What is DBT Therapy? Understanding Dialectical Behavior Therapy

Dialectical Behavior Therapy, often called DBT, is a specific type of talk therapy that helps people manage intense emotions and improve their relationships ^[1]. Dr. Marsha Linehan developed this approach in the late 1980s, originally to help people who experienced chronic suicidal thoughts ^[2].

The word “dialectical” means balancing opposites. In DBT, you learn to accept yourself as you are right now while also working toward change. These two ideas might seem to conflict, but DBT shows they can work together.

How DBT Therapy Works

DBT combines individual therapy sessions with skills training groups. Most people attend both types of sessions each week ^[1].

In individual therapy, you work one-on-one with a counselor. You discuss challenges from the past week and practice using new skills in real-life situations. Your therapist helps you stay motivated and work through difficult moments.

Skills training happens in a group setting, usually with 6-8 people and one or two group leaders. These sessions feel more like a class than traditional group therapy. You learn specific skills and practice them through exercises and homework assignments ^[2].

Between sessions, many people can contact their therapist for brief phone coaching. This support helps you use your skills during crisis moments in daily life.

The Four Core Skills of DBT

DBT teaches four main sets of skills. Each skill area addresses different challenges people face ^[1].

Mindfulness

Mindfulness means paying attention to the present moment without judgment. You learn to notice your thoughts, feelings, and surroundings as they happen. This skill helps you respond thoughtfully instead of reacting automatically.

Examples include:

• Observing your breath
• Describing what you notice without adding opinions
• Participating fully in one activity at a time

Distress Tolerance

These skills help you get through difficult situations without making them worse. When you feel overwhelmed, distress tolerance techniques help you survive the moment safely ^[2].

You might learn to:

• Use temperature changes to calm your body quickly
• Distract yourself with activities until the crisis passes
• Accept reality when you cannot change a situation right now

Emotion Regulation

Emotion regulation skills help you understand and manage strong feelings. You learn to identify what you feel, understand why emotions happen, and reduce emotional suffering ^[1].

These skills include:

• Naming your emotions accurately
• Understanding what makes emotions stronger or weaker
• Doing the opposite of emotional urges when needed
• Building positive experiences into your daily life

Interpersonal Effectiveness

This skill set focuses on relationships. You learn to ask for what you need, set boundaries, and maintain self-respect while interacting with others ^[2].

Key areas include:

• Communicating clearly and directly
• Saying no when necessary
• Maintaining relationships while standing up for yourself
• Balancing your needs with the needs of others

How DBT Differs From Other Therapy Approaches

DBT shares some features with Cognitive Behavioral Therapy (CBT), but several elements make it distinct ^[1].

The emphasis on acceptance sets DBT apart. While many therapies focus primarily on change, DBT teaches that accepting yourself and your current situation is equally important. This balance helps reduce the shame and self-criticism many people struggle with.

The structured skills training component is another key difference. Most traditional therapy happens only in individual sessions. DBT includes regular group classes where you learn and practice specific techniques ^[2].

DBT also offers between-session coaching support. This accessibility helps you apply skills when you need them most, not just during scheduled appointments.

The approach validates your experiences while still encouraging growth. Your therapist acknowledges that your feelings and reactions make sense given your history, even as you work to develop new responses.

Who DBT Therapy Helps

Research shows DBT effectively helps people with several mental health concerns ^[5].

Borderline Personality Disorder

DBT was originally created for borderline personality disorder (BPD). Studies consistently show it reduces self-harm behaviors, suicidal thoughts, and hospitalizations for people with this diagnosis ^[2][5].

People with BPD often experience:

• Intense, quickly changing emotions
• Fear of abandonment
• Unstable relationships
• Unclear sense of identity
• Impulsive behaviors

Emotion Dysregulation

You do not need a BPD diagnosis to benefit from DBT. The therapy helps anyone who struggles to manage intense emotions, regardless of their specific diagnosis ^[1].

DBT may help if you experience:

• Emotional reactions that feel too big for the situation
• Difficulty calming down once upset
• Impulsive actions when feeling strong emotions
• Frequent relationship conflicts
• Self-destructive behaviors as coping strategies

Additional Conditions

Research supports using DBT for several other concerns, including ^[5][6]:

• Depression, especially treatment-resistant forms
• Eating disorders like binge eating and bulimia
• Substance use disorders
• Post-traumatic stress disorder (PTSD)
• Self-harm behaviors

What to Expect in DBT

A full DBT program typically lasts one year, though some people continue longer ^[2]. The time commitment is significant but many people find the structure helpful.

A typical week might include:

• One individual therapy session (50-60 minutes)
• One skills group session (90-120 minutes)
• Daily homework practicing skills
• Phone coaching as needed during difficult moments

You will receive handouts and worksheets for each skill. Homework assignments help you practice skills between sessions. Many people keep a diary card, which is a tool for tracking emotions, urges, and skill use each day.

Your individual therapist and group leaders work together as a team. They consult with each other regularly to provide you with consistent support ^[1].

Is DBT Right for You?

DBT requires active participation and consistent effort. This therapy works best for people who are ready to attend sessions regularly and practice skills throughout the week.

Consider whether you:

• Can commit to attending both individual and group sessions
• Are willing to complete homework assignments
• Want to learn specific skills you can use independently
• Feel ready to work on accepting yourself while making changes

DBT might be especially helpful if other therapies have not fully addressed your needs, particularly if emotional intensity remains a challenge ^[2].

Taking the Next Step

If you think DBT might help you, start by talking with a mental health professional. They can assess your specific situation and discuss whether DBT fits your needs and goals.

Finding a DBT therapist requires some research. Look for clinicians who have completed comprehensive DBT training. Many practice websites specify if they offer DBT or DBT-informed therapy.

Some communities have limited access to full DBT programs. If comprehensive DBT is not available in your area, DBT-informed therapy or skills groups may still offer benefits. Some therapists also offer individual DBT without the group component ^[1].

Remember that seeking support shows strength, not weakness. Many people have found relief and built meaningful lives through learning and practicing DBT skills.

References

^[1] American Psychological Association. Available at: https://www.apa.org/

^[2] APA PsycNet. Available at: https://psycnet.apa.org/

^[5] National Institute of Mental Health. Available at: https://www.nimh.nih.gov/

^[6] Mayo Clinic. Available at: https://www.mayoclinic.org/

Related Articles

• What is Dialectical Behavior Therapy and DBT Distress Tolerance Skills
• Understanding Inward BPD Symptoms: When Borderline Personality Disorder Turns Inside
• Therapy Isn’t Just for Crisis
• Why Starting Therapy Before the Holidays Is One of the Best Gifts You Can Give Yourself

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This blog was developed with support from AI-assisted research tools. All clinical content was reviewed and approved by the Clinical Director, who retains full responsibility for accuracy and clinical appropriateness.

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