Dialectical Behavior Therapy (DBT), developed by Marsha Linehan, was built to help people cope with overwhelming experiences they didn't choose and have to live with nonetheless. Living with cancer so often feels that way. A life-altering diagnosis arrives without warning, bringing difficult decisions, hard conversations, and the challenge of living as meaningfully as possible while feeling flooded by strong emotions. DBT skills help people manage those emotions, communicate more effectively, and stay grounded in what matters most. There is evidence to support using these skills across serious illness populations. Studies have shown reductions in depression in breast cancer patients, decreased death anxiety in people living with HIV, and strengthened resilience and psychological flexibility in adolescents facing leukemia. This curriculum, adapted specifically for cancer patients, enhances psychological flexibility, meaning-centered coping, and self-advocacy, while reducing difficulties in emotion regulation.

This curriculum is built around three essential building blocks of DBT.

Mindfulness — paying attention to the present moment without judgment — helps patients reduce anxiety, minimize rumination, improve sleep, and stay connected to moments of meaning and joy rather than being pulled into regret about the past or dread about the future.

Validation — recognizing that an experience is real and understandable — helps patients quiet their inner critic, trust their own responses, and communicate in ways that make others more likely to truly listen.

Dialectical thinking — the idea that two seemingly contradictory things can both be true — gives people permission to feel frightened and hopeful, to grieve their diagnosis and still find happiness elsewhere. It also supports self-compassion: I'm coping the best I can right now — and I can learn new ways to cope.

No. This curriculum focuses on a targeted subset of DBT skills relevant to anxiety, grief, communication challenges, and emotional overwhelm. The skills are practical and modular, designed to fit naturally within many clinical frameworks (CBT, psychodynamic therapy, social work, oncology nursing, and more), and can be integrated into individual sessions, group work, or family conversations. 

To be clear, this is not comprehensive DBT. Patients presenting with suicidal ideation, self-harm, or other high-risk behaviors should be referred for full DBT assessment and treatment.

When facing cancer, patients are often asked to make high-stakes decisions while flooded by fear, uncertainty, and grief. Stress narrows thinking, intensifies emotion, and pulls people toward autopilot rather than more fully considered choices.

The STOP skill (Stop, Take a step back, Observe, Proceed) interrupts that response, creating space to more fully observe what's actually happening. Patients check the facts, release assumptions, and consider what else is important— relationships, values, quality of life. STOP helps people access their wise mind, an intuitive sense of what is true and right for them. From that place, decisions are more likely to reflect what matters most.