Clinician's Toolkit
EMOTIONAL
REGULATION
Session 1
Presence of a dysfunctional emotional state Overwhelmed,
Exploring the nature of the concern inability to control/cope,
paraphrasing physiological reactions,
Signs? behaviors: binge eating,
encouraging
substance use, avoidance,
summarizing physical action
validating
Assessing the functionality
How does it impact various facets of life/ To what extent: family, work,
social?
How would you rate your distress on a scale of 1-10?
What are your expectations from these sessions?
Psychoeducation
normalizing emotional experiences
importance of expressing emotions: their role, emotions are temporary
Clarification of emotional myths (if any) (acts as a takeaway/
motivating factor to avail of counseling services) * Refer to Page 2
Note: In case the client experiences extreme
emotions, use distress tolerance techniques
(5,4,3,2,1 Technique, STOP, and TIPP)
* Refer to Pages 7, 8
Sessions 2-3
Overall review of last week
Acknowledging, creating awareness, and
Note: Use insights from
labeling emotions: * Refer to Page 2
previous conversation The event that prompted an emotion
to summarize and Interpretations (beliefs) about those events
psychoeducate about The prior history related to the event
the process Physical sensations
Behavioral experiences
Aftereffects of the emotion
(if any difficulty labeling emotion use a list/wheel
of emotions) * Refer to Pages 3/4
Work on accepting emotions * Refer to Page 4
Change unwanted reactions * Refer to Page 5
Check facts
Problem-solving/Opposite action
Sessions 4-5
Feeling Check + Assessing Progress PL - Treat Physical Illness
Working on reducing vulnerability to the E - Balanced Eating
emotional mind: A - Avoid Substances
Introducing ABC PLEASE: * Refer to Page 6 S - Sleep
A - Accumulate Positive Emotions E - Get Exercise
B - Building Mastery
C - Learning to Cope Ahead
Mindfulness of current emotions and
Management
1
Clinician's Toolkit 1
List of Emotional Myths
There is a right way to feel in every situation.
Letting others know that I am feeling bad is a weakness.
Negative feelings are bad and destructive.
Being emotional means being out of control.
Some emotions are stupid.
All painful emotions are a result of a bad attitude.
If others don’t approve of my feelings, I obviously shouldn’t feel the way I do.
Other people are the best judges of how I am feeling.
Painful emotions are not important and should be ignored.
Extreme emotions get you a lot further than trying to regulate your emotions.
Creativity requires intense, often out-of-control emotions.
Drama is cool.
It is inauthentic to try to change my emotions.
Emotional truth is what counts, not factual truth.
People should do whatever they feel like doing.
Acting on your emotions is the mark of a truly free individual.
My emotions are who I am.
My emotions are why people love me.
Emotions can just happen for no reason.
Emotions should always be trusted.
Any other narratives of emotional myths
Clinician's Toolkit 2.1
Getting to Know Your
Emotions
Note: Bringing the client's focus on the aspects given below can aid them to
differentiate between emotions, thoughts, and behaviors. This will also help
to know how one experiences the full-system response of emotions
Body responses Thoughts Urges
(physical (including (what you feel like
sensations, body memories, doing when you
language, facial images, and experience the
expressions) judgments) emotion)
Consequences
Behaviors
(impact or affect
(what you actually
of the behavior,
do when feeling the
such as self-
emotion)
judgments)
2
Clinician's Toolkit 2.2
List of Emotions
ANGER HAPPINESS SADNESS
Aggravated Hateful Amused Honored Abandoned Inadequate
Aggressive Hostile Blissful Hopeful Anguished Lonely
Agitated Hurt Calm Inspired Cheerless Low
Annoyed Ignored Charmed Jovial Defeated Melancholy
Betrayed Impatient Cheerful Joyful Dejected Miserable
Bitter Incensed Comfortable Jubilant Depressed Mournful
Bothered Indignant Confident Overjoyed Despairing Negative
Combative Infuriated Content Pleasant Despondent Pained
Cross Irate Delighted Pleased Disheartened Pessimistic
Distrustful Irritated Eager Proud Distressed Powerless
Disapproving Jealous Ecstatic Relaxed Disturbed Regretful
Disgusted Livid Elated Relieved Dreary Remorseful
Displeased Mad Euphoric Satisfied Dull Sad
Dissatisfied Obstinate Excited Serene Forlorn Somber
Disturbed Offended Exhilarated Thankful Gloomy Sorrowful
Enraged Outraged Exuberant Thrilled Glum Troubled
Exasperated Rejected Fulfilled Tranquil Grieving Unhappy
Frustrated Resentful Glad Triumphant Heartbroken Woeful
Fuming Vicious Grateful Helpless Worthless
Furious Hopeless
FEAR LOVE SHAME/GUILT
Afraid Entranced
Alarmed Panicked Accepted
Fond
Anxious Perturbed Adoring Apologetic
Infatuated Mortified
Apprehensive Petrified Affectionate Ashamed
Intimate Penitent
Bothered Restless Alive Awkward
Kind Pitiful
Concerned Scared Amorous Blamed
Liking Regretful
Disconcerted Startled Appreciative Contrite
Longing Rejected
Distraught Stressed Ardent Degraded
Lovable Remorseful
Distressed Tense Aroused Disgraced
Love-struck Repentant
Disturbed Terrified Attracted Dishonored
Loving Rueful
Edgy Threatened Besotted Embarrassed
Lust Self-
Fearful Troubled Caring Foolish
Passionate conscious
Frantic Uncertain Cherishing Forlorn
Romantic Sorry
Frazzled Uneasy Committed Guilty
Sensual Vulnerable
Fretful Unsettled Complete Humiliated
Smitten Wretched
Frightened Unsure Connected Inferior
Tender
Jittery Uptight Desirous
Worshipful
Jumpy Worried Devoted
Yearning
Nervous
Overwhelmed
3
Clinician's Toolkit 2.2
Wheel of Emotions
Clinician's Toolkit 3.1
Acceptance
Acceptance is NOT
1. the same as giving up or being passive
2. the same as approving of bad situations
3. about accepting judgements about reality (eg. I am a bad person
because I stole money)
Turning The mind, Step By Step
Turning the mind is like facing a fork in the road. You
have to turn your mind toward the acceptance road, and
away from the road of rejecting reality.
