What is dialectical behavioral therapy (DBT)?
Dialectical behavior therapy (DBT) is a form of psychotherapy or “talk therapy” that can assist with managing intense feelings and emotions. The term “dialectical” implies that two opposing things can be true at the same time. This means you can learn to accept your behavior as part of your life experience, but also make positive changes to move forward and change unhelpful ways of behaving.
Based on cognitive behavioral therapy (CBT), DBT incorporates mindfulness training and learning new skills to manage your emotions, change your behavior, and improve your everyday life. The techniques taught can address powerful feelings such as sadness, anxiety, anger, guilt, and thoughts of self-harm. DBT can be an effective treatment for mental health conditions such as anxiety, PTSD, substance use disorder, bipolar disorder, and depression. One study showed that 77% of people with a borderline personality disorder diagnosis showed an improvement in symptoms after a course of dialectical behavioral therapy.
The skills you learn in DBT consist of four areas: mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation. When you’re able to focus on the present moment and simply observe your thoughts without judgment, you can become more aware of how negative self-talk (such as “Nobody likes me,” or “I’ll never be good enough”) may be affecting your emotions. Gaining more insight can make you feel more in control of your emotions and build resilience for handling daily stressors and frustrations.
DBT can also promote empathy and compassion, helping you to consider how others feel in a situation, rather than just your own feelings. In a heated argument, for example, a romantic partner, friend, or family member may feel just as hurt or angry as you. By having more understanding of others’ experiences, and being better able to remain calm rather than reactive, you can improve how well you communicate with others.
Instead of feeling at the mercy of intense and changing emotions, DBT can help you regulate your feelings, attain a more balanced view of the world, and develop a more positive outlook. This can benefit your interpersonal relationships, how you manage stress, and help you avoid destructive behaviors.
Dialectical behavior therapy (DBT) vs Cognitive behavioral therapy (CBT)
Dialectical behavioral therapy is based on cognitive behavioral therapy (CBT), so they share many similarities and both can be used to effectively treat some of the same issues. The goals of both DBT and CBT are to recognize how thoughts can influence your behavior, to develop effective coping skills, and modify unhealthy thought patterns.
DBT is focused more on how you interact with yourself, others, and your environment. It places greater emphasis on coping with uncomfortable feelings and emotions, learning how to accept them instead of grappling with them. CBT focuses more on using practical skills to redirect problematic thinking in order to change the resultant negative behaviors.
While based on CBT principles, DBT uses mindfulness to help you accept your emotions and your situation, feel safe, and regulate intense emotions to avoid harmful behaviors.
CBT is often focused on a very specific end result—I want to feel less anxious at social events, for example—while DBT aims to improve the overall quality of your life. CBT tends to be a shorter-term course of therapy, with results often possible in 5-20 sessions, whereas a DBT course often takes 12 months.
One form of therapy isn’t necessarily “better” than the other, and some therapists may use elements of both treatment modalities, depending on the different issues you’re facing. CBT can often be a good first choice for anxiety and depression, while DBT may be more suited to dealing with emotion dysregulation, borderline personality disorder, or thoughts of self-harm. Talking to an experienced therapist can help you decide if DBT or CBT is the right fit for you.
What is dialectical behavioral therapy (DBT) used for?
Dialectical behavior therapy (DBT) was first developed to treat people with
borderline personality disorder (BPD) and has proven effective for tolerating the intense emotions and mood imbalances associated with the condition. However, DBT is also used to treat a variety of other mental health issues, such as:
Depression. DBT’s focus on accepting thoughts and emotions may help you accept the aspects of life you cannot change, and ease feelings of helplessness that often accompany depression. Skills such as meditation, breathing exercises, and progressive muscle relaxation can all be beneficial for managing symptoms of depression.
Attention deficit hyperactivity disorder (ADHD). People with ADHD tend to have difficulty staying focused and often feel restless or act impulsively. DBT can teach you strategies to help focus on the present moment and think before making snap decisions or responses that you may later regret.
Eating disorders. Several different types of eating disorders can affect the way you think about food, eating, body image, and eating habits. DBT can help regulate emotions and change unhealthy eating behaviors. It may also improve negative or distorted thinking about body image that may lead to disordered eating patterns.
Substance abuse. The excessive use of drugs or alcohol can impair the functioning of your brain and behavior. Addiction is complex and challenging to treat, but DBT may lessen the emotional discomfort of withdrawal and cravings, while also changing the behaviors that contribute to substance use.
Post-traumatic stress disorder (PTSD). Mindfulness can facilitate more calmness when handling flashbacks and emotional triggers related to your trauma. The use of DBT may be particularly effective for PTSD when conducted in a group setting.
Anxiety. Having constant worries and feelings of dread that interfere with your daily activities is difficult to manage without support. As with its use with depression, the skills associated with mindfulness in DBT can improve mood swings and distress tolerance that arise from stress and different anxiety disorders.
