DBT Next Steps Skills Handouts
Building a Life Worth Living
Katherine Anne Comtois, Adam Carmel, and Marsha M. Linehan
Digital professor copy available on VitalSource once published ?“The client handouts and assignments break down complicated concepts in a user-friendly style that fosters everyday application of the Next Steps skills.”
—Janice R. Kuo, PhD, Department of Psychology, Palo Alto University
“What do DBT clinicians and clients do next after they bring down life-threatening behaviors? How do they bring up the behaviors to achieve and maintain a life worth living? DBT Next Steps helps people with intense emotions improve their skills for healthy functioning in work, relationships, and more. As a DBT clinician, supervisor, and trainer, I find DBT Next Steps Skills Handouts and the companion manual for clinicians to be among the most immediately applicable treatment resources I have read in years.”
—Alec L. Miller, PsyD, Cofounder, Cognitive and Behavioral Consultants, White Plains and New York City
“This is what DBT therapists have been clamoring for! DBT Next Steps Clinician's Manual provides invaluable insights and practical tools for therapists to help clients overcome barriers to building full and satisfying lives once the crises have stopped. Whether you treat psychiatrically and financially disadvantaged persons or those who struggle with other barriers to self-sufficiency, this is the manual for you.”
—Kathryn E. Korslund, PhD, ABPP, Director of Clinical Care, Two Chairs
“The focus of DBT Next Steps on getting me out of the mental health system has been a complete success. I pay my own bills, live by myself in my own apartment, and have been for two years! I went from not knowing whether I’d see my next birthday to looking forward to every week as an opportunity to connect with people and live a life I’m proud of.”
—Francis C.
“DBT Next Steps was revolutionary for me. Although being in DBT helped bring me out of crisis, I knew it was DBT Next Steps that would help me gain the traction I needed to build a life worth living. The program taught me so much about finding and respecting my own limits while also pushing me to live a full and effective life. Years out of the program, I continue to visit the skills from it daily. I am so grateful for the growth and stability DBT Next Steps has brought into my life.”
—Lou D.
“I was lucky enough to do a year of Next Steps after a first year of DBT. It helped me refine my ambitions, accomplish the goals that were most important to me, and feel like I was living a worthwhile life. Because of this program I was able to finish grad school after a lengthy medical leave—there's no way I would have had the skills to do that without Next Steps. Several years later, I still refer back to the materials. I recommend DBT Next Steps to anyone who is surviving their life but not thriving yet.”
—Alice Z.
Table of Contents
PrefaceI. DBT Next Steps Overview
- Skills-Training Syllabus
- DBT Next Steps Skills Group Participation Guidelines
- Practice Professional Behavior in DBT Next Steps
- DBT-ACES Requirements toward the Recovery Goals
- DBT Next Steps Check-In Long Form with Instructions
- DBT Next Steps Check-In Short Form
- Examples of Effective Behaviors and Ways to Prevent Avoidance
II. DBT Next Steps Skills-Training Handouts
Perfectionism versus Reinforcement
- Week 1: Perfectionism versus High Achievement
- Week 1 Assignment: Exploring High Achievement over Perfectionism
- Week 2: Another Middle Road Option: Being Average
- Week 2 Assignment: Practicing Alternatives to Being a Perfectionist
- Week 3: The Basics of Reinforcement
- Week 3 Assignment: Practicing Reinforcement
- Week 4: Untraining or Making It Stop!
