DBT Skills and Calming the Anxious Mind

Woman with binge eating disorder seated by the river

Dialectical Behavior Therapy (DBT) is a mental health treatment methodology that has been around since psychologist Marsha Linehan developed it in the 1980s to treat Borderline Personality Disorder (BPD). Over time, it has become clear that this treatment is effective at treating BPD and so many other mental illnesses.

Dialectical Behavior Therapy is a twist on the Cognitive-Behavioral Therapy approach, acknowledging that thoughts dictate feelings and actions. Still, including more psychosocial aspects such as the consideration that some individuals threshold for agitation or arousal might be lower than others, therefore, they engage in seemingly intense or out-of-the-ordinary reactions.

The skills that are taught in DBT “are thought to have the capability of helping those who wish to improve their ability to regulate emotions, tolerate distress and negative emotion, be mindful and present in the given moment, and communicate and interact effectively with others [1].”

Dialectical Behavior Therapy skills are organized into 4 different categories: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Each of these helps to calm the anxious mind in their own way.

Dialectical Behavior Therapy Skills


The concept of mindfulness is simple but challenging as it encourages the individual to focus on responding to the present moment only in a calm manner.

In DBT, individuals are taught to focus on their “What” and “How” skills. “What skills” describe what they are to do – observing, describing, then participating. The “How” skills explain how they are to do these, non-judgmentally, one-mindfully, and effectively [2].

Individuals are also taught about “emotion mind,” purely reacting based off of emotions, “logic mind,” solely reacting based off of logic, or “wise mind, “combining both logic and reason to cope in the present moment without behaving in a destructive manner.

Interpersonal Effectiveness

The second module of DBT teaches individuals how to identify what their needs are in their relationships and how they can communicate these needs effectively.

This module focuses on objective, relationship, and self-effectiveness skills that help the individual in “respecting the self and others, listening and communicating effectively, dealing with difficult people, repairing relationships and being able to say no [3].”

Distress Tolerance

Woman throwing leaves to practice mindfulness in Dialectical Behavior Therapy SkillsThese skills focus on the notion of “reality acceptance,” that is, sometimes in life, challenging, awful, or uncomfortable emotions and circumstances will arise that we cannot change.

Distress Tolerance skills help the individual learn to accept their current reality non-judgmentally, stop trying to change what they cannot, and, instead, practice tolerating the distress.

The skills taught in this module are distracting oneself from the situation, self-soothing by aping into one of the 5 senses, improving the moment by using positive mental imagery, and listing the pros and cons of tolerating or not tolerating the distress [4].

Emotion Regulation

Emotion regulation focuses on the idea that negative emotions are a normal part of life and, therefore, not bad. These skills teach the individual to understand and label their emotions, build positive experiences to balance out life’s negative experiences, and then let go of the emotion or engage in opposite action, behaving contrary to how they generally would when feeling that emotion.

All of these factors help individuals accept their current reality, no matter how uncomfortable or unwanted, and to cope and communicate their way through it effectively. These are skills that, whether struggling with a mental illness, anxiety, or everyday stresses, are useful.


[1] Unknown (2019). Dialectical behavior therapy. Psychology Today, retrieved from https://www.psychologytoday.com/us/therapy-types/dialectical-behavior-therapy.

[2] Ackerman, C. E. (2019). 20 DBT worksheets and dialectical behavior therapy skills. Positive Psychology, retrieved from https://positivepsychology.com/dbt-dialectical-behavior-therapy/.

[3] Unknown (2012). The four skills modules. DBT Skills Group, retrieved from https://www.dbtskillsgroupnj.com/four-skill-modules/.

[4] Bray, S. (2013). Distress tolerance in dialectical behavior therapy. Good Therapy, retrieved from https://www.goodtherapy.org/blog/distress-tolerance-dialectical-behavior-therapy-0117134.

About the Author:

Image of Margot Rittenhouse.Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published December 27, 2019, on EatingDisorderHope.com
Reviewed & Approved on December 27, 2019, by Jacquelyn Ekern MS, LPC

About Baxter Ekern

Baxter is the Vice President of Ekern Enterprises, Inc. He is responsible for the operations of Eating Disorder Hope and ensuring that the website is functioning smoothly.