How to say dialectical behavior therapy

Table of Contents

What does DBT treat?

Research shows that DBT can be helpful in tackling problems like:

It was originally developed for borderline personality disorder (BPD), so most of the evidence for it so far has been about treating people with this diagnosis. Some NHS services are also starting to offer DBT for:

But regardless of your diagnosis or problems, DBT might not be right for you.

DBT is more likely to work for you if:

You’re committed to making positive changes in yourself
You’re ready to work hard at therapy, and do homework assignments
You’re ready to focus mostly on your present and future, rather than your past
You feel able to do some sessions in a group with others

Some people like group work, but others find it harder. You might ideally prefer to work with a DBT therapist 1-to-1, but unfortunately this is not always offered as an option. Talk to your doctor about what you would find most helpful to see what is available in your area.

It’s important to remember that everyone experiences therapy differently.

Overview

What is dialectical behavior therapy (DBT)?

Dialectical behavior therapy (DBT) is a type of talk therapy (psychotherapy). It’s based on cognitive behavioral therapy (CBT), but it’s specially adapted for people who experience emotions very intensely.

Cognitive behavioral therapy (CBT) is a type of talk therapy that helps people understand how thoughts affect emotions and behaviors.

“Dialectical” means combining opposite ideas. DBT focuses on helping people accept the reality of their lives and their behaviors, as well as helping them learn to change their lives, including their unhelpful behaviors.

Dialectical behavior therapy was developed in the 1970s by Marsha Linehan, an American psychologist.

What is dialectical behavior therapy (DBT) used for?

Dialectical behavior therapy (DBT) is especially effective for people who have difficulty managing and regulating their emotions.

DBT has proven to be effective for treating and managing a wide range of mental health conditions, including:

Borderline personality disorder (BPD).
Self-harm.
Suicidal behavior.
Post-traumatic stress disorder (PTSD).
Substance use disorder.
Eating disorders, specifically binge eating disorder and bulimia.
Depression.
Anxiety.

It’s important to note that the reason DBT has proved effective for treating these conditions is that each of these conditions is thought to be associated with issues that result from unhealthy or problematic efforts to control intense, negative emotions. Rather than depending on efforts that cause problems for the person, DBT helps people learn healthier ways to cope.

How do I find a DBT therapist?

A therapist can be a psychiatrist (a medical doctor who can prescribe medications), psychiatric nurse, psychologist, social worker or family therapist.

Finding the right therapist is often a time-consuming task, and DBT therapy isn’t any different. Try not to become discouraged. Talk to people you trust to give you a referral for a therapist who uses dialectical behavior therapy, whether it’s your primary healthcare provider or a friend or family member.

You can also search for therapists online through local and state psychological associations.

Be sure that any therapist you’re interested in seeing is a state-certified and licensed mental health professional and that they treat your area of concern (for example, eating disorders, borderline personality disorder, self-harm, etc.).

Most therapists’ websites list the conditions and problems they treat. If you have questions, call or email the therapist’s office before you choose.

It may be helpful to ask a potential DBT therapist the following questions:

What is the nature of your training in DBT?
Do you provide comprehensive DBT or a modification? If not comprehensive DBT, why not?
Do you belong to a DBT consultation team?
What’s your policy on phone calls and emails during the week?
How much time will you initially ask me to commit to for the entire therapy process?

Procedure Details

How does dialectical behavior therapy (DBT) work?

The main goal of therapists who use dialectical behavior therapy (DBT) is to strike a balance between validation (acceptance) of who you are and your challenges and the benefits of change. Your therapist will help you learn new skills to improve emotion regulation.

The structure of dialectical behavior therapy can vary some from therapist to therapist, but, in general, DBT involves these four types of sessions:

DBT pre-assessment.
Individual therapy.
Skills training in groups.
Telephone crisis coaching.

DBT pre-assessment

Your therapist may offer an assessment before starting DBT. They’ll determine how suitable DBT is for you by asking you questions and explaining how DBT works. If you decide that DBT is the right therapy for you, they’ll ask you to commit to the treatment and the length of treatment.

Individual DBT therapy

Individual DBT therapy involves weekly sessions with your therapist. Each session lasts about 40 minutes to 60 minutes.

