Definition, core skills, when used, components of treatment, benefits, research, resources for practice
Three sections follow:
Background Material that provides the context for the topic
Suggestions for Practice
A list of Supporting Material / References
Feedback welcome!
Background Material
What is DBT?
Dialectical behavior therapy (DBT) is a type of psychotherapy. It is based on cognitive behavioral therapy (CBT). It was devised by Dr. Marsha Linehan and is designed for people with borderline personality disorder (BPD) or who have difficulties controlling very strong emotions. This emotional dysregulation may cause troubled relationships and a disturbed sense of self. People may experience self-harm or have suicidal thoughts. DBT helps people to change unhelpful ways of thinking and behaving and to accept who they are (Heathdirect, 2022). 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 (Schimelpfening, 2023).
Dialectics is understood as a process of change that results from the interplay of two opposites—it combines opposite ideas. DBT focuses on helping people accept the reality of their lives and their behaviors, as well as helping them learn to change their lives, including their unhelpful behaviors. DBT has its roots in cognitive behaviour therapy, Eastern meditative practices, Zen, Buddhism, psychodynamics, systems theory, client-centered humanistic approaches, Gestalt approaches, paradoxical intervention and dialectical philosophy (Cleveland Clinic, 2022; Rad, 2012; Vijayapriva & Tamarana, 2023).
Concepts / Core skills of DBT
Some of the strategies and techniques that are used in DBT include the following (DBT, 2024; Schimelpfening, 2023).
Mindfulness One important benefit of DBT is the development of mindfulness skills. Mindfulness helps people pay attention to their thoughts and emotions, to learn to accept thoughts without judgement, to "live in the moment". Mindfulness skills help people to slow down and focus on using healthy coping skills and stay calm. Rad (2012) suggests mindfulness involves both:
Radical acceptance—accepting that reality is what it is and that everything has a cause. Life can be worth living even when there is pain. Radical acceptance is a particularly effective skill when one is faced with situations or realities that can’t be changed, such as the loss of a child or permanent disability.
Non-judgemental stance—not judging something as good or bad, right or wrong, correct or incorrect. Non-judgemental stance helps people move away from judging both themselves and others and/or idealising or devaluing relationships. It is moving away from either/or to both/and. It is accepting each moment as it is.
Distress Tolerance People use distress tolerance skills to assist in dealing with difficult situations through distraction, improving the moment, self-soothing and thinking of the pros and cons of not tolerating distress. Distress tolerance techniques can lead to a more positive long-term outlook.
Interpersonal Effectiveness Interpersonal effectiveness helps people manage relationships by developing skills to ask for what they want, say no, manage conflict and create friendships.
Emotion Regulation Emotion regulation lets people navigate powerful feelings in a more effective way by identifying, naming and changing emotions. This reduces emotional vulnerability and results in more positive emotional experiences.
When can DBT be used?
Dialectical behavior therapy (DBT) is especially effective for people who have difficulty managing and regulating their emotions. DBT has proven to be effective for treating and managing a wide range of mental health conditions, including:
Borderline personality disorder (BPD). People with BPD have extreme mood swings, unstable relationships and trouble controlling their emotions. They have a higher risk of suicide and self-destructive behavior.
ADHD.
Anger management.
Anxiety.
Bipolar disorder.
Depression.
Eating disorders, specifically binge eating disorder (frequent episodes of binge eating) and bulimia (eating then purging).
Emotional dysregulation.
Obsessive-compulsive disorder (OCD).
Post-traumatic stress disorder (PTSD). Post-traumatic stress disorder (PTSD) is a common mental health condition that can develop after a traumatic event. It involves symptoms like flashbacks, anxiety, negative thoughts and beliefs, hypervigilance and more.
Self-harm.
Substance use disorder.
Suicidal behavior.
DBT has proved effective for treating these conditions because each of these conditions is thought to result from unhealthy or problematic efforts to control intense, negative emotions (Cleveland Clinic, 2022; Healthdirect, 2022; Schimelpfening, 2023). For example, when used for:
Anxiety & Depression: DBT helps people become aware of their negative thought patterns and change them. It also helps people focus more on the positive activity that keeps them healthy.
