What Is Dialectical Behavior Therapy?

Psychologist Marsha Linehan, PhD, developed dialectical behavior therapy in the 1980s for people with suicidal thoughts who also often lived with BPD.

BPD is a mental health condition that involves:

• an unstable sense of self
• intense emotions
• impulsive actions
• relationship difficulties
• black and white thinking

The first word in DBT, “dialectical,” captures the treatment’s foundation. Dialectic philosophy features these core beliefs:

• All things are interconnected.
• Change is constant and inevitable.
• Opposites can be integrated to get closer to the truth.

In other words, two seemingly opposite things can actually be true at the same time. For example, it’s important to accept where you are and strive to grow. It’s important to recognize that you’re doing your best and keep trying.

At its root, DBT takes a biosocial approach to understanding how people’s symptoms arise and continue.

For example, many people with BPD grew up in an invalidating environment and tend to experience emotions intensely. Living in an environment where you don’t have support or acceptance of your needs can perpetuate or worsen those symptoms.

Dialectical behavior therapy is based on cognitive behavior therapy (CBT). CBT has a long track record of success, with hundreds of studies confirming its effectiveness.

In CBT, you identify important-to-you goals and overcome obstacles that prevent you from achieving these goals. You learn skills to change unhelpful thoughts and behaviors.

The same is true for DBT, which is highly structured and teaches critical skills through these four modules:

Core mindfulness

Core mindfulness skills, adapted from Eastern meditation practices, teach you to become more aware of the present moment. You learn to focus on one thing at a time, without judging yourself or others.

Distress tolerance

When difficult situations arise, instead of getting stuck in thought patterns that don’t help you process the situation (like thinking “this isn’t fair!”), distress tolerance teaches acceptance. Accepting things you don’t have control over can help you solve problems and improve low moods.

To prevent impulsive or self-harming behavior, this module also teaches you constructive, in-the-moment alternatives. These include distraction and self-soothing techniques, like doing a deep breathing exercise, taking a walk, or listening to your favorite music.

Interpersonal effectiveness

In this module, you learn the skills to create healthy relationships while taking care of yourself. Interpersonal effectiveness includes working through conflict, listening well, and clearly asking for what you need.

Emotion regulation

Emotion regulation skills help you label your emotions without judging them. You learn how different emotions shape your behavior and what obstacles prevent you from managing your emotions.

Plus, you learn to avoid situations that typically trigger strong emotions and pursue events that boost positive emotions.

DBT’s ultimate goal is to help you live a life you feel good about. A meaningful, fulfilling life looks different for each person. This is why therapists help people hone in on what’s important to them.

Another critical goal of DBT is to address behaviors that pose a life-threatening risk, such as suicidal thoughts, suicide attempts, and self-harm.

It’s also important to address behaviors that interfere with therapy and prevent you from making progress. Therapy-hampering behaviors can include anything from missing appointments to arriving late or not completing homework.

As a team, you and your therapist will identify behaviors you’d like to decrease along with behaviors you’d like to increase. For example, someone might use DBT to address behaviors related to alcohol use or binge eating disorder.

Dialectical behavior therapy consists of these key components:

One-on-one sessions

Once a week, you talk with your therapist to learn how to apply DBT skills to specific challenges and situations in your own life.

To further help you practice these skills, you complete homework outside of your sessions. Homework typically includes filling out daily “diary cards,” which track your emotions, urges, behaviors, and thoughts. You also track the skills you’re using and how helpful they are.

Group skills training

This is often a 2-hour, weekly meeting that teaches you the above four modules. Because your training is done in a group setting, you have the opportunity to interact with others and role-play new skills.

Phone coaching

Unlike with most other therapies, with DBT your therapist is available by phone for in-the-moment support. So, if you’re going through a difficult situation and having a hard time using healthy coping techniques, you can call your therapist.

Consultation team

Because supporting people with life-threatening behaviors can be challenging, DBT therapists work with consultation teams. A consultation team is a group of DBT professionals who meet regularly to help one another navigate potential stressors, stay motivated, and deliver good therapy.

When figuring out whether DBT is right for you, considering these questions (and their answers) can help.

What conditions does DBT help with?

Research has found that beyond BPD, dialectical behavior therapy has been shown to help reduce suicidal behavior in adults. Studies show DBT also reduces self-harming behavior and suicide attempts in teens.

Experts have adapted DBT for other mental health conditions. According to research, DBT may be a promising treatment for:

• eating disorders, such as binge eating disorder
• substance use disorder in adults and teens
• co-occurring substance use and BPD
• depression
• bipolar disorder

Who can benefit from DBT?

In addition to treating the above mental health conditions, DBT may be helpful if:

• you have a hard time dealing with your emotions
• your emotions are intense or explosive
• you regularly experience mood ups and downs
• your relationships feel like a roller coaster
• you feel empty or hopeless
• you’ve tried other therapies that haven’t worked
• your life feels out of control or isn’t fulfilling
• you’re using outlets to cope with stress or overwhelming emotions that could pose health risks, like substances or unprotected sex

DBT is an evidence-based treatment for many mental health conditions. In DBT, you learn to manage intense emotions, cope with distress, and cultivate healthy relationships.

To find a DBT therapist, you can use online tools like Behavioral Tech’s directory of therapists who specialize in DBT.

Asking around can also help. Checking with your primary care physician, other therapists, or your local college, university, or medical center could all be helpful options.

When looking for a therapist, you can also double-check that they specialize in DBT by asking questions like:

• Are you a certified DBT therapist?
• What is your DBT training and experience?
• Are you part of a consultation team?
• How many people have you treated with DBT?