Introduction

The Basics

What is Dialectical Behavioral Therapy (DBT)?

Dialectical Behavioral Therapy (DBT) is a structured form of psychotherapy that teaches practical skills for managing intense emotions, tolerating distress, and improving relationships.

It balances accepting yourself as you are while working to change problematic behaviors. DBT was originally developed for the treatment of borderline personality disorder but is now used for a variety of mental health concerns.

Goal

What is the goal of Dialectical Behavioral Therapy (DBT)?

The fundamental goal of Dialectical Behavioral Therapy (DBT) is to help people build a life worth living. Think of it like learning to navigate a powerful river—you need both the acceptance that the river is strong and sometimes turbulent, and the skills to steer your boat effectively.

DBT aims to help people accept themselves while simultaneously working on change, embracing this seeming contradiction (the “dialectic”) as a path to growth.

Uses

Who could benefit from Dialectical Behavioral Therapy (DBT)?

Dialectical Behavior Therapy (DBT) can benefit people experiencing challenges such as:

• Borderline Personality Disorder (BPD)
• Chronic suicidal thoughts
• Self-harming behaviors
• Disordered eating
• Substance use disorders
• Intense mood swings
• Difficulty managing anger
• Interpersonal conflicts

Subtypes

Are there any subtypes of Dialectical Behavioral Therapy (DBT)?

While there are not formal subtypes of Dialectical Behavior Therapy (DBT), several adaptations have been developed for specific disorders and populations (e.g., DBT for eating disorders; DBT for adolescents). Brief examples include:

• DBT for Adolescents (DBT-A): adapts standard DBT for teens and families (multifamily skills groups, safety focus).
• DBT for Substance Use Disorders (DBT-SUD): adds strategies targeting substance use while preserving core DBT components.
• DBT-PE (DBT with Prolonged Exposure): integrates a PE protocol to treat PTSD within a DBT framework for high-risk clients.
• DBT for Eating Disorders: applies DBT skills to reduce binge eating and improve emotion regulation.

These adaptations keep DBT’s core, balancing acceptance and change through skills like mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness, while tailoring delivery to the needs of particular groups.

Effectiveness

Origins

Who developed Dialectical Behavioral Therapy (DBT) and when?

Marsha Linehan developed Dialectical Behavioral Therapy (DBT) in the late 1980s and early 1990s. Linehan created DBT after discovering that standard cognitive behavioral therapy wasn’t sufficiently effective for people struggling with chronic suicidal thoughts and borderline personality disorder.

Through her own personal experiences and clinical work, she recognized the need for an approach that could balance acceptance and change strategies while teaching specific skills for managing intense emotions.

Early randomized trials (beginning in 1991) showed DBT’s efficacy for chronically suicidal individuals with BPD, and subsequent manuals formalized the four core skills modules: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.

Evidence Base

Is Dialectical Behavioral Therapy (DBT) evidence-based?

The evidence base for Dialectical Behavior Therapy (DBT) is particularly strong. Multiple studies have demonstrated its effectiveness, especially for conditions involving emotional dysregulation and self-destructive behaviors. Research shows DBT can:

• Reduce suicide attempts and self-harm, with randomized trials showing roughly half the risk of a suicide attempt vs. comparison treatments, and fewer medically serious self-injurious acts.
• Lower psychiatric hospitalizations and crisis service use.
• Improve emotion regulation and interpersonal functioning, including in adolescent and adult populations.

What’s especially noteworthy is that DBT shows positive outcomes even for individuals who haven’t responded well to other treatments, with meta-analyses and guideline reviews supporting benefits across high-risk groups (e.g., BPD with chronic suicidality).

How It Works

Techniques Used

How does Dialectical Behavioral Therapy (DBT) work?

Dialectical Behavioral Therapy (DBT) works through four core skill modules that are taught and practiced simultaneously. Those modules are as follows:

1. Mindfulness: learning to observe and participate in the present moment without judgment
2. Distress Tolerance: developing skills to cope with crisis situations without making them worse
3. Emotion Regulation: understanding and managing intense emotions more effectively
4. Interpersonal Effectiveness: learning to navigate relationships and maintain self-respect.

What to Expect in a Session

What can I expect from a Dialectical Behavioral Therapy (DBT) session?

Dialectical Behavioral Therapy (DBT) sessions typically focus on building the four core skills mentioned above: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Here’s what you can generally expect:

• Session Structure: Most DBT programs combine individual therapy sessions with group skills training. Individual sessions usually last 50 minutes and happen weekly, while group sessions run 1.5–2 hours and focus specifically on learning and practicing skills.
• Individual Therapy Sessions: Your therapist will help you apply DBT skills to specific situations in your life. You might review a diary card where you’ve tracked your emotions, behaviors, and skill use throughout the week. The session often involves problem-solving current challenges using DBT techniques and addressing any barriers to using skills effectively.
• Group Skills Training: These sessions are more educational, like a class. You’ll learn specific techniques for managing intense emotions, tolerating distressing situations without making them worse, staying present and aware, and communicating effectively in relationships. Expect homework assignments to practice these skills between sessions.
• The Therapeutic Approach: DBT therapists balance acceptance and change strategies. They’ll validate your experiences while also challenging you to develop new coping mechanisms. The approach is collaborative—you’ll work together to identify goals and track progress.
• Skills You’ll Learn: You’ll practice concrete techniques like deep breathing for distress tolerance, mindful observation exercises, ways to regulate intense emotions before they become overwhelming, and scripts for difficult conversations.

Treatment Length & Structure

How long does Dialectical Behavioral Therapy (DBT) take?

Standard Dialectical Behavioral Therapy (DBT) is typically a longer-term commitment, often lasting 6 months to a year or more, as it takes time to develop and integrate these new skills into daily life. And, many people choose to repeat the skills training for deeper learning.

The treatment has a very specific structure involving multiple components:

• Weekly individual therapy sessions
• Weekly skills training groups
• Phone coaching for crisis situations
• Consultation team meetings for therapists

Getting Care

Finding a Therapist

How do I find a therapist trained in Dialectical Behavioral Therapy (DBT)?

Alma’s directory has many therapists who are trained in Dialectical Behavioral Therapy (DBT), including: