Dialectical Behavior Therapy (DBT)

Medically reviewed by Andrea Brant, LMHC

Updated March 13th, 2025 by BetterHelp Editorial Team

Sometimes, painful emotions and conflicts can take a lot out of a person. If you’ve been wondering what type of therapy can help with these emotions, you may have heard about behavior therapy. Behavior therapy focuses on emotional regulation, healthier lifestyles, and improved behavior and emotions as a result.

Dialectical behavior therapy (DBT) can help people build valuable skills to handle challenging emotions and improve their relationships. Below, we’ll look at dialectical behavior therapy techniques, how it is used, and the benefits of this type of therapy.

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DBT defined

Furthermore, dialectical behavior therapy (sometimes spelled dialectical behaviour therapy) is firmly anchored in the theoretical traditions of the cognitive-behavioral paradigm. The therapy is characterized by the meticulous integration of mindfulness techniques, distress tolerance strategies, and emotional regulation practices. The comprehensive approach harnesses the power of the therapeutic alliance and innovative skills training to help clients navigate the complexities of daily experiences. The emphasis on the thoughtful application of these techniques further underscores the efficacy of the therapy in promoting the development of necessary tools for effective self-management.

Additionally, the therapeutic aspects of DBT are supported by the thorough theoretical underpinnings of the established cognitive-behavioral model. The therapy employs transformative techniques such as mindfulness and emotional regulation, and it leverages the time-tested methods of distress tolerance to ensure the highest standards of care. The thematic focus on balance and the drive for adaptive change empower clients to build the thriving habits essential for managing life’s challenges.

Four key elements of DBT therapy

DBT focuses on mindfulness, which focuses on improving someone's ability to be present in the moment
DBT focuses on distress tolerance, which is geared toward increasing tolerance for negative emotion, rather than trying to escape it
DBT focuses on emotional control, which is a strategy used to manage and change emotions that are intense and create problems in a person's life
DBT focuses on interpersonal effectiveness, or behavioral skills that allow someone to communicate with others in a way that's assertive while maintaining self-respect and strengthening relationships.

When is DBT used?

Dialectical behavior therapy (DBT) was originally used to treat BPD. But, it can help treat those who experience depression, post-traumatic stress disorder (PTSD), binge eating, generalized anxiety disorder, bulimia, bipolar disorder, eating disorders, and substance use.
Dialectical behavior therapy (DBT) is similar to cognitive behavioral therapy (CBT), but it is specially adapted for the needs of people with intense, often uncontrollable emotions.
Rather than trying to change the emotions, dialectical behavior therapy (DBT) teaches strategies for coping with them in healthy ways.
Dialectical behavior therapy (DBT) skills are taught in telephone crisis coaching because the coping skills learned in dialectical behavior therapy (DBT) can be applied immediately to prevent harmful behavior like self-injury.
One study on the benefits of comprehensive dialectical behavior therapy (DBT) for patients with bulimia found that the participants had significantly decreased bulimia nervosa symptoms after learning emotional control skills. However, more research needs to be done on how suitable dialectical behavior therapy (DBT) is for eating disorders.

DBT and skill development

Dialectical behavior therapy (DBT) skills training can help people control their emotions, develop more tolerance of distress and negative emotions, remain present in the moment, improve communication, and interact with others better. Anyone can benefit from learning the skills taught in DBT, but especially people who experience intense emotions.

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DBT as a cognitive behavioral treatment

As a cognitive behavioral treatment, dialectical behavior therapy (DBT) tends to focus on four key elements:

Mindfulness, which focuses on improving someone's ability to be present in the moment
Distress tolerance, which is geared toward increasing tolerance for negative emotion, rather than trying to escape it
Emotional control, which is a strategy used to manage and change emotions that are intense and create problems in a person's life
Interpersonal effectiveness, or behavioral skills that allow someone to communicate with others in a way that's assertive while maintaining self-respect and strengthening relationships.

