Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is a powerful evidence-based treatment approach that combines cognitive-behavioral techniques with mindfulness practices to help you manage emotions, improve relationships, and build a life worth living.

Dialectical Behavior Therapy pairs practical skills with mindfulness, for the times when emotions arrive faster than you can think.

DBT helps you understand your thoughts and emotions, so you can make positive changes.

Imagine having the tools to overcome challenges and find happiness.

What is Dialectical Behavior Therapy?

Dialectical Behavior Therapy (DBT) was developed by Dr. Marsha Linehan in the late 1980s. Originally designed to treat borderline personality disorder, it has since been adapted and proven effective for a wide range of conditions characterized by emotional dysregulation, including:

• Depression and mood disorders
• Anxiety disorders
• Post-traumatic stress disorder (PTSD)
• Substance use concerns
• Eating disorders
• Self-harm and suicidal behaviors

The term "dialectical" refers to the integration of two seemingly opposite concepts: acceptance and change. DBT teaches you to accept yourself and your current situation while simultaneously working toward positive change and growth.

Comprehensive DBT consists of four main components, each addressing different aspects of emotional well-being and life skills:

1. Mindfulness Skills

Mindfulness forms the foundation of all DBT skills. It involves developing awareness of your thoughts, emotions, bodily sensations, and surroundings in the present moment without judgment. Mindfulness skills help you:

• Observe experiences without immediately reacting
• Describe thoughts and feelings accurately
• Participate fully in the present moment
• Focus on one thing at a time
• Be effective by doing what works rather than being "right"

To learn more about how mindfulness can be practiced as a standalone therapeutic approach, visit our Mindfulness therapy page.

2. Distress Tolerance Skills

These skills help you manage crisis situations and intense emotions without making things worse. Rather than trying to immediately escape difficult feelings, you'll learn to:

• Distract yourself in healthy ways
• Self-soothe using your five senses
• Improve the moment with techniques like imagery, meaning-making, prayer, or relaxation
• Weigh pros and cons of different responses
• Accept reality as it is (radical acceptance)

3. Emotion Regulation Skills

These skills help you understand, name, and manage your emotions more effectively. You'll learn to:

• Identify and label emotions
• Identify obstacles to changing emotions
• Reduce vulnerability to emotional suffering (through self-care practices like balanced eating, exercise, sleep, and avoiding mood-altering substances)
• Increase positive emotional events
• Build mastery through engaging in activities that make you feel competent and effective
• Apply mindfulness to current emotions without judgment
• Take opposite action when emotions don't fit the facts or aren't effective

4. Interpersonal Effectiveness Skills

These skills help you navigate relationships and interpersonal conflicts while maintaining self-respect and the relationship. You'll learn to:

• Ask for what you need effectively
• Set boundaries and say "no" when appropriate
• Cope with interpersonal conflict
• Balance priorities and demands
• Build and maintain positive relationships

DBT is supported by extensive scientific research demonstrating its effectiveness. Multiple randomized controlled trials (the gold standard in research) have shown that DBT is effective for:

• Reducing self-harm and suicidal behaviors
• Decreasing hospitalization rates
• Improving treatment retention (people staying in therapy)
• Reducing symptoms of depression, anxiety, and PTSD
• Improving overall quality of life

Studies show that the skills learned in DBT create changes in brain activity associated with better emotional regulation. This demonstrates that learning these skills actually changes how your brain processes emotions.

Comprehensive Evaluation: A Path to Personalized Treatment

We start with a thorough evaluation. It is how we work out which skills would help most, what to tackle first, and what you want to be different by the end.

That means asking about what is happening now, what you have already tried, and what tends to set things off — not so that you can be sorted into a category, but so the work is aimed at your situation rather than a general one.

What to Expect in DBT Treatment

DBT treatment is structured and typically includes:

• Individual therapy: One-on-one sessions focused on your specific challenges and applying DBT skills to your unique situation
• Skills training: Learning the four core skills modules (mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness)
• Between-session coaching: Support for applying skills to real-life situations as they arise
• Homework assignments: Practicing skills between sessions to strengthen their effectiveness

Our approach to DBT is flexible and can be adapted to your needs. We may recommend a comprehensive DBT program or integrate specific DBT skills into your individual therapy based on your unique situation.

