What Is Dialectical Behavior Therapy (DBT)?

Dialectical behavior therapy (DBT) is a type of talk therapy that combines elements from learning theories, cognitive behavioral therapy (CBT), mindfulness, Zen Buddhism, and dialectical philosophy to help you manage emotions and navigate relationships. In the 1980s, American clinical psychologist Marsha Linehan developed this therapy technique to treat mental health conditions that had little improvement with other forms of psychotherapy, such as borderline personality disorder (BPD).

Purpose

DBT can help you accept the realities of your life, while also learning how to manage your emotions and change unhelpful behaviors. Specifically, if you express feeling misunderstood, your therapist or other mental health provider may help you practice acceptance. If you’re searching for motivation, they may help you identify things you can change about your behaviors.

Generally, therapists rely on DBT when other types of psychotherapy haven't helped improve your emotional well-being. DBT can help you learn to regulate and tolerate your emotions, making it an effective and evidence-based treatment for borderline personality disorder and other mental health conditions, such as:

• Depressive disorders
• Substance use disorders
• Mood disorders
• Post-traumatic stress disorder (PTSD)
• Eating disorders
• Attention-deficit/hyperactivity disorder (ADHD)

In some cases, therapists may also use DBT to support people who are experiencing suicidal thoughts, living with non-suicidal self-injury (NSSI), or having trouble regulating their emotions.

What Skills Can DBT Help You Learn?

Your mental health provider can help you learn and develop a range of skills to help reduce symptoms of a mental health condition and improve your quality of life. You can expect to learn how to:

• Effectively assess problems and solve them 
• Accept your life's circumstances
• Cope with difficult situations productively
• Practice mindfulness
• Navigate social situations and conflicts
• Regulate your emotions
• Improve your relationships with others

Does DBT Work?

Research shows that DBT is effective in treating a range of mental health conditions, with the strongest evidence of treating BPD. In 2014, a team of German researchers followed 78 people with BPD through a year of DBT treatment to see the effects. At the end of the year, 77% of participants had improved to the point that they no longer met the criteria for a BPD diagnosis. They also found a reduction in self-harm injuries, hospital stays, and the severity of BPD symptoms.

Another study from 2021 found that DBT skills training, in addition to routine treatment, was beneficial in reducing BPD symptoms, depression, and emotional distress. This suggests that even without the full DBT treatment model, skills training may be useful for BPD treatment. Other research suggests that people who receive six months of DBT treatment may benefit just as much as those who receive one year's worth.

Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) conducted a review in 2021 to understand how effective DBT was on mental health outcomes among college students. Researchers found that DBT had the potential to reduce suicidal thoughts, depressive symptoms, and self-harm, as well as improve social adjustment.

What to Expect

DBT is a comprehensive and long-term treatment consisting of a few components. Typically, you can expect to spend up to 24 weeks in treatment, with weekly skills training in a group and hour-long weekly individual therapy. During this time, you’d also have access to immediate coaching over the phone with a therapist, if needed. These components help you learn the skills that DBT can offer, strengthen them, and apply them in real-life situations.

Depending on your needs, your mental health provider might adjust your DBT treatment plan by focusing primarily on skills-based training or changing the length of your treatment. They also may suggest using apps on your phone or telehealth (virtual therapy) to provide you with flexibility in your treatment plan.

Benefits

Research shows that DBT can offer several benefits, including:

• Reducing suicidal ideation or non-suicidal self-injury (NSSI)
• Improving symptoms of BPD, depression, anxiety, PTSD, and disordered eating
• Helping you adjust to new social situations and life experiences

Additionally, evidence suggests that DBT can offer other benefits that improve your overall quality of life. You may find that you:

• Have more control over your life 
• Are more resilient in difficult situations 
• Develop healthier and more fulfilling relationships with others
• Understand yourself and your emotions better 
• Feel socially supported
  

Limitations

It’s important to note that despite its potential benefits, DBT may not be the right treatment plan for you. If you don’t feel that DBT is working for you, speak with your mental health provider about other types of therapy or alternatives to treatment that may be more beneficial for you. 

DBT has significant benefits, particularly for BPD and other mental health conditions. However, some research suggests that although DBT can reduce self-directed violence, it may not always decrease suicidal thoughts. Some studies also found that there is limited evidence of DBT's effectiveness for men, who are more likely to die by suicide. Additionally, DBT can be time-consuming and lower one's ability to complete the program, which can make it less accessible or effective for some.

If you have questions about whether DBT might be effective for you, speak with your healthcare provider or mental health provider. They can explain the treatment options that might work for you, your specific needs, and your schedule. 

How to Start

If you’re looking to begin DBT or think this treatment may support your well-being, the first step is to find a mental health provider who is properly trained in providing dialectical behavior therapy. You may look for a provider through online databases, ask for a referral from your primary healthcare provider or a community health center, or check with your insurance company to find an in-network therapist who offers DBT services.

When searching for therapists, look for providers who have “DBT-LBC” after their name. This means they have trained in DBT and passed a qualifying exam, in addition to having general psychological training, before they received their license.

A Quick Review

DBT is a type of talk therapy that mental health providers often use to treat borderline personality disorder and other mental health conditions. The therapy consists of three components: individual therapy, group skills training, and ongoing phone support with a trained provider. During sessions, you can expect to gain hands-on skills for problem-solving, coping, and accepting situations, while strengthening social relationships and improving your quality of life.

Although DBT can be a lengthy treatment plan, evidence shows that even skills-based training on its own or a shortened treatment plan can be beneficial. If you're interested in starting DBT or think this type of therapy may help improve your condition, talk to your primary healthcare provider or mental health provider to see if DBT is a good option for you.