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Dialectical Behavioral Therapy (DBT)
Integrating acceptance with change, DBT helps reduce harmful behaviors, improve emotional stability, and foster resilience in everyday life.
Introduction
The basics
What is Dialectical Behavioral Therapy (DBT)?
Dialectical Behavioral Therapy (DBT) is a structured form of psychotherapy that teaches practical skills for managing intense emotions, tolerating distress, and improving relationships.
It balances accepting yourself as you are while working to change problematic behaviors. DBT was originally developed for the treatment of borderline personality disorder but is now used for a variety of mental health concerns.
Goal
What is the goal of Dialectical Behavioral Therapy (DBT)?
The fundamental goal of Dialectical Behavioral Therapy (DBT) is to help people build a life worth living. Think of it like learning to navigate a powerful river—you need both the acceptance that the river is strong and sometimes turbulent, and the skills to steer your boat effectively.
DBT aims to help people accept themselves while simultaneously working on change, embracing this seeming contradiction (the “dialectic”) as a path to growth.
Uses
What conditions does Dialectical Behavioral Therapy (DBT) treat?
Dialectical Behavior Therapy (DBT) can benefit people experiencing challenges such as:
- Borderline Personality Disorder (BPD)
- Chronic suicidal thoughts
- Self-harming behaviors
- Disordered eating
- Substance use disorders
- Intense mood swings
- Difficulty managing anger
- Interpersonal conflicts
Subtypes
What are the subtypes of Dialectical Behavioral Therapy (DBT)?
While there are not formal subtypes of Dialectical Behavior Therapy (DBT), several adaptations have been developed for specific disorders and populations (e.g., DBT for eating disorders; DBT for adolescents). Brief examples include:
- DBT for Adolescents (DBT-A): adapts standard DBT for teens and families (multifamily skills groups, safety focus).
- DBT for Substance Use Disorders (DBT-SUD): adds strategies targeting substance use while preserving core DBT components.
- DBT-PE (DBT with Prolonged Exposure): integrates a PE protocol to treat PTSD within a DBT framework for high-risk clients.
- DBT for Eating Disorders: applies DBT skills to reduce binge eating and improve emotion regulation.
These adaptations keep DBT’s core, balancing acceptance and change through skills like mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness, while tailoring delivery to the needs of particular groups.
Effectiveness
Origins
Who developed Dialectical Behavioral Therapy (DBT) and when?
Marsha Linehan developed Dialectical Behavioral Therapy (DBT) in the late 1980s and early 1990s. Linehan created DBT after discovering that standard cognitive behavioral therapy wasn’t sufficiently effective for people struggling with chronic suicidal thoughts and borderline personality disorder.
Through her own personal experiences and clinical work, she recognized the need for an approach that could balance acceptance and change strategies while teaching specific skills for managing intense emotions.
Early randomized trials (beginning in 1991) showed DBT’s efficacy for chronically suicidal individuals with BPD, and subsequent manuals formalized the four core skills modules: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.
Evidence Base
Is Dialectical Behavioral Therapy (DBT) evidence based?
The evidence base for Dialectical Behavior Therapy (DBT) is particularly strong. Multiple studies have demonstrated its effectiveness, especially for conditions involving emotional dysregulation and self-destructive behaviors. Research shows DBT can:
- Reduce suicide attempts and self-harm, with randomized trials showing roughly half the risk of a suicide attempt vs. comparison treatments, and fewer medically serious self-injurious acts.
- Lower psychiatric hospitalizations and crisis service use.
- Improve emotion regulation and interpersonal functioning, including in adolescent and adult populations.
What’s especially noteworthy is that DBT shows positive outcomes even for individuals who haven’t responded well to other treatments, with meta-analyses and guideline reviews supporting benefits across high-risk groups (e.g., BPD with chronic suicidality).
How it works
Techniques Used
How does Dialectical Behavioral Therapy (DBT) work?
Dialectical Behavioral Therapy (DBT) works through four core skill modules that are taught and practiced simultaneously. Those modules are as follows:
- Mindfulness: learning to observe and participate in the present moment without judgment
- Distress Tolerance: developing skills to cope with crisis situations without making them worse
- Emotion Regulation: understanding and managing intense emotions more effectively
- Interpersonal Effectiveness: learning to navigate relationships and maintain self-respect.
What to expect in a session
What can I expect from sessions in Dialectical Behavioral Therapy (DBT)?
Dialectical Behavioral Therapy (DBT) sessions typically focus on building the four core skills mentioned above: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
Here’s what you can generally expect:
- Session Structure: Most DBT programs combine individual therapy sessions with group skills training. Individual sessions usually last 50 minutes and happen weekly, while group sessions run 1.5–2 hours and focus specifically on learning and practicing skills.
- Individual Therapy Sessions: Your therapist will help you apply DBT skills to specific situations in your life. You might review a diary card where you’ve tracked your emotions, behaviors, and skill use throughout the week. The session often involves problem-solving current challenges using DBT techniques and addressing any barriers to using skills effectively.
- Group Skills Training: These sessions are more educational, like a class. You’ll learn specific techniques for managing intense emotions, tolerating distressing situations without making them worse, staying present and aware, and communicating effectively in relationships. Expect homework assignments to practice these skills between sessions.