Self-harm. Studies indicate that DBT can be effective in reducing incidents of self-harm and thoughts of suicide. DBT can help you understand the reasons why you engage in self-harm behaviors, find healthier ways to tolerate distress, and reinforce behavior change. You can also learn distraction techniques that shift the focus away from your urge to self-harm.
DBT may also be effective for people who have tried other forms of therapy that have been unsuccessful. DBT has a formal structure and often requires a longer time commitment, making it a more intensive therapeutic process.
How DBT works
DBT treatment consists of individual therapy, group therapy, and phone therapy that will help you learn and apply four skills: mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation.
1. Mindfulness
The mindfulness phase of treatment consists of helping you focus on staying in the present moment, without judgment. It is comprised of three “what” skills and three “how” skills.
The “what” skills:
- Observing
- Describing
- Participating
These “what” skills require you to be mindful by noticing the environment around you and what you’re experiencing at a specific time. You observe and describe the thoughts and feelings that come up, but don’t judge them.
The three “how” skills:
- Being non-judgmental.
- Attending to one thing at a time.
- Addressing your needs in the present moment.
The “how” skills refer to the way you practice mindfulness. You may focus narrowly on one particular thing or just a few different things at the present moment. At other times, you may broaden your attention to more of your surroundings or notice everything you’re experiencing, again without being judgmental.
2. Distress tolerance
These skills can assist you in validating and accepting feelings of distress and pain. You can’t always eliminate or completely avoid daily stressors that trigger intense feelings. You may not be able to avoid your morning commute, for example, or the stress of dealing with family at the holidays. But you can learn different ways to cope with stress and tolerate distressing emotions.
For times when you are feeling intense emotional pain, DBT can teach coping strategies, such as physical activity, breathing exercises, or muscle relaxation techniques. Other self-soothing or quick stress relief practices, such as taking a warm bath, listening to calming music, or cuddling with a pet can also help you tolerate distress and comfort you when you’re feeling anxious.
3. Interpersonal effectiveness
You may find certain types of social situations uncomfortable or difficult to deal with. DBT can offer strategies for asserting yourself, expressing your wants and needs, setting boundaries, and better managing your relationships with others.
These interpersonal effectiveness skills can help you improve how well you communicate, deal with conflict in a positive way, and maintain healthy relationships with the people you care about.
4. Emotional regulation
There are strategies that can help you to recognize and gain more control over your emotions, especially those you find intense, uncomfortable, or overwhelming. Emotional regulation necessitates a level of understanding of your emotions. You will learn to identify triggers for these emotions and find ways to respond more appropriately when they occur.
DBT can help you learn how to deal with emotional upheavals by using self-soothing techniques. And instead of acting or speaking without thinking, you’ll learn that you have more control over your emotions. You’ve probably heard of taking a deep breath before you react, but that can be both a very simple and powerful tool for self-regulation.
Individual DBT
Individual dialectical behavior therapy sessions are one-on-one weekly meetings with a therapist, usually an hour long. Together, you will set goals in the different areas of mindfulness, distress tolerance, regulating emotions, and interpersonal relationship skills. You’ll then apply each new skill and practice what you have learned.
At each session, you will complete a “diary card” that addresses the four treatment goals. Like a journal, this allows you to record any thoughts or actions that may be harmful to you and rate the strength of your emotions. This information will be useful for tracking your emotions, how well different techniques are working, and the impact on your quality of life.
You will learn how to recognize your emotions and how this affects your relationships with friends, colleagues, and family members. The mindfulness component of DBT will help you observe what is happening in the present and focus on one thing at a time.
It takes approximately six months to complete the skills training components of DBT. However, you may repeat some of the modules as needed to reach your targeted goals, so this may take a year or longer to complete. Keep in mind that devoting the necessary time to DBT can have a more favorable impact on your life both now and in the future.
Phone coaching in DBT
In addition to individual therapy, a DBT therapist may also provide phone coaching to help you when you’re using your skills in real world situations.
If you feel unable to manage or emotionally overwhelmed, you can contact your therapist to assist you. This might be a situation where you’re in danger of self-harm, for example, or doing something you might later regret, such as compulsive shopping or overeating.
Phone coaching can be a useful method to work on the skills you are learning in the actual times and situations you need them. You can feel safe when practicing your new skills, knowing you can reach out to your therapist by phone for help if you need help.
DBT group training
As part of dialectical behavioral therapy, you will also participate in group sessions to further enhance and practice your skills. These sessions typically meet weekly for 1-2 hours at a time.
The format tends to be a classroom-type setting where a leader and co-leader develop exercises and activities for you and your fellow members to engage in. As you share your experiences with peers from the group, you may also find you can relate to others in a more meaningful way.
As a group, you’ll discuss the new skills you’re all acquiring and the homework assignments you’ve been practicing. Getting feedback from other group members on your homework assignments can be a valuable learning tool. It can help you work through specific behaviors and identify ways to improve your understanding and responses in the future.
Having the support of a community of people who are experiencing similar issues as you can also be empowering. While group therapy isn’t for everyone, the more actively you participate in group sessions, the more benefits you are likely to experience. When you contribute and commit to change, you may also help to inspire others in the group.
