When emotions become so intense that they make it difficult to think clearly or control your reactions, Dialectical Behavior Therapy (DBT) may help. This type of treatment was developed to help people who experience emotions that are difficult to manage and behaviors that can affect their health, relationships, and daily life.
DBT is a widely studied form of psychotherapy. It combines cognitive behavioral therapy (CBT) techniques with mindfulness practices and teaches practical skills that can be used in real-life situations, including during emotional crises.
DBT Therapy: Definition and Origins
Dialectical Behavior Therapy (DBT) is a structured, evidence-based approach to psychotherapy. It combines cognitive behavioral techniques and mindfulness practices to help people manage intense emotions, reduce self-destructive behaviors, and improve relationships.
DBT is based on a central principle: acceptance and change can happen at the same time. A person can recognize and accept their current situation while working to change behaviors and develop new emotion regulation skills. This combination of acceptance and change is what gives rise to the term “dialectical.”
Rather than treating intense emotions as something that simply needs to disappear, DBT helps patients understand their emotions and respond to them more effectively. During DBT treatment, patients learn practical skills they can use in everyday life and during emotional crises.
Who Developed DBT and Why
DBT was developed by psychologist Dr. Marsha Linehan at the University of Washington between the late 1970s and the 1980s. Initially, Linehan sought to apply traditional cognitive behavioral therapy (CBT) to patients with chronic suicidal behavior and people with borderline personality disorder (BPD).
Traditional CBT strategies did not work well for some of these patients. They could perceive the focus on change as a way of invalidating their experience and pain. In some cases, this led them to disengage from treatment.
Linehan then began combining CBT strategies focused on change with practices based on acceptance, mindfulness, and contemplative traditions. The approach sought to recognize the patient’s emotional experience while also teaching new ways to manage it. DBT was formally introduced in the early 1990s and has since been studied in numerous clinical trials over the decades.
What Makes DBT Different from Traditional CBT?
DBT is considered a type of CBT, but there are important differences in how the treatment is structured and delivered:
- Consultation team: DBT therapists work with other professionals trained in the approach to discuss cases and maintain the quality of treatment.
- Structure: DBT may involve individual therapy, weekly group therapy, and remote coaching by phone or text message between sessions. Treatment therefore goes beyond one individual therapy session per week.
- Validation: The therapist works to understand and validate the patient’s emotional experience before working toward changes in thoughts or behaviors.
- Practical skills: DBT teaches a specific set of skills that are practiced and reinforced throughout treatment.
- Focus on crises: The approach was developed to directly address situations that pose a risk to life.
The Four Core DBT Skills
DBT skills training is divided into four modules. Groups generally work through all four modules over approximately six months and then repeat the cycle to reinforce learning.
Mindfulness
Mindfulness is the foundation of the other DBT skills. The practice involves observing and describing thoughts, emotions, and physical sensations without immediately reacting to or judging them.
One of the concepts used in DBT represents the balance between emotional reasoning and logical reasoning. Developing this skill helps a person create space between experiencing an emotion and reacting to it.
Distress Tolerance
Distress tolerance skills are primarily used during times of crisis, when a situation cannot be immediately resolved or changed.
The tools taught include TIP skills, which involve temperature, intense exercise, and paced breathing. This module also works on self-soothing and distraction strategies. The goal is not to eliminate distress in that moment, but to help the person get through a difficult situation without turning to self-harm, substance use, or other harmful behaviors.
Emotion Regulation
Emotion regulation helps patients understand how emotions work and identify factors that can increase their intensity.
Strategies include recognizing and naming emotions, reducing physical factors that can increase emotional reactivity, such as lack of sleep or skipped meals, and practicing opposite action. This technique involves acting differently from what an emotional impulse that is not helpful for the situation may be telling you to do.
Interpersonal Effectiveness
Interpersonal effectiveness focuses on communication and relationships. These skills help a person ask for what they need, say no, set boundaries, and handle conflicts without giving up the relationship or their own self-respect.
What Conditions Does DBT Treat?
DBT was originally created for a specific population, but its use has expanded after decades of research. Today, the approach is used in different situations involving emotion regulation and high-risk behaviors.
DBT for Borderline Personality Disorder
Borderline personality disorder (BPD) remains one of the primary conditions treated with DBT. The approach is considered a first-line treatment for BPD by many clinical guidelines.
People with BPD may experience an intense fear of abandonment, unstable relationships, changes in how they see themselves, and very intense emotional reactions in certain situations.
