Dialectical behavior therapy (DBT)

Written by Grow Therapy

Clinically reviewed by Grow Therapy Clinical Review Team

Dialectical behavior therapy (DBT) is a structured psychotherapy modality that has been shown to help individuals manage emotional distress and reduce self-harm. Based on cognitive-behavioral therapy (CBT) principles, DBT combines talk therapy with mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.

What are the origins of dialectical behavior therapy (DBT)?

The origins of DBT date back to the late 1970s. It was developed by American psychologist Dr. Marsha Linehan, who created DBT as a treatment for borderline personality disorder (BPD) after realizing that other therapy modalities weren’t helping her clients with BPD –– particularly in addressing their self-harm and suicidal behavior. Dr. Linehan initially developed DBT to address the challenges faced by individuals with BPD, particularly in managing self-harm and suicidal behaviors. Over time, its effectiveness has led to adaptations for other mental health conditions.

How does dialectical behavior therapy (DBT) work?

DBT teaches people how to regulate intense emotions, manage distress, and have healthier interpersonal relationships. The goal is to develop skills to manage distress and build a fulfilling life. This is achieved through a combination of talk therapy and practical DBT skills training.

There are four main pillars of DBT. Thoroughly working through all of these pillars creates a well-rounded approach to managing mental health. These four pillars are:

  • Mindfulness – Being aware of the present moment and experiencing all of your thoughts, feelings, and sensations without judgment.
  • Distress tolerance –  The ability to tolerate and withstand difficult or uncomfortable emotions or sensations without relying on unhealthy or harmful coping mechanisms.
  • Emotional regulation – Having better awareness and understanding of emotions and improving the ability to manage intense feelings.
  • Interpersonal effectiveness – Improving relationship skills like communication, conflict resolution, setting and respecting boundaries, saying “no,” maintaining self-respect, and asking for what you need.

When is dialectical behavior therapy (DBT) used?

Various mental health professionals can practice DBT, including:

Dialectical behavior therapy is most commonly used to treat people with borderline personality disorder (BPD) — a personality disorder that is characterized by an unstable sense of self, tumultuous relationships, self-harm, and suicidal thoughts. DBT has become the “gold standard” BPD treatment.

In addition to treating borderline personality disorder, DBT helps treat many other mental health conditions, including:

DBT treatment is useful for many age groups, too. There are two DBT adaptations for children and teens:

  • Dialectical behavior therapy for adolescents (DBT-A)
  • Dialectical behavior therapy for children (DBT-C)

What is dialectical behavior therapy (DBT) like?

DBT is typically conducted in both individual therapy and group settings. If you’re working with a DBT therapist, you’ll likely have weekly individual therapy sessions alongside group skills training sessions. DBT can take place in an outpatient or inpatient setting. Some DBT programs include phone coaching, allowing clients to reach out to their therapist between sessions for guidance. Availability and policies on phone coaching may vary among providers.

In individual sessions, your therapist will help you work through any difficult emotions, use new DBT skills, and address any thoughts of self-injury or suicide. You are encouraged to share concerns with your therapist at your own pace, as DBT provides a supportive space for discussing difficult emotions. In group skills training sessions, the format is more like a class rather than group therapy. The group leaders will teach everyone new dialectical behavior therapy skills and provide you with exercises to practice them.

Your therapist and group leaders might give you “homework” in between sessions, ranging from practicing new skills in your everyday life to completing a diary card that tracks your mood, including any urges to self-harm or suicidal thoughts. It’s important to be completely honest with your therapist about how you’re feeling so they can best help you.

How long does dialectical behavior therapy (DBT) take?

Before officially starting a DBT program, a therapist may conduct a DBT pre-assessment to get a better idea of your symptoms and whether DBT is a good fit for you. They will explain how DBT works and ask if you can commit to the schedule of weekly individual sessions and group sessions for 24 weeks. If you both decide DBT is a fit, you can move forward. If not, the therapist can recommend other modalities to help you.

The standard DBT program typically lasts 24 weeks (approximately six months), but some individuals continue for a year or longer depending on their needs and progress. Treatment typically includes:

  • Weekly individual therapy sessions (~40 minutes to an hour)
  • Weekly group skills training (~1.5 to 2.5 hours)

How to find a therapist who practices dialectical behavior therapy (DBT)

If you think DBT might be right for you, it’s important to speak with a licensed and experienced clinician. There are many types of mental health care providers who practice DBT, including licensed marriage and family therapists (LMFTs), licensed clinical social workers (LCSWs), psychologists, psychiatrists, psychiatric nurses, licensed professional counselors (LPCs), licensed mental health counselors (LMHCs) and more.

On top of finding someone specializing in DBT, you want to make sure they meet your other needs. For example, if you’re seeking treatment for an eating disorder, you may want to find a therapist who is trained in DBT and also specializes in eating disorders. In addition, finding a therapist who accepts your insurance can make therapy much more affordable. 

 

You can find a therapist who accepts your insurance and specializes in DTB by using Grow Therapy. After filtering for your location, insurance, and needs, you can then select “Dialectical Behavior (DBT)” from the “Treatment methods” drop-down.

tiktok
Next up in A Guide to Types of Therapy

Eclectic therapy

Read now
This article is not meant to be a replacement for medical advice. We recommend speaking with a therapist for personalized information about your mental health. If you don’t currently have a therapist, we can connect you with one who can offer support and address any questions or concerns. If you or your child is experiencing a medical emergency, is considering harming themselves or others, or is otherwise in imminent danger, you should dial 9-1-1 and/or go to the nearest emergency room.