Individual DBT therapy sessions have the following goals:

To help keep you safe by reducing suicidal and self-harming behaviors, if applicable.
To limit behaviors that get in the way of productive therapy.
To help you reach your goals and improve your quality of life by addressing what’s blocking your progress, such as mental health conditions or relationship issues.
To help you learn new skills to replace unhelpful behaviors.

Your therapist will likely ask you to keep a diary to track your emotions and actions and to look for patterns of behavior. You’ll bring this diary with you to your sessions so you and your therapist can decide what to work on for each session.

DBT skills training in groups

In these sessions, your therapist will teach you skills in a group setting. This isn’t to be confused with group therapy, in which you discuss your problems with others. Think of it more like a teaching and learning session in a classroom setting.

DBT skills aim to help enhance your capabilities in day-to-day life. The four skills your therapist will teach include:

Mindfulness: This is the practice of being fully aware and focused in the present instead of worrying about the past or future.
Distress tolerance: This involves understanding and managing your emotions in difficult or stressful situations without responding with harmful behaviors.
Interpersonal effectiveness: This means understanding how to ask for what you want and need and setting boundaries while maintaining respect for yourself and others.
Emotion regulation: This means understanding, being more aware of and having more control over your emotions.

Telephone crisis coaching

DBT often involves telephone crisis coaching to support you in your daily life. This means you can call your therapist at certain times for support between sessions.

Examples of when you may need to call your therapist include:

When you need help with an immediate crisis, such as wanting to self-harm.
When you’re trying to use the DBT skills you learned but want some advice on how to do it.

However, your therapist will set clear boundaries about when you can call them, such as during an agreed-upon range of time during the day.

Crisis coaching functions on an as-needed basis. The calls are usually brief, and they shouldn’t replace the work of individual or group sessions.

Risks / Benefits

What are the benefits and risks of dialectical behavior therapy (DBT)?

Dialectical behavior therapy (DBT) has been proven to help people with their mental health conditions in several studies. For people with borderline personality disorder, in particular, DBT results in:

Less self-harm behavior and anger.
Fewer days of inpatient hospitalization.
Less drug and alcohol misuse.
Improved depressive symptoms.

However, DBT isn’t for everyone, and it can be very difficult. DBT is more likely to work for you if you:

Are committed to making positive changes.
Are ready to fully commit to therapy and do homework assignments.
Are ready to focus mostly on your present and future, rather than your past.
Feel able to do some sessions in a group with others.

Recovery and Outlook

How long will I need dialectical behavior therapy?

Dialectical behavior therapy (DBT) usually takes at least six months to a year. However, each person is unique, and mental health conditions are complex. You shouldn’t expect to be completely free of symptoms or no longer have problematic behaviors after one year of DBT.

Many therapists believe that the treatment for borderline personality disorder, in particular, can often take several years.

Try not to get discouraged by how long it may take to be able to better manage your emotions and have a better quality of life. The important thing is that you’re seeking help. Any progress is good progress.

When to Call the Doctor

When should I see my healthcare provider or therapist while doing DBT?

It’s important to go to all of your scheduled individual DBT therapy sessions and group skill training sessions.

If you’re experiencing a crisis, such as feeling suicidal, and can call your therapist, do so.

If your therapist is unavailable, call the National Suicide Prevention Lifeline at 1.800.273.8255. Someone will be available to talk with you 24 hours a day, seven days a week. You can also call 911 or go to the nearest emergency room.

A note from Cleveland Clinic

Dialectical behavior therapy (DBT) is an effective treatment to help people who experience very intense, negative emotions. Although it may be difficult and time-consuming to find the right DBT therapist for you, it’s important to keep trying. The sooner you can start therapy — and stay committed to it — the sooner you’ll have an improved quality of life.

Dialectical behavior therapy (DBT) is a modified type of cognitive behavioral therapy (CBT). Its main goals are to teach people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others.

DBT was originally intended to treat borderline personality disorder (BPD), but it has been adapted to treat other mental health conditions. It can help people who have difficulty with emotional regulation or are exhibiting self-destructive behaviors (such as eating disorders and substance use disorders). This type of therapy is also sometimes used to treat post-traumatic stress disorder (PTSD).

1:45

Everything You Need to Know About DBT Therapy

This video has been medically reviewed by Daniel B. Block, MD.

