Clinically Reviewed by Linda Whiteside, LPCC

Medically Reviewed by: Dr. Ryan Peterson, MD

Dialectical Behavior Therapy (DBT)

Table of Contents

Dialectical Behavior Therapy (DBT) is a type of therapy that helps people deal with strong emotions. It was first developed to help people with borderline personality disorder, a condition that makes it hard for someone to manage their feelings, but now, it’s used to help with many different mental health conditions.

Origins and Development of DBT

Marsha Linehan started DBT in the 1980s. She wanted to find a way to help people who had intense emotions and sometimes hurt themselves. Her work combined ideas from cognitive behavioral treatment, which is another kind of therapy, with new skills to help manage emotions.

Central Goals and Principles of DBT

The main goal of DBT is to help people build a life they feel is worth living. It works by teaching skills like mindfulness and distress tolerance. Mindfulness means staying present and focused, while distress tolerance means finding ways to handle tough situations without making them worse.

How Does DBT Therapy Work?

DBT aims to assist people in acknowledging the truth about their lives and actions while also guiding them in learning new skills to improve their everyday living abilities. Call us today at (323) 307-7997, or visit our contact page and let us walk with you toward a path of healing and transformation.

The Four Components of DBT

DBT has four main parts that work together to help individuals. Each part plays a critical role in teaching, reinforcing, and supporting the use of helpful skills. Here’s what they are:

  1. Individual DBT Therapy: This part involves one-on-one meetings with a DBT therapist. In these sessions, the therapist and the individual work together to understand and manage painful emotions. They also address self-destructive behaviors that often come with conditions like borderline personality disorder. These sessions are important for learning and applying DBT skills to real-life problems.
  2. Group Skills Training: This is sometimes called DBT skills training. In this part, individuals join a group led by a trained leader. Here, they learn important skills in four key areas:
    • Mindfulness: This involves learning to live in the moment and accept things as they are.
    • Interpersonal Effectiveness: This involves learning to ask for what one needs, saying no, and coping with interpersonal conflict.
    • Emotion Regulation: This involves understanding and managing emotions.
    • Distress Tolerance: This involves tolerating pain in difficult situations, not changing it.

    These skills are key to managing intense emotions and improving relationships.

  3. Phone Coaching: This part of DBT gives individuals a chance to reach out to their DBT therapist between sessions. It’s especially helpful when they’re facing a tough situation and need help using their DBT skills. Phone coaching enhances the application of DBT skills in daily life.
  4. DBT Consultation Team: This is a support system for the DBT therapists themselves. Treating people with intense emotions can be hard work. The consultation team helps therapists stay motivated and capable. This, in turn, ensures that individuals get the most effective treatment.

In all of these parts, a core principle of DBT is the balance of acceptance (understanding things as they are) and change (making efforts to improve). This balance is what “dialectical” in DBT is all about. Whether it’s individual therapy, group training, phone coaching, or the consultation team, all work together to help individuals build a life worth living.

Distress Tolerance and Emotion Regulation Techniques

In Dialectical Behavior Therapy (DBT), there are two main techniques to help people manage intense negative emotions: Distress Tolerance and Emotion Regulation. Here’s a closer look at each one:

  1. Distress Tolerance: Life can sometimes throw us into situations that are tough and cannot be changed right away. Distress tolerance skills are all about accepting these situations and finding ways to survive and endure them without resorting to harmful behaviors. Here are some key skills taught in DBT:
    • Radical Acceptance: This is all about completely accepting your situation in your mind, body, and heart. It doesn’t mean you like or agree with the situation, but you accept it as it is. This can help reduce feelings of distress.
    • Self-Soothing: This involves comforting, nurturing, and being kind to yourself when you’re feeling distressed. You might use your senses (like listening to calming music or sipping a warm cup of tea) to help you relax.
    • Distraction: This helps you shift your attention to something else, away from what’s causing distress. You might engage in a hobby, go for a walk, or chat with a friend.
    • Improving the Moment: This involves finding a way to make a difficult situation a bit better, even if you can’t change it entirely. You might visualize a peaceful place, pray, or use positive affirmations.
  2. Emotion Regulation: Sometimes, emotions can feel overwhelming and out of control. Emotion regulation skills help you understand your feelings and manage them better. Here are some strategies:
    • Identifying and Labeling Emotions: This means noticing what you’re feeling and putting a name to it. When you can identify your emotions, they often feel less intense and more manageable.
    • Reducing Vulnerability to Emotion Mind: This involves taking care of your physical and mental health to reduce your vulnerability to intense emotions. Regular sleep, balanced meals, exercise, and avoiding mood-altering substances can all help.
    • Increasing Positive Emotions: This means making an effort to increase experiences that bring you joy, contentment, or satisfaction. It can help balance out the negative emotions you might be feeling.
    • Opposite Action: This involves doing the opposite of your urge in response to a certain emotion. For example, if you feel afraid and your urge is to hide, you might choose to confront the situation instead.

