Dialectical Behavioral Therapy (DBT)

Medically Reviewed by Zilpah Sheikh, MD on February 28, 2024
8 min read

Dialectical behavioral therapy or dialectical behavior therapy (DBT) is a form of talk therapy. It can help you learn to accept yourself without judgment. At the same time, you'll work on changing negative, unhealthy behaviors that are holding you back in your life.

This type of therapy has been around since the 1970s when it was created by an American psychologist. DBT is an evidence-based therapy. That means there's proof that it can help improve many different mental health conditions and your general quality of life.

If you struggle to manage your emotions or control unhealthy or harmful behaviors, DBT could be a good choice for you. You'll learn new problem-solving and coping skills.

DBT is a type of cognitive behavioral therapy (CBT). The goal of CBT is to teach you how to identify negative thinking patterns and change them. That can help you make positive changes in the way you act.

DBT builds on this idea. But it doesn't label any negative thoughts and feelings as "wrong." Instead, DBT will help you accept that all your thoughts are valid because of who you are and the life experiences that you've had. A DBT-trained therapist will work with you to acknowledge that you're doing the best that you can at this moment. And they'll teach you ways to manage strong feelings and stressful thoughts when they come up.

"Dialectical" is the idea that two different things can be true at once. So this type of therapy is centered on helping you accept yourself as you are while also trying to change.

DBT and CBT are alike in that they both:

  • Hone in on your current situation, instead of your past
  • Focus on your views about life, instead of your personality traits
  • Try to replace thoughts or habits that are no longer serving you

DBT skills can become part of your daily life. The four strategies you'll focus on are:

  • Distress tolerance: You can't avoid all stress and pain. But you can learn to tolerate intense, uncomfortable emotions without reacting impulsively, using self-injury, or turning to drugs or alcohol to cover up your stress.
  • Emotion regulation: Once you learn to recognize the emotions that you're having, you'll find it easier to manage them.
  • Mindfulness: Instead of wishing to change the past or worrying about the future, you'll learn ways to stay anchored in the present moment.
  • Interpersonal effectiveness: You'll learn how to better manage the relationships in your life. That includes asking for what you want and need, as well as setting boundaries and dealing with conflicts.

DBT focuses on acceptance and change.

Acceptance techniques can teach you to:

  • Get to know yourself better.
  • Think about why you do the things you do, without judgment. For instance, DBT therapy could help you realize that maybe you drink alcohol every night to avoid feeling anxious.

Change techniques give you tips on replacing a negative behavior or habit with ones that can improve your life. For instance, you could learn how to:

  • Swap out harmful thoughts with helpful ones
  • Get better at managing feelings of stress instead of trying to get rid of them

DBT treatment stages

The four stages of DBT include:

  • Stage I: First, your therapist will focus on the most urgent areas of concern. That means treating any harmful behavior, such as suicide attempts or self-injury. If you feel "out of control," their priority will be making sure that you're safe. Then, they'll help you regain control of your emotions.
  • Stage II: Next, you'll work on accepting who you are as a person. You'll start learning to identify your feelings and how to manage them. You'll also learn other important DBT therapy skills.
  • Stage III: This stage focuses on setting goals in your personal or professional life, building stronger relationships, and improving your self-esteem.
  • Stage IV: Some people need this additional stage. Your therapist will help you learn how to have more joy in your life.

DBT was first designed to treat people with borderline personality disorder. But it's now used to treat many other mental health issues. It's been shown to help people across a range of age groups, from teens to older adults.

DBT for borderline personality disorder

Borderline personality disorder is a condition that affects how you see yourself and how you relate to others. You may have intense bursts of anger and aggression, moods that shift rapidly, and an extreme fear of being rejected or abandoned by others. This can lead to deep issues with your self-image, the goals you have at work or school, and your relationships.

Impulsive behavior such as substance abuse, unsafe sex, or overspending can be common challenges when you live with borderline personality disorder. Self-sabotage can be another problem. For instance, you might quit a job that's going well.

