The document describes the development of a "DBT KIT" to provide ongoing support for those completing dialectical behavioral therapy (DBT). Currently, most DBT programs end abruptly after a year with little follow-up support. This can lead to difficulties maintaining skills and increased risk of relapse. The DBT KIT aims to address this problem by creating an online and in-person hybrid support community. Key features include training and certification for peer facilitators, a standardized meeting agenda and skills reference, and connections to clinical support as needed. The goal is to empower former DBT patients to support each other long-term, while maintaining safety and quality standards.

1. support group in-a-box
DBT KIT

2. INTRODUCTION
*All images are not of research participants. They are stock photos.
INTRODUCTION RESEARCH PROBLEMS SOLUTION FEEDBACK NEXT STEPS

3. Mental Illness
is the Problem
1/5 adults have a mental health condition
3rd most common cause of hospitalization
WHO IS AFFLICTED
57% adults did not receive treatment
20% due to cost
ACCESS TO CARE
http://www.nami.org
http://www.mentalhealthamerica.net/

4. Borderline
Personality
Disorder
A SNAPSHOT
Symptoms include emotional instability,
feelings of worthlessness, insecurity,
impulsivity, and impaired social relationships.
5.9%
of adults have BPD
10%
of them commit suicide
50x
higher suicide rate than
the general population
http://www.nami.org
http://www.mentalhealthamerica.net/

5. 8 stadiums
full of
people die
each year
PEOPLE WITH BPD

6. OUR
CLIENTS
Investment generally results in acquiring an asset,
also worth investing, it is normally expected
Investment generally results.
income, or to appreciate in value, so that it can be
sold at a higher price An investor may bear a risk of
loss of some or all of their capital invested
every
42 seconds
1 person
dies
PEOPLE WITH BPD

7. M o s t t h e r a p i e s d o n ’ t
e f f e c t i v e l y t r e a t B P D .
E x c e p t f o r D B T .
DBT has been proven effective
for a variety of other mental disorders too.

8. D I A L E C T I C A L B E H A V I O R A L T H E R A P Y
DBT
M o s t t h e r a p i e s d o n ’ t
e f f e c t i v e l y t r e a t B P D .
E x c e p t f o r D B T .
DBT has been proven effective
for a variety of other mental disorders too.
Patients learn one skill per week
in a group class.
Patients practice of skills is as
homework assignments.
Patients track skills use in a form
called a diary card.
DBT programs typically last a year.
Learn more about DBT

9. Effectively cope with extreme situations when you cannot avoid them.
Notice what you are thinking and feeling.
Awareness is needed to take effective action and change old habits.
M I N D F U L N E S S
Set healthy boundaries to take care of yourself. Develop, maintain, and improve
healthy relationships with others. End relationships that are toxic.
Challenge your automatic thoughts, feelings, and urges.
Respond proactively instead of reacting instinctually.
D B T
4 M O D U L E S
o f 3 1 S K I L L S
I N T E R P E R S O N A L E F F E C T I V E N E S S
E M O T I O N R E G U L A T I O N
D I S T R E S S T O L E R A N C E

10. D I A L E C T I C A L B E H A V I O R A L T H E R A P Y
DBT
W i t h o u t r e i n f o r c e d
p r a c t i c e , a s k i l l
c a n n o t b e l e a r n e d .

11. D I A L E C T I C A L B E H A V I O R A L T H E R A P Y
DBT
not wanting to
not remembering
not having time
don’t know how
emotional overload
avoidance
T h e m o s t c o m m o n
b a r r i e r s c a n b e
o v e r c o m e w i t h h e l p .

12. Learn Practice Use
G E N E R A L I Z AT I O N
A C Q U I S I T I O N S T R E N G T H E N I N G
S t a g e s o f S k i l l M a s t e r y
D I A R Y C A R D
Requires the application of contingency plans
and procedures, gradual exposure to triggers,
and/or cognitive modification. Skills use is
tracked in a weekly form called a diary card.
S K I L L S C L A S S
In skill acquisition, a trainer teaches new
behaviors, through lectures, discussions,
roleplaying. Skills are referenced in a collection
called a binder.
H O M E W O R K
New skills have to be practiced in the situations
where the skills are needed, not just in the
where the skills are first learned. Each week a
new skill homework module is assigned.

