Dialectical Behavior Therapy (DBT)

What is DBT?

Dialectical behavior therapy (DBT) is a form of cognitive behavioral therapy developed by psychologist Marsha Linehan. “Dialectical” refers to balancing two ideas that can seem opposite: accepting yourself as you are, and working to change.

The four skill areas

• Mindfulness: paying attention to the present moment without judgment.
• Distress tolerance: getting through crises without making things worse.
• Emotion regulation: understanding emotions and reducing their intensity.
• Interpersonal effectiveness: asking for what you need and setting boundaries while maintaining relationships and self-respect.

How DBT is delivered

Comprehensive DBT typically includes weekly individual therapy, a weekly skills group, between-session phone coaching, and a consultation team for therapists. Some programs offer DBT-informed therapy or skills groups alone.

Who DBT may help

DBT has the strongest evidence for borderline personality disorder and for reducing self-harm. Adaptations have been studied for adolescents, eating disorders, substance use and other conditions involving intense emotions.

What to expect

DBT is structured and requires commitment, often for six months to a year in comprehensive programs. Clients typically track emotions and behaviors using diary cards and practice skills between sessions.