If you’ve ever experienced the overshadowing intensity of emotions – from high to low, from what you can’t do to unmanageable – feeling like your feelings are controlling you, wanting to drop relationships like they’re ill, and resorting to unhealthy coping mechanisms just to get through a difficult moment, you’ve likely heard of Dialectical Behavior Therapy, or DBT.
And if you haven’t, it’s time you did.
It is one of the most widely studied, recommended, and revolutionary methods of therapies today. It was created for individuals with borderline personality disorder, but has since grown into one of the most popular therapies for emotional regulation, self-destructive behavior, eating disorders, depression, and PTSD, etc.
What is DBT, though – and what are the 6 primary points that make it work?
Let’s get into it.
What Is Dialectical Behavior Therapy (DBT)?
DBT refers to a structured, evidence-based treatment of cognitive-behavioral therapy (CBT) developed in the late 1980s by psychologist Dr. Marsha Linehan. She developed it after learning that conventional CBT was insufficient for individuals who suffer from intense, chronic emotional pain, especially those who suffered from borderline personality disorder (BPD).
In terms of the word, dialectical means the interaction of two apparently contrasting ideas that are both accepted and negated. While helping DBT clients change their behaviors and thought patterns, they’re also learning to fully accept themselves and their emotions.
It’s this combination of radical acceptance and active growth that makes DBT so powerful.
Today, DBT is the most widely recommended evidence-based treatment for BPD, chronic suicidality, and emotional dysregulation, and endorsed by the American Psychological Association. It’s offered via both individual therapy, group skills training, telephone coaching and therapist consultation.
The Six Main Points of Dialectical Behavior Therapy (DBT)
DBT follows six guiding principles: These aren’t simply abstract concepts, they are the components that drive DBT. Knowing them will help you determine whether DBT is for you.
1. Dialectics – Balancing Acceptance and Change
In essence, the dialectic is at the heart of DBT: the belief that two truths may live together. The key DBT paradigm is:
“You are doing the best you can – AND you need to do better.”
This may sound counterintuitive, but it’s freeing. You don’t feel bad about getting stuck with DBT. It confirms your discomfort is real, your reactions are appropriate to your experiences, and you can transcend them.
This is a core DBT concept that is followed in all of the skills and sessions. It helps to prevent therapy from becoming just validating (which may slow progress) or just change-focused (which may be invalidating and destructive).
2. Mindfulness – The Foundation of All DBT Skills
However, before you can control your emotions, handle distress, and work on your relationships, you must learn one prerequisite thing: how to be present, says DBT.
DBT mindfulness skills are based on contemplative traditions and bring to training clients’ attention the thoughts, emotions, and physical sensations they have without passing judgment on them. DBT teaches the skills of mindfulness: “what” skills (observe, describe, participate) and “how” skills (non-judgmentally, one-mindfully, effectively).
Mindfulness is no simple warm up for your DBT, it’s the backbone of your model. All other skill modules are based on the ability to pause, notice and respond as opposed to react automatically.
This skill can be literally life-changing for people suffering from emotional overdrive.
3. Distress Tolerance – Surviving Crisis Without Making It Worse
Life brings pain. DBT will not claim that it will remove it. What it guarantees you is that it provides you with valid tools at a crisis moment to turn the tide so you don’t do something that will make things worse.
Distress tolerance in DBT refers to a collection of skills that can be used when emotions are the highest, and it seems rational thinking is out of the question. These include:
- TIPP – Temperature, Intense exercise, Paced breathing, Progressive muscle relaxation (if needed, to immediately relax the nervous system)
- ACCEPTS – Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, Sensations (to take a new perspective in crisis)
- IMPROVE the Moment – Imagery, Meaning, Prayer, Relaxation, One thing at a time, Vacation, Encouragement
- Radical Acceptance – Making peace with reality, not how you want it to be
Your Emergency Toolkit are the skills of Distress Tolerance. They don’t have the answer to the problem, they help you through the storm without capsizing.
4. Emotional Regulation – Understanding and Managing Your Feelings
One of the most highly requested features of DBT therapy for managing emotions is the entire module devoted to understanding, naming, and changing emotions.
Many emotional sensitive individuals have not been taught that their emotions are explainable, temporary and controllable. The emotional regulation module is what DBT has to offer.
Key skills in this module include:
- Listen to the Facts – Do my emotions match reality?
- Opposite Action – Do the opposite of the feeling (socialize when feeling down; turn inward when feeling out of control)
- Problem Solving – If it is an appropriate emotion, solve the problem that is triggering it
- ABC PLEASE – Accumulate positive experiences, Build mastery, Cope ahead, and take care of Physical health (sleep, nutrition, exercise)
- Reduce Vulnerability – Understand and work through triggers of emotional reactivity
This module brings people to understand that it is important to recognize emotions as signals rather than enemies. Not to stamp them out but to feel them without them being in control.
5. Interpersonal Effectiveness – Navigating Relationships With Skill
Bad feelings are not in isolation. These typically manifest themselves most strongly in our interactions with partners, parents, friends, or colleagues. Interpersonal effectiveness in DBT provides clients with real-world skills for clear communication, establishing boundaries, and prioritizing their self-respect and needs.
