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“Each lesson is described thoroughly, including required materials, preparation instructions, lesson overviews, and timelines. The authors skillfully weave the philosophical background of dialectics into the first few lessons using language and issues that adolescents can relate to. The intention of this book is not just to be a resource, but to be a how-to book. The authors succeed in providing simple-to-understand, easy-to-implement lessons throughout DBT STEPS-A….This book would be a valuable addition to any middle or high school social worker’s library.”

—School Social Work Journal


“The lessons and the accompanying handouts are impressive….As a practitioner who has used DBT with adolescents and adults as well as working with adolescents in groups for over 35 years, I highly recommend this manual.”

—Social Work with Groups


“Consistent with DBT and dialectics, the authors have found an ingenious way of expanding the reach and implementation of DBT skills to the universal population of adolescents in educational settings. The DBT STEPS-A curriculum offers a fabulous upstream approach for all adolescents to develop DBT skills and reduce the likelihood of emotionally dysregulated behaviors….Your ability to take this book and use it to teach schoolchildren a wealth of effective life and emotion regulation skills has the possibility of helping more than you can imagine.”

—from the Foreword by Marsha M. Linehan, PhD, ABPP, Professor and Director Emeritus, Behavioral Research and Therapy Clinics, University of Washington; developer of DBT


“A truly wonderful curriculum to support social–emotional learning (SEL). The authors give school personnel needed tools to teach SEL skills both universally and to targeted high-risk students. The manual is clear, concise, and comprehensive, while providing enough flexibility that school-based mental health professionals and teachers can adapt it to their schools' particular needs. This book is an important resource for anyone who is charged with helping students to become more emotionally adept, manage stress, and live more balanced lives.”

—Michael Hollander, PhD, Director of Training and Consultations, 3East DBT Services, McLean Hospital; Department of Psychiatry, Harvard Medical School


“The authors of this groundbreaking book—all DBT experts—have done something no one else has done before: created a curriculum based on DBT skills that can be used with a broad range of middle and high school students. The curriculum is presented in a highly structured, useful, and practical manner. As most mental health services for youth are delivered in schools, this book should be required reading for all school-based mental health professionals, teachers, and school administrators.”

—David N. Miller, PhD, Division of School Psychology, University at Albany, State University of New York


“DBT STEPS-A offers school administrators and school-based mental health professionals a skills-based emotion regulation curriculum for students in general education and/or alternative school-based settings. The structured lesson plans and student worksheets facilitate implementation for general education teachers and school-based personnel. The curriculum is ideal for use at the levels of both prevention and intervention in the framework of a multi-tiered system of support. The book clearly spells out the theoretical basis and rationale for the approach, and shows how to teach DBT skills in a way that students and parents can understand. Schools are often at a loss for how to help students with varying levels of complex social-emotional and behavioral problems—DBT STEPS-A addresses this need.”

—Ameet N. Boleigh, EdS, NCSP, school psychologist, Aiken County Public School District, South Carolina


“I have used DBT STEPS-A the last 2 years with sixth, seventh, and eighth graders. In my 36 years as an educator I have used many programs, and this one is the most comprehensive and powerful. I surveyed one of my eighth-grade classes, and 96% of the students said they would use the skills they learned. Imagine students learning that their thoughts and feelings can lie to them in a crisis situation, and gaining the skills to successfully deal with their issues. My district and others cannot afford to be without DBT STEPS-A.”

—Richard Jones, MEd, school counselor, Maple Grove School, Battle Ground, Washington

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Table of Contents

I. Overview of DBT STEPS-A

1. What Is DBT Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A)?

2. Practical Issues in Schools

3. Teaching DBT STEPS-A to Challenging Students

II. Instructor Information, Lesson Plans, and Tests

Lesson 1. Orientation

Lesson 2. Dialectics

Lesson 3. Mindfulness: Wise Mind

Lesson 4. Mindfulness: “What” Skills

Lesson 5. Mindfulness: “How” Skills

Lesson 6. Distress Tolerance: Introduction to Crisis Survival Skills, and ACCEPTS

Lesson 7. Distress Tolerance: Self-Soothe and IMPROVE the Moment

Lesson 8. Distress Tolerance: TIP Skills for Managing Extreme Emotions

Lesson 9. Distress Tolerance: Pros and Cons

Lesson 10. Distress Tolerance: Introduction to Reality Acceptance Skills, and Radical Acceptance

Lesson 11. Distress Tolerance: Turning the Mind and Willingness

Lesson 12. Distress Tolerance: Mindfulness of Current Thoughts (and Distress Tolerance Test)

Lesson 13. Core Mindfulness: Wise Mind

Lesson 14. Core Mindfulness: “What” and “How” Skills

Lesson 15. Emotion Regulation: Goals of Emotion Regulation and Functions of Emotions