Who Can Benefit from DBT?

DBT can be beneficial for anyone struggling with emotional regulation or interpersonal challenges. It's particularly helpful for people who:

• Experience emotions intensely
• Have difficulty managing strong emotions
• Engage in impulsive behaviors when upset
• Have unstable relationships
• Experience frequent mood swings
• Have a history of trauma
• Struggle with anxiety, depression, or PTSD
• Want to improve their emotion regulation and interpersonal skills

For individuals dealing with relationship issues, our Gottman Method Couples Therapy may be particularly beneficial. For military personnel and veterans dealing with trauma, we also offer specialized military-focused therapy services.

What the work is actually like

DBT asks something of you. There is homework, there is practicing a skill when you do not feel like it, and there are weeks where it feels like nothing is shifting. That is normal, and it is not a sign it is failing.

What it does not ask is that you arrive already able to manage. If you could regulate your emotions on demand you would not need the skills training. Turning up is the requirement.

Between sessions you can reach out when a situation comes up and you are not sure which skill applies. That is part of how DBT is designed to work, not an imposition on anyone.

Mindfulness and DBT: Enhancing Self-awareness and Emotional Well-being

Mindfulness is like a superpower that helps you navigate emotional pain and become more resilient.

The Benefits of Mindfulness in DBT

Mindfulness practices in DBT help you:

• Create space between your emotions and your actions
• Reduce automatic reactions to emotional triggers
• Increase awareness of your emotions without judgment
• Stay present rather than dwelling on the past or worrying about the future
• Make wiser choices in difficult moments

Overcoming PTSD: Healing, Resilience, and Hope

If you’re struggling with PTSD, we specialize in supporting you.

Our goal is to help you heal, become more resilient, and find hope for the future.

DBT is proven to be effective in regaining control and finding strength and well-being.

How DBT Helps with Trauma

DBT provides valuable skills for managing trauma-related symptoms, including:

• Emotion regulation skills to manage intense trauma-related emotions
• Distress tolerance techniques to cope with flashbacks and triggers
• Mindfulness practices to ground yourself in the present moment when memories intrude
• Interpersonal effectiveness skills to rebuild trust and relationships that may have been affected by trauma

Skills you keep

The four modules are concrete: how to get through a crisis without making it worse, how to notice an emotion before it has taken over, how to ask for something, and how to say no.

They are taught rather than absorbed, and once learned they are yours. People often find they are still using the distress tolerance skills years after they finished therapy.

How long does DBT treatment typically last?

Standard DBT typically involves a commitment of 6-12 months to complete the full skills training curriculum. However, the length of treatment can be adjusted based on your specific needs and goals. Some people benefit from shorter-term DBT-informed therapy that incorporates key skills and principles.

Is DBT different from CBT (Cognitive Behavioral Therapy)?

Yes. While DBT is a form of CBT, it includes several unique elements. DBT places a stronger emphasis on acceptance, mindfulness, and dialectical thinking (the balance between acceptance and change). It also specifically targets emotional regulation and interpersonal effectiveness, which aren't always central focuses in traditional CBT. To understand the differences and similarities between these approaches, you may want to explore our Cognitive Behavioral Therapy (CBT) page as well.

Do I need to be diagnosed with a specific condition to benefit from DBT?

No. While DBT was originally developed for borderline personality disorder, its skills are valuable for anyone who wants to improve their emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness. These skills are helpful for managing a wide range of mental health concerns and even everyday life challenges.

What makes DBT effective?

DBT combines several powerful therapeutic elements: practical skills training, individual therapy, emphasis on the therapeutic relationship, focus on motivation and reinforcement, and generalization of skills to real-world situations. This comprehensive approach addresses multiple dimensions of psychological and emotional well-being.

If you are not sure whether DBT is the right fit, the free 15-minute consultation exists for exactly that question. It is a conversation, not a commitment.

Get in touch to ask about DBT. Our evidence-based approach to Dialectical Behavior Therapy is tailored to your individual needs, ensuring that you receive the most effective treatment for your specific situation. If you prefer a more traditional approach to therapy before diving into DBT, we also offer Talk Therapy as a starting point.