13. How might we…
E m p o w e r t h o s e w h o a r e n o l o n g e r i n D B T t o
m a i n t a i n a h e a l t h y f u l f i l l m e n t w i t h o u t t h e
n e e d t o g o b a c k t o t h e r a p y ?
I N C R E A S E S K I L L U S E
Putting DBT into action
I M P R O V E L I F E S T Y L E
Increase healthy behaviors and decreasing unhealthy ones
D E C R E A S E S U F F E R I N G
Lower agony dealing with difficult urges, thoughts, and emotions

14. RESEARCH
INTRODUCTION RESEARCH PROBLEMS SOLUTION FEEDBACK NEXT STEPS

15. Interviews
4 DBT patients and 3 Therapists
Messaging
members of 5 online support groups
DBT Facebook group for this project 35 members
Discussions
Surveys
Prototype feedback
Interviews
Read
Professional journals
Official DBT training materials
Psychology blogs and books
R E S E A R C H
Understanding and Empathizing
Details of the research

16. I t ' s b e e n a c o u p l e o f y e a r s s i n c e I
s t o p p e d g o i n g t o g r o u p a n d I a m n o t a s
d i s c i p l i n e d a s I u s e d t o b e . I c o u l d u s e a
r e f r e s h e r/r e m i n d e r t o p r a c t i c e m y s k i l l s .
R E S E A R C H P A R T I C I P A N T
“
L A C K O F F O L L O W U P

17. FOX
MINIMAL
Presentation
I NEED HELP
WITH ACCOUNTABILITY
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18. T h e r e n e e d s t o b e a l o n g e r f o l l o w u p .
P o s s i b l y s e t u p l i k e a 1 2 s t e p . F o r e v e r
w o u l d b e g r e a t . A y e a r w o u l d b e g o o d .
R E S E A R C H P A R T I C I P A N T
“
L A C K O F F O L L O W U P

19. PROBLEMS
INTRODUCTION RESEARCH PROBLEMS SOLUTION FEEDBACK NEXT STEPS

20. W i t h o u t r e i n f o r c e d
p r a c t i c e , a s k i l l
c a n n o t b e l e a r n e d .

21. not wanting to
not remembering
not having time
don’t know how
emotional overload
avoidance
T h e m o s t c o m m o n
b a r r i e r s c a n b e
o v e r c o m e w i t h h e l p .

22. I t ’ s d i f f i c u l t t o
c h a n g e a n d g r o w .
H e r e i s w h a t p e o p l e
f i n d c h a l l e n g i n g :
Need help using skills practicing
skills and using them.
Unable to build and maintain
healthy habits and new lifestyles
Everything gets exponentially
more difficult after therapy ends.
It can feel like diving off the deep
end of the pool when you haven’t
swam by yourself before.

23. ACCOUNTABILITY
PROBLEMS
For a year, therapists
have been checking in
during class and asking
each person if they had
practiced skills the
previous week and get
support if they didn't.
Now there is no one to
make sure they are doing
anything at all.
There are local DBT
support groups, but not
many. Strangely there
are fewer general groups
than there are specific to
BPD or other disorders,
friends and family of
those using DBT. This is
frustrating for many
people who are suffering.
FEW
SUPPORT
GROUPS
LACK OF
FOLLOW UP
Therapy abruptly ends
and most don’t feel ready
to move on instantly.
Many aren’t allowed to
communicate with fellow
classmates during class,
so many people lose
touch. Therapists often
don’t reach out between
therapy sessions and
don't provide after care.