Dialectical Behavior Therapy Techniques

DBT has evolved to become an evidence-based psychotherapy approach that is used to treat many conditions. Settings in which DBT are often used include:

Group therapy where patients are taught behavioral skills in a group setting.
Individual therapy with a trained professional where a patient’s learned behavioral skills are adapted to their personal life challenges.
Phone coaching in which patients can call the therapist between sessions to receive guidance on coping with a difficult situation they are currently in.

Get Help Now

We’ve tried, tested, and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. Find out which option is the best for you.

Some of the strategies and techniques that are used in DBT include the following.

Core Mindfulness

One important benefit of DBT is the development of mindfulness skills. Mindfulness helps you focus on the present or “live in the moment.” This helps you pay attention to what is happening inside you (your thoughts, feelings, sensations, and impulses) as well as using your senses to tune in to what’s happening around you (what you see, hear, smell, and touch) in nonjudgmental ways.

Mindfulness skills help you slow down and focus on using healthy coping skills when you are in the midst of emotional pain. The strategy can also help you stay calm and avoid engaging in automatic negative thought patterns and impulsive behavior.

Sample Exercise: Observe Mindfulness Skill

Pay attention to your breath. Take note of the sensation of inhaling and exhaling. Watch your belly rise and fall as you breathe.

Distress Tolerance

Distress tolerance skills help you accept yourself and your current situation. DBT teaches several techniques for handling a crisis, including:

Distraction
Improving the moment
Self-soothing
Thinking of the pros and cons of not tolerating distress

Distress tolerance techniques help prepare you for intense emotions and empower you to cope with them with a more positive long-term outlook.

Sample Exercise: Putting Your Body in Charge

Run up and down the stairs. If you’re inside, go outside. If you’re sitting, get up and walk around. The idea is to distract yourself by allowing your emotions to follow your body.

Interpersonal Effectiveness

Interpersonal effectiveness helps you to become more assertive in a relationship (for example, expressing your needs and be able to say “no”) while still keeping a relationship positive and healthy. You will learn to listen and communicate more effectively, deal with challenging people, and respect yourself and others.

Sample Exercise: GIVE

Use the acronym GIVE to improve relationships and positive communication:

Gentle. Don’t attack, threaten, or judge others
Interest. Show interest with good listening skills (don’t interrupt someone else to speak)
Validate. Acknowledge the other person’s thoughts and feelings
Easy. Try to have an easy attitude (smile often and be light-hearted)

Emotion Regulation

Emotion regulation lets you navigate powerful feelings in a more effective way. The skills you learn will help you to identify, name, and change your emotions.

When you are able to recognize and cope with intense negative emotions (for example, anger), it reduces your emotional vulnerability and helps you have more positive emotional experiences.

Sample Exercise: Opposite Action

Identify how you’re feeling and do the opposite. If you are feeling sad and want to withdraw from friends and family, make plans to see your loved ones.

Stages of DBT

Dialectical behavior therapy is also divided into four stages of treatment.

Stage 1: During the beginning of treatment, the most serious and self-destructive behaviors are the first things addressed. This may include issues such as self-injury or suicidal behaviors.
Stage 2: Next, treatment moves on to address issues that affect a person’s quality of life, such as their interpersonal effectiveness, emotional regulation skills, and ability to tolerate distress.
Stage 3: The next step is to focus on issues related to self-esteem and interpersonal relationships.
Stage 4: At this point, treatment is focused on helping people get the most out of their lives, including finding ways to experience greater happiness, strengthen their relationships, and pursue their life goals.

What Dialectical Behavioral Therapy Can Help With

DBT was developed in the late 1980s by Dr. Marsha Linehan and colleagues when they discovered that cognitive behavioral therapy (CBT) alone did not work as well as expected in patients with BPD. Dr. Linehan and her team added techniques and developed a treatment to meet the unique needs of these individuals.

Though developed with BPD in mind, DBT might also be an effective treatment for:

Benefits of Dialectical Behavioral Therapy

In DBT, the patient and therapist work to resolve the apparent contradiction between self-acceptance and change to bring about positive changes in the individual in treatment. Part of this process involves offering validation, which helps people become more likely to cooperate and less likely to experience distress at the idea of change.

