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What is Dialectical Behavioral Therapy?

Read on to learn more about dialectical behavioral therapy, mindfulness, emotional regulation, and more.

What is Dialectical Behavioral Therapy?

Dialectical behavioral therapy (DBT) is a type of cognitive-behavioral therapy. This type of therapy aims to identify and change negative thinking patterns and push for positive behavioral changes. Dialectical behavior therapy treatment is effective for people who have difficult emotional lives or have trouble managing life in general. DBT is often used on high-risk individuals and those with difficult-to-treat conditions.

Some may confuse DBT with CBT (cognitive-behavioral therapy). Though they are both types of behavioral therapy, CBT is a type of talk therapy that focuses on identifying and challenging unhelpful thoughts. DBT, on the other hand, is typically a more intensive form of therapy. Dialectical behavior theory is designed to reduce emotional extremes and improve how individuals relate to themselves and others.

Dialectical Theory

Dialectical behavior therapy was initially founded in the late 1970s by a psychologist named Marsha Linehan. Dialectical behavior theory, according to Linehan, operates on the dialectical model, which states that:

  • Everything is interconnected
  • Change is constant and unavoidable
  • Opposites can coexist to get closer to the truth

Understanding DBT

A large part of understanding dialectical behavior therapy is knowing that two things can be true simultaneously. Understanding this concept encourages individuals to continually practice dialectical behavior therapy skills, even after therapy has ended.1

Linehan's dialectical behavior theory found that borderline personality disorder could be successfully managed with dialectical behavior therapy; however, many other conditions were and are treated with DBT. Today, DBT can be used to treat anxiety, eating disorders, post-traumatic stress disorder (PTSD), and several other conditions.2

What to Expect from a Dialectical Behavior Program?

DBT therapy is a structured process. Therapy involves four main steps: pre-treatment, individual therapy, skills training in groups, and intersession contact.


This usually spans two to three sessions, and in these sessions, the therapist and individual will get to know each other and see if they can work well together. The therapist will explain how DBT works, and the individual will decide if they are interested in this type of therapy. Additionally, in pre-treatment, the individual typically makes a few agreements.

First, they must agree to at least one year of DBT; one year is the minimum amount of time needed to complete DBT successfully. Second, they must agree to stop self-harming or other self-destructive behaviors (however, this doesn't mean the treatment will be terminated if individuals engage in these behaviors).3  

Individual Therapy

This stage of treatment focuses on getting an individuals’ unhelpful behaviors under control. Therapists use different analysis and treatment techniques to help individuals in weekly, structured appointments. Sometimes homework is required for individuals.

Group Skills Training

In this phase of treatment, individuals join others in weekly sessions to learn new coping strategies, including mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. These sessions often last 90 minutes to two hours.4 

DBT Phone Coaching

This part of treatment often comes in the form of telephone crisis coaching, meaning individuals can personally reach out to their therapist if they are distressed in between sessions. Individuals can call if they feel overwhelmed or feel that they are at risk of hurting themselves.

Dialectical Behavior Therapy Techniques

In any dialectical behavior therapy program, there are four primary skills (sometimes called modules) that individuals learn. These dialectical behavior therapy techniques help people learn to deal with distress in healthier, more positive ways. Depending on their condition and symptoms, some people may require more intensive dialectical behavior therapy than others, but the following techniques are present in all programs.


This essential skill teaches you to be present in every moment, helping you accept and acknowledge your emotions and feelings without judgement. In DBT, this step is further broken down into "what" and "how" skills — with mindfulness, you focus on "what" you're thinking and feeling in the present moment; and "how" to balance your thoughts, accept yourself, and implement mindfulness into your daily life.

Distress Tolerance

Learning mindfulness can help with stress, but distress tolerance can be needed in times of intense stress. When we're very stressed, sometimes we engage in behaviors that only take us one step back, like avoidance or self-harm. However, learning distress tolerance teaches you more positive and productive ways of coping with hard feelings. Some methods include self-soothing, distracting yourself until you're calm, finding ways to improve the moment despite pain, and comparing different coping strategies by listing pros and cons.

Interpersonal Effectiveness

Having and maintaining strong relationships can be challenging if you struggle with intense emotions and mood swings. Learning this skill can help you become more aware of your feelings and how to communicate your wants and needs. Interpersonal effectiveness teaches listening skills, social skills, and assertiveness training to build better relationships and improve self-respect.5 

Emotion Regulation

Emotions can be very overwhelming, but dialectical therapy can help you manage them effectively. Emotional regulation skills allow you to recognize your emotions, help you increase feelings that have a positive effect, be more mindful of emotions without judging them, avoid giving in to impulsive, emotional urges, and solve problems in a more helpful way.

What Dialectical Behavioral Therapy Treatment Can Help With

Dialectical Behavioral Therapy

Dialectical Behavioral Therapy

Dialectical behavioral therapy was initially used for individuals with BPD or suicidal thoughts. Dialectical behavior disorder can manifest in impulsivity, emotional dysregulation, and relationship problems; dialectical behavior disorder can also be in the form of suicidal thoughts or actions.

Research shows DBT and adapted dialectical behavioral therapy is a particularly beneficial therapy for those with BPD — over 75% of people who participated in a dialectical behavior therapy program for at least a year no longer met the criteria for BPD after completing dialectical behavior therapy.6

Conditions DBT Can Treat

While it’s known to be an excellent treatment for borderline personality disorder, dialectical therapy has been proven effective at treating many other conditions, including:

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Bipolar disorder
  • Eating disorders
  • Obsessive-compulsive disorders (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Generalized anxiety disorder (GAD)

Studies indicate that DBT is effective regardless of a person's age, sex, gender identity, sexual orientation, and race/ethnicity. Research shows that DBT therapy for anxiety can also be an effective treatment.

Benefits of DBT

People who participate in a dialectical behavior therapy program can walk away with many benefits. First and foremost, dialectical therapy should reduce or eliminate self-harming or suicidal behavior. Individuals in dialectical behavioral therapy can also learn to accept their emotions, life circumstances, and themselves. This acceptance can then lead to healthy and positive change. Along these lines, dialectical behavior therapy benefits include helping individuals learn to recognize unhealthy behaviors and replace them with healthier ones, improving relationships and lessening interpersonal conflict.

Dialectical behavior therapy treatment will teach individuals to collaborate with their therapist and learn and utilize valuable dialectical behavior therapy skills. These skills include emotional regulation, mindfulness, and various interpersonal skills. Ultimately, dialectical behavioral therapy can help individuals recognize and appreciate their unique skills and qualities while developing positive traits. 

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