In DBT, these techniques are taught by licensed mental health professionals helping individuals lead a more balanced and less distressing life. Whether it’s through distress tolerance or emotion regulation, the goal of DBT is to help individuals understand and manage their feelings more healthily.

Mindfulness-Based Techniques

Dialectical Behavior Therapy (DBT) heavily incorporates mindfulness-based techniques, which is a practice centered on being fully present in the moment rather than being preoccupied with past regrets or future worries. These techniques also encourage individuals to observe their internal and external experiences without judgment. Here are some core mindfulness techniques in DBT:

  • Observing: This involves simply noticing what’s happening without getting tangled up in the experience or trying to change it. You might observe your thoughts, feelings, and sensations as they come and go. For instance, a DBT therapist might teach a patient to observe their craving for substances if they’re treating opioid-dependent women.
  • Describing: This means putting words to your experiences. You might say to yourself, “I’m feeling anxious,” or “My heart is racing.” Describing helps you see your experiences more clearly and objectively.
  • Participating Fully: This involves diving into your experiences fully, without holding back. It might mean throwing yourself into a conversation with friends, focusing on the taste and texture of your food as you eat, or noticing the sensation of your feet hitting the ground as you walk.
  • Non-Judgmental Stance: This means viewing your experiences without labeling them as “good” or “bad.” Instead of saying, “I’m a failure,” you might say, “I made a mistake.” This can help reduce negative self-judgments and increase self-respect.
  • One-Mindfully: This refers to doing one thing at a time instead of multitasking. When you’re washing dishes, for example, you focus solely on that –the feel of the soapy water on your hands, the clink of the dishes, the smell of the dish soap.
  • Effectiveness: This is about focusing on what works instead of what “should” be. If a certain approach isn’t working, you try something else. This technique can enhance client motivation and help individuals reach their behavioral targets more effectively.

DBT therapists, who are licensed mental health professionals, teach these mindfulness techniques in DBT sessions or as part of DBT skills training. Through these mindfulness-based techniques, DBT aims to help individuals manage their emotions, improve their relationships, and reduce self-destructive behaviors often seen in conditions like borderline personality disorder and other mental health conditions.

The Role of the Therapeutic Relationship in DBT

The therapeutic relationship in Dialectical Behavior Therapy (DBT) is a crucial component of the treatment process. It involves a partnership between the individual undergoing therapy and their DBT therapist, a licensed mental health professional. This relationship is marked by collaboration, with the therapist teaching the individual new skills from modules such as emotion regulation strategies and cognitive behavior therapy. These skills aim to help the individual manage their life more effectively, particularly in dealing with self-destructive behaviors often seen in conditions like borderline personality disorder and eating disorders.

Beyond the therapy sessions, the therapist often provides phone consultations to offer on-the-spot coaching, facilitating the real-time application of the skills learned. The therapist is also part of a DBT consultation team or treatment team, maintaining their motivation and effectiveness in the therapeutic process. This comprehensive approach ensures the therapy aligns with the DBT model, effectively meeting the individual’s needs and helping them navigate their day-to-day life more successfully.

