Dialectical Behavior Therapy (DBT)

What is DBT?

Dialectical behavior therapy (DBT) is a form of cognitive behavioral therapy developed by psychologist Marsha Linehan. “Dialectical” refers to balancing two ideas that can seem opposite: accepting yourself as you are, and working to change.

The four skill areas

• Mindfulness: paying attention to the present moment without judgment.
• Distress tolerance: getting through crises without making things worse.
• Emotion regulation: understanding emotions and reducing their intensity.
• Interpersonal effectiveness: asking for what you need and setting boundaries while maintaining relationships and self-respect.

How DBT is delivered

Comprehensive DBT typically includes weekly individual therapy, a weekly skills group, between-session phone coaching, and a consultation team for therapists. Some programs offer DBT-informed therapy or skills groups alone.

Full DBT programs are more intensive than typical weekly therapy. Some therapists on online platforms such as BetterHelp and Sesame offer DBT-informed individual therapy; ask whether skills groups are included.

Who DBT may help

DBT has the strongest evidence for borderline personality disorder and for reducing self-harm. Adaptations have been studied for adolescents, eating disorders, substance use and other conditions involving intense emotions.

What to expect

DBT is structured and requires commitment, often for six months to a year in comprehensive programs. Clients typically track emotions and behaviors using diary cards and practice skills between sessions.

The idea behind “dialectical”

A dialectic is the idea that two things that seem opposite can both be true. DBT’s central dialectic is acceptance and change: you are doing the best you can with what you have, and you can learn new ways to cope that make life better. Therapists model this balance by validating your feelings and experience while also encouraging skills and change. Many people who have felt dismissed or invalidated in the past find this combination helpful, and it’s one reason DBT has been effective for people whose emotions are very intense.

DBT skills in more detail

• Mindfulness builds the ability to observe thoughts and feelings without being swept away, using skills such as describing what’s happening, participating fully and taking a non-judgmental stance. It is the foundation for other skills.
• Distress tolerance helps you get through a crisis without making it worse. Examples include distracting yourself, self-soothing through the senses, changing body chemistry through cold water or paced breathing, and radical acceptance of what you can’t change right now.
• Emotion regulation teaches you to understand and name emotions, reduce vulnerability to intense feelings through sleep, regular meals, exercise and avoiding mood-altering substances, build positive experiences and act opposite to an unhelpful urge.
• Interpersonal effectiveness helps you ask for what you need, say no and keep relationships and self-respect, with skills for clear, calm communication. See how to set healthy boundaries.

What the evidence says

DBT is one of the best-studied treatments for borderline personality disorder, with trials showing reductions in self-harm, suicidal behavior and hospitalization. Adapted versions have shown benefit for eating disorders, substance use, depression in adults and adolescents, and difficulties with anger or emotion regulation. Not every study shows the same results, and standard DBT requires a significant time commitment. See personality disorders and eating disorders for context.

What a typical week looks like

In standard DBT, you may attend an individual therapy session, a skills group of around two hours and complete homework, such as diary cards on which you track emotions, urges, behaviors and skills used. Between sessions you may be able to contact your therapist for coaching in a difficult moment, depending on the program. The skills group is taught in modules and often takes about six months to complete the cycle, and many programs repeat it for a year. A therapist consultation team supports the clinicians.

DBT-informed therapy versus full DBT

Many therapists describe their work as “DBT-informed,” meaning they use some DBT skills in individual sessions. That can be helpful, but it isn’t the same as a full program with skills group, coaching and a consultation team. If you have intense symptoms such as frequent self-harm or suicidal thoughts, ask about full, comprehensive DBT. If your difficulties are milder, a skills group or DBT-informed individual therapy may be enough. See our comparison of CBT vs. DBT.

Finding DBT

Specialist clinics, hospitals and private practices offer DBT, and some programs run online skills groups. Online therapy platforms may list DBT among therapists’ approaches; ask about their training and whether they offer skills training. See online therapy and how to find the right therapist.

Who may not need DBT

DBT isn’t the only choice. People with a single focused problem, such as a specific phobia or panic, often do well with CBT or exposure therapy, which usually take less time. A clinician can help match you to an approach.

If you’re in crisis

DBT teaches crisis skills, but it isn’t an emergency service. If you are thinking about harming yourself or ending your life, call your local emergency number or a crisis line right now; see Get Help Now. Reaching out is a skill too, and a safe one to practice.