What is Dialectical Behavior Therapy (DBT)?

Therapy is a valuable tool for mental health wellness and overall well-being. It gives us a safe space to explore our thoughts, emotions, and behaviors and develop healthier coping mechanisms. Many types of therapy are available to address specific concerns, one of the most popular being dialectical behavioral therapy (DBT). But exactly what is DBT, what can it treat, and how does it work? We’ll explore just that and more here.

What is Dialectical Behavior Therapy (DBT)?

Dialectical behavioral therapy is a type of talk therapy developed for people who experience intense emotions. It is based on cognitive behavioral therapy (CBT), another type of psychotherapy that helps people understand how thoughts, emotions, and behaviors are interrelated.

The core of DBT is in the first word, “dialectic.” It is defined as “any investigation of the truth of ideas through juxtaposition of opposing or contradictory opinions [*],” in other words, combining opposite ideas. This illustrates how DBT accomplishes two things: it helps a person accept their reality while, at the same time, allowing them to change their life for the better.

DBT was developed by Dr. Marsha Linehan, an American psychologist, in the 1970s.

How Does Dialectical Behavior Therapy (DBT) Work?

DBT works by teaching people strategies and skills that are helpful for mood problems, including sadness, anger, anxiety, panic, guilt, and shame. DBT can be used to treat a variety of diagnoses, including ADHD, and anxiety among others. The skills taught in this type of therapy can also address relationship problems, stress management, and improve self-esteem.

At the heart of DBT is acceptance and change, a concept that therapists employ to strike a balance between validating who you are and your challenges and the benefits of change. This unique characteristic of DBT brings these two opposites together in therapy to produce better results.

What is Dialectical Behavior Therapy (DBT) Used For?

DBT has a strong emphasis on emotional regulation skills, making it ideal as a treatment for a wide range of mental health conditions. These include:

• Personality disorders, particularly borderline personality disorder
• Post-traumatic stress disorder
• Depression
• Anxiety
• Bipolar disorder
• Eating disorders, including bulimia and binge eating
• Substance use disorder

What’s the Difference Between Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT)?

It is important to distinguish the difference between CBT and DBT. DBT is a branch of CBT, but what each therapy focuses on is different

CBT aims to help clients recognize when their thoughts become negative or troublesome enough to affect their emotions and behavior. This therapy introduces techniques that can help patients redirect those negative thoughts.

DBT, on the other hand, helps clients find ways to accept themselves and manage their emotions so that they can eventually change any unhealthy, harmful, or destructive behaviors.

What are the Primary Skills Taught in Dialectical Behavior Therapy (DBT)?

We mentioned earlier that DBT teaches skills and strategies to help individuals with mood, stress, relationships, and self-esteem. These therapeutic skills fall into four key areas.

• Mindfulness. Mindfulness exercises allow individuals to be present in and accept the current moment. As you observe how fleeting emotions are during mindfulness, you may realize that even the strongest emotions have less of an impact on your actions.
• Distress Tolerance. Distress tolerance is another skill in DBT that improves your ability to tolerate negative emotions. Instead of needing to escape from a negative emotion or acting in ways that might make the situation worse, you get better at dealing with the negative emotion head on.
• Emotion Regulation. DBT also focuses on emotion regulation skills, which are all about empowering you to manage and change intense emotions that are causing issues in your life.
• Interpersonal Effectiveness. The last DBT skill is interpersonal effectiveness. This allows you to communicate with others assertively while remaining self-respect and strengthening relationships. One of the core principles here is that you should learn how to ask directly for what you want to diminish hurt feelings and resentment.

What are the Benefits of Dialectical Behavior Therapy (DBT)?

Studies have shown that DBT can benefit those who have mental health conditions in the long term [*]. Here are some of the specific benefits of undergoing DBT.

• Reduced anxiety, trauma, and stress symptoms
• Reduced suicidal and self-harming thoughts and behaviors
• Reduced drug and alcohol misuse
• Improved depressive symptoms
• Increased self-worth and self-respect
• Adaptable to various populations, mental health problems, and settings
• Improved quality of life

What are the Risks of Dialectical Behavior Therapy (DBT)?

DBT has many benefits, but it isn’t for everyone. Some of the risks and disadvantages of DBT include the following.

• Requires a significant time commitment from both the client and the clinician
• Can be overwhelming; patients may find it complex and be unwilling to try
• Structure and strict boundaries that must be set and followed may not be for everyone
• No formal trauma processing, which may be necessary for clients with that background
• There is a possibility of increased risky behavior from the client during treatment

What to Expect During Dialectical Behavior Therapy (DBT) Sessions

DBT sessions are typically held privately, in groups, or remotely. Therapists will help patients learn and apply the four skill modules at their own pace. The goal is to learn self-acceptance while understanding how essential change is.

DBT typically includes:

• Weekly One-on-One Sessions. DBT patients have one-on-one sessions with their therapist every week. Each session lasts 45 minutes to an hour and covers concepts of self-acceptance and modalities for changing harmful behavior. Patients will discuss the homework they’ve done as well as any progress or challenges that occurred.
• Group Sessions. You can also expect to be part of group sessions, which therapists use to teach skills needed to cope with daily life. These group sessions may include role play and other exercises. You are expected to share your wins and struggles of the week and listen to others do the same. In DBT for kids or teens, parents may be involved in family group therapy sessions, in family therapy sessions, or in separate sessions for children and/or parents.
• Emergency Sessions. In the first few months of DBT, it is normal to feel overwhelmed. You may need emergency sessions with your therapist from time to time. The specifics of the approach may differ from therapist to therapist, but they will typically allow short sporadic calls or messages during certain hours to help you alleviate the distress of emotional outbursts.

How Long Does Dialectical Behavior Therapy (DBT) Treatment Last?

How long someone takes to complete a DBT program will vary depending on the response to therapy and individual treatment goals [*]. Generally, outpatient DBT requires at least six months but may take a year or longer to complete.

How Can I Find a Dialectical Behavior Therapy (DBT) Therapist?

When choosing a therapist for DBT, it’s crucial to find someone who you feel comfortable with and who has experience in DBT. The therapist should be understanding, open to your feedback, and respectful of your experiences. If these qualities are missing, it might be difficult to continue therapy.

Here are some ways to find a DBT therapist:

• Ask family and friends for referrals
• Ask your primary healthcare provider for referrals
• Ask a list of therapists from your insurance company
• Use an online therapist dictionary
• Use a search engine to search for therapists near you, like Google

The Bottom Line

Ultimately, DBT is an excellent and comprehensive approach to therapy that can be highly effective for many individuals. It will work particularly well for people who struggle with intense emotions, self-harm, and relationship challenges. By focusing on the four skills modules, DBT helps you develop healthier coping mechanisms and improve your overall quality of life. You can also use tools such as DBT worksheets to supplement your therapy. If you’re considering DBT, then finding a qualified therapist is a top priority to help guide you through this transformative process.

References:

1. American Psychological Association. Dialectic. 19 April 2018.
2. Gillespie C, Murphy M, Kells M, et al. Individuals who report having benefitted from dialectical behaviour therapy (DBT): a qualitative exploration of processes and experiences at long-term follow-up. 1 March 2022.
3. Yale Medicine. Dialectical Behavior Therapy (DBT). 2024.