DBT explained: what it is and who it helps

“Dialectical” means bringing opposites together. In DBT, the big pair is acceptance and change. It helps people step out of all-or-nothing positions and find a middle path.

Examples of a “both/and” thought

• “I am doing the best I can, AND I can learn new ways to cope.”
• “I feel furious, AND I care about this friendship.”
• “This is really hard, AND I can get through the next ten minutes.”

The behavioural side of DBT means looking carefully at situations and the actions you want to change, then practising new skills to replace them.

Many people track their feelings, urges and actions on a daily diary card. It helps you and your therapist spot patterns without guessing.

DBT adds acceptance strategies such as validation to the change tools of CBT. Validation means recognising that your emotions are real and understandable. Too much focus on change alone can leave people feeling misunderstood.

One of DBT’s core assumptions is that people are doing the best they can, and still need to learn new ways of coping.

The NHS explains DBT’s starting idea: some people are especially emotionally sensitive, and if they grew up with their emotions dismissed, they can get caught in a cycle of intense feelings and guilt. DBT aims to break that cycle.

Many unhelpful behaviours can be understood as attempts to cope with overwhelming emotions. DBT aims to replace them with healthier ways of coping.

DBT was developed in the 1970s by Marsha Linehan, an American psychologist. It grew out of CBT.

It was first built to help people with borderline personality disorder who lived with ongoing suicidal thoughts and actions, a group many therapies had struggled to help.

Behavioral Tech, a training company founded by Marsha Linehan, teaches DBT to clinicians and health systems. Its nonprofit partner, Behavioral Tech Institute (formerly the Linehan Institute), was founded in 1997.

The DBT-Linehan Board of Certification is an independent nonprofit, co-founded by Marsha Linehan, that certifies individual clinicians and DBT programs. It keeps a public, searchable list of who is certified.

Researchers describe DBT today as “transdiagnostic” and modular, meaning its parts can be used across different conditions. Shorter, skills-only versions have been developed for particular groups and settings.

Individual sessions are usually weekly and last about 40 to 60 minutes. You bring your diary card, and together you look at what happened that week.

What sessions focus on, in order of priority

• First, anything that threatens your life or safety
• Next, anything getting in the way of therapy itself, like missed sessions
• Then, problems blocking a better quality of life
• All the way through: building skills to replace what isn’t working

Skills are usually taught in a weekly group. It is run like a classroom: you learn a skill, practise it, and get homework to try during the week. You are not expected to share painful personal stories with the group.

The full skills curriculum runs about 24 weeks. Shorter schedules covering some of the skills exist for particular groups.

Between sessions, you may be able to contact your therapist during agreed hours for quick coaching on using a skill in a hard moment. These calls are short and don’t replace sessions.

DBT therapists meet regularly in a consultation team. It helps them stay true to the treatment, keep building their skills and stay motivated. It’s a fair question to ask a provider: “Are you part of a DBT consultation team?”

Mindfulness is the base for every other DBT skill. It includes finding your “wise mind”, where feeling and reason meet.

These skills help you tolerate pain in hard situations rather than trying to fix everything at once. They include STOP, TIPP, healthy distraction and radical acceptance.

These skills help you lower your vulnerability to painful emotions and change emotions you want to change. They include naming emotions, checking the facts, opposite action and caring for your body.

These skills help you ask for what you need, say no and set boundaries, while keeping respect for yourself and others. The best known are DEAR MAN, GIVE and FAST.

In a 2018 NIMH-funded trial with teens aged 12 to 18, DBT included one-to-one therapy, skills groups that families attended together, phone coaching for both teens and parents, and a weekly therapist team.

DBT is more likely to work if you

• Are committed to making changes
• Are open to learning in a group setting
• Are ready to do homework between sessions
• Want to focus mostly on the present and future, more than the past

DBT isn’t for everyone. If it doesn’t feel right now, that doesn’t mean you have failed. There are other good therapies, and you can come back to DBT later.

Researchers at the University of Washington, where DBT was developed, describe increasing evidence that skills training alone can be helpful for people with and without a mental health condition.

Learning skills from a guide is a good start. It is not the same as full DBT, which includes a trained therapist and coaching.

Studies have found that, compared with other treatments, DBT reduced self-injury, suicidal thoughts, hospital stays, hopelessness, depression, anger and impulsive behaviour in people with BPD.

The NHS says DBT has been particularly effective for women with BPD who have a history of self-harm, and that NICE recommends it as the first treatment for them to try.

A 2020 Cochrane review looked at 75 trials of talk therapies for BPD. Compared with usual care, DBT came out ahead for symptom severity, self-harm and daily functioning.

The authors rated all of these findings as low-quality evidence and said the results could change as more studies are done. This is common in therapy research, and it’s honest to say so.

In the 2018 NIMH-funded trial, teens in DBT were significantly less likely to self-harm by the end of six months of treatment than teens in a comparison therapy. They also attended more sessions and were more likely to finish.

By 12 months, self-harm had dropped in both groups. DBT was still lower, but the gap was no longer big enough to be statistically sure.

A 2015 trial with 99 women compared full DBT, skills training with case management, and one-to-one DBT without skills training. All three improved suicide-related outcomes. The versions that included skills training did better on self-harm and depression, and full DBT had half the dropout of the version without skills (24% vs 48%).

DBT is also used for substance use, depression, PTSD and eating disorders, with promising results. Many studies are small, and most early research was with women, so we know less about how well it works for everyone.

• Each day: fill in a short diary card about emotions, urges and skills used
• Once a week: one-to-one session, guided by your diary card
• Once a week: skills group with homework
• In between: brief coaching contact in hard moments, if your program offers it

DBT asks a lot: weekly sessions, a group, homework and months of commitment. Feeling nervous about the group or tired of diary cards is normal. Say so in session. Problems with therapy itself are something DBT expects to work on with you.

Try saying

• “I’m interested in DBT, but I’m nervous about being in a group. What is the group like?”
• “I work shifts. Is there an evening or online group?”
• “What happens if I miss a week or struggle with homework?”

You don’t need to say

• A full life story on the first call
• Anything you are not ready to share yet
• That you are “sure” DBT will work

The DBT-Linehan Board of Certification (dbt-lbc.org) has free search tools for certified clinicians and certified programs. You can search by name, country, state, city or zip code.

Certification shows a clinician or program has been assessed on delivering DBT as it was researched. Many skilled DBT therapists are not certified, so it is one helpful sign, not the only one.

Behavioral Tech lists teams where at least one member completed its comprehensive DBT training. Listing is voluntary, and the directory says it is a resource, not an endorsement. That training is not the same as certification.

• Ask your health care provider or another professional you trust
• Call your insurance company and ask for “DBT” providers or programs
• Contact a local psychological or psychiatric association
• Contact a local NAMI chapter
• Try university psychology or psychiatry departments, which sometimes run lower-cost clinics
• Use FindTreatment.gov, SAMHSA’s treatment locator

Comprehensive DBT includes all four parts. Some services offer a modified version, such as a skills group only, or therapy that borrows DBT skills. These can still help. Ask whether a program is comprehensive or modified, and why that fits you.

• Are you a licensed mental health professional?
• Are you part of a DBT consultation team?
• Do you offer comprehensive DBT or a modified version? Why?
• How long is the program, and how often do we meet?
• What is your policy on phone or text coaching between sessions?
• What DBT training have you had?

• Ask about sliding-scale fees and training clinics if cost is a barrier
• Ask if the group and the one-to-one sessions are billed separately
• Ask your insurer whether both individual and group therapy are covered, and how many sessions
• Check whether coaching calls have any extra cost
• Online DBT groups may widen your options if there is nothing nearby

• “It makes sense that you felt that way.”
• “I noticed you used a skill. That took effort.”
• “Do you want me to listen, or help you think of a skill?”
• “I’m proud of you for going, even on hard weeks.”

• “Shouldn’t you be fixed by now?”
• “Just use your skills.” (said in the heat of the moment)
• “You’re overreacting.”
• Reading their diary card or homework without asking

Reading the four DBT skills guides helps you understand terms like “wise mind” or “TIPP”. Some programs offer family skills groups. For loved ones of someone with BPD, see Loving someone with BPD.

If you are thinking about suicide, are worried about someone, or are in emotional distress, call or text 988 or chat online. It is free, confidential and open 24 hours a day. If a life is in danger right now, call 911.

FindTreatment.gov is the U.S. government’s locator for mental health and substance use services. You can search for services near you.

In the UK, DBT is offered through the NHS, especially for people with BPD who self-harm; ask your GP. The DBT-Linehan Board of Certification directory can be searched by country. For free, confidential crisis support worldwide, Find A Helpline lists helplines in 175+ countries.