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Dialectical Behavior Therapy (DBT): Definition,
Techniques, and Benefits
By Nancy Schimelpfening Updated on May 01, 2023
Medically reviewed by Steven Gans, MD
Dialectical behavior therapy (DBT) is a modified type of cognitive behavioral therapy
(CBT). Its main goals are to teach people how to live in the moment, develop healthy
ways to cope with stress, regulate their emotions, and improve their relationships with
others.
DBT was originally intended to treat borderline personality disorder (BPD), but it has been
adapted to treat other mental health conditions beyond BPD. It can help people who have
difficulty with emotional regulation or are exhibiting self-destructive behaviors (such as
eating disorders and substance use disorders). This type of therapy is also sometimes
used to treat post-traumatic stress disorder (PTSD).
This video has been medically reviewed by Daniel B. Block, MD.
DBT Techniques
DBT has evolved to become an evidence-based psychotherapy approach that is used to
treat many conditions. Settings in which DBT are often used include:
Group therapy where patients are taught behavioral skills in a group setting.
Individual therapy with a trained professional where a patient's learned behavioral
skills are adapted to their personal life challenges.
Phone coaching in which patients can call the therapist between sessions to
receive guidance on coping with a difficult situation they are currently in.
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Some of the strategies and techniques that are used in DBT include the following.
Core Mindfulness
One important benefit of DBT is the development of mindfulness skills. Mindfulness helps
you focus on the present or "live in the moment." This helps you pay attention to what is
happening inside you (your thoughts, feelings, sensations, and impulses) as well as using
your senses to tune in to what's happening around you (what you see, hear, smell, and
touch) in nonjudgmental ways.
Mindfulness skills help you slow down and focus on using healthy coping skills when you
are in the midst of emotional pain. The strategy can also help you stay calm and avoid
engaging in automatic negative thought patterns and impulsive behavior.
Sample Exercise: Observe Mindfulness Skill
Pay attention to your breath. Take note of the sensation of inhaling and exhaling. Watch
your belly rise and fall as you breathe.
Distress Tolerance
Distress tolerance skills help you accept yourself and your current situation. DBT teaches
several techniques for handling a crisis, including:
Distraction
Improving the moment
Self-soothing
Thinking of the pros and cons of not tolerating distress
Distress tolerance techniques help prepare you for intense emotions and empower you to
cope with them with a more positive long-term outlook.
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Sample Exercise: Putting Your Body in Charge
Run up and down the stairs. If you're inside, go outside. If you're sitting, get up and walk
around. The idea is to distract yourself by allowing your emotions to follow your body.
Interpersonal Effectiveness
Interpersonal effectiveness helps you to become more assertive in a relationship (for
example, expressing your needs and be able to say "no") while still keeping a relationship
positive and healthy. You will learn to listen and communicate more effectively, deal with
challenging people, and respect yourself and others.
Sample Exercise: GIVE
Use the acronym GIVE to improve relationships and positive communication:
Gentle. Don't attack, threaten, or judge others
Interest. Show interest with good listening skills (don't interrupt someone else to
speak)
Validate. Acknowledge the other person's thoughts and feelings
Easy. Try to have an easy attitude (smile often and be light-hearted)
Emotion Regulation
Emotion regulation lets you navigate powerful feelings in a more effective way. The skills
you learn will help you to identify, name, and change your emotions.
When you are able to recognize and cope with intense negative emotions (for example,
anger), it reduces your emotional vulnerability and helps you have more positive
emotional experiences.
Sample Exercise: Opposite Action
Identify how you're feeling and do the opposite. If you are feeling sad and want to
withdraw from friends and family, make plans to see your loved ones.
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What Are the 4 Stages of DBT?
Dialectical behavior therapy is also divided into four stages of treatment:
Stage 1: During the beginning of treatment, the most serious and self-destructive
behaviors are the first things addressed. This may include issues such as self-injury
or suicidal behaviors.
Stage 2: Next, treatment moves on to address issues that affect a person's quality
of life, such as their interpersonal effectiveness, emotional regulation skills, and
ability to tolerate distress.
Stage 3: The next step is to focus on issues related to self-esteem and
interpersonal relationships.
Stage 4: At this point, treatment is focused on helping people get the most out of
their lives, including finding ways to experience greater happiness, strengthen their
relationships, and pursue their life goals.
What Is DBT Used For?
DBT was developed in the late 1980s by Dr. Marsha Linehan and colleagues when they
discovered that cognitive behavioral therapy (CBT) alone did not work as well as
expected in patients with BPD. Dr. Linehan and her team added techniques and
developed a treatment to meet the unique needs of these individuals.
