Just the "FAQs"
This page answers some "Frequently Asked Questions" about the DBT-CBT Workbook and program. Most of the information on this page is taken from the "FAQs and More" section of the DBT-CBT Workbook.
The "footnote" numbers or superscripts (example - Dialectical 1) let you know that you can find more information about that word or topic in the yellow margin on the left side of this page. Look for the section "Margin Notes" to find these.
Notice: All information on this website is copyright protected.
What is DBT?
The small numbers in the yellow highlight below are "footnotes" that relate to
the text in the yellow margin on this page.
Click hete to go to that section called "Margin Notes"
Dialectical 1 Behavior Therapy (DBT) is a highly respected skills training program developed by Dr. Marsha Linehan to treat Borderline Personality Disorder (BPD). BPD is a severe disorder that’s very difficult to treat. Many studies show DBT to be an effective treatment program for BPD. DBT addresses four major skill areas. The Mindfulness2 unit teaches skills to increase awareness of our thoughts, feelings, behaviors, and experiences. The Interpersonal Effectiveness3 unit teaches skills for developing and maintaining fulfilling relationships. The Emotion Regulation4 unit focuses on labeling emotions, increasing positive emotions, and decreasing upsetting emotions. The Distress Tolerance5 unit focuses on dealing with uncomfortable feelings and situations in positive ways. Crisis survival skills and acceptance are also discussed.
DBT teaches skills for managing stress and difficult emotional states. It wasn’t designed to work through the traumas, losses, and difficult experiences in our past.6 DBT focuses on the here-and-now…today’s problems and concerns that lead to problematic emotions and behavior.7
What Is Borderline Personality Disorder (BPD)?
People with BPD have major problems controlling their thoughts, feelings, and behavior when upset. They’re very sensitive to rejection and abandonment and they often respond to relationship problems in intense and desperate ways. Their lives are very unstable and they live in an almost constant state of distress or crisis.8
The DSM-IV9lists the symptoms of BPD.10 They include desperate attempts to avoid abandonment; intense and unstable relationships; identity problems; impulsive behavior; suicidal behavior, gestures, and threats; self-mutilation; mood swings; intense emotional reactions; feelings of emptiness; intense anger or difficulty controlling anger; and paranoia or severe dissociation.11
What Is DBT-CBT? What Is This Workbook
All About?
DBT-CBT is a psychoeducational,12 skills training program. It combines traditional DBT and Cognitive-Behavioral Therapy (CBT)13 principles. IT ALSO INCLUDES MANY NEW14 Cognitive-Behavioral concepts and techniques. DBT-CBT addresses REAL LIFE and the problems and experiences common to people with Self-Destructive Coping Addictions and habits. This workbook is FILLED WITH THOUGHT-PROVOKING WORKSHEETS AND ACTIVITIES which explain major principles and concepts. The worksheets also PROMOTE INSIGHT, LIFE APPLICATION, AND A PERSONAL CONNECTION with the material. Alike DBT, this workbook is NOT designed to fully process or resolve specific traumas from the past. ITS’ PURPOSE is to address the emotions, behaviors, thought patterns, and Destructive Coping Responses that have developed IN RESPONSE TO trauma, loss, and other difficult experiences.15 MAJOR GOALS OF THIS STUDY are self-awareness, self-understanding, self-respect, tolerating and accepting difficult times, effective coping, goal-directed behavior, life management and stability, and the experience of relief, peace, acceptance, and healing.
Over time, the use of DBT has expanded. It’s not just for BPD anymore. It’s now used to treat many problems like depression, anxiety, anger, substance abuse, and eating disorders.16 Likewise, DBT-CBT addresses the needs of people WITH and WITHOUT BPD. This program will teach us ways to manage our emotional states and reactions to DAILY STRESS and MAJOR LIFE ISSUES…both past and present.
When we’re filled with upsetting emotions, we often do things for quick relief…like drugs and alcohol; suicide attempts, gestures and threats; cutting and other forms of self-harm; overtaking medication; verbal and physical aggression; temper tantrums; walking off and leaving the situation; withdrawal; overeating or not eating enough; overshopping; “sleeping around”; rebound relationships; gambling; and other risky and reckless behaviors. The Nature of the Problem is…the things we do to feel better end up multiplying and intensifying our problems. Our Destructive Coping Behaviors help us to cope in the Heat-of-the-Moment…but, they have many negative consequences. They make our current problems more severe…and they CREATE many new problems for us to struggle with. The importance of this workbook is best understood by recognizing how our Destructive Coping Behaviors impact AND DESTROY the Big Picture of Our Life. DBT-CBT IS ALL ABOUT THE NATURE OF THE PROBLEM AND WHAT TO DO ABOUT IT!