In practice, the therapist validates that an individual’s actions “make sense” within the context of their personal experiences without necessarily agreeing that the actions are the best approach to solving a problem.

Each therapeutic setting has its own structure and goals, but the characteristics of DBT can be found in group skills training, individual psychotherapy, and phone coaching.

Acceptance and change: You’ll learn strategies to accept and tolerate your life circumstances, emotions, and yourself. You will also develop skills that can help you make positive changes in your behaviors and interactions with others.
Behavioral: You’ll learn to analyze problems or destructive behavior patterns and replace them with more healthy and effective ones.
Cognitive: You’ll focus on changing thoughts and beliefs that are not effective or helpful.
Collaboration: You’ll learn to communicate effectively and work together as a team (therapist, group therapist, psychiatrist).
Skill sets: You’ll learn new skills to enhance your capabilities.
Support: You’ll be encouraged to recognize your positive strengths and attributes and develop and use them.

Recap

The six main points of DBT are to develop skills related to (1) accepting circumstances and making changes, (2) analyzing behaviors and learning healthier patterns of responding, (3) changing unhelpful, maladaptive, or negative thoughts, (4) developing collaboration skills, (5) learning new skills, and (6) receiving support.

Effectiveness of Dialectical Behavior Therapy

Because this approach to therapy is able to help people successfully improve their coping skills, they are able to develop effective ways to manage and express strong emotions. Researchers have also found that DBT is effective regardless of a person’s age, sex, gender identity, sexual orientation, and race/ethnicity.

For BPD: Studies have found that DBT is effective in the treatment of borderline personality disorder (BPD) and reducing suicide risk in individuals with BPD. One study found that after a year of treatment, more than 75% of people with BPD no longer met the diagnostic criteria for the condition.
For suicidal behavior: Another study found that interventions that incorporated skills training as a treatment component appeared to be more effective in reducing suicidality than DBT without skills training.
For other conditions: Most DBT research has focused on its effectiveness for people with borderline personality disorder who have thoughts of suicide and self-harm, but the method could also be a successful treatment for other mental health conditions. For example, research has found that this type of therapy also appears to be effective in the treatment of PTSD, depression, and anxiety.

Research also suggests that DBT may also be useful in the treatment of children with disruptive mood dysregulation disorder.

Things to Consider About Dialectical Behavior Therapy

DBT requires a significant commitment of time. In addition to regular therapy sessions, people are also required to do “homework” to work on skills outside of the individual, group, and phone counseling sessions. This may pose a challenge for people who have difficulty keeping up with these assignments on a regular basis.

Practicing some of the skills may also be challenging for some people. At different stages of treatment, people explore traumatic experiences and emotional pain, which may be upsetting.

Can You Do Dialectical Behavior Therapy On Your Own?

DBT is complex, and it’s generally not something that people can do on their own without the guidance of a trained therapist.

However, there are some things you can do on your own to help you develop new coping skills. For example, mindfulness, breathing exercises, and progressive muscle relaxation are all skills you can utilize to improve your ability to tolerate distress.

It is important to remember that this should not be used in place of professional help. If you’re struggling with a mental health condition, it’s always best to seek out the help of a qualified mental health professional.

How to Get Started With Dialectical Behavior Therapy

The best way to find out if DBT is right for you is to talk with a professional who is trained in the method. They will evaluate your symptoms, treatment history, and therapy goals to see if DBT might be a good fit.

If you or a loved one might benefit from DBT, it’s important to talk with a healthcare provider or mental health professional who is trained in the approach. That said, it’s not always easy to find DBT therapists.

You can start your search with the Clinical Resource Directory, which is maintained by Behavioral Tech (an organization founded by Dr. Linehan to train mental health professionals in DBT). The directory lets you search by state for clinicians and programs with DBT training through Behavioral Tech, LLC, or the Behavioral Research and Therapy Clinics at the University of Washington.

You can also ask your provider, current therapist, or another trusted mental health professional to refer you to a colleague who specializes in DBT. You may also find online therapists who offer DBT therapy.

Free Online Therapy Webinar

Is online therapy right for you? Click here to sign up for our free webinar on Wednesday, February 22nd at 1:00pm ET to learn more about the benefits of online therapy and find out if it’s the right option for your needs.