Lesson 16. Emotion Regulation: Describing Emotions

Lesson 17. Emotion Regulation: Check the Facts and Opposite Action

Lesson 18. Emotion Regulation: Problem Solving

Lesson 19. Emotion Regulation: The A of ABC PLEASE

Lesson 20. Emotion Regulation: The BC PLEASE of ABC PLEASE

Lesson 21. Emotion Regulation:The Wave Skill— Mindfulness of Current Emotion

Lesson 22. Emotion Regulation: Emotion Regulation Test

Lesson 23. Mindfulness: Wise Mind Review

Lesson 24. Mindfulness: “What” and “How” Skills Review

Lesson 25. Interpersonal Effectiveness: Goals and Overview

Lesson 26. Interpersonal Effectiveness: DEAR MAN Skills

Lesson 27. Interpersonal Effectiveness: GIVE Skills

Lesson 28. Interpersonal Effectiveness: FAST Skills

Lesson 29. Interpersonal Effectiveness: Evaluating Options for How Intensely to Ask or Say No

Lesson 30. Interpersonal Effectiveness: Interpersonal Effectiveness Test

III. Student Handouts

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About the Authors

James J. Mazza, PhD, is Professor in the College of Education at the University of Washington, where he teaches and conducts research in the field of adolescent mental health. Dr. Mazza’s research focuses particularly on adolescent internalizing disorders, such as depression, anxiety, posttraumatic stress disorder, exposure to violence, and, especially, suicidal behavior. His work also examines the complex relationships among adolescent mental health issues, social–emotional abilities, and academic skills, and how to address these within a multi-tiered systems of support framework. Dr. Mazza has written extensively on how to identify youth who are at risk for suicidal behavior, as well as on how to develop social–emotional learning curricula to help all students learn emotion regulation skills. A codeveloper of the DBT STEPS-A and DBT STEPS-E curricula, he provides consultation and training to school personnel internationally. Dr. Mazza is a cofounder of DBT in Schools, LLC.

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Elizabeth T. Dexter-Mazza, PsyD, President and cofounder of DBT in Schools, LLC, is a codeveloper of the DBT STEPS-A and DBT STEPS-E curricula. She provides DBT training and consultation to schools, mental health agencies, and mental health providers around the world. Certified as a DBT therapist by the DBT-Linehan Board of Certification, Dr. Dexter-Mazza completed her postdoctoral fellowship under the direction of Marsha M. Linehan at the University of Washington. She served as Clinical Director and a research therapist for Dr. Linehan’s research studies, providing comprehensive DBT to clients. Dr. Dexter-Mazza has published many book chapters and peer-reviewed articles on DBT, borderline personality disorder, and graduate school training in managing suicidal clients.

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Alec L. Miller, PsyD, is cofounder and codirector of Cognitive and Behavioral Consultants, a treatment, training, and consultation center in White Plains and Manhattan, New York; cofounder and Board Vice President of the nonprofit Access Psychology Foundation; and Clinical Professor of Psychiatry and Behavioral Sciences at Montefiore Medical Center of the Albert Einstein College of Medicine, Bronx, New York. Since the 1990s, Dr. Miller has adapted and applied DBT to youth in outpatient, inpatient, and school settings, as well as to youth who have chronic medical illnesses. His publications include over 100 peer-reviewed articles and book chapters, as well as the coauthored books Dialectical Behavior Therapy with Suicidal Adolescents and DBT Skills Manual for Adolescents and the DBT STEPS-A and DBT STEPS-E curricula for secondary and elementary school settings. Dr. Miller has trained thousands of clinicians and school personnel in DBT internationally.

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Jill H. Rathus, PhD, is cofounder and codirector of Cognitive Behavioral Associates, a treatment and training center in Great Neck, New York. She is a former Professor of Psychology at Long Island University Post, where she directed the DBT Clinical Research Lab, and serves as Visiting Professor at Shanghai Mental Health Center of Shanghai Jiao Tong University School of Medicine. Dr. Rathus is coauthor of books including Dialectical Behavior Therapy with Suicidal Adolescents and DBT Skills Manual for Adolescents, and is a coauthor of the DBT STEPS-A and DBT STEPS-E curricula for secondary and elementary school settings. She consults internationally, has trained thousands of mental health professionals in the United States and worldwide, and is widely published in peer-reviewed journals. Dr. Rathus serves as Co-Chair of the Treatment Integrity Committee of the World DBT Association and is a recipient of the Cindy Sanderson Outstanding Educator Award from the International Society for the Improvement and Training of DBT.

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Heather E. Murphy, PhD, NCSP, has a private practice in Seattle, Washington, where she works with self-harming and suicidal adolescents. She is adjunct faculty in educational psychology at the University of Washington. Dr. Murphy previously worked as a school psychologist in elementary, middle, and high schools for 7 years. During that time, she developed districtwide procedures for intervening with suicidal youth and standard practices for responding to a suicide. Dr. Murphy’s research, publications, and clinical work focus on adolescent mental health, LGBT youth, and suicide intervention with adolescents.

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Audience

School psychologists, counselors, social workers, and nurses working with students ages 11–17 (grades 6–12); general education teachers, particularly health teachers.

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Special package offer: Together, DBT Skills in Elementary Schools (grades K–5) and DBT Skills in Schools (grades 6–12) provide innovative, developmentally informed SEL curricula, grounded in dialectical behavior therapy, for students of all ages.

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