It may seem wild to say that Self-Destructive Coping Behaviors are normal!17 However, we’ve all responded to distress and conflict in overly intense and self-defeating ways. We ALL do these things…some more often than others…and some behaviors are much more destructive than others. Most of us struggle with stressful lives and many of us struggle with traumatic or otherwise difficult experiences. These things take their toll on our physical and emotional stamina.18Sometimes, when we’ve had enough or we’ve had more than we can bear, we blow. We lose controL. We do something desperate and impulsive… and often regrettable. This type of response causes us GREAT PAIN AND SUFFERING.
This workbook is about HOW TO STOP THE PAIN…and HOW TO TURN PAIN AND SUFFERING that we cannot tolerate… INTO A RECOVERY EXPERIENCE we can tolerate…one that BRINGS PEACE AMIDST THE CHAOS.19
How Was DBT-CBT Developed?
DBT-CBT came into existence when I was asked to take over a traditional DBT Group. Very few people attended because it was for severe Borderline patients only. My department was short-staffed at the time and we were pressured to provide services to as many patients as possible. In response, the DBT Group was expanded to include folks WITH MAJOR LIFE PROBLEMS with or without BPD. Most Members were diagnosed with Major Depression or Bipolar Disorder,20 some had PTSD (Post Traumatic Stress Disorder)21 and some had Schizoaffective Disorder.22 Some of these patients had full-blown BPD, others had a few features of BPD, and some did not have a personality disorder. Most were hospitalized for suicidal behavior or gestures, or serious thoughts or threats to suicide. Others were hospitalized for physical aggression or serious thoughts or threats of aggression. About 80% had substance abuse problems and about 80% had history of some form of abuse. 100% were suffering from major life issues, problems, and losses. A common theme was noted among Group Members - HIGHLY DESTRUCTIVE RESPONSES TO EMOTIONALLY CHARGED SITUATIONS. As such, about 60% found themselves “starting over” to a significant degree. The material for the traditional DBT Group changed to meet the needs of these new Members.
Another reason the material changed is that I was “thrown into” leading the Group before I knew much about DBT! Naturally, I began teaching what I already knew about human nature and the mechanisms of change and recovery! As I studied DBT, I found Dr. Linehan’s work to be brilliant for understanding addictions and self-destructive behavior. The DBT concepts and principles that best targeted Members’ needs were added to the Group material as I learned them. What resulted was a blend of DBT, CBT, Psychodynamic theory,23 and a bunch of other stuff I had learned from over 20 years in the mental health profession. My boss, Dr. John Pichitino, suggested renaming the Group “DBT-CBT” to highlight the major changes.
The new name, DBT-CBT, emphasizes that this program is AN OFFSHOOT24 of traditional DBT that RESTS HEAVILY on Cognitive-Behavioral traditions and MANY NEW concepts and principles.
Another reason the Group material changed is that the new Members had short hospital stays (1-2 weeks) whereas the severe borderlines in the traditional DBT Group had much longer stays (2 or more months). Their short stays created great pressure to provide a Big Picture approach…fast! The material had to quickly “hit home” and make sense. Many chalkboard illustrations, worksheets, and activities were developed to provide a visual presentation of major concepts and principles to go along with the discussion. These were designed to be attention grabbers and to lead Members to look at and process the major issues and situations that led to hospitalization. Most Members are very active in Group and blurt out answers to the worksheets and activities so it is THEIR lives that are illustrated on the board.
DBT-CBT evolved as a fast-track program to provide practical tools and insights to promote recovery for people suffering from painful experiences and major emotional issues and concerns.
How Is This Program to Be Delivered?
This workbook was written to provide program materials for Group Members to study outside of Group and as a take-home study. The workbook format provides Members the opportunity to review and reflect on the material and to complete the study at their own pace. This encourages in-depth processing and application. This workbook can be completed as part of an Individual or Group Therapy program, a support group,35 or as an independent home-based study.