DBT for Depression
CBT is often one of the first approaches considered for treating depression. DBT may also be helpful when depression is associated with emotional dysregulation, chronic hopelessness, or a history of self-harm.
Mindfulness and distress tolerance techniques may help interrupt cycles of repetitive thoughts that contribute to ongoing depressive episodes.
DBT for Adolescents with Emotional Dysregulation
DBT for adolescents, known as DBT-A, adapts the traditional model for adolescent patients. Treatment generally includes parents or caregivers through specific groups for caregivers or joint sessions.
The approach may be used with adolescents who experience intense mood changes, family conflicts, self-harm, or symptoms associated with the risk of emotional or behavioral crises.
Because adolescence can involve significant emotional changes, the structured and practical format of DBT may be particularly useful for adolescents who find traditional therapy too abstract.
DBT for Self-Harm and Suicidal Ideation
DBT was originally developed to treat chronic suicidality, and reducing self-harm and suicidal behavior remains one of the most studied outcomes of the approach.
Treatment uses a hierarchy of targets. Behaviors that pose a risk to life are addressed first during sessions. Phone coaching between sessions is also part of the model and can help patients use the skills they have learned when facing a difficult emotional situation.
What Is DBT Treatment Like?
Comprehensive DBT involves different components that work together. Treatment is not limited to one individual therapy session per week.
Individual Therapy Sessions
Weekly individual therapy sessions are where DBT skills are applied to specific situations in the patient’s life.
Sessions generally begin with a review of a diary card, where the patient tracks emotions, urges, and behaviors throughout the days. This information helps the therapist and patient identify patterns and determine which issues need to be prioritized.
Individual therapy follows a hierarchy of targets. First, behaviors that pose a risk to life are addressed. Next come behaviors that interfere with treatment, followed by issues related to quality of life.
DBT Skills Groups
The weekly skills group works similarly to a class. Participants learn new skills, receive exercises to practice, and discuss how these strategies work in real-life situations during the week.
Groups typically work through the four skills modules over approximately 24 weeks. This component is an important part of comprehensive DBT and provides much of the practical skills training.
Phone Coaching Between Sessions
Phone or text coaching between sessions is one of the characteristics of DBT. When a patient is facing a difficult situation, they can contact their therapist for brief guidance on which skill may be useful at that moment. The goal is not to conduct a full therapy session during a crisis, but to help the patient apply what they have learned during treatment in real-life situations.
How Long Does DBT Take?
A complete course of DBT generally lasts between six months and one year. The program is often structured around two cycles through the four skills modules, with approximately 24 weeks per cycle, although some programs use shorter formats. The length of treatment may vary depending on the patient’s goals, the intensity of their symptoms, and the type of DBT being provided.
DBT for Adolescents: What Parents Should Know
Seeing a teenager deal with intense emotions, self-harm, or frequent conflicts at home can be difficult for the entire family. Several aspects of treatment can help parents understand what to expect.
- The model is skills-based, not blame-based: DBT does not treat an adolescent’s behavior as “bad” or place responsibility for the situation on how parents raise their child. Emotional dysregulation is treated as a difficulty that can be understood and addressed by the entire family.
- Family participation is generally part of treatment: Most DBT programs for adolescents include caregivers because parents play an important role in practicing skills at home and reducing conflict.
- Consistency is more important than perfection: DBT tends to work best when the treatment structure, including individual therapy, group therapy, and coaching, is followed consistently, even when progress seems slow.
- Confidentiality has limits: The therapist needs to balance the adolescent’s privacy with the parents’ need to receive information related to safety. A DBT therapist should explain these boundaries before treatment begins.
FAQs
CBT primarily focuses on identifying and changing unhelpful thoughts and behaviors. DBT uses these same change-based strategies but adds mindfulness, distress tolerance, and acceptance techniques. DBT also has a more specific structure that may include individual therapy, group skills training, and coaching.
Yes. Comprehensive DBT, including individual sessions, skills groups, and phone or text coaching, can be provided through telehealth therapy. Research also supports the effectiveness of the approach in a virtual format.
No. DBT was originally developed for BPD and continues to be considered one of the primary treatments for this condition. It is also used for depression, PTSD, eating disorders, substance use disorders, and emotional dysregulation in adolescents and adults.
DBT may be an option for people who experience emotions very intensely or rapidly, have difficulty with impulsive or self-destructive behaviors, experience intense and unstable relationships, or have tried other forms of therapy without achieving the expected change. A consultation with a DBT-trained therapist can help assess the individual’s situation and determine whether a comprehensive DBT, a skills-focused group, or another therapeutic approach is the most appropriate option for the situation presented.