Substance Abuse: DBT helps people reduce cravings, avoid situations that lend themselves to substance abuse, and find better ways to manage stress.
Self-Harm: DBT provides specific techniques to manage self-harm impulses and avoid unhealthy behavior.
Attention Deficit Hyperactivity Disorder (ADHD): DBT skills help people improve impulse control and develop life organizational skills.
Borderline Personality Disorder (BPD): DBT helps moderate excessive emotions and be more tolerant of high stress levels and other triggers. It also helps with addressing associated behaviors like problem relationships, self-harming behavior, and impulsivity.
Eating Disorders: DBT helps with bulimia and binge-eating by developing distress tolerance and emotional regulation skills.
Post-Traumatic Stress Disorder (PTSD): DBT has been found useful in processing traumatic events and providing grounding techniques to reduce the severity of PTSD symptoms.
Anger Management: DBT helps people recognize triggers and provides tools to reduce emotion without aggressive behavior.
The treatment process
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. 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: accepting circumstances and making changes.
Behavioral: analysing behaviors and learning healthier patterns of responding.
Cognitive: changing unhelpful, maladaptive, or negative thoughts.
Collaboration: developing collaboration skills.
Skill sets: learning new skills.
Support: receiving support (Schimelpfening, 2023).
DBT usually takes at least six months to a year, but it varies depending on personal qualities and the complexity of the mental health condition. However, many therapists believe that the treatment for borderline personality disorder, in particular, can often take several years (Cleveland Clinic, 2022).
DBT therapists are required to embrace several assumptions:
The therapeutic relationship is a real relationship between equals.
DBT and its therapists can fail.
DBT can fail even if therapists don’t.
Therapists treating patients need support.
Patients may not have caused all of their problems but they have to solve them anyway.
Patients must learn new behaviours in all relevant contexts.
The lives of suicidal, borderline patients are unbearable as they are currently lived.
Patients are doing the best they can.
Patients want to improve.
Patients need to do better, try harder and be more motivated to change (Rad, 2012).
Dialectical behavior therapy is 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: 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: Focus is on issues related to self-esteem and interpersonal relationships.
Stage 4: Focus is 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 (Schimelpfening, 2023).
The structure of dialectical behavior therapy can vary some from therapist to therapist, but, in general, DBT involves these four types of sessions:
DBT pre-assessment.
Individual therapy.
Skills training in groups.
Telephone crisis coaching.
1. DBT pre-assessment In a pre-assessment the therapist determines how suitable DBT is for the person by asking questions and explaining how DBT works.
2. Individual DBT therapy Individual DBT therapy involves weekly sessions with the therapist. Each session lasts about 40 minutes to 60 minutes. Individual DBT therapy sessions have the following goals:
To help keep people safe by reducing suicidal and self-harming behaviors, if applicable.
To limit behaviors that get in the way of productive therapy.
To help people reach their goals and improve quality of life by addressing what is blocking progress, such as mental health conditions or relationship issues.
To help people learn new skills to replace unhelpful behaviors.
People are asked to keep a diary to track emotions and actions and to look for patterns of behavior. This is reviewed each session and informs what happens in the session.
3. DBT skills training in groups This skills training in groups is akin to a teaching and learning session in a classroom setting, It is not group therapy, in which people discuss problems with others. It is more like a teaching and learning session in a classroom setting. DBT skills aim to help enhance your capabilities in day-to-day life. The four skills your therapist will teach include:
Mindfulness: This is the practice of being fully aware and focused in the present instead of worrying about the past or future.
Distress tolerance: This involves understanding and managing your emotions in difficult or stressful situations without responding with harmful behaviors.
Interpersonal effectiveness: This means understanding how to ask for what you want and need and setting boundaries while maintaining respect for yourself and others.
Emotion regulation: This means understanding, being more aware of and having more control over your emotions.
4. Telephone crisis coaching DBT often involves telephone crisis coaching to support people in their daily life. People call their therapist at certain times for support between sessions, for example:
When needing help with an immediate crisis, such as wanting to self-harm.
When wanting advice on how to use the DBT skills recently learned.
The calls are usually brief, and they shouldn’t replace the work of individual or group sessions (Cleveland Clinic, 2022; Rad, 2012).
Benefits / Outcomes of DBT
With DBT people learn to:
accept who they are
build skills to regulate emotions
improve interpersonal relationships
DBT usually involves acceptance and change, by:
sessions with a therapist
skills training in groups
telephone coaching sessions with a therapist if people have a crisis (Healthdirect, 2023).
For people with borderline personality disorder, in particular, DBT results in:
Less self-harm behavior and anger.
Fewer days of inpatient hospitalization.
Less drug and alcohol misuse.
Improved depressive symptoms.
However, DBT can be very difficult. DBT is more likely to work if people:
Are committed to making positive changes.
Are ready to fully commit to therapy and do homework assignments.
Are ready to focus mostly on present and future, rather than the past.
Feel able to do some sessions in a group with others (Cleveland Clinic, 2022)
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 counselling 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 (Schimelpfening, 2023).
Some research findings
Dialectical behavior therapy has been proven to help people with their mental health conditions in several studies (Cleveland Clinic, 2022). Brief outlines of four studies follow.
A systematic review of the effectiveness of CBT and DBT in addressing adolescent eating disorders found CBT and DBT demonstrated good feasibility, acceptability, and preliminary effectiveness across adolescent eating disorders in real-world clinical settings, but their efficacy relative to more established treatments was not examined. These treatments offer an alternative to the usual family-based treatment, which is not suitable for some families due to family factors such as a history of caregiver abuse, lack of caregiver availability or other barriers to treatment engagement. Co-occurring disorders and/or other psychopathology conditions suggest some eating disorders may be better managed within a DBT framework (Vogel et al., 2021).
A long-term follow-up study with 12 people found DBT contributed positively to the participants’ lives and helped advance their recovery through promoting further development in the years after the programme. DBT gave participants control over their lives and the ability to manage setbacks and difficult situations. DBT contributed to healthier and more meaningful relationships with others (Gillespie et al., 2022).
A systematic review examining the effectiveness of DBT on cognitive function improvement found it to be an efficacious treatment for disorders characterised by high levels of emotional instability. This review examined 12 studies involving 703 participants. Results indicate that DBT has the potential to improve key cognitive functions such as attention, memory, fluency, response inhibition, planning, set shifting, tolerance for delayed rewards and time perception (Vijayapriva & Tamarana, 2023).
A study of 30 male students, aged 10 to 17 years, with disruptive mood disorder found DBT had a significant effect (at the 95% tolerance level) on increasing self-control and distress tolerance these children and adolescents. Disruptive mood disorder is persistent and severe irritability, which is manifested in two ways: the person has explosive anger many times and these outbursts of anger usually occur in response to failure and can be verbal or behavioral (outbursts of behavioral anger are expressed as aggression towards oneself, others, or one's own belongings or others). In the period of intense outbursts of anger, the person is constantly irritable or angry, and this condition exists most of the day, almost every day, and those around easily notice it. It can affect interpersonal relationships, academic performance, and self-efficacy.
Suggestions for Practice
As DBT is a specialised psychotherapy those practising it require specific training in the approach and would only use it as a therapy after this training, and after some years of experience as a social worker. However, the resources available to DBT therapists can be adapted by social workers for use in other contexts or in their general practice. The following websites have a number of resources that may be helpful in general practice.
Therapist Aid (2025) https://www.therapistaid.com Search for DBT.
The Illustrated Social Worker (2025). Sign into Facebook, search for ‘the illustrated social worker’ and then type DBT into the search facility on that page.
DBT (2024) https://dialecticalbehaviortherapy.com/
Mindfulness
Mindfulness is a post elsewhere on this site. You will find it by clicking on the ‘contents’ button on the ‘home’ page, i.e. https://www.thesocialworkgraduate.com/post/contents
Examples of Therapist Aid worksheets:
Mindfulness https://www.therapistaid.com/therapy-worksheet/dbt-mindfulness-skills The site has numerous other worksheets on mindfulness; use the search facility.
Radical Acceptance https://www.therapistaid.com/therapy-worksheet/dbt-radical-acceptance
DBT (2024) has 10 exercises around mindfulness (https://dialecticalbehaviortherapy.com/mindfulness/): observing, mental body scan, internal vs external, describe your emotions, mental noting, thought defusion, mindful breathing, wise mind, negative judgements and letting to of judgements.
Distress Tolerance
Examples of Therapist Aid worksheets:
Urge Surfing https://www.therapistaid.com/therapy-worksheet/urge-surfing-handout
Improve the moment https://www.therapistaid.com/therapy-worksheet/dbt-improve
Distress Tolerance https://www.therapistaid.com/therapy-worksheet/dbt-distress-tolerance-skills
DBT (2024) has 10 exercises around distress tolerance (https://dialecticalbehaviortherapy.com/distress-tolerance/):
Cost benefit analysis, recognise emotional crisis, distracting activities, RESISTT technique, grounding, willingness vs wilfulness, radical acceptance, self-soothing, actions based on values, and TIPP.
Interpersonal Effectiveness
Examples of Therapist Aid worksheets:
Dear Man https://www.therapistaid.com/therapy-worksheet/dbt-dear-man
Interpersonal effectiveness https://www.therapistaid.com/therapy-worksheet/dbt-interpersonal-effectiveness-skills
DBT (2024) has 10 exercises around interpersonal effectiveness (https://dialecticalbehaviortherapy.com/interpersonal-effectiveness/): Communication styles, skills of assertiveness, parts 1 & 2, assertiveness scripts and interpersonal rights, listening abd validation, barriers to interpersonal effectiveness, trust in relationships, interpersonal boundaries, modulating intensity, and resistance ad conflict.
Emotion Regulation
Examples of Therapist Aid worksheets:
DBT (2024) has 10 exercises around emotion regulation (https://dialecticalbehaviortherapy.com/emotion-regulation/): Recognising your emotion, being effective, emotions & physical vulnerability, emotions & cognitive vulnerability, self-validation, myths about emotions, emotion exposure. Balancing emotional urges, problem solving, and mastery & coping ahead.
References
Cleveland Clinic. (2022). Dialectical behavior therapy (DBT). https://my.clevelandclinic.org/health/treatments/22838-dialectical-behavior-therapy-dbt
DBT: Dialectical behavior therapy. (2024). DBT: Dialectical behavior therapy. https://dialecticalbehaviortherapy.com/
Gillespie, C., Murphy, M., Kells, M., & Flynn, D. (2022). Individuals who report having benefited from dialectical behaviour therapy (DBT): A qualitative exploration of processes and experiences at long-term follow-up. Borderline Personality Disorder and Emotion Dysregulation, 9, 8-22 . https://doi.org/10.1186/s40479-022-00179-9
Healthdirect. (2022). Dialectical behaviour therapy. https://www.healthdirect.gov.au/dialectical-behaviour-therapy-dbt
Rad, S. (2012). Dialectical behaviour therapy (DBT). In G. Meadows, J. Farhall, E. Fossey, M. Grigg, F. McDermott & B. Singh (Eds.). Mental health in Australia: Collaborative community practice (3rd ed., pp.496-499). Oxford University Press.
Salimi, S., & Gheirati, S. (2024). The effectiveness of dialectical behavior therapy on self-control and anxiety tolerance in adolescents with mood disorders. Journal of School Psychology and Institutions, 12(4):93-108. https://doi.org/10.22098/jsp.2024.10767.5273
Schimelpfening, N. (2023). Dialectical behaviour therapy (DBT): Definition, techniques, and benefits. Verywell mind. https://www.verywellmind.com/dialectical-behavior-therapy-1067402
Therapist Aid. (2025). Therapy tools for mental health professionals: For therapists, by therapists. https://www.therapistaid.com/
Vijayapriya, C. V., & Tamarana, R. (2023). Effectiveness of dialectical behaviour therapy as a transdiagnostic treatment for improving cognitive functions: A systematic review. Research in Psychotherapy: Psychopathology, Process and Outcome, 26, 662-677. doi:10.4081/ripppo.2023.662
Vogel, E., Singh, S., & Accurso, E. (2021). A systematic review of cognitive behaviour therapy and dialectical behaviour therapy for adolescent eating disorders. Journal of Eating Disorders, 9, pp. 131-139. https://doi.org/10.1186/s40337-021-00461-1
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