This workbook IS NOT AN emotionally EASY STUDY. It packs a punch…AND it hits hard and quick.
It addresses Destructive Coping Behavior AND the difficult emotions and life experiences that lead to self-destructive behavior.36
If you have difficult issues which significantly bother or overwhelm you, it‘s recommended THAT you SEEK PROFESSIONAL HELP.
A professional can help you process and work through your experiences AND the material in this workbook.
Before starting this study, it’s recommended that you inform trusted others37 THAT you’ll be dealing with difficult emotions, experiences, situations, and behaviors. IT’S ALSO RECOMMENDED THAT YOU SHARE THE INFORMATION YOU’RE LEARNING WITH THEM.
This will create a knowledgeable support system and you’ll have discussion partners who can give you ideas and feedback for responding to the activities and worksheets! MOST folks find this material very interesting…so they should be interested in learning this information, too!
What Are Some Goals of This Study?
- * To increase self-awareness and self-monitoring38 skills (Mindfulness)
- * To gain a better understanding of our emotional lives, including skills to recognize and describe our emotions and to effectively respond to troubling emotional states (Emotion Regulation Skills)
- * To gain skills for effectively dealing with difficult experiences and situations as well as daily hassles and frustrations (Distress Tolerance Skills, Life-Enhancing Coping Skills, and Behavioral Control Skills)
- * To achieve acceptance, healing, and peace with the troubling experiences in our life, both past and present (Recovery and Healing)
- * To gain knowledge and skills to improve our relationships and social functioning (Interpersonal Effectiveness Skills)
- To understand we’re human and in our humanity we make mistakes and bad decisions…and sometimes, we behave in ways which hurt ourselves and others (Acceptance and Self-Forgiveness Skills)
- To understand that many of our “abnormal” and self-destructive behaviors are normal given our history of abnormal, difficult, or traumatic experiences (Acceptance and Self-Forgiveness Skills)
- To understand that impulsive, quick-fix coping behaviors work for a short period of time (minutes, hours, or days)…but lead to awful consequences and many more problems…AND to understand these behaviors are very self-defeating and make our lives MORE unmanageable and our life circumstances HARDER TO BEAR (Insight and Understanding)
- * To have the serenity to accept the things we cannot change, the courage to change the things we can, and the wisdom to know the difference39 (Wisdom, Distress Tolerance Skills, and Goal-Directed Behavior)
How Is This Workbook Set Up? What Are the Special Features?
"Statements of Support and Encouragement" - the first two pages of the workbook have space where our support people can write statements of support and encouragement for our journey through the pathways of recovery.
"Table of Contents" - a detailed 7-page table of contents not only lists the chapter titles, but also the major topics or sections in each chapter. This is VERY useful in Group when we're trying to find a particular topic FAST.
"Introduction" - the book opens with a general introduction to the program.
"FAQs and More" - an opening section that answers several "frequently asked questions" about the program and workbook.
"An Overview of the Three Mind States" - a two-page chart describes Emotional Mind, Rational Mind, and Wise Mind so folks have a general idea of what these are before they begin reading the book. In addition, various emotions are listed with examples of the types of emotional thoughts that go with them. Then, examples of how Rational Mind and Wise Mind might respond to these emotions and thoughts are listed.
"An Overview of the DBT-CBT Process and the Pathways of Recovery and Relapse" - a flowchart that shows how we use Emotional Mind, Rational Mind, and Wise Mind to deal with difficult life events and emotions in a healthy, recovery-based way. It also shows what happens when we just act on our emotions without using Rational Mind or Wise Mind. A written description of this process is also provided. This also serves as a very good overview of the DBT-CBT program.
"How Bad Do I Really Want Recovery?" - a introductory worksheet to help us gauge our readiness for recovery...before we get started with the workbook.
There are 14 chapters in this workbook:
- The Nature of the Problem
- The Big Picture of My Life
- The Pathways of Recovery
- Mindfully Protecting My Peace and Stability
- Mindfulness Is a Skill
- Emotional Mind
- Rational Mind
- Challenging Negative Judgments of Me
- Wise Mind
- The Wise Mind Worksheet
- Distress Tolerance
- Acceptance
- Life-Enhancing Coping Skills
- The Game Plan
"Rest Stops" - the 14 chapters are divided into three sections. After each section is a "Rest Stop" which provides a summary of each chapter in the section, "Where We've Been...What Ground We've Covered." They also tell us "Where Do We Go from Here" or what we are getting ready to cover in the next section or sections. (See the "What the DBT-CBT Workbook Is All About" section on the home page of this website to read actual text from the Rest Stops.)
