Dialectical Behavior Therapy (DBT)

Discover how Dialectical Behavior Therapy effectively treats emotional dysregulation, self-harm, and interpersonal challenges with specialized skills for lasting recovery.

How Does DBT Work?

DBT is grounded in a biosocial theory that suggests emotional regulation difficulties stem from a combination of biological predisposition and invalidating environments. The therapy works through a structured framework that balances acceptance and change strategies:

Core Components of DBT Treatment

Standard DBT treatment involves four main components working together. First, weekly one-on-one sessions with a DBT therapist focus on applying skills to your specific challenges and motivational issues. These individual therapy sessions typically follow a treatment hierarchy addressing life-threatening behaviors first, then therapy-interfering behaviors, quality-of-life issues, and skill development.

Second, skills training groups provide psychoeducational instruction in a classroom-like format rather than traditional group therapy. These groups typically meet weekly for 2-2.5 hours to teach practical skills in four key modules (discussed below).

Third, phone coaching offers brief between-session consultations with your therapist to help apply skills during crisis moments in real-life situations, rather than waiting until the next scheduled appointment.

Finally, DBT therapists meet regularly in consultation teams to receive support, maintain fidelity to the model, and stay motivated while working with clients who experience intense emotions.

The Four Core Skill Modules

DBT skills training is organized into four modules, each addressing different aspects of emotional and interpersonal functioning:

Mindfulness Skills
The foundation of all DBT skills, mindfulness teaches you to be present in the moment and observe your thoughts, feelings, and sensations without judgment. These skills help you become more aware of your experiences and make conscious choices rather than reacting automatically. Mindfulness in DBT is practiced regularly and serves as the base upon which other skills are built.
Distress Tolerance Skills
These skills help you cope with crisis situations without making them worse. Rather than immediately trying to change painful emotions (which isn't always possible), distress tolerance teaches you to accept and survive difficult moments using techniques like distraction, self-soothing, improving the moment, and weighing pros and cons. A key concept is "radical acceptance"—acknowledging reality as it is, even when it's painful.
Emotion Regulation Skills
This module helps you understand, identify, and manage your emotions more effectively. You'll learn to recognize and label emotions, identify triggers, reduce vulnerability to emotional reactivity (through self-care practices like balanced eating, exercise, and sleep), and increase positive emotional experiences. These skills help decrease the frequency and intensity of painful emotions while building resilience.
Interpersonal Effectiveness Skills
These skills focus on maintaining healthy relationships while respecting your own boundaries and self-respect. You'll learn strategies for asking for what you need, saying no to unreasonable requests, and managing conflict while preserving relationships. The skills help balance priorities, wants, "shoulds," and relationships in interactions.

What Conditions Does DBT Effectively Treat?

DBT has substantial research support for treating various mental health conditions. It's particularly effective for borderline personality disorder (BPD), as the original target of DBT. Numerous studies show its effectiveness in reducing self-harm, suicide attempts, and hospitalization rates while improving overall functioning for people with BPD. It's also highly effective for suicidal and self-harming behaviors, with significant reductions in self-injury and suicide attempts across multiple populations.

For substance use disorders, modified versions of DBT help address dependency, especially when it co-occurs with emotional regulation difficulties. With eating disorders, DBT has shown promising results for binge eating disorder and bulimia nervosa by addressing emotional triggers for disordered eating behaviors.

Growing evidence supports DBT's effectiveness for mood disorders, particularly treatment-resistant depression and bipolar disorder. For post-traumatic stress disorder (PTSD), DBT skills can help manage the intense emotions and impulsive behaviors that often accompany trauma responses.

DBT is also being increasingly used to treat other conditions where emotional dysregulation plays a role, including attention deficit hyperactivity disorder (ADHD) and anger management problems. Additionally, adaptations like DBT for adolescents (DBT-A) have been developed to address the specific needs of younger populations.

What to Expect During DBT Sessions

Starting DBT treatment involves a structured approach that typically follows these steps:

Assessment and Orientation

Before beginning treatment, you'll undergo a thorough assessment to determine if DBT is appropriate for your needs. This usually involves discussing your history, symptoms, and treatment goals; learning about the DBT model and philosophy; making a commitment to treatment, including regular attendance and practicing skills; and setting initial treatment targets and goals.

Individual Therapy

Individual DBT sessions typically last 50-60 minutes and focus on reviewing diary cards where you track your emotions, urges, behaviors, and skill use. Your therapist will help address target behaviors from the past week, analyzing them through "chain analysis" to identify triggers and alternative responses. These sessions are designed to help you learn how to apply specific skills to your unique challenges while building motivation for change and receiving validation.

Skills Training Groups

Skills group sessions are structured like classes rather than traditional therapy groups. Sessions usually include 6-10 participants and run 2-2.5 hours weekly. Homework is assigned to practice skills between sessions, and the complete skills curriculum takes about 6 months to complete, often repeated for a full year of treatment. The focus is on learning and practicing skills rather than processing personal issues.

Typical Duration and Frequency

Standard DBT is an intensive treatment typically lasting 6-12 months, though duration may vary depending on individual needs and treatment goals. The recommended frequency includes weekly individual therapy (50-60 minutes), weekly skills group (2-2.5 hours), and as-needed phone coaching through brief calls. Some programs offer "graduate groups" for continued skill reinforcement after completing the standard program.