Structure of a Dialectical Behavior Therapy (DBT) Therapy Session

Dialectical Behavior Therapy (DBT) is a treatment designed to help people manage life better. It usually includes four types of get-togethers:

  1. One-on-one Therapy: This is where the person in therapy meets with their DBT therapist every week. These meetings typically last between 45 to 60 minutes. Together, they work on specific goals, like reducing harmful behaviors or making relationships better. The person in therapy might also complete “diary cards” as homework. These cards help them keep track of their feelings and actions and spot patterns or triggers in their life.
  2. Group Training: These are weekly meetings that last 2 to 2.5 hours. Here, people learn new skills in four key areas: staying present (mindfulness), dealing with hard times (distress tolerance), managing feelings (emotion regulation), and getting along with others (interpersonal effectiveness).
  3. Phone Coaching: This is extra support that’s available between the meetings. It helps people apply what they’ve learned in real life.
  4. Therapist Meetings: These are weekly gatherings of the therapy team. Here, therapists help each other stay motivated and offer each other support.

Typical Session Format and Components

In a regular DBT session, the person in therapy and the therapist discuss the challenges that have arisen during the week. To keep track of these challenges, the person in therapy uses a self-monitoring form, kind of like a personal diary. This form details their thoughts, emotions, and behaviors throughout the week.

Then, during the session, they go over these challenges with the therapist. The therapist helps them apply DBT skills like emotion regulation or distress tolerance to these problems, finding practical solutions. To solidify these skills, the person in therapy gets homework assignments. These could include practicing mindfulness exercises or using new strategies for managing difficult emotions.

The Role of the Therapist in Guiding the Session

The DBT therapist has a critical role in guiding the session. They focus on what’s called “treatment targets.” These are the main problems that need tackling, which could range from self-harm to suicide attempts, especially when treating conditions like borderline personality disorder.

The therapist ensures these targets are addressed in a prioritized order, ensuring the person’s safety first and foremost. The therapist also helps the person in therapy understand their behavioral patterns, which can help in finding effective strategies to manage them.

Collaborative Relationship Between Therapist and Client

In DBT, the relationship between the therapist and the person in therapy is a partnership. They work together like a team. The person in therapy brings their experiences, emotions, and challenges, and the therapist brings their professional skills and knowledge in DBT. Together, they aim to tackle the person’s problems.

This collaboration enhances the client’s motivation and helps them feel validated and understood. It’s not just about treating disorders; it’s about building a better, healthier life. This partnership is the heart of DBT, focusing on mutual respect and shared goals.

Mindfulness and DBT Therapy

Mindfulness in DBT means being aware and accepting of the present moment. It’s important because it helps people understand and manage their feelings.

Techniques for Cultivating Mindfulness in Therapy

In DBT, people learn mindfulness skills through practice. They learn how to observe their thoughts and feelings without judgment and how to stay focused in the present moment.

The Relationship Between Mindfulness and Emotional Regulation

In Dialectical Behavioral Therapy (DBT), the relationship between mindfulness and emotional regulation is integral. Here’s how they interact:

  • Recognizing Emotions: Mindfulness allows people to become aware of their emotional state. This is the first step in emotional regulation, as recognizing emotions is crucial before they can be managed effectively. It’s particularly important in treating conditions like borderline personality disorder, where individuals may experience intense, fluctuating emotions.
  • Preventing Overwhelming: By focusing on the present moment, mindfulness helps prevent individuals from becoming overwhelmed by their feelings. They learn to observe their emotions without judgment, reducing the likelihood of reactive behaviors.
  • Promoting Balanced Responses: Mindfulness encourages individuals to respond to their emotions instead of reacting impulsively. This can lead to more balanced and effective responses, an important aspect of DBT training.
  • Enhancing Self-Awareness: Mindfulness fosters self-awareness, allowing individuals to understand their emotional triggers better. This can be a pivotal factor in comprehensive DBT, assisting individuals in navigating their emotional landscape more successfully.
  • Supporting Skills Practice: The skills modules in DBT, including mindfulness, are interconnected. Mindfulness supports the practice of other DBT skills, such as distress tolerance and interpersonal effectiveness, by creating a mental space where these skills can be applied more effectively.

Mindfulness and emotional regulation work hand in hand in DBT to help individuals manage their feelings in more productive ways. This dual approach is a key part of why DBT is a suitable and often effective treatment for personality disorders and other mental health conditions.

What Can DBT Therapy Help With?

Dialectical Behaviour Therapy (DBT), which was created as a method for treating Borderline Personality Disorder and suicidal thoughts, has expanded to address a wider range of mental health issues. DBT is especially suitable for conditions where self-destructive behavior is a major concern, affecting a person’s safety, interpersonal relationships, job performance, and emotional balance.

