Adult DBT Skills Group · Pittsburgh

A curriculum for a life worth living

The four DBT skill modules, taught across eight cycles, with each week touching every domain. The plan below is the actual rotation a Center for Discovery skills group runs, adapted from Linehan and ordered so the body has a chance to learn before the mind insists on understanding.

I. The arc

Stages of treatment

Linehan’s four stages name where a patient is in the work, so the work in front of us can be appropriate to the work the body is actually capable of doing now. Each stage resolves before the next one opens; if a stage destabilizes, the work returns to it.

Stage 1

Severe behavioral dyscontrol Behavioral control

Moving out of crisis. The work is to stop the behavior that is making other work impossible.
Stage 2

Quiet desperation Non-anguished experiencing

The crisis has passed; the suffering remains. The work is to feel without being pulled under.
Stage 3

Problems in living Ordinary happiness and unhappiness

A regular life, with its regular problems. The work is to address those problems as themselves, not as proxies for older injuries.
Stage 4

Incompleteness Capacity for joy and freedom

The work that begins after symptom relief: the existential question of what a life is for.

II. What gets addressed first

Target behavior hierarchy

In Stage 1 the order matters. We address what is threatening the life before we address what is interfering with therapy, and we address what is interfering with therapy before we address what is interfering with quality of life. The pyramid is read from the bottom up.

Life Worth Living Creating a Life Worth Living
Building Skills Increasing Behavioral Skills
Quality of Life Decreasing Quality-of-Life-Interfering Behavior
Therapy-Interfering Decreasing Therapy-Interfering Behavior
Life-Threatening Decreasing Life-Threatening Behavior

What that looks like

Life-Threatening

Self-injurious behavior
Suicidal ideation
Consistent eating disorder behaviors
Unsafe living environment

Therapy-Interfering

Not attending program on scheduled days
Arriving late or leaving early
No clear treatment goals identified
Denial of severity
Refusal or willfulness around weekly tasks

Quality of Life

Restricting
Bingeing
Purging
Exercising outside movement plan
Not attending school or work
Withdrawal from people

Building Skills

Daily diary card practice
Skills coaching outside session
Generalization to natural environment

Life Worth Living

Mindfulness
Distress Tolerance
Emotion Regulation
Interpersonal Effectiveness
Pleasant activities
School, work, vocational engagement
Social environments

III. How the room is held

Working assumptions

Linehan’s seven assumptions are the load-bearing dispositions a DBT therapist holds about the people in the room. Center for Discovery’s eating-disorder protocol restates each one in language that meets the specific resistance of the population. Both columns are true at once.

Linehan original CFD adaptation

Patients are doing the best they can.

Doing the best they can with their current resources and capacities.

Patients want to improve.

Patients can recognize the barriers and obstacles that are getting in the way.

Patients need to do better, try harder, and be more motivated.

Taking accountability through engagement and reflection. Learning the difference between intention and impact.

Patients may not have caused all of their problems, but they have to solve them anyway.

Circumstances are often unfair; patient engagement and self-reflection are still an important ingredient for change.

Patients are living unbearable lives as they are now.

They have outgrown their coping strategies.

Patients must learn new behaviors in all relevant contexts.

A beginner’s mind: the willingness to be a learner again.

Patients cannot fail in DBT.

Healing is messy and non-linear; “failure” is required for ongoing evolution.

IV. The skill ladder

Which skill, at what intensity

Skills are not interchangeable. The right move at a 9 is the wrong move at a 3, and vice versa. The thermometer below pairs a self-rating with a tier of skills that fit the body in that moment.

Find your zone

The regulation scale runs from -10 (dorsal shutdown) through 0 (the window of tolerance) to +10 (peak sympathetic elevation). Different zones call for different skills. Drag the marker.

+7 to +10

Elevation

High sympathetic activation. Panic, rage, hyperarousal. The thinking brain has been overrun by the survival brain.

TIPP
STOP
Distractions (ACCEPTS)
Crisis Survival

+3 to +6

Activation

Sympathetic mobilization. Anxiety, anger, urgency. PFC partially online; the body is picking up speed.

Self-Soothe (five senses)
Mindfulness
Paced breathing
Pros & Cons
Wise Mind

-2 to +2

Window of tolerance

Ventral vagal. Regulated, present, social engagement online. The zone where new learning actually consolidates.

DEAR MAN
Check the Facts
Wise Mind
Mindfulness practices
Emotion Myths work

-6 to -3

Collapse

Functional shutdown. Heavy, hopeless, low energy, "I can’t." Sub-threshold dorsal.

Opposite Action
Pleasant Activities
Accumulating Positives
ABC PLEASE

-10 to -7

Shut down

Dorsal vagal collapse. The body has gone offline because the threat exceeded what mobilization could solve.

TIPP (cold water, intense exercise)
Behavioral activation
Opposite Action (do anything)

Current rating 0

Centered. Body and mind matched.

Negative values mark dorsal-vagal territory: collapse, shutdown, the body going offline. Positive values mark sympathetic mobilization: activation, elevation, the body picking up speed. Zero is ventral-vagal regulation. Most skills install best in the middle band; the extremes need crisis tools first.

V. The thirty-two

The full curriculum

Four domains, eight modules, thirty-two skills. Every module touches all four domains in the same week, so a skill in mindfulness gets practiced beside a skill in distress tolerance and one in interpersonal effectiveness. The body learns the rotation, not just the individual skills.

The four-domain weekly cycle, eight modules deep. Each cell is a clickable skill; the program advances outward from the center through twenty-six weeks.

Curriculum at a glance

Four domains, eight modules. Each cell is a clickable skill.

Domain	M1	M2	M3	M4	M5	M6	M7	M8
Mindful Awareness	Pros / Cons	Wise Mind	Wisemind Imagery	What / How Skills ●	Non-judgementalness	Mindful Perspectives	Loving Kindness	Doing / Being
Distress Tolerance	STOP ●	TIPP	ACCEPTS ●	Self-Soothing	Improve the Movement	Radical Acceptance	Turning the Mind	Chain Analysis
Emotion Regulation	Naming Emotions	Emotion Myths ●	Describing Emotions ●	Check the Facts ●	Opposite Action	ABC PLEASE	Pleasant Activities	Values / Priorities
Interpersonal Effectiveness	Myths of IE ●	DEAR MAN ●	GIVE FAST ●	Options / Saying No ●	Building / Ending Relationships	Middle Path	Validation	Assertiveness

VI. The diagnostic spine

Chain analysis

When a target behavior happens in the week between sessions, the next session reverse-engineers it. The chain analysis worksheet maps every step from the conditions that preceded the trigger through the urge’s commitment to behavior, and looks for places where a different skill could have entered.

The chain, mapped

Chain analysis is the diagnostic spine of DBT. A behavior is reverse-engineered into the sequence that produced it; each link is examined for an earlier place a skill could have interrupted the chain. Hover any circle.

Hover or focus a node

Tracing the sequence backward turns a behavior that felt like it came out of nowhere into a chain with an examinable structure.

Adjacent

Other gatherings

Work that runs alongside the curriculum: process groups, depth-psychological complements, and special-population modules.