24. TREATMENT AS USUAL
Once you’re done, you’re done.
Year 1 Year 2 Year 3 Year 4
Class
1:1
The End of Therapy
How do people know
where to go from here?
Therapy

25. Year 1 Year 2 Year 3 Year 4
TREATMENT AS USUAL
Once you’re done, you’re done.
Psychologist to the Rescue
Patients who make use of their resources
can get extra support when needed
Repeating Therapy
Over and over again? For how long?
Class
1:1
Triggering Event
Who knows when it might come.
Therapy

26. TREATMENT AS USUAL
Once you’re done, you’re done.
Year 1 Year 2
Plummet to the Bottom
Severe conditions can lead to suicide if
the proper support is not in place.
Class
1:1
Therapy

27. A B E T T E R WAY
T H E R E M U S T B E

28. A B E T T E R WAY
T H E R E W I L L B E

29. You can neglect your homework and
dismiss your notifications, but
it’s really hard to ignore a team of peers.

30. SOLUTION
INTRODUCTION RESEARCH PROBLEMS SOLUTION FEEDBACK NEXT STEPS

31. support group in-a-box
DBT KIT

32. FROM
Relapse & Perpetual Therapy

33. In Person
Virtual DBT
TO
Ongoing Peer Support
Location and time are no longer limiting factors
to support on the go
Nothing can replace being in the same room
with someone, eye to eye, face to face

34. Year 1 - Core Therapy Year 2 - Transition and Momentum Year 3 - Robust Stability Year 4+ Independence
Therapy
Class
1:1
In Person
Virtual
Support Group
DBT KIT IS THERE FOR THE LONG HAUL
Your community is there for you

35. A HYBRID MODEL
m e e t i n p e r s o n + c o n t i n u e o n l i n e

36. IN PERSON
Nothing can replace being in the same room with
someone, eye to eye, face to face. Most of
communication is nonverbal and local meet ups are
the only way to take advantage of that. A immediate
sense of comfort and community is what makes local
support groups have emotional resonance. With this
style of group, it's intimate, warm, and the feeling of
connection is palpable.
Not everyone can meet all the time though….

37. VIRTUAL
A remote support group can meet at any time and any
place. If members are in different time zones or even
different countries, you can meet 24/7. You need not be
limited to those that happen to live near you, since you
can connect with a seemingly limitless pool of people and
find members that are more similar to you in condition,
symptoms or level of DBT expertise. Many people live
remotely and have no access to local groups, others are
so busy that a virtual group is the only way to make DBT
a part of their life.
But something about the digital divide doesn’t provide
that same level of connection….

38. From what’s not working
to the
Evolution
of the
Support
Group

39. CURRENT STATE DBT KIT
Location In Person Remote
Hybrid
In Person + Remote
Can be used in person, in-between local meetings, and for virtual / remote meetings too.
Facilitation
Model
Peer Pro Peer Pro
Hybrid
Peer + Pro
Though designed to be peer lead, a professional clinician can facilitate as well.
Structure Centralized Decentralized
There is no one host or leader of these groups, providing that multiple people get certified,
anyone can lead the meetings so the group can go on even with wildly varied attendance.
Availability
(time & place)
Limited Unlimited Unlimited
Since the app works locally and remotely, you can always reach out to others regardless of
distance.
Format Varied Standardized The default meeting agenda gives every group the same boiler plate base to build on.
Quality Unknown Mixed
Each group has different membership and can customize everything to fit the unique needs of
the members. Quality will naturally fluctuate from group to group, meeting to meeting.
Training and
Certification
Unknown Yes Peer facilitators are encouraged to take training and certified provided by DBT KIT.
Scalability Limited Medium High
All anyone needs is the app and certification, then they can be an affiliate chapter of DBT
Skills Group in a box. The network of these Groups scales as fast as the word spreads.
Support None or Ad-Hoc
Hybrid
Peer + Pro
Since there will be many groups using the same platform, they can be supported by the same
company / organization.
Advocacy Local Global
All chapters of the DBT KIT in a Box can unify their message and marketing to spread
awareness of DBT and conduct collaborative fundraising.

