Keeping Your Balance with Growth, Healing, and Maintenance

PATTERN WHEEL
The Diary Card is a great tool to help you remember your skills and to help you monitor your daily ups and
downs. But what happens when you’re really stuck? What do you do when you find yourself in the same
situation over and over again? Or when you keep making the same mistakes time and time again? What
happens when you’re in a blind spot and you can’t see your way out? It’s time for the Pattern Wheel!

1.
Triggering Event

6. 2.
Consequences and Interpretations
Vulnerabilities and Distortions

PATTERN WHEEL

3.
5.
Emotional and
Behaviors
Physical Reactions

4.
Problem Urges

Now let’s decode this illustration so you can understand how the Pattern Wheel works.

1. Triggering event. First, we identify a problem situation that keeps happening over and over
again. This is called the triggering event.

2. Interpretations and distortions. Next we need to figure out: What were my beliefs and
assumptions about that event? We should identify any ANTs that may be influencing our
interpretation.

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3. Emotional and physical reactions. The next step is to notice our physical and/or emotional
reactions to the situation. It is especially helpful if we can figure out where exactly in our body
we feel each emotion.

4. Problem urges. Next we identify our problem urges. Remember, problem urges are what we
feel like doing when triggered, not necessarily what we end up doing. Problem urges, when
acted on, make the situation even worse.

5. Behaviors. Now we identify our actual behaviors. This is what we end up doing. If we lack
self-regulation, our behavior is probably not too different than our problem urge.

6. Consequences and vulnerabilities. Finally, we need to identify the consequences of our

behaviors. It’s especially important to notice when the consequences make us vulnerable (set
us up) for the same old prompting event to happen all over again.

But wait, we’re not done! Once we have documented steps 1 through 6, we must go back to each step
and identify at least one DBT skill that we have learned in this workbook that we can apply to stop the
cycle from repeating itself.
Before we look at a sample of the Pattern Wheel in action, there are several things I want you to notice
about this exercise. First, did you notice that the Pattern Wheel is designed to increase awareness, just like
the Diary Card? While the Diary Card is meant to increase general daily awareness, the Pattern Wheel is
designed to increase awareness of specific dysfunctional cycles that trap us. In particular, the Pattern
Wheel helps us identify each link in that cycle so that we can develop better insight into what specifically
is keeping us stuck.
Second, did you notice that you can break this cycle at any point? There are specific DBT skills that
we can use at each link in this chain that will cause the chain to snap. Even though it’s always best to break
the cycle as soon as possible, it’s never too late. You can end the cycle at any time, even if you’ve spun
around this wheel for the hundredth time!
Let’s take a look at an example of the Pattern Wheel before you try this on your own. For the sake of
argument, let’s just pretend that this is not a personal (recurring) example from my own marriage!

1. Triggering event: My wife makes a suggestion, perhaps in the form of a helpful

critique.
Possible skills: Mindfulness (awareness + acceptance)

2. Interpretations and distortions: “Nothing I ever do is ever good enough for her.” Possible
ANTs: overgeneralizing, personalizing, mind reading
Possible skills: Work the TOM, Stomp the ANTs

3. Emotional and physical reactions: I feel criticized. I feel humiliated. Breathing increases.
Fists start to clench.
Possible skills: Controlled Breathing, Muscle Relaxation, Self-Soothing

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4. Problem urges: I feel like criticizing her back.

Possible skills: Acting Opposite, Ride the Wave, Imagery

5. Behaviors: I say something negative to her.

Possible skills: Finding Humor, Mini Vacation, DEAR Adult—Assert

6. Consequences and vulnerabilities: The negative comment I make about my wife con-
firms her original criticism. Because of how I handled this situation, I have directly
contributed toward the same triggering event that started the whole sequence in the
first place.
Possible skills: DEAR Adult—Apologize, Cope Ahead (for next time)

Enough about my own dysfunction. Now it’s your turn to practice!

Pattern Wheel Practice

Identify a situation that keeps repeating in your own personal life. Next, identify the domino effect of how
one thing leads to another to another, all the way until you are back in the same situation that started off
this entire sequence.

1. Triggering Event

What is the situation that keeps happening over and over again?

What skills could I use before this puppy even gets out of the cage?

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2. Interpretations and Distortions

What are my beliefs and assumptions about this situation?

Are there any ANTs influencing my interpretation?

What skills could I use to come up with a more accurate interpretation?

3. Physical and Emotional Reactions

What am I feeling physically in response to this situation?

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What am I feeling emotionally in response to this situation?

Try to identify a specific connection between each physical feeling and each emotional feeling.

What skills could I use to cope with these feelings?

4. Problem Urges

What do I feel like doing in this situation?

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Would this reaction help the situation or make it worse?

What skills could I use to cope with these urges?

5. Behaviors

How do I usually handle this situation?

What skills could I use to handle this situation differently in the future?

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6. Consequences and Vulnerabilities

What are the real-world consequences of my behavior?

How does my behavior contribute toward the same situation that started off this whole ordeal?

What skills can I use to repair the damage and prevent another go-around?

DEAR SELF
In the chapter on Restoring Balance with Relationships, do you remember how we learned the DEAR
Adult tool to assert, appreciate, and apologize? In this chapter, you are going to learn a similar tool to
continue your healing journey: DEAR Self.
You will be writing a series of letters to your traumatized self. Please note: The following exercises
should be completed only (1) if you are currently receiving support from a professional counselor or (2) if
you have already worked your way through the rest of this workbook. Here’s why: There are many models
for treating trauma, but they all overlap on one point: Your life should not currently be in active crisis when

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The Dialectical Behavior Therapy Skills Workbook for

The tools you need to begin healing from trauma

I f you’ve experienced trauma or have been diagnosed with post-traumatic stress disorder
(PTSD), you may struggle with anxiety, depression, anger, fear, insomnia, flashbacks, and
even addiction. You aren’t alone, and it’s not your fault. Trauma is a normal reaction to a The Dialectical
distressing or painful event. Fortunately, there are real steps you can take now to begin healing.

Behavior Therapy
This powerful workbook will help guide you.

In The Dialectical Behavior Therapy Skills Workbook for PTSD, you’ll find practical exercises for
overcoming trauma and PTSD using mindfulness, distress tolerance, emotion regulation,

Skills Workbook
dialectical thinking, and interpersonal effectiveness skills. You’ll learn how to be present
in the moment and identify the things or situations that trigger your trauma. You’ll also
find activities to help you cope with stress, manage intense emotions, reduce conflict with

for
others, and move past the unhealthy thoughts that keep you feeling stuck. If you’re ready to
heal from trauma and start living your life again, this workbook will help you find your way.

The skills in this evidence-based guide will help you:

• Identify your triggers • Balance difficult emotions
• Manage stress in healthy ways • Improve communication with others
PTSD
“An excellent tool that will benefit trauma survivors and Practical Exercises for
those working in the field of trauma.”
—DANETTE MONTOYA, MSW, LCSW, psychotherapist and military sexual
Overcoming Trauma &
trauma coordinator, San Francisco Veterans Affairs Health Care System
Post-Traumatic Stress Disorder

PTSD
KIRBY REUTTER, PhD, is a bilingual licensed psychologist, mental health counselor, and
internationally certified substance abuse counselor. He specializes in working with residential populations,
traumatized adolescents, and Spanish-speaking clients. REUTTER
newharbingerpublications
w w w. n e w h a r b i n g e r . c o m
KIRBY REUTTER, PhD
FOREWORD BY DAWN DEPASQUALE, LMHC