2 -​​ Dialectical-Behaviour Therapy (DBT) Skills in Community Practice: What Can the DBT Distress Tolerance Skills Do for You?​​ 

Saturday, 24 October​​ 

11:15 – 12:45 (1.5 hrs)
Kathy Fitch*, BA (Hons), MD, FRCPC; Maria Astorga, MD, FRCPC​​ 


CanMEDS Role:​​ 

  • Medical Expert​​ 

At the end of this session, participants will be able to:​​ 1) Describe how dialectical-behaviour therapy (DBT) simplifies decision making in a moment of crisis, with the concept of "four solutions to any problem"; 2) Describe how to implement some of the DBT "distress tolerance skills" to a colleague or patient; and 3) Identify pitfalls in the overuse of distress tolerance skills.​​ 

Dialectical-behaviour therapy (DBT) teaches that there are four solutions to any problem: solve the problem, feel better about the problem, tolerate the problem, or stay miserable. A fifth potential response or solution is also standardly acknowledged: make things worse. In response to this framework for the individual’s moment of choice, DBT distress tolerance (DT) skills teach patients how to navigate significant stressors without reactive decisions that actually worsen their situations (in the category of “tolerate the problem” skills, which are useful even when, eventually, solving the problem would be the focus). The DT skills also focus on helping patients to accept and acknowledge reality as it really is, seen as fundamental to navigating a situation effectively (i.e., helping patients digest the difference between what can be changed and what cannot and what one would prefer to be the situation and what the situation actually is).

This workshop will be facilitated by two psychiatrists who are experienced in using DBT DT skills in various settings, including inpatient settings, general community practice, specialized DBT programs, and the emergency room. The DT skills are easily taught and can be useful for both clinicians and patients. The pitfalls of overusing DT skills are also important to acknowledge, and this will be explored to better prevent this dysfunctional overuse. Participants will be offered opportunities to actively practise using and teaching DT skills and troubleshooting problems, with the goal of leaving this workshop feeling equipped with specific tools they could consider using with the next distressed patient they see.


  • Koerner K. Doing Dialectical Behavior Therapy: A Practical Guide. New York (NY): The Guilford Press; 2011.

  • Linehan M. DBT Skills Training Manual. 2nd ed. New York (NY): The Guilford Press; 2014.


/ Virtual Conference 2020