Self-directed DBT
Once you understand the skills of DBT regarding regulation of your emotions, improving your relationships, and managing your stress, you can implement them in your daily life on your own. That’s one of the many advantages of this treatment.
Mindfulness and distress tolerance skills can be practiced any time you need them. If you’re feeling overwhelmed, for example, you can try different breathing exercises to focus on your breath and calm yourself down.
You can also practice reframing how you talk to yourself, substituting language that is self-critical with more positive phrases. Using the word “and” instead of “but” is a simple way to improve your mindset. Instead of saying “I made a mistake, but I always do stupid things” you can say “I made a mistake and I can learn from this.”
A self-directed mindfulness exercise
In addition to practicing a mindfulness meditation, you can also learn to stay in the present moment as you participate in daily activities, such as household chores, walking, or eating.
- Bring your attention to the sensations in your body.
- Breathe in deeply through your nose, letting your abdomen fully expand.
- Then breathe out through your mouth.
- Notice the sensations of each breath in and out.
- Focus on the task at hand, deliberately and with full concentration.
- Notice each sight, sound, smell, touch and taste so that you employ all your senses.
- If you notice that your mind has wandered from the task, gently re-engage your senses and bring your attention back to the sensations of the moment.
A self-directed distress tolerance exercise
Many simple breathing exercises can be useful for self-soothing in times of stress and anxiety. When your exhales are longer than your inhales, your heart rate slows and your nervous system moves away from the “fight or flight” response.
One example of a quick and easy breathing exercise is to simply inhale as you count to four. Then, exhale as you count to eight. Repeat this pattern for a few minutes. You should notice your mind grow calmer and your physical tension ease.
You can also add visualization to a breathing exercise. As you breathe, visualize a scene that makes you feel more peaceful. For example, you could picture yourself relaxing on a towel at the beach.
- What does the breeze feel like?
- Can you hear the gentle lapping of the waves, the cry of a gull?
- What does the warm sun feel like on your face?
- What does the towel feel like beneath you?
- Can you smell the salt air?
Engaging in physical movement, whether it’s working out, dancing to a favorite song, or a walking around the block, is another way to feel calmer and more in control of your emotions when you experience distress.
Benefits of dialectical behavioral therapy
There can be many advantages to DBT in terms of improvements in your quality of life. Research shows that the effects are long-lasting for gaining more control over your emotions, being able to deal with difficult situations, and having healthier relationships.
Here are some specific benefits of DBT:
- Reduces anxiety, stress, depression, and self-harming behaviors.
- Increases your self-confidence and self-esteem.
- Provides accessibility to connect with a mental health professional at any time.
- Teaches you how to utilize mindfulness practices in your daily life.
- Teaches skills you can practice and employ in daily life to improve your overall well-being.
Shortcomings of DBT
As with any type of therapy, you should not expect DBT to be a magical cure or a quick fix. It’s a comprehensive program that involves a significant commitment of time and effort to see the desired results.
Here are some potential drawbacks to consider:
- You will need to learn and apply many different skills, with a focus on mindfulness.
- There is homework to complete after each session.
- DBT entails both individual and group counseling.
- DBT requires that you adhere to a structured format.
- You may not have a complete resolution of all your symptoms.
While many people benefit from the social support and bonding that takes place in the group therapy portion of DBT, others may prefer a form of therapy that doesn’t require group participation. You may feel more comfortable with just individual therapy to explore confidential issues in a private space.
How to get the most from DBT
As with most other things in life, the more effort you put into the therapeutic process, the more you’re likely to get out. When you’re ready and motivated to make changes that will improve your life, DBT can be well worth the investment.
Find a therapist you connect with. Having a therapist who’s a good fit can make all the difference to your experience. You want to find someone who you can trust, feel comfortable discussing difficult subjects with, and has experience in dialectical behavior therapy. Ask plenty of questions when talking to potential therapists and don’t be afraid to make a switch if you have to.
Fully commit. To get the most benefit from DBT, it’s important to commit fully to all the components of the program. This includes setting goals, learning new skills, actively participating in all aspects, and completing homework assignments.
Evaluate your progress. The diary card you complete in DBT is one way to track and assess your progress. Your therapist will also help you evaluate how you’re feeling and the progress you’re making toward your goals at various stages. But as the treatment progresses, reflect on whether you’re noticing improvements in how you cope with stress, anger, and personal relationships. Are you less reactive to conflicts or disagreements with family and friends? Are you better able to focus on your good qualities rather than the negatives?
Improve your mental health using DBT
Depending on your circumstances, DBT can have a profound impact on your mental health. Rather than lashing out at yourself and others, you can learn to take a step back and respond more productively when conflicts arise. Instead of dwelling on the past or worrying about the future, you can focus more on the present moment.
Acquiring and using the problem-solving and coping skills of dialectic behavior therapy can help you ease the impact of intense emotions, avoid unhealthy or harmful behaviors, and improve your overall mental health and well-being.
Last updated or reviewed on September 11, 2024