1. OBSERVE that you are not accepting.
Indicators include
Emotions like anger, bitterness
Avoiding emotions
Self talk such as "Why me?", "Why is this
happening?"
2. Make an INNER COMMITMENT to accept
reality as it is.
3. DO IT AGAIN, over and over.
Keep selecting accepting reality over
rejecting it every time
4. DEVELOP A PLAN
Catch yourself in the future when you drift
out of acceptance
4
Clinician's Toolkit 3.2
Worksheet for Problem
Solving/Opposite Action
Problem Solving
Step 1: Figure out and describe the problem situation
Step 2: Check the facts
Step 3: If facts are correct and the situation is the problem, then identify the
GOAL of problem solving, (What needs to happen to make you feel OK)
Step 4: Brainstorm multiple solutions
Step 5: Choose a solution that fits your GOAL and is likely to work
Step 6: Put the solution into ACTION
Opposite Action
Step 1: Identify and name the emotion you want to change
Step 2: Check the facts
Step 3: Identify and describe action urges (what you feel like doing)
Step 4: Ask WISE MIND - Is acting on these urges effective in this situation?
Step 5: If acting on urges is not going to be effective or if emotion does not
fit facts, then identify opposite action
Step 6: Act opposite all the way/ commit to opposite action all the way
Step 7: Repeat opposite action until emotions change
Every emotion has an action urge.
Change the emotion by acting opposite to it's action urge
Emotion: Action Urge: Opposite Action:
Fear Run away/avoid Approach/don't avoid
Anger Attack Gently avoid/be a little nice
Sadness Withdraw/Isolate Get active
Shame Hide/Avoid Tell the secret to people who
will accept it
5
Clinician's Toolkit 4.1
ABC PLEASE
A
Accumulate Positive Emotions
Short Term: engage in pleasant activities that are possible now
Long Term: make changes in your life so that pleasant events
occur more frequently. "Build a life worth living"
B Building Mastery
Engage in activities that make you feel competent/effective.
Helps in dealing with helplessness/hopelessness.
One activity every day
Manage the difficulty level of the activities:
start with easy activities
gradually increase the difficulty level
activities should be challenging but doable
Learning to Cope Ahead
C Planning and rehearsing steps to be taken in case problem
situation recurs in future
2.Rehearsing:
1.Planning:
Imagine yourself IN the
Describe problem situation
situation
Decide coping strategies
Rehearse actions in multiple
situations
Take care of your mind by taking care of your body
PL Treat Physical Illness: See a doctor when necessary
E Balanced Eating: Eat mindfully and regularly
A Avoid Mood Altering Substances
S Sleep: Try to get 7-9 hours of sleep a night
E Exercise: Try to build up to 20 minutes of daily exercise
6
Clinician's Toolkit 4.1
Distress Tolerance
S TOP
Stop! Your emotions may try to make you act without
thinking. Stay in control! Do not just react.
T
AKE A
BREAK
Take a step back from the situation. Take a deep breath.
Do not let your feelings make you act impulsively.
O BSERVE
Notice what is going on inside and outside you.
What is the situation? What are your thoughts and
feelings? What are others saying or doing?
P
ROCEED
MINDFULLY
Act with awareness.
Consider your thoughts and feelings, the situation, other
people’s thoughts and feelings. Think about your
goals. Which actions will make the situation better.
TIPP Skills: changing your Body chemistry
Temperature: change the temperature of your face with
T COLD WATER to calm down fast. Hold for 30 seconds. Keep
water above 10°C
Intense exercise: Expend your body’s stored-up physical
I energy by running, walking fast, playing, etc.
P Paced Breathing: pace your breathing by slowing it down
P
Paired muscle relaxation: pair muscle relaxation with
breathing out to calm down
7
Clinician's Toolkit 4.1
Distress Tolerance
5-4-3-2-1 Grounding Technique
Use the 5 senses to focus on the moment
and prevent multiple anxious thoughts
Take a few deep, slow and long breaths then proceed with the
following:
Acknowledge five things you can
5 SEE around you
Acknowledge four things you
can TOUCH around you
4
Acknowledge three things you
3 can HEAR around you
Acknowledge two things you can
SMELL around you
2
Acknowledge one thing you can
1 TASTE
Related Resources
Download the DBT Skills Training
Handouts here.