40. Design
Principles
Empower peers to help each another consistently and
maintain high safety standards
Peers are doing all the work, but clinical and emergency aid will need to be on call
when working with at risk populations.
Ensure a quality facilitation and leadership
and allow for flexibility and customization
Anyone can lead any kind of group, but that does not mean they should.
This model teaches people how to be effective, follow proven guidelines
but provides space to meet the diverse needs of their community.
Allow people to access the same kind of support locally
and virtually and everything in-between
Face to face connections has proven to be the most effective support
modality, but people can’t or don’t always meet in person. Support can
meet them where they are, and not the other way around.
Combine self care with strategies to increase
accountability and followthrough over the long haul
DBT is not enough on its own. Many need help with consistency.

41. The meeting agenda and skills list are
instantly available. Once you
understand wha content is available you
can get started with your first meeting in
as long as it takes members to join you.
Main Features
Training and Certification
24/7 Remote Clinical and Safety Support
Discount for the coach.me habit utility
MEMBERSHIP
Your group need not be an island. By
starting a DBT KIT support group
member, you instantly become part of a
global network of other people just like
you. Connect with them, share best
practices, and find groups when you
travel or move.
Main Features
Connect with other groups
Find remote members
Share resources
PORTAL
The meeting agenda and skills list are
instantly available. Once you
understand wha content is available you
can get started with your first meeting in
as long as it takes members to join you.
Main Features
Expectations, Rules, and Consent forms
Customizable Agenda with Timer
Skills Reference
Accountability Support
Messaging
APP
Free | Release 1
Paid Membership | Release 2
Paid Membership | Release 3

42. APP
Use your time efficiently and
remember what to do next.

43. CUSTOMIZABLE
AGENDA
App
A meeting plan that is based on DBT and
influenced by other support groups
Never start from scratch or wonder what to do in your
meetings. Those who have gone to DBT skills training will find a
similar schedule with additional elements that have proven
effective in other groups. Good support groups borrow, great
ones steal.
Make it yours
Any section can me shortened, rearranged, or removed.
Change it up based on the needs of the community or feel free
to experiment to see what works best.
Adapt to fluctuations in membership
Enter the number of participants in a meeting, and the timing
recommendations for relevant activities update. Set a timer for
each activity if you want to. When you cook for more people
you change the recipe, and the same is true in meetings.

44. Creating the
container
safety clearance and consent
Agree to rules, expectations,
and boundaries
Mindfulness
Get grounded and ready
Individual Reflection
Decide what want to get out of
group today
Check In
Briefly describe how you are
and how your week was
Retrospective - are you
accountable
O P E N
DBT Skill
Teach or review one DBT Skill
Share a related personal story
Questions / Answers
Sticky Skill
Teach or review one DBT Skill
Share a related personal story
Questions / Answers
L E A R N
Collaborate
self access and declare the
degree they need support and
help from the group on a scale
of 0 to 5
Members show their scores
and vote on who will receive
the most attention
Chosen members explain their
situation and others provide
advice, ask questions, and help
him or her get what they need
to move forward
W O R K
Accountability
Action Plan
Define the behavior
Type of change
Set a goal (SMART)
Create a contingency plan (WOOP)
Commit
Check In
Keep Track
Reinforce
C L O S E
AGENDA PHASES

45. DBT AND STICKY
SKILLS REFERENCE
App
All the DBT skills are there - and more
Each skill gets a one page ‘cheat’ sheet that summarizes what is
found in official DBT training. You no longer need to lug that
large binder since all you need is on your phone. Sills are
augmented by recommended books, videos, apps, etc.
Make it stick
The DBT skills work wonders…when you use them. Even the
best of us have trouble being our best selves and doing what
we should do. Sticky strategies help you work smarter and
increase your ability to start healthy habits and stop bad ones.
It’s all connected
Skills build on one another and work better when used
together. Each skill shows you what others might be helpful.
Relevant content references official DBT materials.