Some adaptations of DBT offer shorter versions, but research suggests that the full model produces the strongest outcomes. Many clients find they benefit from multiple rounds of skills training, as the skills take significant practice to master and integrate into daily life.

Common DBT Tools and Techniques

DBT employs several distinctive tools and techniques to facilitate change. Diary cards are structured daily logs that help you track emotions and their intensity, urges for problematic behaviors, actual behaviors, and skills used throughout the day. These cards create accountability and help identify patterns connecting emotions and behaviors.

Chain analysis provides a detailed behavioral assessment that breaks down problematic incidents to understand the specific vulnerability factors leading up to the event, the triggering event, thoughts, feelings, and actions that followed, consequences of the behavior, and points where different skills could have been used. This process helps identify where to intervene to create different outcomes in the future.

Skills coaching between sessions focuses specifically on helping you apply appropriate skills during difficult moments, preventing crisis situations from escalating, building confidence in using skills independently, and reinforcing the use of effective behaviors. This real-time support is a unique feature of DBT that helps generalize skills to daily life.

Benefits and Challenges of DBT

Key Benefits

DBT offers several distinctive advantages as a treatment approach:

Evidence-based effectiveness: Substantial research supports DBT's efficacy, particularly for conditions that have been difficult to treat with other approaches
Practical skills focus: Rather than just focusing on insight, DBT provides concrete tools you can apply in your daily life
Balance of acceptance and change: DBT helps you accept yourself while also working toward meaningful change
Comprehensive approach: By combining individual therapy, skills training, and phone coaching, DBT addresses multiple aspects of functioning
Crisis prevention and management: The focus on distress tolerance helps reduce hospitalizations and dangerous behaviors
Community and support: The group format provides peer learning and decreases isolation

Potential Challenges

While highly effective, DBT may present some challenges. The time commitment required for the standard DBT program means significant dedication to weekly individual and group sessions, plus homework. Working on deeply ingrained patterns can create emotional intensity, and there's an initial skill learning curve where the skills may feel awkward or unnatural before becoming more automatic.

Depending on your location, there may be availability and cost concerns, as comprehensive DBT programs may not be available in all areas or covered by all insurance plans. Finally, DBT requires active participation—success depends on your willingness to practice skills consistently.

Is DBT Right for You or Your Loved One?

DBT might be particularly well-suited for you if:

You experience intense emotions that are difficult to manage
You engage in impulsive behaviors to cope with emotional pain
You struggle with self-destructive urges or behaviors
Traditional therapy approaches haven't been effective for you
You have difficulty maintaining stable relationships
You're willing to commit to learning and practicing new skills

Signs that suggest DBT could be beneficial include feeling emotionally overwhelmed by situations others seem to handle easily, experiencing rapid mood shifts throughout the day, and using harmful behaviors to cope with feelings. If your relationship patterns swing between intense closeness and painful conflicts, or if you struggle with a persistent sense of emptiness or unclear identity, DBT may be particularly helpful.

Finding a Qualified DBT Provider

Finding a properly trained DBT therapist is crucial for effective treatment. When evaluating potential DBT providers, consider asking:

What formal training have you received in DBT?
Do you follow the standard DBT model with all components?
Are you part of a DBT consultation team?
What experience do you have treating my specific concerns?
How do you measure progress in treatment?

Look for providers who have received specialized training in DBT, participate in a consultation team, offer both individual therapy and skills training components, and have experience treating your specific concerns.

Our directory makes it easy to find qualified DBT providers in your area. You can filter results by location and distance, insurance accepted, treatment specialties, availability for new clients, and type of DBT program offered.

Taking the Next Step Toward Emotional Wellness

If you're struggling with emotional regulation, impulsive behaviors, or relationship difficulties, DBT offers a proven path forward. With its balance of acceptance and change, focus on practical skills, and substantial research support, DBT has helped countless individuals build lives worth living.

Learning DBT skills takes time and practice, but the investment pays off in greater emotional stability, improved relationships, and a stronger sense of identity and purpose. While the journey may be challenging at times, you don't have to face it alone.

Ready to find a qualified DBT provider near you? Browse our comprehensive directory of treatment centers and therapists who specialize in Dialectical Behavior Therapy. Our easy-to-use search tools will help you find the right match for your specific needs and preferences.

References

[1] Linehan, M. M., & Wilks, C. R. (2015). The Course and Evolution of Dialectical Behavior Therapy. American Journal of Psychotherapy, 69(2), 97-110. https://psychiatryonline.org/doi/10.1176/appi.psychotherapy.2015.69.2.97

[2] Dialectical Behavior Therapy. (2023, December). What Is Dialectical Behavior Therapy? https://dialecticalbehaviortherapy.com/

[3] Robins, C. J., & Chapman, A. L. (2004). Dialectical behavior therapy: Current status, recent developments, and future directions. Journal of Personality Disorders, 18(1), 73-89. https://pmc.ncbi.nlm.nih.gov/articles/PMC2963469/

[4] The Four Skill Modules. DBT Skills Group of NJ. https://dbtskillsgroupnj.com/four-skill-modules/

[5] Jones, B. D. M., Kittur, M. E., Dimick, M. K., Goldstein, B. I., Mulsant, B. H., & Husain, M. I. (2023). A systematic review on the effectiveness of dialectical behavior therapy for improving mood symptoms in bipolar disorders. International Journal of Bipolar Disorders, 11(6). https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-023-00288-6