Sample Clinical Interventions: Download this list, Highlight the ones you use
most, and add any additional favorites!
CBT
1. Cognitive Restructuring (Cognitive Reframing)
• Purpose: To identify and challenge irrational or maladaptive thoughts.
• Process:
o Identify negative or distorted thoughts.
o Evaluate the evidence for and against these thoughts.
o Replace distorted thoughts with more realistic and balanced ones.
o Example: If a person thinks, "I always fail at everything," they would examine the evidence for
this belief and then reframe it to, "I have succeeded in many things and can learn from my
mistakes."
2. Behavioral Activation
• Purpose: To increase engagement in positive activities to improve mood.
• Process:
o Identify activities that bring pleasure or a sense of accomplishment.
o Schedule these activities regularly.
o Gradually increase the complexity and frequency of the activities.
o Example: If someone is feeling depressed, they might start with small activities like taking a
walk or reading a book, and gradually increase to more social or challenging activities.
3. Exposure Therapy
• Purpose: To reduce fear and avoidance by gradually exposing individuals to feared situations or
objects.
• Process:
o Create a hierarchy of feared situations, from least to most anxiety-provoking.
o Gradually expose the individual to these situations, starting with the least frightening.
o Use relaxation techniques and coping strategies during exposure.
o Example: For someone with a phobia of elevators, exposure might start with imagining being in
an elevator, then watching videos of elevators, and eventually riding in an elevator.
4. Mindfulness and Relaxation Techniques
• Purpose: To increase awareness of the present moment and reduce stress.
• Process:
o Practice mindfulness meditation, focusing on the breath or bodily sensations.
o Use relaxation exercises such as deep breathing, progressive muscle relaxation, or guided
imagery.
o Example: During a stressful situation, an individual might use deep breathing techniques to calm
their nervous system.
5. Problem-Solving
6. Activity Scheduling and Planning
• Purpose: To organize daily activities and ensure engagement in meaningful and enjoyable tasks.
• Process:
o Create a daily or weekly schedule that includes necessary, pleasurable, and meaningful activities.
o Ensure a balance between work, self-care, and leisure.
o Example: An individual might plan their week to include work tasks, exercise, social activities,
and relaxation time.
7. Thought Records
• Purpose: To track and analyze negative thoughts and their impact on emotions and behaviors.
• Process:
o Record the situation, thoughts, emotions, and behaviors associated with a distressing event.
o Identify cognitive distortions and challenge them.
o Replace negative thoughts with balanced alternatives.
o Example: After experiencing anxiety about a work presentation, an individual might use a
thought record to identify that they thought, "I will make a mistake and everyone will
judge me," and then reframe it to, "I have prepared well and can handle any questions."
8. Skills Training
• Purpose: To develop new skills to manage specific problems, such as assertiveness,
communication, or anger management.
• Process:
o Identify areas where new skills are needed.
o Provide education and practice in these skills.
o Implement and reinforce these skills in real-life situations.
o Example: An individual might learn and practice assertiveness techniques to improve their
ability to express their needs and opinions clearly and respectfully.
DBT Communication Skills:
1. DEAR MAN
DEAR MAN is an acronym that outlines a step-by-step approach for communicating effectively in order to
achieve your objectives. You can write in your progress note "Discussed DBT DEAR MAN communcation
skill of sticking to the facts" etc
• Describe: Describe the current situation. Stick to the facts.
• Express: Express your feelings and opinions about the situation clearly.
• Assert: Assert yourself by asking for what you want or saying no firmly.
• Reinforce: Reinforce the benefits of getting what you want by explaining positive outcomes.
• Mindful: Stay focused on your goals and ignore distractions.
• Appear Confident: Maintain eye contact, use a confident tone, and keep a steady posture.
• Negotiate: Be willing to give to get. Offer alternatives and be open to compromise.
2. GIVE
GIVE is an acronym that helps improve and maintain relationships while communicating.
• Gentle: Be gentle in your approach. Avoid attacks, threats, and judgmental statements.
• Interested: Show interest by listening and being engaged in the conversation.
• Validate: Validate the other person’s feelings and point of view.
• Easy Manner: Use an easy, relaxed manner. Smile, use humor, and try to be lighthearted.
3. FAST
FAST is an acronym that focuses on maintaining self-respect during communication.
• Fair: Be fair to yourself and others.
• Apologies: Avoid apologizing unnecessarily. Don’t apologize for having an opinion or for existing.
• Stick to Values: Stick to your values and what you believe is right.