46. ACCOUNTABILITY
ACTION PLAN
App
Teamwork and collaboration win the day
Life is hard enough, so why fly solo? Find one member from
your group and become accountability partners. Together you
check in on one another during the week to offer whatever help
is needed. Know that someone is in your corner and cares.
Do a little, get a lot
Studies have shown that just writing down goals and having
another person helping keep you accountable have a dramatic
impact on adopting and maintaining habits
Plan for the worst, expect the best.
Define the one thing that you want to accomplish and what one
skill will help most. Define goals in detail, and form a
contingency plan when life gets in the way. You’ll leave each
meeting with a mission to accomplish, and you’ve got backup.
*Membership Required

47. Behavior to change
You can only pick one
Type of change:
stop, less, or more
Goal
SMART
Specific
Measurable
Achievable
Realistic
Time Bound
Who, What, Where,
When, and Why
Resources Needed
Main Plan
Tiny Habits
Trigger
Action
Reward
Contingency Plan
WOOP
Wish
Outcome
Obstacle
Plan
Check in
Accountability buddy
connection with another
person / just saying Hi
In between meetings
When and how / set
boundaries
Reminders
Keep Track
Don’t break the chain
Similar to the diary card
Thematic consistency - one
thing at a time
‘Ghost racing’ / competition
against self, not others
You can’t improve what you
can’t measure
Reinforce
Celebrate success
Loss aversion for a boost
Possible deterrent
Retrospective
Failing forward / Learn from
mistakes
Inform the next contingency
plan
Hindsight is 20:20
ACTION PLAN STEPS
Commit
Contract with yourself
Contract with a peer
Verbally share what you
have agreed to do with the
entire group

48. MEMBERSHIP
Training and Certification
24/7 Clinical Support

49. TRAINING AND
CERTIFICATION
Membership
Safety first
Facilitators need to know how to properly handle a crisis and
deescalate situations where people could be at risk.
Confidence in competence
Only those with the proper training should be allowed to lead
and facilitate a DBT support group. This DBT Peer Support
Specialist certification lets former or current DBT clients to
encourage, validate, and nurture others in a safe and effective
manner.
The gold standard
Peer training has been adapted from the Official Linehan Board
of Certification.

50. GROUP
MESSAGING
App
Safety and Privacy First
Talk with fellow members without exchanging phone numbers.
Add usernames to your friends list to stay connected devoid of
personal information. All messages are protected with AES-256
bit encryption. Thats a lot of bits.
DBT all the way
Combine text, audio, and video with DBT specific quick
responses, self-harm related keyword detection, and a chat bot
who knows about DBT, so you can chat even when no one is
around to sharpen your skills.
Shout or whisper
Talk with the whole support group or specific members. Join
content specific channels to focus your conversations and see
only whats important to you.
*Membership Required

51. 24/7 CLINICAL
SUPPORT
Membership
Safety first
Facilitators need to know how to properly handle a crisis and
deescalate situations where people could be at risk.
Always there
Teams of dedicated clinicians and mental health specialists are
available to members and can provide medical advice, advise
on crisis management procedures, answer questions, and help
you get the resources you need. Contact them by phone, email,
or even text. Support teams are available in various timezones
and can be reached at any time.

52. PORTAL
Connect with other groups
Find remote members
Share resources

53. COMMUNITY
PORTAL
Membership
Connect
Each group that becomes an official DBK chapter (all members
are trained and certified and are actively paying dues) has their
own page on and access to an online community.
Network
If you move or are traveling, there is no better way to connect
to your DBT peers If members leave your group, you can find
others who would like to join.
Share
Discuss issues and share experiences / best practices with
other groups at a local, national and international level. Think
of this as support for your support group.

54. FEEDBACK
INTRODUCTION RESEARCH PROBLEMS SOLUTION FEEDBACK NEXT STEPS

55. FOX
MINIMAL
Presentation
WITH THIS
I PROBABLY
WOULDN’T GO BACK
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56. FOX
MINIMAL
Presentation
THIS WOULD
MAINTAIN MY
TRANSFORMATION Audio playback requires
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57. NEXT STEPS
INTRODUCTION RESEARCH PROBLEMS SOLUTION FEEDBACK NEXT STEPS

58. Mo Goltz
www.sgoltz.net/
https://www.linkedin.com/in/shlomogoltz
THEY NEED
OUR HELP
Thank you for spending the time to think about and consider the
issues people with mental illness face. I believe that everyone can live
a life worth living if they just have the proper resources and support.
This project is just the beginning of my efforts to do whatever I can to
help others find relief and joy in their lives. If you’d like to know more
or get involved, please contact me.
Thank you.

