DBT (Dialectical Behaviour Therapy) Therapy

What is Dialectical Behaviour Therapy?

Dialectical Behaviour Therapy, commonly known as DBT, is a structured form of psychotherapy designed to help people manage intense emotions, reduce harmful behaviours and build healthier relationships. It is often described as a practical, skills-based therapy because it does not only focus on talking about problems. It also teaches tools that people can use in daily life when emotions, conflict or stress feel overwhelming.

DBT is a well-established approach for people who experience intense emotions, emotion dysregulation or difficulty managing impulses, although it may not be the right fit for everyone.[1] It is commonly used with people who experience emotional instability, relationship difficulties, self-harm, suicidal thoughts or suicidal behavior. It may also be adapted for a range of mental health conditions where strong emotions and unhelpful coping patterns play an important role.

The word “dialectical” refers to the idea that two things can be true at the same time. In DBT, one of the most important dialectics is acceptance and change. A person can learn to accept themselves, their feelings and their experiences as real and valid, while also working to change patterns that are causing pain or harm. This balance is one reason DBT can be especially useful for people who feel caught between self-criticism and emotional overwhelm.

DBT is most closely associated with four skill areas: mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. These skills help people notice what they are feeling, respond rather than react, survive difficult moments without making things worse, and communicate more effectively with others.

The Origins of DBT

DBT was originally developed by psychologist Dr Marsha Linehan to treat people with borderline personality disorder, particularly those experiencing suicidal behavior or self-harm.[2] It was first designed for people whose symptoms were severe, persistent and difficult to treat with standard therapeutic approaches.

DBT grew out of cognitive behavioral therapy, but it added important elements that made it more suitable for people with intense emotional experiences. Traditional cognitive behavioral therapy often focuses on identifying and changing unhelpful thoughts and behaviours. DBT includes many of these change-based strategies, but it also places greater emphasis on validation, acceptance, mindfulness and the therapeutic relationship.

This matters because people with intense emotions may not respond well to approaches that feel purely focused on change. For some, being pushed to change without first feeling understood can increase shame, resistance or hopelessness. DBT addresses this by combining behavioural change with acceptance-based strategies.

Linehan’s model recognises that people may be doing the best they can with the skills they currently have, while also needing to learn new skills to build a safer and more stable life. This combination of compassion and accountability is central to DBT.

Over time, DBT has expanded beyond its original use. It is still strongly associated with borderline personality disorder, suicidal behavior and recurrent self-harm, but it is also used or adapted in some settings for post-traumatic stress disorder, substance use disorders, eating disorders, depression, anxiety and other conditions involving emotion dysregulation.[3]

Core Principles of DBT

The foundation of DBT is the belief that acceptance and change are both necessary. A person’s emotions, experiences and behaviours can make sense in context, even when those behaviours are no longer helping them. DBT does not assume that people are choosing to suffer or act destructively. Instead, it recognises that many people have learned coping strategies that may once have helped them survive but are now causing problems.

Validation is a key part of this process. A DBT therapist may help a person understand why their reaction makes sense, while also helping them find a more effective response. For people who have often been told they are “too sensitive”, “overreacting” or “difficult”, this can be an important shift. Validation does not mean agreeing that every behaviour is helpful. It means recognising the real feelings and circumstances behind the behaviour.

Another important principle is radical acceptance. In DBT, radical acceptance means acknowledging reality as it is in the present moment, rather than spending all of one’s energy fighting against what has already happened. This does not mean approving of painful events or giving up on change. It means reducing the extra suffering that can come from denial, avoidance or constant internal resistance.

DBT also has a strong behavioural focus. Clients may track emotions, urges, behaviours and skills practice between sessions. This helps therapy become more than a weekly conversation. It becomes a process of noticing patterns, identifying triggers and practising new responses in real situations.

How DBT is Delivered

A comprehensive DBT program usually includes several parts. The first is individual therapy, where the client works one-on-one with a therapist. These sessions often focus on current challenges, emotional crises, relationship issues and behaviours the client wants to change. The therapist may help the client analyse what happened before, during and after a difficult situation so they can understand the chain of events and identify where a different skill could be used next time.

The second part is DBT skills training, often delivered through group sessions. This is not usually a general support group where people simply discuss their problems. Instead, it is more like a structured class. Participants learn DBT skills, practise examples and complete homework between sessions.

In many programs, this skills component may be described as group therapy, although it is usually more educational and skills-focused than traditional process-based group therapy. The group format can help people learn from examples, practise new behaviours and realise they are not alone in their struggles.