• Truthful: Be truthful and avoid exaggeration or lying.
4. Validation
Validation involves recognizing and affirming another person's feelings, thoughts, and experiences. This skill
helps in making others feel understood and respected, which can improve communication and relationships.
5. Active Listening
Active listening means fully concentrating, understanding, responding, and remembering what is being said.
This involves giving full attention to the speaker, acknowledging their message, and responding thoughtfully.
6. Mindfulness of Others
This skill involves being aware of the needs, feelings, and viewpoints of others in the conversation. It requires
observing without judgment and being present in the interaction.
7. Self-Soothing and Distress Tolerance
These skills help in managing emotional responses that can interfere with effective communication. By
regulating your own emotions, you can communicate more clearly and calmly.
Using these DBT skills can greatly enhance your ability to communicate effectively, maintain healthy
relationships, and achieve your interpersonal goals.
DBT Distress Tolerance Skills:
1. TIPP Skills
TIPP skills are quick, actionable techniques to reduce distress in a crisis.
• Temperature: Change your body temperature quickly to trigger the dive response. For example, splash
your face with cold water or hold an ice pack.
• Intense Exercise: Engage in short bursts of intense physical activity to expend excess energy and reduce
emotional intensity.
• Paced Breathing: Slow down your breathing to calm your body. Try inhaling for 4 seconds, holding for
4 seconds, and exhaling for 4 seconds.
• Paired Muscle Relaxation: Tense and then relax different muscle groups in your body to release tension
and promote relaxation.
2. STOP Skills
STOP skills help you pause and avoid impulsive actions during high-stress moments.
• Stop: Literally stop what you are doing. Do not react impulsively.
• Take a step back: Take a deep breath and step away from the situation if possible.
• Observe: Notice what is happening both inside and outside of you. What are your thoughts, feelings, and
sensations?
• Proceed mindfully: Think about your goals and proceed with awareness, making a wise decision based
on your observations.
3. Pros and Cons
Evaluate the pros and cons of tolerating distress versus acting impulsively. Write down the benefits and
drawbacks of each option to help guide your decision-making.
4. Radical Acceptance
Fully accepting the reality of the situation without judgment. This does not mean you approve of or like the
situation, but you acknowledge it as it is. Practice statements like "It is what it is" or "This is the way it has to be
right now."
5. IMPROVE the Moment
Use these strategies to make a difficult situation more tolerable.
• Imagery: Visualize a peaceful scene or imagine yourself coping successfully.
• Meaning: Find or create meaning in the distressing situation.
• Prayer: Connect with your spiritual beliefs or practice meditation.
• Relaxation: Engage in activities that relax you, such as deep breathing or progressive muscle relaxation.
• One thing in the moment: Focus your attention on the present moment to avoid becoming overwhelmed.
• Vacation: Take a brief mental or physical break from the stress.
• Encouragement: Use positive self-talk and affirmations to motivate and comfort yourself.
6. Self-Soothe
Use your five senses to comfort yourself.
• Vision: Look at something beautiful or calming.
• Hearing: Listen to soothing music or nature sounds.
• Smell: Use pleasant scents like essential oils or candles.
• Taste: Enjoy a small treat or savor a comforting beverage.
• Touch: Use a soft blanket, take a warm bath, or practice gentle self-massage.
7. Distract with Wise Mind ACCEPTS
Engage in activities to distract yourself from distressing thoughts and emotions.
• Activities: Engage in enjoyable or meaningful activities.
• Contributing: Help someone else or do something kind.
• Comparisons: Compare yourself to those less fortunate or to how you were in the past when you were
struggling more.
• Emotions: Generate different emotions by watching a funny or uplifting movie, listening to music, etc.
• Pushing away: Temporarily leave the situation mentally.
• Thoughts: Engage your mind with puzzles, books, or other mentally stimulating activities.
• Sensations: Create a different physical sensation (e.g., hold ice, squeeze a stress ball).
8. ACCEPTS Self-Soothe Skills
Self-soothe using your five senses:
• Vision: Look at something beautiful or calming.
• Hearing: Listen to soothing music or nature sounds.
• Smell: Use pleasant scents like essential oils or candles.
• Taste: Enjoy a small treat or savor a comforting beverage.
• Touch: Use a soft blanket, take a warm bath, or practice gentle self-massage.
