthrough. Learn the card together: emotions, urges, and skills used, rated daily.
6. Skills feedback. A member describes using a skill and the group names what worked and one thing to try.

DBT games and creative exercises

1. DBT Jeopardy. Categories by module, answers are the acronyms and what each letter stands for.
2. Acronym relay. Teams race to write out DEAR MAN, GIVE, FAST, TIPP, and ACCEPTS from memory.
3. Skill of the week collage. Magazine images that show the chosen skill in action.
4. Scenario cards. Draw a situation card and a module card. Name a skill from that module that fits the situation.
5. Gratitude round. One specific thing from the past 24 hours, no repeats around the circle.
6. Wise Mind check-in. Open each group by having everyone say which mind they walked in with: emotion, reasonable, or wise. Our post on Wise Mind explains the three states.

Movement and wellness

1. Gentle yoga with mindfulness cues. Attention on breath and sensation rather than form.
2. Nature walk with observe-and-describe. Walk the grounds, then describe three things without evaluating them.
3. Guided relaxation. Paired muscle relaxation as a group, which doubles as TIPP practice.
4. Music and attention. Listen to one track and follow a single instrument the whole way through.

How DBT skills are taught

A full DBT program has several parts: a weekly skills group where the modules above are taught in order, individual therapy where you apply them to your own week, between-session phone coaching, and a consultation team that supports the therapists.² The full skills curriculum takes about 24 weeks, and it is often repeated to make a one-year program.²

At Rockland Recovery Behavioral Health, DBT skills groups run weekly alongside individual sessions inside our partial hospitalization program and intensive outpatient program, with telehealth available when getting to Sharon is not practical.

Frequently asked questions about DBT skills

How many DBT skills are there?

It depends how you count. There are four modules, roughly 20 to 25 named core skills, and dozens of sub-skills under acronyms like TIPP and DEAR MAN. The cheat sheet fits the core set on one page.

Can you learn DBT skills on your own?

You can learn the vocabulary on your own, and workbooks help. What a skills group adds is practice under mild stress, feedback from people who are learning the same thing, and a clinician who notices which skill you keep avoiding. Most people find the acronyms stick only after practicing them out loud.

What is the difference between DBT skills and CBT?

CBT works mainly on identifying and changing unhelpful thoughts. DBT keeps that change focus and adds acceptance skills, a formal skills group, and a heavier emphasis on emotion and crisis.

Our CBT vs. DBT comparison goes further.

What are DBT games?

Games are how skills groups review material without it feeling like a quiz. DBT Jeopardy, acronym relays, and scenario cards (all listed above) are the most common. They work because recalling a skill under light pressure is closer to using it in real life than reading about it is.

Practice DBT skills with a group in Sharon, MA

Reading the list is a start. Practicing the skills weekly with a group and a clinician is where they take hold.

Our DBT therapy in Massachusetts pairs skills groups with individual sessions at our Sharon, MA center, five minutes off I-95. Call 855.520.0531, contact us online, or verify your insurance to get started.

Footnotes:

1. Linehan, M. M. (2015). DBT Skills Training Manual (2nd ed.). Guilford Press.
2. Behavioral Tech Institute (founded by Marsha Linehan). Frequently Asked Questions: Dialectical Behavior Therapy. behavioraltech.org