Overview of Dialectical Behavior Therapy (DBT)

Mindfulness meditating

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In This Article

Dialectical behavior therapy (DBT) is a type of cognitive-behavioral therapy. Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others.

DBT was originally intended to treat borderline personality disorder (BPD), but it has been adapted to treat other mental health conditions.

DBT can help people who have difficulty with emotional regulation or are exhibiting self-destructive behaviors (eating disorders and substance use disorders). DBT is sometimes used to treat post-traumatic stress disorder (PTSD).

History

DBT was developed in the late 1980s by Dr. Marsha Linehan and colleagues when they discovered that cognitive-behavioral therapy (CBT) alone did not work as well as expected in patients with BPD. Dr. Linehan and her team added techniques and developed a treatment to meet the unique needs of these patients.

DBT incorporates a philosophical process called dialectics. Dialectics is based on the concept that everything is composed of opposites and that change occurs when there is a "dialogue" between opposing forces.

In more academic terms, dialectics can be summarized as thesis, antithesis, and synthesis. The process makes three basic assumptions:

  • All things are interconnected.
  • Change is constant and inevitable.
  • Opposites can be integrated to form a closer approximation of the truth.

In DBT, a patient and therapist work to resolve the apparent contradiction between self-acceptance and change to bring about positive changes in the patient.

Another technique offered by Linehan and her colleagues was validation. Linehan and her team found that when validation was used along with the push for change, patients were more likely to cooperate and less likely to suffer distress at the idea of change.

In practice, the therapist validates that a patient's actions "make sense" within the context of their personal experiences without necessarily agreeing that they are the best approach to solving a problem.

How It Works

DBT has evolved to become an evidence-based psychotherapy approach that is used to treat many conditions. DBT is used in three therapeutic settings.

  • Group settings where patients are taught behavioral skills by completing homework assignments and role-playing new ways of interacting with others.
  • Individual therapy with a trained professional where a patient's learned behavioral skills are adapted to their personal life challenges.
  • Phone coaching in which patients can call the therapist between sessions to receive guidance on coping with a difficult situation they are currently in.

In DBT, individual therapists also meet with a consultation team to help them cope with the emotional demands of treating their patients. Consultation teams also help therapists navigate difficult and complex issues related to providing therapy.

Each therapeutic setting has its own structure and goals, but the characteristics of DBT can be found in group skills training, individual psychotherapy, and phone coaching.

  • Acceptance and change. You’ll learn strategies to accept and tolerate your life circumstances, emotions, and yourself. You will also develop skills that can help you make positive changes in your behaviors and interactions with others.
  • Behavioral. You'll learn to analyze problems or destructive behavior patterns and replace them with more healthy and effective ones.
  • Cognitive. You'll focus on changing thoughts, beliefs, behaviors, and actions that are not effective or helpful.  
  • Collaboration. You'll learn to communicate effectively and work together as a team (therapist, group therapist, psychiatrist).
  • Skill sets. You’ll learn new skills to enhance your capabilities.
  • Support. You'll be encouraged to recognize your positive strengths and attributes and develop and use them.

DBT Strategies

People undergoing DBT are taught how to effectively change their behavior using four main strategies.

Core Mindfulness

Perhaps the most important strategy used in DBT is developing mindfulness skills. Mindfulness helps you focus on the present or “live in the moment.” This helps you pay attention to what is happening inside you (your thoughts, feelings, sensations, and impulses) as well as using your senses to tune in to what's happening around you (what you see, hear, smell, and touch) in nonjudgmental ways.

Mindfulness skills help you slow down and focus on using healthy coping skills when you are in the midst of emotional pain. The strategy can also help you stay calm and avoid engaging in automatic negative thought patterns and impulsive behavior.

Sample Exercise: Observe Mindfulness Skill

Pay attention to your breath. Take note of the sensation of inhaling and exhaling. Watch your belly rise and fall as you breathe.

Distress Tolerance

Distress tolerance skills help you accept yourself and your current situation. You will four techniques for handling a crisis:

  • Distraction
  • Improving the moment
  • Self-soothing
  • Thinking of the pros and cons of not tolerating distress

Distress tolerance techniques help prepare you for intense emotions and empower you to cope with them with a more positive long-term outlook.

Sample Exercise: Putting Your Body in Charge

Run up and down the stairs. If you're inside, go outside. If you're sitting, get up and walk around. The idea is to distract yourself by allowing your emotions to follow your body.

Interpersonal Effectiveness

Interpersonal effectiveness helps you to become more assertive in a relationship (for example, expressing your needs and be able to say "no") while still keeping a relationship positive and healthy. You will learn to listen and communicate more effectively, deal with challenging people, and respect yourself and others.

Sample Exercise: GIVE

Use the acronym GIVE to improve relationships and positive communication:

  • Gentle. Don't attack, threaten, or judge others
  • Interest. Show interest with good listening skills (don't interrupt someone else to speak)
  • Validate. Acknowledge the other person's thoughts and feelings
  • Easy. Try to have an easy attitude (smile often and be light-hearted)

Emotion Regulation

Emotion regulation lets you navigate powerful feelings in a more effective way. The skills you learn will help you to identify, name, and change your emotions. When you are able to recognize and cope with intense negative emotions (for example, anger), it reduces your emotional vulnerability and helps you have more positive emotional experiences.

Sample Exercise: Opposite Action

Identify how you're feeling and do the opposite. If you are feeling sad and want to withdraw from friends and family, make plans to see your loved ones.

Is DBT Right for You?

Most DBT research has focused on its effectiveness for people with borderline personality disorder who have thoughts of suicide and self-harm, but the method could also be a successful treatment for other mental health conditions.

DBT might be an effective treatment for:

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Bipolar disorder
  • Eating disorders (such as anorexia nervosa, binge eating disorder, and bulimia nervosa)
  • Generalized anxiety disorder (GAD)
  • Major depressive disorder (including treatment-resistant major depression and chronic depression)
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Substance use disorder

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Researchers have also found that DBT is effective regardless of a person's age, sex, gender identity, sexual orientation, and race/ethnicity. That said, the only way to find out if DBT is right for you is to talk with a professional who is trained in the method. They will evaluate your symptoms, treatment history, and therapy goals to see if DBT might be a good fit.

A Word From Verywell

If you or a loved one might benefit from DBT, it's important to talk with a healthcare provider or mental health professional who is trained in the approach. That said, it's not always easy to find DBT therapists.

You can start your search with the Clinical Resource Directory, which is maintained by Behavioral Tech (an organization founded by Dr. Linehan to train mental health professionals in DBT). The directory lets you search by state for clinicians and programs with DBT training through Behavioral Tech, LLC, or the Behavioral Research and Therapy Clinics at the University of Washington.

You can also ask your provider, current therapist, or another trusted mental health professional to refer you to a colleague who specializes in DBT.

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