- Week 4 Assignment: Untraining Behavior
Establishing and Re-Evaluating Relationships
- Week 1: Developing Accurate and Ideal Maps of My Community
- Week 1 Assignment: Complete Maps Now and Ideal
- Week 2: Diving Into New Relationships
- Week 2 Assignment: Do One Thing Every Day toward New Relationships
- Week 3: Re-Establishing Existing Relationships
- Week 3 Assignment: Accurate Assessment of Two Relationships
- Week 4: Variations on GIVE: Casual Conversation and Creating Distance
- Week 4 Assignment: Casual Conversation and Creating Distance
Time Management
- Week 1: Assessment of Time versus Values and Ambitions
- Week 1 Assignment Assessment of Time versus Values and Ambitions
- Week 2: Developing an Ideal Time Map
- Week 2 Assignment: Ideal Time Map
- Week 3: Moving from the Ideal Time Map to a Trial Time Map
- Week 3 Assignment: Trial Time Map
- Week 4: Moving from the Trial Time Map to Your Schedule
- Week 4 Assignment: Moving from the Trial Time Map to Your Schedule
Managing Emotions Effectively
- Week 1: Assessment of Reducing Vulnerability Skills
- Week 1 Assignment: Assessment of Reducing Vulnerability Skills
- Week 2: Regulating Yourself When You Need It
- Week 2 Assignment: Regulating Yourself When You Need It
- Week 3: Identifying and Managing Irritability
- Week 3 Assignment: Identifying and Managing Irritability
- Week 4: Managing Anxiety with the Body and the Mind
- Week 4 Assignment: Managing Anxiety with the Body and the Mind
Succeeding after DBT
- Week 1: Practice DBT 24/7
- Week 1 Assignment: Practice DBT 24/7
- Week 2: Therapy-Interfering Behaviors
- Week 2 Assignment: Therapy-Interfering Behaviors
- Week 3: Your Future and Therapy
- Week 3 Assignment: Your Future and Therapy
- Week 4: Practice Making Non-DBT Treatment Work
- Week 4 Assignment: Practice Making Non-DBT Treatment Work
Applications of Mindfulness
- Week 1: Daily Mindful Practice and Mindfulness to Control Attention
- Week 1 Assignment: Mindfulness to Control Attention
- Week 2: Opening and Refocusing the Mind
- Week 2 Assignment: Opening and Refocusing the Mind
- Week 3: Using the Mindfulness Skills for Anxiety
- Week 3 Assignment: Using the Mindfulness Skills for Anxiety
- Week 4: Mindfulness as a Doorway Opening to Skillful Behavior
- Week 4 Assignment: Mindfulness as a Doorway Opening to Skillful Behavior
Appendices
- Appendix 1. SDBT Diary Card
- Appendix 2. DBT Next Steps Diary Card
- Appendix 3. Overview of the Role of the Life Ambition in DBT Next Steps
- Appendix 4. Community Map Example
- Appendix 5. Ideal Time Map Example
References
Index
About the Authors
Katherine Anne Comtois, PhD, MPH, is Professor in the Department of Psychiatry and Behavioral Sciences and Adjunct Professor in the Department of Psychology at the University of Washington. She was a research therapist and co-investigator with Marsha M. Linehan on her clinical trials from 1994 to 2006 and Director of the DBT program at Harborview Mental Health and Addiction Services from 1996 to 2019. Dr. Comtois now leads the DBT standard and training programs at the University of Washington Medical Center Outpatient Psychiatry Clinic. She is the recipient of the Research Award from the American Foundation for Suicide Prevention and the Distinguished Psychologist Award from the Washington State Psychological Association, among other honors. In addition to leading the development of DBT Next Steps and the DBT-ACES program, she provides training and consultation in DBT internationally.Adam Carmel, PhD, is Clinical Professor in the Department of Psychiatry and Behavioral Sciences and co-director of the Annual Comprehensive DBT Training program at the University of Washington (UW). Dr. Carmel was previously Clinical Assistant Professor in the Department of Psychology, where he taught DBT in the Behavioral Research and Therapy Clinics under the direction of Marsha M. Linehan. Prior to that, he served as Director of the DBT program at the Massachusetts Mental Health Center while on the faculty of Harvard Medical School. Dr. Carmel is a recipient of teaching and mentoring awards from the UW Psychology Internship Program and the Beth Israel Deaconess Medical Center, Department of Psychiatry.
Marsha M. Linehan, PhD, ABPP, the developer of Dialectical Behavior Therapy (DBT), is Professor Emeritus of Psychology and Director Emeritus of the Behavioral Research and Therapy Clinics at the University of Washington. Before retiring in 2019, she devoted her career to developing and evaluating evidence-based treatments for populations with high suicide risk and multiple, severe mental disorders. Dr. Linehan is the 2025 recipient of the Lifetime Achievement Award from the American Foundation for Suicide Prevention. Her contributions to suicide research and clinical psychology research have also been recognized with the University of Louisville Grawemeyer Award for Psychology, the Career/Lifetime Achievement Award from the Association for Behavioral and Cognitive Therapies, the Gold Medal Award for Life Achievement in the Application of Psychology from the American Psychological Foundation, and the James McKeen Cattell Award from the Association for Psychological Science. In her honor, the American Association of Suicidology created the Marsha Linehan Award for Outstanding Research in the Treatment of Suicidal Behavior. Dr. Linehan was featured in TIME Great Scientists: The Geniuses and Visionaries Who Transformed Our World. She is founder of the Linehan Institute and is a Zen master.