"Applications" - the "general knowledge" information presented in the workbook is applied to situations that are familiar to us. The information is applied to Real Life...and often it's our life that it's applied to or the lives of people we know.
"Skill Builders" - these are activities and worksheets that help us to practice and apply the skills and concepts we're learning. Several are highly therapeutic and will lead us to major insight, self-understanding, and change.
Workbook Questions - the pages of the workbook are FILLED with "workbook" type questions. These help us to process the material and apply it to our life. "Answers" or comments can be found in the text following most questions.
"Chapter Reviews" - each chapter ends with a set of questions about the material and space for writing responses to these questions.
"For Reflection" - at the end of each chapter is a lined space to "journal" or write. We're encouraged to write about whatever comes to mind or heart. Some ideas for what to write are listed in the margin...such as how the material relates to our life, how it affects us, motivates us, what we have learned, major insights, etc.
"The Concepts and Skills Tracking Sheets" - worksheets at the end of each chapter which list the major concepts, principles, understandings, and skills presented in the chapter. They are a tool to help us learn, practice, and apply the skills and information in each chapter. They help us to remember what we've read and they offer a way to TRACK our practice and Real Life use of the recovery skills and understandings.
Margin Text - the left side of each page has a 1-1/2 inch margin that provides the following information and features:
- Definitions - easy to understand definitions of words used in the text.
- "Phonetic" or "Sound-Out" Spellings of less common or hard to pronounce words.
- Further information or comments about topics discussed.
- "Footnote Style Numbering" - the margin items listed above are numbered and the text in the main part of the page that they go with is also numbered (small matching numbers). This is so we know how the margin information connects to the text...to know when it should be read.
- Quotes and Sayings - the margins are also used for quotes and sayings that relate to the text.
"A List of Negative Emotions" - this is a fairly long list of unpleasant, upsetting emotions. Similar types of emotions are grouped together. This helps us to be aware of the emotions we experience and it gives us words to describe our feelings.
"Turning Point Worksheets" - listed below are SOME of the worksheets that have had the greatest impact on Group Members.
- "The Cycle of Suffering in My Life Worksheet" - helps us to understand how the problems we're having in life are greatly worsened by how we are trying to cope with them. It shows that the things we're doing to try to feel better in-the-moment end up causing us long-term pain and suffering.
- "The Big Picture of My Life Worksheet" - helps us to recognize the many things that bring meaning and satisfaction to life...and what happens to these things when we respond to life in self-destructive Emotion-Driven ways. It helps us to understand the consequences of Emotion-Driven Behavior. The worksheet provides many insights that help our Rational Mind to rationally challenge many Emotional Mind "desires."
- "The Mindfully Protecting My Peace and Stability Worksheet" - helps us to understand the number of stressors, pressures, demands, and difficult things "Coming Our Way" and the importance of being mindful of these things, maintaining boundaries, prioritizing, and coming up with a Game Plan for managing what's "Coming at Us." The purpose is to protect our peace and stability and the quality of our life...to minimize Emotional Mind flare-ups and crises...and relapse into self-destructive coping behavior.
- "The Challenging Negative Judgments of Me Worksheet" - provides us a structured way to rationally challenge the abusive, hurtful, destructive statements made about us. Members are often shocked at the results of this worksheet because it shows or "proves" how much of a lie those statements were...and how irritational we are to continue to believe those lies.
- "The Well Analogy Worksheet" - helps us to talk our way through an Emotional Mind crisis or situation...to go from impulsive coping responses to a Wise Mind response.
- "The Wise Mind Worksheet" - walks us through the use of the three mind states so we can come up with a Wise Mind plan for dealing with a major issue or problem.
- "The Game Plan" - this worksheet is for the development of a personalized recovery plan. The principles, concepts, skills, and understandings gained throughout this workbook are used to develop this recovery plan. The use of Rational Mind and Wise Mind are built into the plan as is a respect for our Emotional Mind issues and dynamics and who we are and how we are as a person.