Some comprehensive DBT programs also include phone or crisis coaching. This allows clients to receive brief support when they are trying to use skills in real life. The goal is not to replace therapy sessions or create dependence on the therapist. The goal is to help the person practise healthier responses at the exact moment they need them.

DBT therapists may also participate in consultation teams. These teams help therapists stay effective, supported and consistent, particularly when working with high-risk or emotionally intense situations.

The Four Main DBT Skills Modules

DBT skills are usually divided into four groups: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Mindfulness skills help people pay attention to the present moment without immediately judging it. In DBT, mindfulness helps people observe their thoughts, emotions and body sensations without being completely controlled by them. This can create a small but important pause between feeling something and acting on it.

Distress tolerance skills focus on getting through painful moments without making the situation worse. These skills are especially useful during crises, urges to self-harm, panic, conflict, overwhelming sadness or intense anger. Distress tolerance does not mean pretending everything is fine. It means learning how to survive the moment safely until the emotional intensity passes.

Emotion regulation skills help people understand and influence their emotional responses. This includes recognizing emotions correctly, improving physical health through sleep and self-care, creating positive experiences, and learning to act opposite to an emotion when it does not match the facts.

Interpersonal effectiveness skills teach communication, boundaries and relationship strategies. Many people struggle to ask for what they need, say no, handle conflict or maintain self-respect during difficult conversations. DBT offers practical frameworks for balancing personal goals, the relationship and self-respect.

Together, these four modules give people a toolkit for everyday life. The skills are simple in concept, but they require practice. DBT works best when people apply the skills repeatedly, especially outside the therapy room.

What DBT Can Help With

DBT is widely regarded as an evidence-based therapy, particularly for borderline personality disorder, suicidal behavior and recurrent self-harm.[4] Clinical guidelines and research reviews support its use in these areas, although the strength of the evidence varies depending on the population, setting and outcome being measured.[5]

DBT may also be used or adapted for other mental health conditions involving emotion dysregulation, impulsive coping or relationship difficulties. These can include post-traumatic stress disorder, substance use disorders, eating disorders and mood disorders.[3] In eating disorder treatment, DBT-informed approaches may be used when behaviours such as binge eating are connected to emotional overwhelm, shame, impulsivity or attempts to cope with distress.

The benefits of DBT often come from learning how to respond differently in difficult moments. People may become better at naming emotions, calming themselves, asking for support, setting boundaries and repairing relationships. Over time, DBT can help reduce impulsive reactions and increase a person’s confidence in their ability to cope.

It is important to be realistic, though. DBT is not a quick fix. It can be demanding because it asks people to practise skills, complete homework and examine painful patterns in detail. It may also be more suitable for some people than others. A person who wants practical strategies and is willing to practise between sessions may find DBT especially useful.

What to Expect from DBT

A person starting DBT can expect an active approach. They may be asked to complete worksheets, monitor emotions, practise skills and discuss recent situations in detail. This can feel challenging at first, especially for people who are used to avoiding painful emotions. However, the aim is not to judge or shame the person. The aim is to understand what is happening and build more effective ways to respond.

Finding a suitable DBT therapist or program is important. Some clinicians offer comprehensive DBT, while others integrate DBT skills into general therapy. People seeking DBT may want to ask whether the therapist provides individual therapy, DBT skills training, group sessions, crisis coaching or a full DBT program.

DBT is not simply positive thinking, and it is not only about calming down. It is a structured, compassionate and practical therapy that helps people build a life with more stability, connection and choice. For people who experience emotions intensely, DBT can offer something deeply valuable: the belief that acceptance and change can happen together.

Footnotes

[1] Cleveland Clinic, “Dialectical Behavior Therapy (DBT): What It Is & Purpose”; Yale Medicine, “Dialectical Behavior Therapy (DBT)”.

[2] Yale Medicine, “Dialectical Behavior Therapy (DBT)”; Behavioral Tech Institute, “Marsha Linehan, PhD, ABPP”.

[3] Yale Medicine, “Dialectical Behavior Therapy (DBT)”; Cleveland Clinic, “Dialectical Behavior Therapy (DBT): What It Is & Purpose”; Chapman, A. L., “Dialectical Behavior Therapy: Current Indications and Unique Elements”.

[4] Chapman, A. L., “Dialectical Behavior Therapy: Current Indications and Unique Elements”; May, J. M. et al., “Dialectical behavior therapy as treatment for borderline personality disorder”.

[5] NICE Guideline CG78, “Borderline personality disorder: recognition and management”; Chapman, A. L., “Dialectical Behavior Therapy: Current Indications and Unique Elements”.