Dialectical behavioral therapy helps people tolerate and regulate their emotions. It is based on cognitive behavioral principles and focuses on problem solving and acceptance.

Dialectical behavioral therapy (DBT) first appeared in the 1990s for treating borderline personality disorder (BPD) and suicidal behaviors. Today, mental health professionals use it to treat other complex conditions and issues as well.

In this article, we look at DBT, including how it works and what it can treat.

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DBT can help with distress tolerance, emotional regulation, mindfulness, and interpersonal effectiveness.

The American Psychological Association (APA) define DBT as a flexible psychotherapy that comprises elements of behavior therapy, cognitive behavior therapy (CBT), and mindfulness.

The term “dialectical” refers to the combination of two opposing ideas.

The first of these ideas is the acceptance of the reality of a person’s life and behaviors.

The second opposing idea is the change of situations and dysfunctional behaviors.

DBT is a stage-based therapy, meaning it involves specific stages. According to experts, these stages are as follows:

Stage 1

This stage involves stabilizing people and helping them gain control of their behaviors. Therapy in stage 1 involves crisis intervention and keeping people safe from suicide, self-harm, or addiction issues.

Stage 2

During stage 2, individuals will work on their emotional pain and traumatic experiences. Therapists help clients to identify unhelpful thoughts, behaviors, and beliefs.

Stage 3

Stage 3 involves solving issues the individual associates with their everyday life. Therapy focuses on maintaining progress and setting achievable goals. The aim is to help people take responsibility for their actions and find joy in life.

Stage 4

In the final stage, individuals work toward advancing their lives and achieving spiritual fulfillment.

DBT is a modified form of CBT. Both therapies allow people to better understand and manage their thoughts and behaviors.

CBT aims to change negative thought processes to impact mood and behaviors positively. Research indicates that CBT is an effective treatment for depression, anxiety, substance misuse, eating disorders, and more.

While DBT and CBT have a lot in common, DBT focuses more on managing emotions and interpersonal relationships. This is because therapists originally developed DBT to treat BPD.

Other differences include using a consistent dialectical philosophy and employing mindfulness and acceptance-based interventions.

DBT focuses on enhancing the following fourkey life skills:

Distress tolerance

This skill involves being able to feel intense emotions, such as anger or grief, without reacting impulsively or using maladaptive coping techniques, such as substance abuse or self-harm.

Emotion regulation

Regulating emotions is a key component of DBT. Individuals will learn to recognize and accept their emotions without judgment. They will learn to stop letting negative emotions take over.

For example, individuals can learn to stop an emotion, such as sadness, from escalating into feelings of anguish, depression, guilt, and shame.

They can also learn how to increase emotions that feel good, such as joy and love.


Mindfulness involves fostering an increased awareness of the present moment while having an open, nonreactive attitude and an acceptance of how things are.

Living in the moment can have positive outcomes for a person’s awareness of their body, their ability to regulate their emotions, and their perception of themselves.

DBT helps people to learn mindfulness techniques so they can more fully live in the present.

Interpersonal effectiveness

Learning to regulate emotions can help people to deal with conflict and to communicate more assertively. In turn, these skills increase interpersonal effectiveness, or the ability to interact with others.

Through DBT, people can learn interpersonal skills, such as listening, assertiveness, and other social skills.

DBT uses specific techniques to achieve its treatment goals. These include:

Individual therapy

During individual therapy, people typically work on emotional regulation, traumatic experiences, and other issues that arise.

The therapist may assign homework, troubleshoot issues that present, and help people put their new skills into practice outside the therapy setting.

Each week, the individual will typically complete a diary card, or self-monitoring form, to track their various treatment goals. This card helps to inform treatment and allocate session time.

Skills training group

DBT often involves a weekly skills group session. In the group, members typically discuss new skills, practical work, and homework assignments. According to older research, each group typically comprises 4–10 participants.

Telephone consultations

DBT therapists are often available by phone between sessions to deal with crises.

Therapist consultation team

Working with BPD and other hard-to-treat conditions can be challenging for therapists. Therefore, the therapy team typically meets weekly for support, training, and feedback. This ensures that the therapists remain capable and motivated.

Dr. Marsha Linehan developed DBT to treat BPD, a mental health disorder that involves intense fear of abandonment, self-image issues, difficulty managing emotions, and relationships.

BPD also has associations with suicidal behaviors and self-harm. Some research indicates that up to 10% of people with BPD will die by suicide.

The lifetime prevalence of BPD is 5.9%, according to some estimates. In psychiatric inpatient settings, it can be as high as 20%.

Several studies and organizations support DBT’s efficacy in the treatment of BPD.

Since its development, mental health professionals have adapted DBT for the treatment of various other conditions and issues, including:

Benefits of DBT include:

  • a reduction in suicidal and self-harming behaviors
  • improved tolerance and regulation of emotions
  • a reduction in symptoms of anxiety, depression, trauma, and stress
  • learning to set reasonable goals to improve quality of life
  • decreasing maladaptive behaviors and thoughts affecting quality of life and relationships
  • improving self-belief and self-respect

While DBT can offer many benefits, it may not work for everyone. Some of the criticisms and potential limitations of DBT include:

  • The therapy requires a significant time commitment in terms of attendance and homework.
  • Not everyone is receptive to or able to complete homework on a regular basis.
  • Some people are more spiritually minded, and these people may not appreciate the logical and academic style of DBT.
  • Much of the research on DBT involves small sample sizes, and not all studies include post-treatment follow-ups. This makes it difficult to know who the therapy will work for and how long the effects will last.

There are many other forms of psychotherapy available. Different types may be suitable for certain people. Options include:

  • CBT, which involves modifying negative thoughts and core beliefs to influence emotions and behaviors positively.
  • Family and couple therapy, which involves attending therapy with family members or partners to resolve interpersonal and relationship issues.
  • Humanistic therapies, which encourage individuals to view themselves more positively and to improve their self-awareness.
  • Interpersonal psychotherapy (IPT), a brief form of psychotherapy that involves resolving interpersonal problems to aid recovery from mental health issues.
  • Psychodynamic therapy, which focuses on unconscious processes to increase a person’s self-awareness and to understand how issues from their past influence their present behavior.

DBT appears to be an effective therapy for BPD and other issues that can be challenging to treat, including substance misuse and eating disorders.

It is a structured treatment that involves individual therapy, group work, and phone consultations. Individuals will learn to regulate and accept their emotions and to set goals to improve their quality of life.

DBT may not be for everyone, however. If an individual does not feel that DBT is working for them, they should consider trying one of the many other types of therapy. A doctor or mental health professional can advise on their options.