When is DBT used in treatment? Borderline personality disorder and more

DBT therapy for borderline personality disorder

Dr. Marsha Linehan originally developed dialectical behavior therapy in the late 1970s to treat borderline personality disorder (BPD). The original goal of this type of therapy was for a patient’s treatment team to give a patient radical acceptance as they are (using elements of comprehensive validation therapy), then help them build a “life worth living” through DBT skills training. According to the study Mechanisms of change in dialectical behavior therapy: theoretical and empirical observations, the goal of DBT is to help a patient “engage in functional, life-enhancing behavior, even when intense emotions are present.”

With a combination of individual dialectical behavior therapy, group therapy, and phone coaching with a licensed mental health professional, patients are able to learn emotion control strategies and communication skills that lead to the ability to tolerate feelings of distress, accept their situations, and change their behaviors.

Dialectical behavior therapy (DBT) for other conditions

Although dialectical behavior therapy was originally used to treat BPD, it can help treat other mental health conditions as well, such as depression, post-traumatic stress disorder (PTSD), binge eating disorder, generalized anxiety disorder, bulimia, bipolar disorder, eating disorders, drug and alcohol dependence, substance use disorder, and self-harm. Additionally, one study found DBT to be successful in reducing substance use of opioid-dependent women. Dialectical behavior therapy is similar to cognitive behavioral therapy (CBT), but it is specially adapted for the needs of people with intense, often uncontrollable emotions.

Rather than trying to change the emotions, dialectical behavior therapy teaches strategies for coping with them in healthy ways. DBT skills are taught in telephone crisis coaching because the coping skills learned in dialectical behavior therapy can be applied immediately to prevent harmful behavior like self-injury.

Dialectical behavior therapy (DBT) in addressing a range of behaviors

Another study performed a systematic review of dialectical behavior therapy’s treatment outcome literature and discovered “preliminary evidence supporting the use of DBT skills training as a method of addressing a range of behaviors.”

Dialectical behavior therapy skills training can help people control their emotions, develop more tolerance of distress and negative emotions, remain present in the moment, improve communication, and interact with others better. Anyone can benefit from learning the skills taught in dialectical behavior therapy, but especially people who experience intense emotions.

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DBT and skill development

Rather than just addressing problems, dialectical behavior therapy teaches skills modules because behaviors that are problematic can start to evolve as unhealthy coping mechanisms. While addressing problems can provide temporary relief, it's often not helpful in the long term. DBT therapists focus on teaching patients healthy coping skills and mindfulness skills to help them notice and respond to intense emotions in a healthy way.

To provide effective treatment, dialectical behavior therapy assumes that clients are trying as best as possible but that they need to learn behaviors in different contexts. The word “dialectical” means to combine opposites. DBT therapy can teach people how to accept their intense emotions without reacting to them in a maladaptive way. People with borderline personality disorder and other mental health conditions may engage in self-injury and other harmful behaviors. DBT teaches skills to stop unwanted behaviors and replace them with positive coping skills.

Dialectical behavior therapy focuses on helping people make positive changes in their life by controlling intense emotional reactions. Dialectical behavior therapy aims to teach these different skills, which may allow a person to navigate situations in everyday life or manage challenges that get too big. These skills, according to Linehan, can be a huge part of building a fulfilling life. Being fully aware of their emotions can help people with a personality disorder manage intense emotions in day-to-day life.

How does DBT work?

Dialectical behavior therapy is mainly categorized as cognitive therapy. Cognitive therapy is a form of talk therapy that focuses on how cognitive distortions, or negative thought patterns, can impact the way one behaves. Since it was originally used for those with BPD, we’ll explore how it works with those who have BPD.

People who have BPD can have extreme emotions, which can be difficult to manage. These can be intense, uncontrollable emotions that become a problem when someone with BPD is interacting with other people, including friends, romantic partners, and even their own family.

Individual therapy sessions in a dialectical behavior therapy program tend to be influenced by the philosophy of dialectics, which often focuses on balancing opposites. A therapist might work with you to find different ways to balance different perspectives that are influencing you. This work may help you to avoid extremes in the way you think. In clinical psychology, dialectical behavior therapy training may provide you with distress tolerance skills, coping skills, and thought reframing.

Therapy expectations

This type of therapy may consist of both group work and one-on-one sessions. The therapist may occasionally seem like a coach to the client. The goal of individual sessions is to keep the person motivated, help them apply the learned skills in their life, and address any obstacles that might arise during treatment. Therapists may use a variety of methods, including role-playing, experiments, and homework assignments. Doing any homework assignments, the therapist assigns can help you get the most out of dialectical behavior therapy.

