Dialectical Behavior Therapy (DBT): What It Is & How It Works

Dialectical behavioral therapy (DBT) is a form of therapy often used to treat a variety of mental health conditions such as borderline personality disorder. DBT is a structured, skills based therapy that helps you manage intense emotions and cope with challenging situations.

DBT was born out of Marsha Linehan’s efforts to find a treatment for women struggling with multiple mental health concerns and suicidal tendencies. When Linehan began looking at the current treatments used for anxiety, depression, and other mood disorders, she found that much of the focus was on changing your thinking and behaviors.

This type of intervention led to patients feeling judged, misunderstood, and invalidated in their experience. Linehan thus began a treatment that allowed the patient to accept their emotions and thoughts while also working to make positive changes.

The term “dialectical” refers to “opposing forces.” This is what DBT seeks to do: find a balance between the opposing forces of accepting one’s self while also working toward change.

How Does DBT Work?

Dialectical behavior therapy techniques help you gain skills to regulate your emotions and increase your distress tolerance. This in turn enables you to more effectively deal with your emotions, reframe your thoughts, and manage your behavior in healthy and constructive ways.

Here’s what to expect during dialectical behavioral therapy:

A nonjudgmental and accepting environment from your therapist
Mindfulness exercises such as self monitoring behavior and journaling
Using distraction as a way to tolerate distress
Improving self esteem through positive self talk and affirmations
Practicing interpersonal communication and conflict resolution
Deep breathing and relaxation techniques for emotional regulation
Observing thoughts, feelings, and sensations
Learning self care and self soothing skills such as meditation or yoga

The Five Functions of DBT

DBT involves a multimodal approach that often includes a mix of individual therapy, group therapy, and a therapist consultation team. There are five functions of DBT:

Improving coping skills such as emotional regulation, mindfulness, interpersonal skills, and distress tolerance
Applying these skills to everyday life through “homework assignments” from the therapist
Maintaining motivation toward change and decreasing dysfunctional behaviors
Improving therapist’s motivation and skills through team consultations
Making changes to a patient’s environment that will support positive changes and not reinforce negative behaviors

Who Benefits from DBT?

While DBT can benefit just about anyone, it’s particularly helpful when treating depression, anxiety, and other mood disorders. These types of conditions often come with intense emotions and DBT helps you to learn how to understand and cope with those strong feelings.

Those who struggle with mood disorders also often battle intensely negative feelings about themselves including shame, guilt and self loathing. Patients will describe feeling ashamed that they cannot control their thoughts and feelings.

When work or relationships suffer because of a mental health concern, this can negatively impact your self esteem and shake your confidence. DBT can be helpful since it promotes acceptance and compassion alongside cognitive restructuring and behavioral change.

DBT for Specific Conditions

DBT has been proven to be very effective in treating borderline personality disorder (BPD), post-traumatic stress disorder (PTSD), substance use, self-harming behaviors, and other mental health conditions.

BPD

Borderline personality disorder-focused dialectical behavior therapy helps individuals manage emotional instability and impulsivity. People with BPD are born with a biologically hard wired disposition toward emotional vulnerability which means they have a relatively low threshold for managing intense emotions. They also have difficulty returning to a baseline level of emotion.

Since DBT focuses on regulating emotions and increasing distress tolerance, those with BPD benefit greatly from the techniques.

PTSD

Post traumatic stress disorder (PTSD) is a disorder that affects those who have experienced a traumatic event. PTSD often involves symptoms such as flashbacks of the traumatizing event, intrusive thoughts, anxiety, phobias, depression, and suicidal thoughts.

DBT helps patients learn how to regulate their emotions and intrusive thoughts. The balance between acceptance and change helps these patients accept their reality and their traumatic past while taking back control over their present state.

SUD

Substance use disorder is another condition that has been shown to respond positively to DBT.

One technique when using DBT to substance use disorder is for the patient to commit to sobriety for a certain amount of time, even if it’s just for the duration of a therapy session. The goal is for you to eventually achieve long term abstinence by piecing together successive drug or alcohol free periods.

Another element of the DBT strategy used to treat SUD involves a concept called “coping ahead.” This involves learning how to anticipate certain signals or cues that you may be about to encounter a tempting situation or urge to misuse substances. Then you will learn ways to respond proactively to those situations to maintain your sobriety.

Relapse is a common occurrence in SUD. If and when this does happen, it can often feel like a failure, but DBT focuses on it as a problem to solve and not as an inadequacy of the patient.

DBT is also effective in treating self harming behaviors which often arise as a response to anxiety. Utilizing DBT techniques to increase distress tolerance is particularly helpful in this case.

Learning to pay attention to certain things that trigger the urge to self harm is part of the process. You’ll also learn to distract yourself from that harmful urge and redirect the urge into other positive behaviors.

Group Therapy and Skills Training

An important part of DBT includes engaging in group therapy. The following are some aspects of what to expect from dialectical behavior therapy groups:

Learning a new skill each week
Practicing mindfulness exercises together
Discussing how therapy homework assignments went throughout the week
Assigning a new homework assignment to the group

Group sessions differ from individual therapy in a few different ways. Individual therapy allows you time to process your feelings and gain a deeper understanding of your specific issues.

Group therapy focuses on learning new skills and practicing them, not processing emotions. DBT groups provide peer support and structured learning. In groups, you will be able to hear from your peers about their progress and learn from each other’s experiences.

FAQs

What is Dialectical Behavioral Therapy?

DBT is a type of therapy that utilizes individual counseling as well as group therapy and therapist team consultations. It can help to alleviate the symptoms of many mental illnesses, including mood disorders such as depression, anxiety, and borderline personality disorder.

What are Dialectical Behavior Therapy Skills?

The main skills that are focused on in DBT are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

How Does Dialectical Behavior Therapy Help With Borderline Personality Disorder?

DBT helps those with BPD by teaching them how to regulate emotions and increase their tolerance to distressing situations. DBT therapists will work to create an environment that is free of judgment, enabling patients to accept themselves and their challenges while also working towards positive and deliberate change.

How Do Dialectical Behavior Therapy Groups Work?

DBT therapy groups consist of a small group of patients who are all engaged in individual DBT sessions and will meet together with a therapist to practice the new coping skills that they’ve learned on their own, in individual therapy sessions, or in group meetings. Patients can discuss their progress or barriers to progress with the group.

Finding a DBT Therapist

Our directory has a comprehensive list of therapists offering DBT across the United States.

Some therapists offer both in person and online counseling. You can specify which you are looking for when searching for practitioners. Many professionals will also offer free consultations so you can meet with the therapist first to see if you would be a good fit to work together.

Some things to look for in your DBT therapist include:

Supportive and nonjudgmental attitude
Training in DBT techniques
Access to a therapist consultation team
Group therapy options

Working with a trained DBT therapist can help you learn new coping skills and effective strategies for achieving positive change. Equipped with the tools DBT offers, you can build the healthy, happy, and purposeful life you want and deserve.

How Dialectical Behavior Therapy (DBT) Helps You Heal