DBT is now effectively used to treat high-risk disorders such as eating disorders, substance use disorders, mood disorders, and posttraumatic stress disorder. This comprehensive validation therapy helps patients accept their current situation while also teaching them behavioral skills to manage their emotions and relationships better.

The DBT treatment process involves a strong commitment from the patient and a well-trained individual therapist, enhancing the client’s motivation to bring about positive change. The role of the therapist extends beyond the therapy sessions, often providing support through antidepressant medications or additional consultations when needed.

The effectiveness of DBT has been backed by both theoretical and empirical observations. A systematic review assessing DBT’s efficiency shows its potential in clinical psychology, providing a path toward recovery for many. By focusing on skills such as mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness, DBT teaches patients to navigate their lives better.

Common Psychological Issues Addressed by DBT

Dialectical Behavioral Therapy (DBT) has shown effectiveness in addressing a range of mental health conditions by teaching patients crucial coping skills. These conditions include:

  • Borderline Personality Disorder: DBT was originally developed to treat this disorder. It’s well-suited for managing intense emotional swings, self-destructive behaviors, and unstable interpersonal relationships often associated with it.
  • Eating Disorders: DBT can be suitable for conditions like bulimia nervosa and binge eating disorder. It helps patients accept their emotional discomfort, develop healthier coping mechanisms, and improve their relationship with food.
  • Post-Traumatic Stress Disorder (PTSD): DBT can help those with PTSD manage intense emotions and intrusive memories, reducing their impact on day-to-day life.
  • Other Mental Health Problems: DBT’s focus on emotion regulation, mindfulness, and distress tolerance makes it adaptable to treat various other conditions involving intense emotions or self-destructive behaviors, such as substance abuse disorders or severe mood disorders.

DBT’s Effectiveness in Treating Various Mental Health Conditions

Research shows that DBT can be effective for treating conditions including borderline personality disorder, suicidal ideation, eating disorders, substance use disorders, mood disorders, posttraumatic stress disorder, ADHD, bipolar disorder, and treatment-resistant major depression. It can help reduce self-harm, suicide attempts, and other behaviors that can be harmful.

The Versatility of DBT for Different Populations and Settings

DBT isn’t just for adults. It can be used with teens and even children in some cases. It can be used in different settings, like hospitals, clinics, schools, and even online.

Is DBT Therapy Effective?

Dialectical Behavioural Therapy (DBT) has proven to be a suitable treatment for individuals grappling with borderline personality disorder and thoughts of suicide. It’s also shown to be beneficial in treating a variety of other mental health issues, demonstrating how versatile and adaptable DBT is. It is particularly effective for treating:

  • Eating Disorders: DBT helps individuals develop healthier relationships with food and their bodies, addressing the underlying emotional issues that often fuel these disorders.
  • Substance Use Disorders: DBT can help individuals manage cravings, avoid triggers, and cope with life stresses in healthier ways.
  • Mood Disorders: Through DBT, individuals can learn skills to regulate intense emotions and mood swings, improving overall stability and well-being.
  • Posttraumatic Stress Disorder (PTSD): DBT can equip individuals with tools to process traumatic memories and manage related emotional responses.

Research Findings on the Efficacy of DBT

Studies show that DBT works well for many people. For example, people who go through DBT often have fewer inpatient psychiatric days, which means they’re able to stay out of the hospital and manage their feelings at home.

Comparisons with Other Therapeutic Approaches

Compared to other therapies, DBT stands out because it focuses on both acceptance and change. This balance can make it more effective for some people.

Factors Contributing to the Success of DBT

The success of DBT comes from its focus on building new skills, like mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. These skills can help people manage their feelings and relationships better.

How to Find a DBT Therapist

Criteria for Choosing a DBT Therapist

When looking for a DBT therapist, it’s important to find someone who has been trained in DBT. You also want to find someone you feel comfortable with since you’ll be working closely with them.

Resources for Locating Qualified DBT Practitioners

There are resources online that can help you find a DBT therapist. You can also ask your doctor or another trusted health professional for recommendations.