There may be one or more licensed mental health professionals involved in treatment. Some facilities offer a consultation team to provide comprehensive dialectical behavior therapy treatment. The DBT consultation team may include a primary healthcare provider, behavioral tech, nurses, therapists, and other professionals. The following are some skills that you may work on during dialectical behavior therapy.

Mindfulness

During dialectical behavior therapy sessions, a therapist may help a client become more mindful of any triggers that cause emotional distress or any situations that can cause a desire to lash out and an inability to accept change. Accepting change tends to be a significant part of this type of therapy.

Distress tolerance

When it comes to the skill of distress tolerance, the therapist may focus on helping the person try to tolerate negative emotions. Oftentimes, a person may flee negative situations or lash out, which tends to breed more negativity. With dialectical behavior therapy, a therapist may help the client tolerate their current emotions and handle distress more skillfully.

Emotion control skills

Emotion control skills consist of strategies that can be used to help a person become more emotionally balanced. This part of the treatment targets one’s ability to manage emotions in order to help prevent blowups, allowing them to harness control over their emotions.

Interpersonal effectiveness

Interpersonal effectiveness training aims to help a person become more assertive in their relationships. This component of DBT may help them to get better at communicating and have a stronger, healthier relationship not just with themselves but also with other people.

Group sessions using dialectical behavior therapy (DBT) with a therapist

This group aspect of dialectical behavior therapy focuses mostly on learning how to practice these skills. The one-on-one aspect of training tends to focus on the why, but group work allows you to practice your skills. Other people have their own experiences, and they may know of something that can help you cope with challenging situations better. Also, group work can give you a better, more reliable support network. Usually, one trained therapist leads all of this work, and they practice different skills and exercises with group participants.

The group component of DBT usually lasts about two hours, with the group meeting weekly for approximately six months, depending on the needs that people have. DBT can be conducted in different ways, depending on the participants and the therapist. Some people don't need skills groups, but others may find that they work better with others.

Group sessions can have many benefits, including social support and encouragement from the other group members. Practicing the skills learned in DBT with others can help increase self-esteem and confidence. However, how suitable DBT group sessions are for people may depend on several factors. People with social anxiety may feel uncomfortable in a group setting and prefer individual DBT. The effectiveness of group sessions may depend on the participant’s willingness to participate.

Dialectical behavior therapists offering treatment

If you’re interested in trying DBT, you can search for "DBT therapy near me" with experience in this therapeutic modality. The price of DBT therapy depends on several factors. For individual sessions, it can cost between $150 - $300. Your insurance can also cover a portion of the DBT session, and it potentially costing you between $20 - $40.

Alternatively, you might try DBT through online therapy, which research has shown to be just as effective as in-person sessions. With an online platform like BetterHelp, you can speak with a licensed therapist without leaving home, which may be more comfortable than going to a therapist’s office if this is your first time speaking with a therapist. BetterHelp costs between $65 - $100 per week (billed every four weeks).

With BetterHelp, you can communicate with a DBT therapist via phone or video chat at a time that suits your schedule. Also, you can contact your therapist in between sessions via in-app messaging, and they’ll get back to you as soon as they can.

Takeaway

Whatever personal challenges you’re experiencing at the moment, you don’t have to face them alone. You can be matched with a BetterHelp therapist with training and experience in dialectical behavioral therapy (DBT). Take a step toward improved emotional balance and reach out to BetterHelp online therapy today.

Frequently asked questions

Read more below for answers to questions commonly asked about DBT.

What are the six main points of DBT?

Therapists who provide comprehensive DBT treatment will address six main points of dialectical behavior therapy:

Mindfulness
Distress tolerance
Emotional regulation
Interpersonal effectiveness
Middle path
Walking the talk

What are the 4 skills of DBT?

The four DBT skills include

Mindfulness skills
Interpersonal effectiveness skills
Emotional regulation skills
Distress tolerance skills

What are some examples of DBT? Is it only for borderline personality disorder?

Some examples of dialectical behavior therapy include:

For substance use disorder (formerly substance abuse)
As a standalone treatment for borderline personality disorder; and DBT for ADHD.

