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Dialectical behavior therapy (DBT)

Reviewed by Stephanie Steinman, PhD, CSAC

A woman sits on a couch facing her therapist with a thoughtful look

What is dialectical behavior therapy?

Dialectical behavior therapy (DBT) is a form of talk therapy that combines principles of cognitive behavioral therapy (CBT) with mindfulness skills. Originally developed by Marsha Linehan, PhD, and her team to treat suicidality in patients with borderline personality disorder, DBT is now used to treat a wide variety of mental health conditions.1

This type of therapy can be especially helpful for high-risk disorders that involve self-destructive behavior and intense emotions, such as:

What does “dialectical” mean?

The term “dialectical” refers to the fact that two seemingly opposed forces or feelings can both be true at the same time. In DBT, two of the most commonly discussed forces are acceptance and change.

Though they may seem like opposites, change and acceptance actually shape each other. DBT teaches that accepting your current reality doesn’t mean you like or agree with it—it just means you understand what it is. This acceptance helps you acknowledge what needs to change, since you can’t work to change something if you don’t accept that it exists in the first place.

Acceptance is also an important part of the client-therapist relationship. Clients need to feel nonjudgmentally accepted by their therapist before they can pursue change. Because of this foundation of acceptance, DBT may be effective for people who initially resist therapy.

How does DBT work?

DBT therapists usually ask clients for a commitment of six months to a year, though treatment can take longer.2 During this time, clients learn to embrace “both-and” thinking instead of “either-or.” This dialectical approach allows two apparent opposites to be true: You can accept your life nonjudgmentally, and you can also work toward committed change.

DBT treatment includes four components, or “modes”: individual therapy, group skills training, phone coaching, and a therapist consultation team. Within each mode, much of the treatment focuses on teaching clients new skills in four areas, or “modules.” In addition, clients in DBT treatment progress through four different stages.

Modes of treatment

Here are the four modes of DBT treatment and how they work in tandem:

  • Individual therapy: As with most other types of individual therapy, you typically meet with your therapist once a week for about an hour.
  • Group skills training: Additional group therapy sessions focus on skills training. Groups meet weekly for two to three hours.
  • Phone coaching: Therapists offer coaching over the phone in times of crisis.
  • Therapist consultation: In order to provide treatment in a sustainable, healthy way, therapists need their own support system. DBT therapists meet weekly with a team of other practitioners to support one another and consult on cases.

Skills modules

Dialectical behavior therapy helps people acquire skills in four areas:

  • Mindfulness: You learn how to focus on the present moment and notice your thoughts and feelings without judgment.
  • Distress tolerance: You learn how to get through difficult or distressing situations and soothe yourself instead of trying to escape through self-destructive behaviors.
  • Emotion regulation: You learn to identify, understand, experience, and manage your emotions without acting on them impulsively.
  • Interpersonal effectiveness: You learn how to communicate your needs, relate to others, and create and respect boundaries.

Treatment stages

DBT therapists recognize four stages of treatment, each one marked by the level of distress the client is facing.3 Clients don’t have to go through all the stages, but in order to tailor treatment it’s helpful to identify which stage a person is in.

  • Stage one: DBT’s first stage focuses on stabilizing clients and stopping them from threatening or harming themselves or others. This can involve addressing suicidal ideation, self-harm, and other destructive or dangerous behaviors.
  • Stage two: By the second stage of treatment, clients have mostly stopped or are not engaging in actively harmful behaviors, but they continue to suffer mentally and emotionally. In this stage, clients learn to explore their past trauma and pain and work through it with healthy coping skills.
  • Stage three: In the third stage, clients learn to set goals for themselves and work toward them. They move toward trusting themselves as they seek out happiness and fulfillment.
  • Stage four: The final stage of DBT focuses on helping clients see their lives in terms of a greater meaning or purpose. For some clients, this may mean focusing on a spiritual or religious practice.

How does DBT compare with CBT, ACT, and RO-DBT?

DBT vs. CBT

Although dialectical behavior therapy is based on cognitive behavioral therapy, they’re two distinct types of treatment. CBT is designed to teach you to challenge unhelpful thoughts (cognition) so you can choose healthier responses to stress (behaviors). DBT focuses on accepting difficult or painful feelings, rather than fighting against them, and is particularly beneficial for people who struggle with extreme or self-destructive behaviors.

DBT vs. ACT

Like DBT, acceptance and commitment therapy (ACT) has a foundation of acceptance and change. However, ACT is usually a less structured form of treatment. Instead of requiring group therapy and therapist consultations, ACT can happen simply as a form of individual therapy.

DBT uses a more collaborative approach, allowing clients to work with individual therapists, group leaders, and fellow group therapy members, while therapists also work together. ACT therapy usually takes place in the context of one client and their therapist, though more ACT groups are becoming available and may offer additional support.

DBT vs. RO-DBT

Self-destructive behaviors like self-harm and suicidal ideation may result from two very different personality styles: “undercontrolled” (experiences overwhelming moods and impulsive behaviors) and “overcontrolled” (rigidly follows certain rules and can’t stand making mistakes).

DBT is often most effective for people who struggle to control their emotions. Radically open dialectical behavior therapy (RO-DBT), meanwhile, is a form of DBT meant to help people whose self-destructive behaviors are the result of overcontrol.

Is DBT effective?

DBT has proven effective for people with borderline personality disorder and suicidal ideation.4 There’s also evidence of its usefulness in treating eating disorders, posttraumatic stress disorder, and substance use disorders in people who also present with borderline personality disorder.5, 6, 7 More research is needed to assess the impact of DBT treatment on other types of mental health disorders.

Drawbacks of DBT

Typical DBT treatment plans require you to undergo three to four hours a week of individual and group therapy, not including the time needed to complete homework assignments from your therapy team. These large investments of time and resources may be a barrier to treatment for some people.

How to get help

If you have borderline personality disorder or struggle with other self-destructive behaviors, dialectical behavior therapy may be able to help you heal. Browse our directory to find a DBT therapist near you.

If you’re in crisis, immediate support is available:

About the author

The editorial team at therapist.com works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends.

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