DBT Worksheets for Youth: Enhancing Treatment

Dialectical Behavior Therapy (DBT) is a groundbreaking treatment based on cognitive-behavioral techniques, mindfulness, and dialectical strategies. DBT helps us better regulate emotions and improve our interpersonal skills. DBT worksheets for youth are supplemental materials that support the work in therapy and enable teens to put their skills into practice; they are an essential piece to the healing puzzle. 

How DBT Worksheets Fit Into Treatment for Teens

DBT’s benefits became apparent when it was first used to treat Borderline Personality Disorder (BPD) in adults, and it was soon expanded for teenagers with emotion dysregulation. The reason for its success, in part, is its focus on skill building. DBT skills provide alternative tools for teenagers to manage intense feelings. In DBT, therapists focus on skills acquisition, skill strengthening, and skills generalization.

Skills Acquisition Skills Strengthening Skills Generalization
Individuals learn four specific coping skills:

 

  • Mindfulness
  • Distress tolerance
  • Emotion regulation
  • Interpersonal effectiveness
Once the skillful behavior is learned (acquisition), skill strengthening is to shape, refine and increase the likelihood of use. This is where skillful behavior is reinforced, and clients receive feedback and coaching on their new skillful behavior from an individual or group therapist. Clients receive between-session consultation (phone coaching), DBT homework (worksheets) and diary cards that are reviewed in individual therapy.
DBT worksheets for youth fit into the skills generalization phase of therapy. Teens learn to apply these lessons in their daily lives, and they use worksheets to keep a record. Each DBT skill teens learn will have its own worksheet.

The sections below include a summary breakdown for each skill discussed as well as a sample worksheet for one, however, it should be noted that each skill discussed in our program typically includes a total of 10 worksheets that discuss different aspects of employing that skill.

 

Distress Tolerance Worksheet

Distress Tolerance
Distress tolerance is a set of coping skills and strategies individuals use to endure and manage difficult or distressing situations without resorting to unhealthy or destructive behaviors. It involves accepting and tolerating the emotional discomfort and pain often accompanying challenging circumstances rather than attempting to escape or avoid it. 

 

[Download Sample Worksheet Here]

Distress tolerance DBT worksheets for youth are tricky because this skill is designed to address particularly challenging situations. Emotions are intense, and the urge to engage in unhealthy coping mechanisms, like self-harm or suicidal ideation, is high. Worksheets addressing this should be clear and concise and offer practical tips to help the teen manage this emotional intensity. One way patients learn to do this in DBT is with the “TIPP” skill: 

Temperature

Temperature-related methods, specifically cold stimuli, can quickly divert attention from emotional distress and elicit tangible physical sensations. For example, “ice diving” – submerging one’s face in ice water – can distract a teenager who typically turns to self-harm, providing a strong stimulus that can help divert their focus from the urge. 

Intense exercise

Vigorous physical activities can trigger the release of mood-enhancing endorphins and help channel emotional energy. For example, a stressed teenager might find relief from a short burst of vigorous exercise, like running in place for a few minutes. 

Paced breathing

Deep breathing involves inhaling slowly through the nose, pausing briefly, and then exhaling gradually through the mouth. This practice helps center the mind and stabilize emotions. It’s also an exercise that can be done in virtually any setting.   

Paired muscle relaxation 

Paired muscle relaxation is another method that can be done anywhere. By tensing muscle groups and gradually relaxing them, the teenager becomes aware of the tension they’re holding and can let it go. 

Distress tolerance worksheets are practical tools for managing immediate distress and can function as valuable historical records. Over time, as a teenager consistently uses these worksheets to develop and refine their distress tolerance skills, they create a documented journey of personal growth.

 

Mindfulness Worksheet

Mindfulness
Mindfulness is a mental practice and state of awareness characterized by paying deliberate and non-judgmental attention to the present moment. It involves observing thoughts, emotions, bodily sensations, and the surrounding environment without trying to change or react to them.
An effective mindfulness DBT worksheet for youth will teach them how to make mindfulness a daily practice. Worksheets in this area guide the teen through different exercises and encourage them to reflect on their results. After each exercise, the teen should reflect on their feelings so they can see how it worked.