59. G E T O T H E R S I N V O L V E D
Partnerships, endorsements, guidance networking, etc.
Official DBT Institutions
The Linehan Institue
Behavioral Tech
Washington University
Moderators of the largest DBT forums
DBT Peer Connections
BPD & DBT
DBT Peers Helping Peers
DBT Self Help
The one (real) online DBT support group
My DBT Life
Online DBT Skills Training
DBT Skills Coaching
Emotionally Sensitive
My Dialectical Life
Dialectical Living
Other DBT experts
Authors of DBT Books
Leaders of local DBT support groups
Collaborators
Project Manager
Researcher
Programmer / Prototyper
Additional Support
Lawyer / Attorney
(Patents, Copyright)
H O W T O G E T T H E R E
What I would need to make this a reality
I’d like to continue working on this project so that other people
can benefit from this work. For that I will need more resources.
I am primarily considering grants at this point for funding, but am
open to other means such as a Kickstarter, or even taking out a
few small loans.
I honestly have no idea how long a project like this would take,
and how much money I’d even need. Finding out the answers to
these issues are next on my agenda.
Until then,I will start prototyping the core content of my idea, the
agenda and skills reference with one friend who has gone
through DBT. If we role-play the support group meetings, we can
see where it goes from there.
I’d appreciate any support in moving this project forward.
Thank you for your time and consideration.

60. support group in-a-box
DBT KIT

61. APPENDIX

62. PRELIMINARY PROJECTS
the prototypes that helped inform my final design

63. AccountailiBuddies
First Iteration
Description
A person teams up with others who are also
practicing DBT. Together, they fill out their own mini
diary card which indicates they practiced or used a
skill that day. Peers can tell if you are filling in the
diary, and if they do use it, they can see how well
their day has been. Teammates can check in on you
to provide support and advice via chat if your diary
indicates you are having trouble.
Key Takeaways
Liked a simpler way to track skills use
Tracking skills may not be useful since skills are not
needed all the time
Messaging is preferred to over tracking by some.
1
Phase
Skill Integration
Priorities
Compare, Track,
Communicate
Location
Remote
Type
Sketches
Format
Storyboard
and Wireframes
Tools
Pen, Pencil, Paper

64. AccountailiBuddies
Second Iteration
Description
A person teams up with others who are also
practicing DBT. Together, they fill out their own mini
diary card which indicates they practiced or used a
skill that day. Peers can tell if you are filling in the
diary, and if they do use it, they can see how well
their day has been. Teammates can check in on you
to provide support and advice via chat if your diary
indicates you are having trouble.
Phase
Skill Integration
Priorities
Compare, Track,
Communicate
Location
Remote
Type
Digital Product
Format
Form and Spreadsheet
With Chat
Tools
Google Forms and Google
Sheets
2
Key Takeaways
Comparing skills use to others may be
intimidating or demotivating
Messaging was reemphasized as most valuable

65. Skills Team
Third Iteration
Description
People who have agreed to be in a DBT support group
all use an App to stay in touch with each other when
they aren’t meeting in person. This app allows people
to message the group and one another, share DBT
related resources (links to articles, recommendations
for books, etc), and get track their skills use.
Key Takeaways
Liked the many ways to communicate with others
Addressed many use cases and needs
Flexible, adaptable, and customizable
Too many bells and whistles
Security of data is important
May get too many notifications
Phase
Skill Integration
Priorities
Communicate,
Track
Location
Remote
Type
Digital Product
Format
Forms and a Database,
with Robust Chat
Tools
Slack, Airtable, Skype, and
many 3rd party Slack
integrations
3
*Not photos of a research participants

66. All The Ideas
Several Iterations
Common themes of feedback
People want and are in need of ongoing support
Face to face is important
Trusting and caring about others (rather than in a
group with strangers) would make this more effective.
Learnings from prototyping
Technology isn’t always the answer.
As in the Agile Manifesto, “Individuals and interactions
over processes and tools”. Instead, focus on human
connection and communication.

67. support group in-a-box
DBT KIT