Introduction
If you've heard of DBT, you might associate it with borderline personality disorder. But DBT is helpful for many conditions-and its skills are useful for everyone.
DBT (Dialectical Behavior Therapy) teaches powerful skills for emotional regulation, distress tolerance, and interpersonal effectiveness.
This guide covers everything you need to know about DBT therapy.
What is DBT?
Dialectical Behavior Therapy (DBT) is a type of cognitive behavioral therapy developed by Marsha Linehan in the late 1980s. It was originally designed to treat borderline personality disorder (BPD), but has since been adapted for many conditions.
The word "dialectical" refers to the integration of opposites-accepting yourself as you are while working to change.
Core Principles
DBT is based on several key principles:
Dialectics Everything is connected, and apparent opposites can both be true. You can accept yourself AND want to change.
Behavioral DBT focuses on changing behaviors through skill-building.
Mindfulness Being present in the moment without judgment.
Validation Recognizing that your responses make sense given your history and experiences.
What Can DBT Help With?
DBT is evidence-based for:
- Borderline personality disorder
- Depression
- Anxiety disorders
- PTSD
- Substance use disorders
- Eating disorders
- Self-harm behaviors
- Suicidal thoughts
It's also helpful for anyone who wants to improve emotional regulation.
The Four Modules of DBT
DBT teaches skills in four main areas:
1. Mindfulness
Mindfulness skills help you:
- Be present in the moment
- Observe your thoughts without judgment
- Focus attention intentionally
- Increase awareness
Key Skills:
- "What" skills: Observe, Describe, Participate
- "How" skills: Non-judgmentally, One-mindfully, Effectively
2. Distress Tolerance
Distress tolerance skills help you:
- Get through crisis situations without making things worse
- Tolerate emotional pain without using unhealthy coping
- Survive urges to self-harm or use substances
Key Skills:
- TIPP: Temperature, Intense exercise, Paced breathing, Paired muscle relaxation
- Self-soothing (5 senses)
- Pros and cons
- Radical acceptance
- Checking the facts
3. Emotion Regulation
Emotion regulation skills help you:
- Understand your emotions
- Reduce emotional vulnerability
- Increase positive emotional events
- Take opposite action
Key Skills:
- Identifying and labeling emotions
- Increasing positive activities (PLEASE)
- Opposite action
- Reducing vulnerability
4. Interpersonal Effectiveness
Interpersonal effectiveness skills help you:
- Communicate assertively
- Maintain relationships
- Build self-respect
- Deal with conflict
Key Skills:
- DEAR MAN: Describe, Express, Assert, Reinforce, Mindful, Appear confident, Negotiate
- FAST: Fair, no Apologies, Stick to values, Truthful
- GIVE: Gentle, Interested, Validate, Easy manner
DBT Techniques in Daily Life
Mindfulness Practice
Start with 5 minutes of mindful breathing daily. Gradually increase. Notice without judging.
TIPP for Crisis
When you're in crisis:
- Temperature: Cold water on face
- Intense exercise: Quick burst of movement
- Paced breathing: Slow breaths
- Paired muscle relaxation: Tense and release
Radical Acceptance
When facing pain you can't change:
- Acknowledge the reality
- Don't fight or deny
- Notice the urge to resist
- Let go of "should" and "fair"
Opposite Action
When you feel an emotion that doesn't fit the facts:
- Do the opposite of what the emotion prompts
- If you feel like isolating but need connection, reach out
DEAR MAN for Assertiveness
When you need to ask for something:
- Describe the situation factually
- Express your feelings/opinions
- Assert what you want
- Reinforce why it's beneficial
- Stay Mindful
- Appear confident
- Negotiate if needed
DBT Therapy Structure
Individual Therapy
Weekly sessions with a DBT-trained mental health professional:
- Review of past week
- Skill coaching
- Crisis planning
- Diary card review
Skills Group
Weekly group where you learn DBT skills:
- Didactic teaching
- Homework review
- Practice exercises
- Peer support
Phone Coaching
Between-session support for applying skills in real situations.
Consultation Team
mental health professionals meet regularly to maintain fidelity to DBT.
DBT vs. CBT
| Aspect | DBT | CBT |
|---|---|---|
| Focus | Emotional regulation | Thought patterns |
| Origin | BPD | Depression/anxiety |
| Skills | Heavy emphasis | Less explicit |
| Validation | Central | Less prominent |
Both are effective. DBT is more skills-focused.
Is DBT Right for You?
Consider DBT if you:
- Have intense emotions
- Struggle with self-harm or suicidal thoughts
- Have difficulty maintaining relationships
- Feel stuck in unhelpful patterns
- Haven't responded to other therapies
How to Find DBT
- Search "DBT mental health professional" in your area
- Check DBT-Linehan listserv for certified mental health professionals
- Look for DBT programs at clinics
- Some mental health professionals offer DBT-informed therapy (less intensive)
FAQ
What is DBT best for?
DBT was originally for borderline personality disorder but helps with depression, anxiety, PTSD, and anyone who struggles with emotional regulation.
How long does DBT take?
Full DBT typically takes 6-12 months of intensive treatment. Skills can be learned in shorter timeframes.
Can I do DBT on my own?
Some skills can be practiced independently using workbooks, but full DBT works best with mental health professional guidance.
Is DBT better than CBT?
They're different approaches. DBT is more skills-focused and better for emotional intensity; CBT is better for thought patterns.
Does DBT work for anxiety?
Yes. DBT skills help with anxiety, though CBT may be more common for anxiety alone.
Conclusion
DBT offers powerful skills for managing emotions, surviving crises, and improving relationships. Even if you don't have full DBT treatment, the skills can transform how you handle difficult emotions.
The core message: accept yourself as you are while working to build the life you want. Both are possible.
Paula incorporates DBT principles-emotion regulation, distress tolerance, and mindfulness techniques. Download Paula to start practicing DBT skills today.
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Related Reading
- What Is DBT? - Complete Guide to Dialectical Behavior Therapy
- What Is DBT? - Complete Guide
- What Is DBT Therapy? - Complete Guide
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