"Step-by-Step Instructions" - detailed instructions are provided for the completion of the worksheets and tracking sheets.
"Samples of Completed Worksheets" - one or more completed samples are provided for each worksheet. These aid in understanding how to complete the worksheets. Oftentimes, seeing how a worksheet is done helps to better understand how to complete it! Many of the completed samples are used for discussion in the workbook, too.
Real Life Stories" - four stories that describe the life events and situations common to a recovery population are shared. Many Group Members feel as if these stories were written about them...sparing some details.
What Reading Level Is Needed for This Workbook?
The average reading level required to read this book is estimated to be a 6th grade reading and comprehension level. Two measures of reading ability were used to make this estimate. A Flesch-Kincaid Grade Level score was obtained for each chapter, including the introduction. This score estimates the reading comprehension level needed to understand a book. The scores for the workbook ranged from a low of 5.5 (the middle of 5th grade) to a high of 8.2 (early 8th grade). The introduction to the book was the highest at 8.2. Most of the text on this web page is taken from the introduction and you'll notice that it's a bit technical. However, the workbook chapters are not...and they ranged from 5.5 to 6.9 each... from the middle of the 5th grade to the end of the 6th grade.
A Flesch Reading Ease score was also obtained for the workbook. This score is a measure of reading ease on a scale from 1 to 100. A book that ranks at 30 is "very difficult" to read and one that ranks at 70 is "easy" to read. Scores ranged from 66 to 79 on the workbook chapters with only 3 chapters scoring less than 71. A score in the range of 70-79 falls at the 6th grade level and approximately 88% of U.S. adults have reading skills at or above this level.
Overall, these scores suggest that someone with a 6th grade reading level or better should be able to read this book. However, there are two unique features that make this workbook EVEN MORE READER FRIENDLY! The left margin on each page is used as a "footnote" area. Many of the "bigger" or less common words are "phonetically" spelled out in ways that make these words easy to pronounce. Most folks have heard these words before, so being able to read them increases their understanding. ALSO, many of these words are defined in the margins ...and the definitions are easy to understand.
These features were added based on experience using this material in the DBT-CBT Group over the years. This workbook was made to be reader friendly and useable for people from different educational backgrounds. Over time, an audio version of this workbook will be available to better meet the recovery needs of people who struggle with reading.
How Big Is the Book, How Many Pages?
The book is 8-1/2 by 11, the size of a standard piece of paper. It is about 1 inch thick. It has a total of 432 pages. The paper is fairly thick (60 pound paper) since it is a workbook and is meant to be written in. The book weighs about 2 pounds and 11 ounces. It is a soft cover book that is bound by the perfect binding method. The cover is laminated. It is a very high quality book. Pictures of the front and back cover can be viewed on the home page of this website and actual pages can be viewed on the Table of Contents page.
This Is a Comprehensive Treatment Program... It's 436 Pages Long...It Printed on Such Nice Paper...Why Are You Selling It So Cheap?
I can't tell you how often I get asked this question! Many folks understand my reasoning...others think I'm stupid and stubborn. As mentioned in the above section...this book is meant to get into the hands of the people...people who are in recovery...and people who are struggling with life. Many of these people do not have the financial resources to purchase a $40 - $80 book...nor do psychiatric hospitals and chemical dependency centers have the funding to purchase an expensive book for their patients. Now, if this book were aimed at a professional audience (psychologists, medical doctors, college professors, psychiatric nurses, etc), it would be sold for what it's worth.
What's Up with the Improper Grammar
and Punctuation?
~~ ~~ This response comes from a section in the workbook entitled,
"Saving Face: DBT-CBT in Action." ~~ ~~
You’ve heard the saying about “stepping in it.” Well, I sometimes “step in it”…and the work of this book is no exception! I spoke to a professor at Texas A&M, Dr. Brian Stagner, about reviewing this workbook. He was my mentor during graduate school and he graciously agreed. Although I’m proud of this work, at the same time, I’m a little embarrassed by it! That’s a dialectical problem by the way! I figured he’d be impressed by the content, but stunned40 by the language and grammar…so, I never sent it to him!