Additional Clinical Interventions
1. Administered questionnaire to assist with diagnosis/assess symptom severity (ex. Beck Depression
Inventory, Burns Anxiety Inventory or Burns Depression Checklist); gave follow-up questionnaire to
check for progress
2. Utilized EMDR / EFT techniques to address trauma symptoms
3. Monitored medication compliance [Note: Add details about compliance, even if all is fine: ex. "client
reports taking medications as prescribed with no negative side effects"]
4. Discussed behavioral homework / journal / letter-writing assignment / reading assignment. (note
insights)
5. Taught self-soothing techniques, including _____ (ex. breathing techniques, progressive relaxation,
visualization)
6. Helped client identify negative impact of anger, and positive consequences of anger management
7. Used motivational interviewing to strengthen commitment to therapy and to change dysfunctional
behavior
8. Helped client identify and challenge cognitive distortions, and to replace with positive affirmations
9. Helped client identify negative self-talk; taught thought-stopping techniques
10. Taught mindfulness meditation to help …. (ex. self-soothe when anxious, combat insomnia, etc)
11. Helped client identify how key life figures coped with anger, and how this affected client expression of
anger
12. Had client visualize scene that provokes anxiety or anger, then after using relaxation skills, to visualize
utilizing healthy coping skills or alternate outcome
13. Educated client about addiction / codependency / enabling / 12 Step concepts
14. Helped client identify dysfunctional coping mechanisms from alcoholic/abusive childhood home she
still uses
15. Taught assertive communication techniques; role played using techniques
16. Taught problem-solving skills, including clearly defining problem, brainstorming possible solutions,
evaluating the pros and cons of each, and implementing a plan of action.
17. Taught conflict resolution skills (ex. _____________________________)
18. Taught and practiced active / reflective listening
19. Conducted couples/family session to give client support to speed progress and assess for any barriers to
change
20. Predicted possible causes of "relapse." Had client make list of how she would deal with it if felt that
depressed/anxious/angry again, or faced same problem again
21. Utilized art therapy techniques, had client draw / sculpt / paint etc. how she felt when _____________
occurred.
22. In order to lower client defenses, utilized play therapy techniques, while encouraging client to describe
stressors
23. Assessed for risk factors, including substance abuse, suicidal or homicidal ideation; none reported by
client.
24. Discussed moving to twice monthly sessions to maintain therapeutic gains while preventing relapse.
25. Due to exacerbation of symptoms, suggested second session this week; client agreed
26. Reviewed progress toward treatment goals (specify progress); updated treatment plan (how?)
27. Processed fears related to ________________________
28. Pointed out strengths and coping abilities; explored how client had dealt with difficult situations in past
29. Discussed safety plan for when client feels like acting on thoughts of self-harm
30. Helped client identify worst-case scenario, and how she could deal with it.
31. In session, introduced her to DBT distress tolerance concepts, and had her complete DBT worksheet
Practical Interventions
1. Discussed confidentiality / limits of confidentiality /what information may be needed by insurance
2. Discussed appropriate use of answering service / crisis coverage
3. Discussed fees / policies / vacation coverage in my absence
4. Discussed bringing in spouse, and risks and benefits of doing couples and individual therapy with same
therapist.
5. Got release for doctor/psychiatrist/counselor. Discussed concerns about and benefits of care
coordination
Referrals (state purpose of referral)
1. Referred for medication evaluation / physical exam
2. Referred to EMDR as an adjunct treatment for trauma symptoms
3. Referred to couples therapy / individual therapy / self-help support group / 12-Step group / therapy
group
4. Referred client to (assertiveness / healthy communication / mindfulness / stress reduction etc.) class
Homework
1. Assigned journaling of situations that cause anger or irritation, to increase awareness of anger triggers
2. Assigned client to write letter (not to send) to person she is having trouble forgiving, to increase
awareness of causes of hurt/anger and to assist in letting go of emotions contributing to symptoms
3. Assigned client to identify and journal negative self-talk, and practice writing replacement affirmations
4. Assigned client to write complete alcohol and drug history, including reasons for use and negative
consequences
5. Assigned material to read, view, or listen to (handouts, books, articles, podcasts, videos, etc).
6. Client will practice assigned Systematic Desensitization exercises to face fears for increasing amounts of
time
7. Assigned clients to go on night out without children to strengthen marital support system
8. Assigned daily physical exercise to reduce symptoms, helped client choose type and time that she could
do daily.
9. Assigned client to engage in insight collection (observation during the week of behaviors or patterns
discussed in therapy to gain greater understanding)
10. Assigned client behavioral chart to engage in during the week
11. Assigned family to practice emotional language with child to increase child’s ability to express feelings
12. Assigned emotional response worksheets