What is Dialectical Behaviour Therapy (DBT)?

Dialectical Behaviour Therapy (DBT) is a modified form of Cognitive Behavioural Therapy (CBT) developed by psychologist Marsha Linehan. It was originally created to treat individuals with borderline personality disorder (BPD), especially those who experience chronic emotional pain, suicidal thoughts, or self-harming behaviours.

Since its development, DBT has been adapted for a wide range of mental health challenges including emotional dysregulation, self-harm, eating disorders, PTSD, and substance use problems. The term “dialectical” refers to the balance between two opposing ideas — acceptance and change — which is central to DBT’s approach.

DBT is structured, skills-based, and typically delivered through a combination of individual therapy, skills training groups, phone coaching, and therapist consultation teams.

How Does DBT Work?

DBT helps people better understand and manage their emotions by teaching coping skills and building awareness of thoughts and behaviours. Unlike some therapies that focus mostly on change, DBT equally emphasises accepting oneself as they are — while also working toward meaningful change.

The core components of DBT include four key skills modules:

• Mindfulness: The foundation of DBT. Teaches individuals how to stay present, observe without judgement, and respond rather than react to intense emotions.
• Distress Tolerance: Focuses on surviving crisis situations without making them worse. Clients learn tools to tolerate painful feelings without acting impulsively or destructively.
• Emotion Regulation: Helps individuals understand, name, and manage intense emotional experiences. Skills include reducing vulnerability to emotional extremes and increasing positive emotions.
• Interpersonal Effectiveness: Teaches how to ask for what you need, set boundaries, and maintain healthy relationships — all while maintaining self-respect.

DBT programmes typically include:

• Individual Therapy: One-to-one sessions where clients apply DBT skills to their personal life challenges.
• Skills Training Group: Group sessions that focus on learning and practising DBT skills in a classroom-like setting.
• Phone Coaching: Real-time support from the therapist between sessions to help apply DBT skills in daily life.
• Therapist Consultation Team: A support structure for DBT therapists to maintain fidelity to the model and prevent burnout.

Benefits of DBT

• Improved Emotional Regulation: DBT helps individuals understand and gain control over overwhelming emotions, reducing reactivity and impulsivity.
• Reduced Self-Harm and Suicidal Behaviours: DBT has a strong track record in reducing self-injurious behaviours, suicidal ideation, and hospitalisations.
• Better Relationship Skills: By learning assertiveness, boundary-setting, and listening skills, clients often see improvements in their personal and social relationships.
• Effective for Complex Diagnoses: DBT is one of the few structured therapies designed specifically for those with multiple diagnoses or high emotional sensitivity.
• Balanced Approach: DBT respects where clients are in their journey, promoting acceptance while supporting positive change.

While DBT was originally developed for borderline personality disorder, it’s now used successfully with individuals experiencing chronic emotional difficulties, intense shame, identity confusion, and relationship chaos.

Risks and Considerations

DBT is an intensive therapy that requires a significant time commitment and active participation. Some challenges to be aware of include:

• Emotional Intensity: Early sessions can bring up difficult feelings as clients begin to address painful thoughts and behaviours.
• Homework and Practice: Like CBT, DBT includes regular practice outside of sessions, which can feel demanding for some.
• Availability: Full DBT programmes with all four components (individual, group, coaching, consultation) can be hard to access in some areas.

However, many therapists offer "DBT-informed" therapy, which incorporates the core skills and principles without requiring full programme participation.

Who Can Benefit?

DBT is especially useful for individuals who:

• Struggle with intense, rapidly shifting emotions
• Experience ongoing suicidal thoughts or urges to self-harm
• Have difficulty maintaining stable relationships
• Feel things “too deeply” or feel easily overwhelmed
• Live with diagnoses such as BPD, PTSD, eating disorders, or bipolar disorder
• Have tried other therapies without success and need more structure or emotional safety

DBT is also used preventively to help teens and adults develop healthy emotion regulation before symptoms become more severe.