 

Emotion Regulation Worksheet

Emotion Regulation
Emotion regulation involves managing and controlling emotions adaptively. Strategies include changing how one thinks about situations (cognitive modification), acting opposite to the outward expression of emotions when necessary, and using techniques like mindfulness and seeking social support.

The Mind is Not A one-size-fits-all Puzzle

At Compass Behavioral Health, we believe everyone should have access to evidence-based treatment. That’s why we are committed to providing top expert care to every family we serve. Begin your journey with DBT and schedule your free consultation today at Compass Behavioral Health.

Emotion regulation DBT worksheets for youth offer several ways for teens to face an emotional trigger, depending on which one (there are usually around 10 in a program) they use. These worksheets guide them through:

  • Identifying the specific emotion they are experiencing.
  • Describing the situation that triggered the emotion.
  • Recognizing and labeling any negative thoughts
    or interpretations.
  • Assessing the intensity of the emotion on a scale.
  • Reframing thoughts about the situation.
  • Choosing and implementing appropriate emotion regulation strategies to manage their immediate emotional reaction.
  • Reflecting on the effectiveness of the chosen strategies and any changes in their emotional state.

The benefit of having the teen cover these phases in a DBT worksheet is ongoing. The teen may run into similar scenarios and complete the exercise again. Then, they can compare those results to the earliest ones and gauge real-time progress.

 

Interpersonal Effectiveness Worksheet

Interpersonal Effectiveness
Interpersonal effectiveness refers to the ability to navigate and manage one’s interactions and relationships with others to achieve desired outcomes while maintaining respect from the self and others. It involves effective communication, assertiveness, and conflict-resolution skills.
Interpersonal effectiveness worksheets help teens develop practical interpersonal skills relevant to their everyday experiences and challenges. They can also be adapted for different situations, allowing teens to generalize this skill further. The worksheet walks them through:

  • Identifying their emotions and reactions to specific social situations.
  • Encouraging them to reflect on whether they’ve experienced similar situations before.
  • Offering strategies for approaching the situation.
  • Providing space for them to plan and practice assertive communication skills if they decide to address the issue.
  • Encouraging them to consider the potential outcomes and consequences of their chosen approach.

Build Lifelong Coping Skills With Compass

DBT worksheets for youth are critical in helping your teen generalize the skills they learn in therapy. It allows them to apply this information and adapt it to different situations. At Compass Behavioral Health, our DBT-Linehan Board-certified™  clinicians help your teen acquire, strengthen, and generalize these skills through proven techniques and engaging supplemental materials.

Our residential program is designed to support adolescents with individualized treatment plans based on a DBT curriculum. This curriculum helps young individuals learn essential skills to manage emotions and overcome self-destructive behaviors.

If you’re interested in understanding how DBT can be effective for youth and how it can benefit your teenager, please reach out for a consultation.

Marissa Colangelo, LCSW, DBT-Linehan Board of Certification, Certified Clinician™

Associate Director of Compass Research & Training Institute

Marissa Colangelo is the associate director of Compass Research & Training Institute (CR&TI), teaching DBT didactics to UCI’s Psychiatry Fellows as well as providing DBT training and managing CR&TI’s continuing education program. She also serves as a Field Instructor with the Columbia School of Social Work.

Marissa became interested in emotional regulation and substance abuse while finishing up her M.A. It was during this time that she completed her initial DBT training under Dr. Andre Ivanoff. Her subsequent experiences providing DBT treatment to prisoners on Riker’s Island led her to pursue providing affordable DBT to traditionally underserved communities.

This is a passion project for all of us here at Compass, and the knowledge contained above comes from 25 years of referring our outpatient teens to residential care all over the country.

For more information regarding how to choose a residential treatment center for teens, or to inquire about the residential program at Compass, please contact us today for a free consultation.