What is Dialectical Behavioral Therapy (DBT)?

Dialectical behavioral therapy (DBT) is a type of talk therapy developed to help people struggling with intense and overwhelming emotions and relationship difficulties. Although DBT was originally developed to treat borderline personality disorder, it’s now used to help a wide range of challenges. DBT focuses on teaching practical skills to manage intense emotions and build healthier relationships. 

Understanding Dialectical Behavioral Therapy

Dialectical behavioral therapy is a type of cognitive behavioral therapy. So, it shares a similar foundation and theories, but DBT has unique features that make it a distinct approach. 

Both CBT and DBT have the following in common: 

• They focus on the connection between thoughts, feelings, and behaviors. 
• They aim to help individuals identify and change unhelpful patterns. 
• They use an active collaborative approach where a therapist and client work together. 

Dialectical behavioral therapy is its own distinct approach that brings in unique techniques, tools, and strategies: 

• It emphasizes acceptance and validation. DBT puts a strong focus on accepting and validating an individual’s emotions and experiences. 
• It focuses on emotional regulation and includes specific skills building for emotional regulation, distress, and mindfulness. 
• It emphasizes the importance of finding a balance between acceptance and change. 

In DBT, “dialectical” means finding a balance between two seemingly opposite things, like acceptance and change. People with extreme and intense emotions can sometimes get stuck in either accepting everything as it is, even if it’s harmful, or trying to change things without accepting reality and getting frustrated. Put simply, DBT helps people find a middle ground and teaches that it’s possible to achieve both acceptance and change. It recognizes that acceptance and change are essential for personal growth and well-being.  

Curious about which type of therapy might be right for you? Read our guide to explore different types of therapy. 

The Core Principles of DBT

At the heart of DBT is a set of principles that guide the approach. These components help you to understand the thinking behind DBT. 

• Dialectics (Balance of Acceptance and Change): This is the overarching principle of DBT and a crucial aspect of DBT. It’s about accepting yourself and what’s currently happening while at the same time also working towards change. 

• Validation: When someone feels validated, they feel heard and respected. Validation is a key part of DBT because it helps individuals accept their emotions and experiences without judgment, create a greater sense of self-worth, and set a foundation for change. 

A key element to understanding DBT is recognizing the role of emotional sensitivity and reactivity. Individuals struggling with emotional distress often experience intense emotional sensitivity and reactivity, making skills like distress tolerance and emotional regulation essential for well-being.

DBT assumes that individuals struggle not because of an inherent flaw but because of a lack of skills. That’s why DBT focuses heavily on teaching skills and equipping individuals with the tools they need.

How DBT Balances Acceptance and Change

A fundamental part of DBT is balancing the two opposites: acceptance and change. A central idea of DBT is that acceptance makes change more possible. So, you learn to recognize and accept difficult emotions and experiences without judgment. Then, while you’re learning to accept and regulate those emotions, you’re in a better position to change harmful behaviors. While these two opposites sound contradictory, DBT teaches acceptance and change through a combination of tools, techniques, and strategies. 

For example, mindfulness in DBT encourages greater self-awareness and acceptance without judgment. One way that DBT helps with changing behaviors is through teaching emotional regulation skills. This would include learning how to identify triggers, challenging unhelpful thoughts, and developing healthier ways to cope. 

Key Techniques Used in DBT

The principles of DBT lead directly to the teachings and development of skills in four key areas: distress tolerance, interpersonal effectiveness, mindfulness, and emotional regulation. 

Distress Tolerance:

These techniques help individuals learn to accept and deal with difficult emotions and situations, cope more effectively, and develop confidence and resilience. Techniques include distraction, self-soothing, and improving the moment. 

Interpersonal Effectiveness

Interpersonal effectiveness focuses on teaching skills to help you build and maintain healthy relationships. These can include assertiveness and relationship skills, and learning to communicate more effectively, listen, and respect yourself and others. 

Mindfulness

Mindfulness is about learning to be present and aware without judgment. DBT incorporates mindfulness exercises and practices, like body scans. 

Emotional Regulation 

Emotional regulation skills teach you to understand and manage emotions more effectively. DBT uses techniques such as problem-solving, identifying and labeling emotions, and opposite action. 

These are just a few techniques used in DBT to give you a clearer idea of what to expect. The specific techniques and tools used in therapy will depend on your unique needs, preferences, goals, and challenges. 

Conditions Commonly Treated with DBT

DBT can be helpful for a wide range of conditions, including: 

• Borderline Personality Disorder (BPD)
• Anxiety Disorders
• Depression
• Eating Disorders
• Post-traumatic Stress Disorder (PTSD)
• Substance Use Disorders
• Suicidal and Self-Harming Behaviors 

DBT’s focus on developing core skills (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness) makes it helpful for many conditions. It addresses emotional dysregulation, a common factor in several mental health conditions, and teaches skills to help manage intense emotions, improve relationships, reduce impulsive behaviors, and contribute to a better quality of life overall.  

The Benefits of DBT for Emotional Regulation

Emotional regulation is at the heart of DBT because the therapy was originally developed for treating borderline personality disorder (BPD). BDP is characterized by very intense and fluctuating difficult emotions. While DBT is used for other mental health conditions and challenges, emotional regulation is still a key part of DBT. 

Here’s how DBT helps with emotional regulation: 

• It teaches you practical skills to manage your emotions. 
• It helps you to understand your emotions better.
• It helps you to handle tough feelings without falling apart, building resilience. 
• It helps you control how intensely you react to things. 
• It helps you to feel more stable and positive, improving your mood. 
• It helps you to communicate more effectively and build healthier relationships.

What to Expect in a DBT Program

DBT programs are comprehensive and structured and involve several components that come together to help an individual. While the exact structure may change depending on your therapist, DBT programs usually include the following: 

• DBT Pre-Assessment: Before starting a DBT program, you would speak with a therapist to assess your needs and determine if DBT is the best fit for you. They would also explain what DBT is and what to expect.  

• Individual Therapy: Typically, individual DBT therapy sessions are held weekly and last for about 45-60 minutes. During sessions, you speak with your therapist about your concerns, needs, goals, challenges, and progress. You work with your therapist to identify problems, explore solutions, and apply the skills you learn in real-life scenarios. 

• Skills Training in Group Sessions: Skills training is an essential aspect of DBT. Unlike group therapy, which focuses on sharing experiences and relying on peer support, group skills training involves learning DBT skills in a group setting. 

• Telephone Coaching: DBT programs often include telephone coaching, where you would speak to your therapist for support in your daily life. For example, you need support using DBT skills. Keep in mind that your therapist will set boundaries for calls, including how long and when they should be contacted, which will be clear from the beginning. 

How Do I Get Started with DBT? 

DBT can be helpful for individuals struggling with intense emotions, relationship difficulties, impulsive behaviors, and emotional regulation. If you think you or a loved one could benefit from DBT therapy, it could be time to speak with a therapist.  

Finding the right DBT therapist can be overwhelming. At Thriving Center of Psychology, we’re here to help. Take just 5 minutes to complete our questionnaire, and we’ll match you with someone who understands your specific challenges. We look forward to starting this journey with you!