At the heart of this module lie three key acronyms:
- DEAR MAN – Describe, Express, Assert, Reinforce, Remain Mindful, Appear confident, Negotiate (for getting what you need)
- GIVE – be Gentle, act Interested, Validate, use an Easy manner (for maintaining relationships)
- FAST – be Fair, no Apologies, Stick to values, be Truthful (for keeping your self-respect)
They do not consist of robots – they are guidelines for dealing with the chaotic, uncertain, high-stakes moments of human touch. This module helps those who shut down in conflict or escalate rapidly, by creating a link between how they feel and how they will express what they want.
6. The Biosocial Theory – Understanding Why You Feel So Intensely
The sixth principle of DBT is not a set of skills, it is an explanatory model for clients to avoid self-blame for their tribulations.
Dr. Linehan’s theory of emotional dysregulation is a biosocial theory suggesting two factors:
- Biological sensitivity – some individuals have a nervous system that is more sensitive and takes longer to calm down following emotional arousal.
- An invalidating environment – a setting that discouraged, downplayed, or expressed frustration with emotional expression, such as, “Stop crying”, “You are too sensitive!”, or “You are too dramatic!
If there is high biological sensitivity coupled with chronic invalidation, then it will be very challenging to regulate emotions, to feel good about oneself and to have an adaptive coping strategy.
This theory can be very healing to DBT clients. It helps them re-story their struggles as well as not weakness or disorder but rather a reasonable result of their neurobiology reacting with their environment. It moves the conversation to “What went wrong with me?” to “Here’s what happened to me – and here’s how I can change.”
Who Can Benefit From DBT Therapy?
It began with DBT therapy for borderline personality disorder, but has since been proven useful to a variety of people and situations:
- Depression (particularly treatment-resistant and chronic)
- DBT anxiety treatment – General anxiety disorder, panic disorder
- Binge eating, bulimia, and other eating disorders
- Self-harm, thoughts of suicide
- Post Traumatic Stress Disorder (PTSD) and Complex Trauma
- Substance use disorders
- For teens with emotional dysregulation, school stress, and/or self-harm, DBT helps
- Adult DBT for couples going through relationship issues, work stress, or emotional fatigue
In the event, if you feel emotions more strongly than others, don’t bounce back as quickly, or your reaction is deeper than the situation requires – DBT was designed for you.
DBT vs. CBT: What’s the Difference?
One frequent question is what is the difference between DBT vs CBT? Both fall into the evidence-based category and have a distinctive cognitive-behavioral basis, though there are some distinguishing differences:
| Feature | CBT | DBT |
|---|---|---|
| Focus | Changing thoughts and behaviors | Balancing acceptance and change |
| Best For | Anxiety, depression, phobias | Emotional dysregulation, BPD, self-harm |
| Format | Primarily individual sessions | Individual + group skills training |
| Emphasis | Cognitive restructuring | Skills-based + validation |
Both approaches are successful, they just cater to different needs. Some individuals may find both helpful at various stages in their recovery.
What to Expect in DBT Therapy Sessions
A full DBT program typically includes:
- Individual therapy weekly – to discuss goals, practice skills, and resolve problems/crises in real life situations
- English skills training group – a group-based course format in which all four skills are covered in a structured course
- Phone coaching – brief between sessions calls with therapist for real time skill coaching.
- Therapist consultation team – this is the group of DBT therapists who consult with each other to deliver quality care
Some therapists also provide DBT-informed therapy (treatment sessions that utilize DBT techniques in conjunction with rather than instead of structured DBT treatment). Ideal for anyone not wishing to purchase the complete model but who wishes to develop particular abilities.
Ready to Build Skills That Actually Change Your Life?
DBT isn’t a ‘think positive’ or ‘just talk it out’ approach. It’s a serious, formal and skills-based method for the real-life human problem of feeling so deeply, you can’t help but want to live well anyway.
At Go Beyond Talk Therapist, we go beyond conversation to give you tools that work in real life: in hard moments, in relationships, and in the quiet space where you’re just trying to hold it together.
If you’re ready to explore whether DBT therapy is right for you, schedule a consultation today and let’s build something better together.
Frequently Asked Questions About DBT Therapy
A typical DBT program takes anywhere from 6 months to a year, with all four skill modules covered. The duration of an individual therapy might be shorter, depending on your goal, if it is DBT informed therapy. Your therapist will develop a timeline depending on your individual requirements.
Not at all. Although DBT was designed for BPD, it is also a useful treatment for depression, anxiety, eating disorders, PTSD, self-harm, substance use and more. When managing emotions is hard, DBT skills apply.
Yes. Telehealth DBT has expanded in prominence and there is evidence of its efficacy. Individual sessions and skills groups can be virtually held and are accessible more than ever.
Individual therapy, a skills group, phone coaching and a therapist consultation team are all included in full DBT. DBT-Informed Therapy applies DBT concepts and skills to single sessions without complete structure. Either can be helpful depending on the circumstance.
Absolutely. Teens are well supported by research on DBT, and especially benefit from working with teens with troubled families, school refusal, emotional outbursts and self harm. Family aspects are included in adolescent DBT programs.
If you have strong emotions that often seem difficult to regulate, have trouble keeping relationships stable, act impulsively to manage emotion, or feel like your emotional responses are “too much” – DBT is worth trying. During an initial consultation you can evaluate fit with a qualified therapist.
Seek refuge with a licensed therapist that has all skills in the full DBT model. There is a directory of Clinicians Certified by the DBT-Linehan Board of Certification. There are also directories of therapists to search and a filter to narrow down results by DBT specialty.
