DBT Group Counseling Activities: Skill Building And More

Dialectical behavior therapy, also known as DBT, is a type of talk therapy that focuses on helping people learn how their thoughts can affect their emotions and behaviors. It can be particularly useful for people who experience intense emotions. According to Psychiatry Journal, it can be highly effective for treating borderline personality disorder.

What is group DBT?

DBT frequently involves group therapy, although some therapists may practice individual DBT. In group DBT, individuals often learn new skills that may help them live healthier and happier lives. These skills can include stress management skills, emotional regulation, coping skills, and mindfulness activities.

Group DBT may seem more like a class than a support group. Rather than each individual telling their own challenges, the focus of a group therapy session may be teaching new skills. While there may be no tests or quizzes, there can be frequent homework, which typically involves trying out the skill or concept you learned in class. Below, we’ll explore various group DBT ideas that you might find useful. 

Mindfulness exercises

Mindfulness is often a core tenet of DBT. It is a state of being focused on one’s internal and external environment without judgment or desire to change. Practicing mindfulness and learning to be present in the moment can have many benefits. For instance, studies show that mindfulness activities can help reduce anxiety and depression, potentially improving other health conditions such as high blood pressure or insomnia. When it comes to DBT, mindfulness can be effective at helping individuals focus less on stressors from the past or future. 

Five exercises to promote mindfulness that may be used in group DBT include:

• Body scanning. This exercise involves mentally scanning the body, bringing your focused awareness to each part of your body and the sensations you feel in each area.
• Observations. Simply observing a single object (e.g., a water bottle, chair, or pencil) and noting its shape, color, size, texture, and any other details can help hone mindfulness skills.
• Mindful breathing. Various breathing techniques can be used to help calm the mind and body. One example is diaphragm or belly breathing, in which individuals focus on breathing into the stomach instead of the chest. 
• Wise mind. The “wise mind” can act as a balance to your emotional mind. Individuals can intentionally try to connect with their wise mind (rather than their emotional or reactive mind) when thinking about a problem or challenging situation.
• Mental noting. This exercise involves becoming aware of one’s thoughts by helping a person gain distance from difficult emotions and reframe negative thinking. For example, a person thinking, “I’m not good at anything” could use mental noting to change that thought to, “I’m just having a thought that I’m not good at anything”.

Interpersonal effectiveness

One of the many skills taught in DBT is interpersonal effectiveness skills. This refers to a person’s ability to effectively connect with others. Learning interpersonal effectiveness can help individuals relate to others with less conflict, fear, or defensiveness. It may also help you become a more engaged listener, have better social skills, and be more assertive in certain situations. 

There are many ways to learn interpersonal effectiveness skills. Therapists may teach group participants how to utilize body language, navigate differing viewpoints without conflict, and be active listeners. Worksheets, icebreakers, and role-playing scenarios, for example, can all be effective methods to help teach interpersonal effectiveness. 

Distress tolerance strategies

Distress tolerance is designed to teach people how to handle stressful or challenging situations in healthy ways. While some individuals may respond to stress with avoidance, anger, or fear, distress tolerance can empower individuals to accept their stressors and learn to soothe their emotions. 

Some activities that may assist in learning distress tolerance include the following:

• Worksheets. Filling out a distress tolerance worksheet can help individuals identify healthy coping techniques they have tried in the past or would like to try in the future. Worksheets can also center around maintaining mindfulness in stressful situations or coming up with distractions to utilize in demanding moments.
• Self-soothing techniques. There may be times when we’re experiencing challenging situations, and we’re unsure of how to help ourselves feel better. A group DBT session may involve the therapist listing self-soothing techniques such as listening to music or going for a walk, for instance, and inviting group participants to see which ones work well for them. 
• Focusing on senses. Therapists can teach group participants the benefits of centering their attention on their senses in times of distress. Individuals may be encouraged to write down or talk about what they’re seeing, hearing, touching, smelling, or tasting.

Learning emotion regulation

People who experience dysregulated emotions may find it challenging to manage how they feel, especially when their emotions rapidly change or evolve. Emotional dysregulation can cause individuals to engage in behaviors to dull painful emotions or find ways to validate them. Still, these behaviors can sometimes be destructive. Emotional regulation can enable individuals to accept and work with their emotions.

There are several activities people can do to help regulate their emotions, including physical activity, drawing, meditating, journaling, performing breathwork, and more. In group DBT, therapists often focus on helping individuals understand their emotions, realize that there are no “right” or “wrong” emotions, and label the feelings they experience. 

A DBT therapist can teach individuals how to acknowledge, accept, and let go of challenging emotions. Instead of trying to escape a feeling, learning to accept it can help people move on with minimal consequences. Therapists might also outline healthy (versus unhealthy) ways to regulate emotions. Other activities that can be useful in teaching emotion regulation include:

• Radical acceptance. Radical acceptance involves reflecting on the demanding situation we’re in and the current emotion we are experiencing. This can help us understand that we can’t control some of our circumstances. Radical acceptance may be practiced via worksheets or writing prompts in a group setting.
• Mantras and affirmations. Mantras (i.e., “This is just the way things are right now”) and affirmations (i.e., “I can handle difficult things”) can facilitate radical acceptance and lessen distress. 

Role-playing exercises

Role-playing can be a useful tool to help individuals practice integrating the skills they’ve learned in DBT. Therapists may suggest group participants role-play specific scenarios or conversations that allow them to practice setting boundaries, resolve conflict, or work on other interpersonal skills. 

Some role-playing DBT exercises include:

• GIVE. GIVE stands for: be Gentle, act Interested, be Validating, and keep an Easy manner. Putting group participants into pairs, giving them a conversation topic, and assessing their ability to adhere to the GIVE outlines of interpersonal communication can be a useful role-playing option.
• Difficult conversations. Some people may struggle to speak up when something is bothering them; others may be too confrontational and come across as aggressive when trying to resolve conflicts. Individuals in DBT group therapy can have practice discussions with other group participants or their therapist to practice healthy communication skills that they can later apply in real life. 

Benefits of therapy

Overall, DBT can be a highly effective form of therapy. One 2014 study demonstrated that 77% of people with borderline personality disorder who received DBT for one year no longer met the criteria for BPD after that one-year mark. 

Of course, DBT is just one type of therapy. There is a broad range of modalities that can be effective for different challenges and mental health conditions. Many people who seek therapy for mental health challenges such as stress, anxiety, and depression, for instance, also happen to be juggling numerous responsibilities and obligations. For those with hectic schedules, online therapy may be a convenient option since it enables you to connect with a therapist from the comfort of your own home. You can also easily create web-based appointments that fit into your schedule. 

Moreover, studies show that online therapy is often just as effective as traditional, in-person therapy. No matter the type of therapy you choose, consider that the benefits of treatment are well-documented and, often, long-lasting. The skills someone learns in therapy can stay with them even after they stop attending sessions.