Dialectical behavior strategies have been adapted for several conditions. For instance, in substance use disorder (formerly known as substance abuse), this structured approach helps individuals recognize and change unhelpful patterns, supporting recovery and healthier choices. It is also employed as a standalone method for borderline personality disorder, offering skills to manage intense emotions, reduce impulsivity, and improve relationships. Additionally, adaptations of these strategies support those with ADHD, providing tools for enhancing focus, emotional regulation, and overall self-control.

What is the difference between CBT and DBT treatment?

Both DBT and CBT have similar goals, and DBT is actually a branch of cognitive behavioral therapy. The primary difference is that DBT focuses on emotion regulation skills and is designed for those who experience intense emotions. Both methods may emphasize identifying and challenging negative thoughts while embracing positive emotions.

What are the pros and cons of DBT?

There are both pros and cons to DBT treatment, and they could vary from one person to the next. For example, potential advantages of dialectical behavior is that clients develop skills that they can continue to practice after therapy has ended, such as interpersonal skills and emotion regulation strategies. Moreover, DBT sessions are flexible and can be adapted to various populations and mental health conditions. According to the Linehan Institute (Behavioral Tech Institute), DBT can change lives.

In terms of disadvantages, DBT could be time consuming and expensive for some clients. It may not work for everyone, including people with past trauma or who want to discover the root causes of their problems.

What are the 4 core areas of DBT?

The four core areas of dialectical behavior therapy are mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance. Mindfulness focuses on being present in the moment without judgment, helping you notice thoughts and feelings as they occur. Emotional Regulation equips you with strategies to understand, manage, and change intense emotions for better balance. Interpersonal effectiveness teaches practical communication skills for expressing needs, setting boundaries, and resolving conflicts in relationships. Distress tolerance offers tools to cope with and survive crises without resorting to harmful behaviors, ensuring you can navigate stressful situations safely.

What is dialectical behavior therapy (DBT) in a nutshell?

Dialectical behavior therapy was developed by Marsha Linehan in the 1970s to treat borderline personality disorder. Since then, the scope of the treatment has expanded, but the core philosophy remains the same. DBT works to help people accept their emotions without judgment, identify behavioral targets, and work towards significant improvement in their relationships by developing a specific skill set. In session, clients learn and practice skills such as mindfulness techniques, managing intense emotions, and radical acceptance techniques.

What are the four stages of DBT?

The four stages of DBT are focused on treating the following:

Behavioral dysregulation
Quiet desperation/improving emotional regulation
Building a healthy lifestyle
Freedom of choice/meaning and purpose

What is the first skill taught in DBT?

The first skill taught in DBT is mindfulness. This foundational skill encourages clients to become aware of their thoughts, emotions, and surroundings without judgment. By practicing mindfulness, individuals learn to accept their emotions and circumstances, setting the stage for further skill development. Additionally, during the initial session, patients complete a pre-assessment—a self-monitoring tool that helps determine if DBT is the right treatment approach for them.

In the very first session, clients also complete a DBT pre-assessment—a self-monitoring tool designed to evaluate patterns in behavior, emotional responses, and triggers. This assessment helps determine whether this is the appropriate treatment approach and provides a baseline from which progress can be measured. The insights gained from the pre-assessment guide the therapist in tailoring mindfulness exercises to the client’s specific needs.

Overall, establishing mindfulness early in treatment not only enhances self-awareness but also creates a solid platform for integrating other skills like emotional regulation, distress tolerance, and interpersonal effectiveness.

Can DBT be used for anxiety?

Yes, comprehensive skills-based therapy that emphasizes mindfulness and emotional regulation can be highly effective for managing anxiety. By learning to stay present in the moment and better understand and adjust emotional responses, individuals often find relief from anxious thoughts and behaviors. These strategies help create a calmer mental state, enabling more adaptive responses to stressors and reducing overall anxiety levels.

Additionally, techniques for regulating emotions equip individuals with practical tools to moderate intense feelings and respond more adaptively to stress. This not only reduces the overall intensity of anxiety but also fosters a sense of control and resilience. Through these practices, people often experience a calmer state of mind and improved capacity to handle everyday challenges.

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