- The Therapeutic Approach: DBT therapists balance acceptance and change strategies. They’ll validate your experiences while also challenging you to develop new coping mechanisms. The approach is collaborative—you’ll work together to identify goals and track progress.
- Skills You’ll Learn: You’ll practice concrete techniques like deep breathing for distress tolerance, mindful observation exercises, ways to regulate intense emotions before they become overwhelming, and scripts for difficult conversations.
Treatment length & structure
How long does Dialectical Behavioral Therapy (DBT) typically take? Is there any set structure?
Standard Dialectical Behavioral Therapy (DBT) is typically a longer-term commitment, often lasting 6 months to a year or more, as it takes time to develop and integrate these new skills into daily life. And, many people choose to repeat the skills training for deeper learning.
The treatment has a very specific structure involving multiple components:
- Weekly individual therapy sessions
- Weekly skills training groups
- Phone coaching for crisis situations
- Consultation team meetings for therapists
Getting care
Finding a therapist
How do I find a therapist who uses Dialectical Behavioral Therapy (DBT)?
Alma’s directory has many therapists who specialize in Dialectical Behavioral Therapy (DBT), including:
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Similar types of therapy
Besides Dialectical Behavioral Therapy (DBT), what other types of therapy might be right for me?
If after reading this, you’re not sure if Dialectical Behavioral Therapy (DBT) is quite the right fit, here are some other types that might be worth looking into:
Mindfulness-Based Stress Reduction (MBSR): if mindfulness tools feel like a fit
MBSR teaches mindfulness practices that help people observe thoughts, emotions, and body sensations with less reactivity.
Compassion Focused Therapy (CFT): if self-criticism is a central concern
CFT builds self-compassion and emotional safety, especially for people who struggle with shame, self-criticism, or threat-based thinking.
Somatic Experiencing/Sensorimotor Therapy: if symptoms feel connected to the body
Somatic approaches focus on body sensations, nervous system responses, and gradual regulation, especially when stress or trauma feels physically held.
Applied Behavioral Analysis (ABA): if behavior patterns need structured support
ABA uses behavioral learning principles to understand what reinforces behavior and build practical skills through structured support.
This article was written and medically validated by Drs. Jill Krahwinkel-Bower and Jamie Bower.
FAQs
How do I know if DBT is right for me?
DBT was originally developed for people with borderline personality disorder, but it has since expanded to help anyone who struggles with intense, difficult-to-manage emotions or self-destructive behaviors. If you find that your feelings often feel overwhelming, that you frequently act in ways you later regret, or that your relationships tend to be unstable and conflict-heavy, DBT's four skill modules — mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness — may offer exactly the kind of concrete, practical tools you've been looking for. A consultation with a DBT-trained therapist can help clarify whether the full program or a DBT-informed approach is the right fit.
Can DBT be done online?
Yes. Just like most types of therapy, this approach works effectively online through secure video platforms. Studies consistently show that online therapy achieves the same results as in-person care for a wide variety of conditions. If you're looking for this type of therapy online, you can use this link to find therapists near you who are trained in DBT and take your insurance.
Is DBT covered by insurance?
Whether DBT is a covered benefit for you depends on your individual insurance plan. Most major insurance plans cover therapy when it's provided by a licensed mental health professional, regardless of the type of therapy you choose. What matters more is whether therapy is considered medically necessary given your diagnosis. The best way to find out what you'll pay is to check your plan's explanation of benefits, call the member services number on your insurance card, or use Alma's free cost estimator tool before booking.
What's the difference between DBT and CBT?
CBT focuses primarily on identifying and changing unhelpful thought patterns, and is practical, structured, and typically time-limited. DBT grew out of CBT but added something crucial: an emphasis on acceptance. Where CBT might ask you to challenge a thought, DBT asks you to first acknowledge that your emotional experience makes sense, and then work toward change. DBT also includes more components than standard CBT — typically combining individual therapy with group skills training and phone coaching — making it a more intensive commitment, though one that comes with a particularly strong evidence base for high-risk presentations.
Does DBT help with emotional regulation or self-harm?
Yes, and this is where DBT's evidence base is especially robust. The approach was specifically designed to address the kind of emotional dysregulation that can lead to self-harm and suicidal behavior, and research shows it roughly halves the risk of a suicide attempt compared to other treatments. The emotion regulation module teaches concrete strategies for understanding and managing intense feelings before they become overwhelming, while the distress tolerance module gives you tools for surviving crisis moments without making things worse. DBT's combination of acceptance and skill-building makes it particularly effective for these challenges.
Why does DBT focus on skills training?
Marsha Linehan, who developed DBT in the late 1980s, found that traditional talk therapy wasn't sufficient for people with chronic suicidal thoughts and intense emotional dysregulation. She recognized that these individuals needed to learn specific, concrete skills — not just insights — in order to navigate their lives differently. That's why standard DBT combines individual therapy with weekly skills training groups, which work like a class: you're taught specific techniques, practice them with others, and take them home to use between sessions. The skills focus makes DBT unusually practical, and the homework makes the learning stick.
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