DBT Skills for Managing Anxiety: A Practical Overview
Anxiety often shows up in ways that feel both overwhelming and persistent. The thoughts spiral, the body tenses, and the urge to avoid or escape gets strong. DBT offers skills that can help—not by making anxiety disappear, but by changing your relationship to it and providing concrete tools for the moments when it peaks.
These skills come from different DBT modules and work together: mindfulness helps you notice what's happening, distress tolerance gets you through the most intense moments, emotion regulation addresses underlying patterns, and interpersonal effectiveness handles the relationship aspects that often fuel anxiety.
Mindfulness for Anxiety
Mindfulness is the foundation of DBT, and it's particularly relevant for anxiety. Anxiety often involves getting caught up in future-focused thoughts—what might happen, what could go wrong. Mindfulness brings attention back to the present moment.
Practical Mindfulness Techniques
Observe and describe: Notice what you're experiencing without getting swept away by it. "I'm having anxious thoughts" is different from being consumed by the thoughts themselves.
One thing in the moment: Focus your attention fully on one thing—your breath, a sound, a physical sensation. When your mind wanders to anxious thoughts, gently return attention to the focal point.
Participate: Engage fully in whatever you're doing right now, rather than doing one thing while anxiously thinking about another.
The goal isn't to stop anxious thoughts—it's to notice them without automatically believing or acting on them.
Grounding Techniques
Grounding is especially useful when anxiety feels like it's pulling you away from the present moment or when panic is building:
5-4-3-2-1: Name five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste. This uses your senses to anchor you in the present.
Feel your feet: Notice the sensation of your feet on the floor. Press them down slightly. Feel the ground supporting you.
Cold water: Splash cold water on your face or hold ice. The physical sensation can interrupt the anxiety spiral.
For more grounding exercises, see DBT Distress Tolerance Exercises.
Distress Tolerance for Anxiety Peaks
When anxiety spikes to its most intense, distress tolerance skills help you get through without making things worse:
TIPP: Change your body's physiological state through Temperature (cold water on face), Intense exercise, Paced breathing (slow exhales), and Paired muscle relaxation.
Self-soothing: Comfort yourself through your senses—calming music, a soft blanket, a warm drink.
Radical acceptance: Accept that anxiety is happening right now. Fighting against the fact that you're anxious often increases the intensity.
Emotion Regulation for Anxiety Patterns
Emotion regulation skills address the broader patterns that make anxiety more frequent or intense:
Check the facts: Is the threat your anxiety is responding to real and likely? What's the actual probability? What would you tell a friend in this situation?
Opposite action: When anxiety urges avoidance, and the fear isn't justified by the facts, do the opposite—approach rather than avoid. (This should be done gradually with support, not all at once.)
Reduce vulnerability: Take care of the basics—sleep, eating, exercise, treating physical illness. When these are neglected, anxiety often intensifies.
Interpersonal Effectiveness for Social Anxiety
When anxiety involves relationships or social situations, interpersonal effectiveness skills can help:
DEAR MAN: A structured way to ask for what you need or say no—Describe the situation, Express your feelings, Assert your request, Reinforce the benefit, stay Mindful, Appear confident, Negotiate.
Validation: Validate your own feelings about social situations rather than criticizing yourself for having them. Anxiety in social situations is common and understandable.
Building a Practice
These skills work better when practiced regularly, not just during moments of peak anxiety. Try:
- Practicing grounding when you're calm so it's accessible when you need it
- Using a diary card to track anxiety levels and which skills help
- Starting with the skills that feel most manageable
- Working with a therapist who can help you apply these to your specific patterns
How DBT Pal Supports Anxiety Management
DBT Pal keeps these skills accessible and helps you track your practice:
- Access grounding and distress tolerance techniques when anxiety spikes
- Log anxiety intensity and what triggered it
- Track which skills you used and how effective they were
- Build patterns of consistent practice over time
When to Seek More Support
DBT skills can help with anxiety, but they're most effective as part of broader treatment. If anxiety is significantly impacting your life, consider working with a therapist trained in DBT or evidence-based anxiety treatment.
These skills are tools—a therapist helps you figure out when and how to use them for your specific situation.
Getting Started
If you want to practice DBT skills for anxiety, DBT Pal provides access to exercises and tracking.
For more on specific skills: