DBT, or Dialectical Behavior Therapy, is a structured, skills based therapy for people whose emotions feel too big, too fast, or out of their control. It was developed by psychologist Marsha Linehan and is now one of the most researched treatments for suicidal behavior, self harm and intense emotional distress.
This guide explains what DBT is, what the word dialectical means, what treatment actually looks like week to week, and who it helps. If you want the skills themselves, see the full DBT skills list.
Where Does DBT Come From?
In the late 1970s and 1980s, Marsha Linehan was trying to help chronically suicidal women using standard cognitive behavioral therapy. Many of them felt that the focus on change meant their pain was not being understood, and they left treatment. Acceptance on its own, though, did not bring the change they needed either.
DBT was her answer: a treatment that holds acceptance and change together. It kept the behavioral tools of CBT, added validation, and brought in mindfulness from contemplative practice. The first randomized trial was published in 1991, and the treatment manual followed in 1993.
What Does Dialectical Mean?
A dialectic is a tension between two things that both seem true. The central one in DBT is this: you are doing the best you can, and you need to do better. Neither half cancels the other.
In practice, that means a DBT therapist validates why your reactions make sense and, in the same session, pushes for change. You will hear the phrase both and a lot. More on the philosophy in the dialectical philosophy under DBT skills.
What Does DBT Look Like Week to Week?
Comprehensive DBT is not one weekly conversation. It has four parts that work together, and that structure is what the main research studied. The walkthrough below shows a typical week.
The Four Skills Modules
- Mindfulness. Noticing the present moment without judgment. Start with Wise Mind.
- Distress tolerance. Getting through a crisis without making it worse, with skills like STOP, TIPP and radical acceptance.
- Emotion regulation. Understanding emotions, reducing vulnerability to painful ones, and deciding whether changing an emotion or how you express it would help, for example with opposite action.
- Interpersonal effectiveness. Asking for what you need and saying no, with DEAR MAN and validation.
The core skills in each module are explained in the DBT skills list.
Who Does DBT Help?
DBT was built for people with chronic suicidal behavior and borderline personality disorder, and that is where the evidence is strongest. In a 2006 trial, people in DBT were about half as likely to make a suicide attempt as people treated by experienced community therapists, and needed fewer hospital and emergency visits. A 2018 trial with adolescents at high risk found fewer suicide attempts and less self harm with DBT than with supportive therapy.
It has since been adapted for adolescents and families, eating disorders, substance use and other problems driven by emotion dysregulation. You do not need a diagnosis to benefit from the skills. For a fuller picture of the evidence, read who DBT is for and understanding emotion dysregulation.
DBT, CBT and Other Talk Therapy
DBT is a form of cognitive behavioral therapy, but it differs in emphasis. CBT focuses mainly on changing thoughts and behaviors. DBT adds validation, mindfulness, a skills group and coaching between sessions, because for people with intense emotions, change without acceptance often backfires. See CBT vs DBT, how DBT and CBT fit together and how DBT differs from other talk therapy.
How Long Does DBT Take?
Going through all four skills modules usually takes about six months, and many comprehensive programs ask for a commitment of six months to a year. Some people repeat the skills cycle. Skills training groups and individual therapy that uses DBT skills are recognized adaptations and can be a good fit. They differ from comprehensive DBT in structure, not automatically in value.
Starting DBT
A good DBT program will begin with a few sessions focused on goals and commitment, often framed around building a life worth living. If you are unsure what a first appointment involves, read what happens in a first therapy session.
Dr. Jesse Finkelstein provides DBT therapy in NYC at Axis Psychological Services, with the DBT skills group offered through partner clinics. He is co author, with Shireen Rizvi, of Real Skills for Real Life. You can book a free consultation.
References
Linehan, M. M. (1993). Cognitive Behavioral Treatment of Borderline Personality Disorder. Guilford Press.
Linehan, M. M. (2015). DBT Skills Training Manual (2nd ed.). Guilford Press.
Linehan, M. M., et al. (2006). Two year randomized controlled trial and follow up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757–766.
McCauley, E., et al. (2018). Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: A randomized clinical trial. JAMA Psychiatry, 75(8), 777–785.
Common questions about DBT
What is DBT in simple terms?
DBT, or Dialectical Behavior Therapy, is a structured form of talk therapy that teaches practical skills for handling intense emotions, crises and relationships. It balances accepting yourself as you are with changing the behaviors that make life harder.
What does DBT stand for?
Dialectical Behavior Therapy. Dialectical refers to holding two things that seem opposite at the same time, mainly acceptance and change. Behavior therapy refers to its roots in cognitive and behavioral treatment.
What is DBT used to treat?
DBT was first developed for people with chronic suicidal behavior and borderline personality disorder. It has since been adapted and studied for self harm in adolescents, eating disorders, substance use and other problems where emotions feel out of control.
How long does DBT take?
A full skills curriculum usually takes about six months, and many comprehensive programs run for six months to a year. Shorter skills training adaptations are also used and can be a good fit, though they are structured differently from comprehensive DBT.
What is the difference between DBT and CBT?
DBT grew out of CBT and keeps its focus on behavior and skills. It adds an explicit focus on acceptance and validation, mindfulness, a skills group, and coaching between sessions.