The American Psychiatric Association has endorsed DBT as a really useful treatment for borderline personality disorder. It could lead to:

  • Less frequent and less severe suicidal behavior
  • Shorter hospital stays
  • Less anger
  • Finding it easier to form and maintain relationships with others

Other conditions DBT can treat

DBT can also help manage many other mental health conditions, such as:

  • Self-harm
  • Suicidal behavior
  • Posttraumatic stress disorder (PTSD)
  • Substance use disorder
  • Bipolar disorder
  • Eating disorders
  • Attention deficit hyperactivity disorder (ADHD)
  • Depression
  • Anxiety

DBT involves more than one visit to a therapist. It's a structured process that requires time and patience.

  • DBT pre-assessment: First, you'll meet with a therapist who has special training in DBT. They'll ask questions about you and what's going on in your life. If they think DBT is the right fit for you, they'll explain more about DBT and what your next steps will be.
  • Individual therapy: Weekly sessions with a DBT-trained therapist are the norm. These usually last 45 minutes to an hour. You'll discuss the goals you want to reach and issues that might be getting in your way. This could mean talking about your personal life as well as your mental health.
  • Group training: You'll also attend a weekly group session with others who are in DBT. This isn't a support group. It's more like a class. Your therapist will teach DBT skills that you can use on your own to better manage your feelings and your relationships with others. You could also do group exercises, such as role-playing certain stressful situations.
  • Phone crisis coaching: You may need extra support between sessions. That's common, so your therapist may suggest check-ins by phone. These are typically short phone calls of 5-15 minutes. You'll have a chance to tell your therapist how things are going and address any urgent concerns.
  • DBT workbook:You'll be given homework that allows you a chance to practice new skills. For instance, you might be asked to keep a daily journal where you keep track of your emotions, urges, reactions, and behaviors. Or you could get a DBT workbook with brief exercises that help reinforce the new concepts that you're learning.
  • DBT worksheets: Your therapist could give you handouts instead of, or along with, a DBT workbook. They'll also break down skill-building strategies step by step so you remember how to use them. For instance, you could get a DBT worksheet on ways to quickly calm down.

In some cases, medication may be part of your treatment, too.

In a complete DBT program, your therapist will also meet regularly with other therapists. They'll consult each other about their cases.

If you think DBT could be a good fit for you, ask your doctor if they can suggest a therapist. You can also search online. For instance, Behavioral Tech Institute is a group that trains therapists in DBT and offers a list of providers. The DBT Linehan Board of Certification also keeps a directory.

Once you find a potential therapist, ask about:

  • Training. What type of DBT training do they have?
  • Experience. For instance, do they often see clients with the same issues that you have?
  • Health insurance. Do they accept your plan if you have one?
  • Where sessions will take place. Will they be in-person or virtual? 
  • Check-ins. Will you touch base over the phone or email?
  • Fees. If you'll be charged for missing a session, it's good to know that upfront.

Finding a therapist you feel comfortable with and trust may take some time, but it will be a key part of your treatment. You may talk to several people before you find the right match.

Depending on where you live, you may have trouble finding a complete DBT program that includes individual sessions, group skills classes, and phone coaching. If so, you can look for a therapist who uses DBT techniques in their practice.

How long will I need DBT?

This is a good question to ask your therapist. You'll both need to agree on how long you'll commit to treatment. Usually, DBT lasts at least 6 months, and sometimes, up to a year. If you have been diagnosed with borderline personality disorder, your treatment may last longer than that.

DBT doesn't flip a switch and make you feel better. (No talk therapy can do that.) It will work best for you if you're committed to change, ready to practice the skills you learn, and comfortable sometimes being in a group, as well as in one-on-one sessions.

Some people start to feel better and notice a positive difference within a few months of starting DBT. But everyone is different.

If you're thinking about hurting yourself or having thoughts of suicide, seek help right away. You can:

  • Call or text 988. The 988 Suicide & Crisis Lifeline is free. You can reach someone 24 hours a day, 7 days a week. You can also chat with someone at https://988lifeline.org.
  • Go to your nearest hospital ER.
  • Call 911.

Once you begin DBT, your therapist may suggest that you call them first in a crisis.

DBT is a type of talk therapy that helps you accept yourself for who you are while also trying to change and feel better. Studies show that it's a good way to learn to manage your intense emotions. DBT requires a big commitment, so make sure you find a specially-trained therapist whom you can trust.

When is DBT not appropriate?

DBT isn't meant for young children. If you think your child could benefit from some type of therapy, talk to your pediatrician. They can suggest other types of therapy that might be a good fit.