Dialectical Behavioral Therapy

Medically Reviewed by Smitha Bhandari, MD on April 01, 2022
3 min read

Dialectical behavioral therapy (DBT) is a type of cognitive behavioral therapy. Cognitive behavioral therapy tries to identify and change negative thinking patterns and pushes for positive behavioral changes.

DBT may be used to treat suicidal and other self-destructive behaviors. It teaches patients skills to cope with, and change, unhealthy behaviors.

The term "dialectical" comes from the idea that bringing together two opposites in therapy -- acceptance and change -- brings better results than either one alone.

A unique aspect of DBT is its focus on acceptance of a patient's experience as a way for therapists to reassure them -- and balance the work needed to change negative behaviors.

Standard comprehensive DBT has four parts:

  • Individual therapy
  • Group skills training
  • Phone coaching, if needed for crises between sessions
  • Consultation group for health care providers to stay motivated and discuss patient care

Patients agree to do homework to practice new skills. This includes filling out daily "diary cards" to track more than 40 emotions, urges, behaviors, and skills, such as lying, self-injury, or self-respect.

Dialectical behavioral therapy focuses on high-risk, tough-to-treat patients. These patients often have multiple diagnoses.

DBT was initially designed to treat people with suicidal behavior and borderline personality disorder. But it has been adapted for other mental health problems that threaten a person's safety, relationships, work, and emotional well-being.

Borderline personality disorder is a disorder that leads to acute emotional distress. Patients may have intense bursts of anger and aggression, moods that shift rapidly, and extreme sensitivity to rejection.

People with borderline personality disorder may have difficulty regulating emotions. They experience instability in:

Impulsive behavior, such as substance abuse, risky sex, self-injury, and repeated life crises such as legal troubles and homelessness, are common.

The American Psychiatric Association has endorsed DBT as effective in treating borderline personality disorder. Patients who undergo DBT have seen improvements such as:

  • Less frequent and less severe suicidal behavior
  • Shorter hospitalizations
  • Less anger
  • Less likely to drop out of treatment
  • Improved social functioning

Substance abuse is common with borderline personality disorder.DBT helps substance abusers with borderline personality disorder but hasn't proven effective for addiction alone.

DBT may also help certain people with depression, according to some studies. Your therapist or health care provider may suggest it on its own or in combination with antidepressant medications. 

In addition, researchers are investigating whether DBT may be effective in treating these conditions:


Comprehensive DBT focuses on four ways to enhance life skills:

  • Distress tolerance: Feeling intense emotions like anger without reacting impulsively or using self-injury or substance abuse to dampen distress.
  • Emotion regulation: Recognizing, labeling, and adjusting emotions.
  • Mindfulness: Becoming more aware of self and others and attentive to the present moment.
  • Interpersonal effectiveness: Navigating conflict and interacting assertively.

DBT offers a commonsense, multistage approach:

  • Stage 1: Treats the most self-destructive behavior, such as suicide attempts or self-injury.
  • Stage 2: Begins to address quality-of-life skills, such as emotional regulation, distress tolerance, and interpersonal effectiveness.
  • Stage 3: Focuses on improved relationships and self-esteem.
  • Stage 4: Promotes more joy and relationship connection.


Show Sources


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Dimeff, L. and Linehan, M.M. The California Psychologist, 2001.

Linehan, M.M. The American Journal on Addictions, 1999.

Robins, C.J. and Chapman, A.L. Journal of Personality Disorders, 2004.

Brody, J.E. The New York Times, June 15, 2009.

American Psychiatric Association: "Practice Guideline for the Treatment of Patients with Borderline Personality Disorder."

National Institute of Mental Health: "Borderline Personality Disorder."

National Institute of Mental Health: Transcript of lecture on Feb. 8, 2011, by Marsha M. Linehan, PhD, to the NIMH.

Behavioraltech.org: "Dialectical Behavior Therapy: Diary Card."

Chapman, A.L. Psychiatry, September 2006.

Pennay, A. Journal of Substance Abuse Treatment, July 8, 2011.

Bohus, M. Psychother Psychosom Med Psychol, March 2011.

Spoont, M.R. Psychiatric Services: A Journal of the American Psychiatric Association, May 2003.

Anxiety & Depression Association of America: “Stuck?! Enhancing Treatments For Anxiety And Depression Using Principles From Dialectical Behavior Therapy.”

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