Though developed with BPD in mind, DBT might also be an effective treatment for:
Attention-deficit/hyperactivity disorder (ADHD)
Bipolar disorder
Borderline personality disorder (BPD)
Eating disorders (such as anorexia nervosa, binge eating disorder, and bulimia
nervosa)
Generalized anxiety disorder (GAD)
Major depressive disorder (including treatment-resistant major depression and
chronic depression)
Non-suicidal self-injury
Obsessive-compulsive disorder (OCD)
Post-traumatic stress disorder (PTSD)
Substance use disorder
Suicidal behavior
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Benefits of DBT
In DBT, the patient and therapist work to resolve the apparent contradiction between self-
acceptance and change to bring about positive changes in the individual in treatment.
Part of this process involves offering validation, which helps people become more likely to
cooperate and less likely to experience distress at the idea of change.
In practice, the therapist validates that an individual's actions "make sense" within the
context of their personal experiences without necessarily agreeing that the actions are the
best approach to solving a problem.
Each therapeutic setting has its own structure and goals, but the characteristics of DBT
can be found in group skills training, individual psychotherapy, and phone coaching.
These are the six main points of DBT:
Acceptance and change: You’ll learn strategies to accept and tolerate your life
circumstances, emotions, and yourself. You will also develop skills that can help you
make positive changes in your behaviors and interactions with others.
Behavioral: You'll learn to analyze problems or destructive behavior patterns and
replace them with more healthy and effective ones.
Cognitive: You'll focus on changing thoughts and beliefs that are not effective or
helpful.
Collaboration: You'll learn to communicate effectively and work together as a team
(therapist, group therapist, psychiatrist).
Skill sets: You’ll learn new skills to enhance your capabilities.
Support: You'll be encouraged to recognize your positive strengths and attributes
and develop and use them.
Recap
The six main points of DBT are to develop skills related to (1) accepting circumstances
and making changes, (2) analyzing behaviors and learning healthier patterns of
responding, (3) changing unhelpful, maladaptive, or negative thoughts, (4) developing
collaboration skills, (5) learning new skills, and (6) receiving support.
Effectiveness of DBT
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Because this approach to therapy is able to help people successfully improve their coping
skills, they are able to develop effective ways to manage and express strong emotions.
Researchers have also found that DBT is effective regardless of a person's age, sex,
gender identity, sexual orientation, and race/ethnicity.
For BPD: Studies have found that DBT is effective in the treatment of borderline
personality disorder (BPD) and reducing suicide risk in individuals with BPD. One
study found that after a year of treatment, more than 75% of people with BPD no
longer met the diagnostic criteria for the condition.
For suicidal behavior: Another study found that interventions that incorporated
skills training as a treatment component appeared to be more effective in reducing
suicidality than DBT without skills training.
For other conditions: Most DBT research has focused on its effectiveness for
people with borderline personality disorder who have thoughts of suicide and self-
harm, but the method could also be a successful treatment for other mental health
conditions. For example, research has found that this type of therapy also appears
to be effective in the treatment of PTSD, depression, and anxiety.
Research also suggests that DBT may also be useful in the treatment of children with
disruptive mood dysregulation disorder.
Things to Consider About Dialectical Behavior
Therapy
DBT requires a significant commitment of time. In addition to regular therapy sessions,
people are also required to do "homework" to work on skills outside of the individual,
group, and phone counseling sessions. This may pose a challenge for people who have
difficulty keeping up with these assignments on a regular basis.
Practicing some of the skills may also be challenging for some people. At different stages
of treatment, people explore traumatic experiences and emotional pain, which may be
upsetting.
Can You Do Dialectical Behavior Therapy On Your Own?
DBT is complex, and it's generally not something that people can do on their own without
the guidance of a trained therapist.
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However, there are some things you can do on your own to help you develop new coping
skills. For example, mindfulness, breathing exercises, and progressive muscle relaxation
are all skills you can utilize to improve your ability to tolerate distress.
It is important to remember that this should not be used in place of professional help. If
you're struggling with a mental health condition, it's always best to seek out the help of a
qualified mental health professional.
How to Get Started With Dialectical Behavior
Therapy
The best way to find out if DBT is right for you is to talk with a professional who is trained
in the method. They will evaluate your symptoms, treatment history, and therapy goals to
see if DBT might be a good fit.
If you or a loved one might benefit from DBT, it's important to talk with a healthcare
provider or mental health professional who is trained in the approach. That said, it's not
always easy to find DBT therapists.
You can start your search with the Clinical Resource Directory, which is maintained by
Behavioral Tech (an organization founded by Dr. Linehan to train mental health
professionals in DBT). The directory lets you search by state for clinicians and programs
with DBT training through Behavioral Tech, LLC, or the Behavioral Research and Therapy
Clinics at the University of Washington.
You can also ask your provider, current therapist, or another trusted mental health
professional to refer you to a colleague who specializes in DBT. You may also find online
therapists who offer DBT therapy.
11 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within
our articles. Read our editorial process to learn more about how we fact-check and keep our content
accurate, reliable, and trustworthy.
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