Part of DBT-CBT is Choosing Our Battles and Taking a Stand and Fighting for what’s MOST IMPORTANT to us…NOT EVERYTHING in life. It’s also about being prepared for and accepting the consequences of our behavior and choices. It’s also about being wise…and we’ll see if I made a wise choice! I expect to take some hits on grammar, like dangling participles, commas instead of semicolons, overuse of contractions, pronoun and antecedent disagreement, Texas slang, and other informal language and grammar. The truth, I wrote this for the average person and in a language many people speak…except for some southern slang! It wasn’t written for a professional audience,41 though I hope many in that audience will read it. I’m an informal, “down-home girl”42 and I wrote this for “down-home people.” I CAN BE formal if I have to be, but I certainly PREFER NOT!
Another criticism I expect is repetition in the workbook. I tried to write this as I would speak it and teach it in Group. When I teach important principles and concepts, I often repeat myself by explaining the same thing in different words…one sentence right after another. Sometimes, hearing something said in different ways helps us to understand and remember it better…and if our minds have wandered, maybe we’ll get it the second or third time around! I’m very invested in the people I work with…and I’m passionate about doing my part to change lives. I drill home some points because this is intended to be a learning AND recovery experience. It’s NOT designed for casual reading or entertainment purposes!
You’ll notice some repetition across chapters. My belief, most people don’t have audiographic memories43…like they hear something once and remember it. My goal is for people to understand and remember these life-changing principles, concepts, and skills…so they’ll be equipped to apply them in Real Life. Many of us are hard-headed and need this information drilled into our minds. We may not WANT to hear some things and we may not be ready to look at or process some things. We usually have to be emotionally MOVED before we DECIDE to make difficult life changes. Being MOVED often involves looking at the Big Picture of Reality until our eyes are opened and the truth sinks in. Further, to learn how to carry out these skills and to live these concepts…we need to live, eat, and breathe this information until we know it so well we can repeat it back to ourselves. We LEARN by repetition.
Also, everyone doesn’t read a book cover to cover in a few days. When time goes by, a review of important principles and concepts helps us to get the most out of what we’re reading. Further, when we’re stressed out by life, our brain is working full capacity to survive and meet here-and-now demands…and it isn’t always so able to fully process and learn new information. On top of all this, some of us have used a lot of drugs and alcohol, are aging, on medications, or have had head injuries…and our attention, concentration, and memories aren’t like they used to be! Also, some folks have had learning problems all their lives. Others may have symptoms of mental illness44 which affect their ability to concentrate. In my mind…REPETITION IS GOOD!
Some folks don’t like how I’ve used CAPITAL LETTERS. I took some out, but left many. Again, I’m trying to drill home points. The capital letters are intended to draw attention to important principles and concepts…things I really want folks TO GET and be aware of! Sometimes, they’re for emphasis (like to say louder when we’re reading), but most often they’re there to highlight a point. The capital letters may make reading a little difficult until you get used to the writing style.
The last point of embarrassment is…there WILL BE errors and typos…and Lord, I hope not…lost lines…where they disappear when the document is printed. I know I’m obsessive-compulsive…a perfectionist in many ways. I could review this book for ANOTHER year…and continue to make changes. However, if I don’t GET ‘ER DONE… it’ll be half of forever before it’s in print and can be helpful to people who are HURTING and SUFFERING. Getting this in print is much more important than perfection and my ego. This website has a feedback forum...if your heart is there, let me know about the errors you find! I know as soon as it’s in print…errors I’ve missed will jump right off the page!
So, I resolve my dialectical problem of being both proud of this work and embarrassed by it. I realize I want to print the PERFECT book to please a professional audience…however, I also recognize this book is for the average person who desperately seeks recovery. THAT IS its value and purpose. I ACCEPT that no matter how obsessive-compulsive and perfectionistic I am, I’m not perfect and I’ll make errors despite my best efforts to avoid them. I also understand that although I’m a highly educated professional, it’s not my spirit to interact with the world in a formal manner. I’m different, I’m down-to-earth, I am ME…and I’m okay. Some people will accept and embrace this work…others will criticize it. I understand some people will find fault no matter what…but, I’ve “stepped in it” and have set myself up for criticism because I haven’t used proper grammar or writing rules. I’ll take my hits, do Damage Control, fix things as I see appropriate, and I’ll move on down the Recovery Path…and on with life! Perhaps our paths will cross as we journey through the Pathways of Recovery. Hope to see you there.