Questions to Ask Potential Therapists

When you’re considering a DBT therapist, it’s important to ask them a few key questions to ensure they’re the right fit for you. Here are some questions you might want to ask:

  • DBT Training and Experience: Ask about their formal training in Dialectical Behavioural Therapy. Have they undergone DBT training, and if so, to what extent? How long have they been practicing DBT?
  • DBT Individual Therapy Approach: How do they approach individual therapy sessions? What can you expect from these sessions?
  • Group Therapy Involvement: Does their treatment plan involve group therapy sessions? If so, what does this typically look like?
  • Treatment Plan: What does a typical treatment plan look like? How do they decide what is suitable for each patient?
  • DBT Techniques and Focus: What key DBT techniques do they tend to use most? How do they focus treatment on the specific needs of the patient?
  • Patient Acceptance and Commitment: How do they work towards helping patients accept their current situation and commit to making positive changes?
  • The measure of Treatment Success: How do they measure treatment success? What kind of progress can you expect to see, and over what timeline?

Remember, the goal of these questions is to get a sense of whether the therapist’s approach and experience with DBT align with your needs and expectations.


DBT is a type of therapy that can help people manage intense emotions and improve their lives. It involves individual therapy, skills training in a group setting, phone coaching, and a consultation team. DBT can be effective for a variety of mental health conditions.

For Individuals Considering DBT Therapy

If you or someone you know is struggling with intense emotions, self-destructive behaviors, or challenges associated with borderline personality disorder, Dialectical Behavior Therapy (DBT) might be a suitable option. Call us today at (323) 307-7997 or send us a message from our contact page to schedule your friendly and personalized consultation. Take control of your future and embark on a journey toward a brighter, healthier life.

The Potential Benefits of DBT for Mental Health and Well-being

DBT can help you build new skills to handle tough emotions and situations. It can help you create a life that you feel is worth living.

Frequently Asked Questions

DBT therapy is used to help people manage intense emotions and behaviors that can be harmful. It's used for many mental health conditions, like borderline personality disorder and eating disorders.
DBT focuses on both acceptance and change. It also involves a team approach, with individual therapy, group skills training, and phone coaching.
The four components of DBT are individual therapy, group skills training, phone coaching, and a consultation team for the therapist.
Let's say a person gets really angry and doesn't know how to handle it. In DBT, they might learn mindfulness skills to notice their anger without reacting right away. They might also learn distress tolerance skills to cope with the feeling without doing anything harmful.
Research shows that DBT is effective for many mental health conditions. It can help reduce harmful behaviors and improve people's quality of life.
Yes, DBT can be used with adults, teens, and in some cases, children. The key is to find a DBT therapist who is trained to work with your specific age group.
Yes, one of the skills taught in DBT is distress tolerance, which can be very helpful for managing anxiety.
Yes, DBT has been shown to be effective in treating PTSD. It can help people manage intense emotions and distressing memories.
DBT usually involves a commitment of at least one year. This usually includes weekly individual therapy sessions and group skills training sessions.
DBT requires a significant time commitment, which can be a challenge for some people. It also requires practicing new skills regularly, which can be hard work.
DBT was originally developed for people with borderline personality disorder and has been shown to be very effective for this group. It can help reduce self-harm, suicide attempts, and other harmful behaviors.
You can find a DBT therapist through online resources, or by asking your doctor or another trusted health professional for recommendations.
Mindfulness plays a big role in DBT. It's one of the core skills taught, and it helps people notice and accept their feelings and thoughts without judgment. This can be a helpful first step in managing intense emotions.

The American Psychiatric Association (APA) (2018, April 30). American Journal of Psychotherapy: Transdiagnostic Applications of DBT for Adolescents and Adults. Psychiatry Online.

The American Psychiatric Association (APA) (2018, April 30). American Journal of Psychotherapy: Transdiagnostic Applications of DBT for Adolescents and Adults. Psychiatry Online.

Tan, M. (2021, August 24). Application of Dialectical Behaviour Therapy in treating common psychiatric disorders: Study protocol for a scoping review. BMJ Open.

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Written By: Linda Whiteside

Licensed Clinical Professional Counselor who has been providing mental health services for over 10 years.

Medically reviewed by: Dr. Ryan Peterson

Went to medical school at The George Washington University School of Medicine in Washington, D.C.

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