Dialectical Behavior Therapy (DBT)

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Dialectical Behavior Therapy (DBT)

Evidence Status: Well-established evidence

Medically reviewed · Dr. Sarah Whitfield, PsyD · Sunday, 16 August 2026

A structured therapy combining cognitive behavioral techniques with mindfulness and acceptance strategies to help manage intense emotions and reduce self-destructive behavior.

What Is Dialectical Behavior Therapy (DBT)?

Dialectical behavior therapy (DBT) is a structured, skills-based psychotherapy originally developed for chronic suicidality and borderline personality disorder. It combines standard cognitive behavioral techniques with concepts of mindfulness, acceptance, and distress tolerance, balancing the goals of accepting oneself as one is while working toward meaningful change.

How It Works

DBT is grounded in a model that views intense emotional reactivity as arising from a combination of biological sensitivity and an invalidating environment. Treatment typically combines individual therapy with group skills training covering four core skill areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. This overview uses original explanatory language rather than reproducing any specific treatment manual.

What Happens During Therapy?

Full DBT programs typically include weekly individual therapy, a weekly skills training group, and between-session phone coaching for skills generalization. Individual sessions often begin by reviewing a diary card tracking urges, emotions, and behaviors since the last session. Homework practicing specific skills between sessions is a core component. Program structure can vary depending on setting and available resources.

Evidence and Effectiveness

Research supports the use of DBT for borderline personality disorder, with strong evidence for reducing self-harm and suicidal behavior. Evidence also supports adapted forms of DBT for some eating disorders and emotion dysregulation more broadly. Research on DBT for other conditions, such as substance use disorders, is more limited and continues to develop.

Who May Benefit?

DBT may be considered as part of an individualized treatment plan for people experiencing intense emotional dysregulation, self-harm, chronic suicidal thoughts, or borderline personality disorder, particularly when a structured, skills-focused approach is appropriate.

Limitations and Considerations

Full DBT programs require a significant time commitment, often including both individual and group sessions weekly, which may not be accessible or feasible for everyone. Availability of comprehensive DBT programs varies by region, and program fidelity to the full model differs between providers.

Finding a Qualified Therapist

DBT is delivered by psychologists, licensed clinical social workers, licensed mental health counselors, and other mental health professionals who have received specialized DBT training. Given the specialized skill set required, it may be helpful to ask about a provider’s specific DBT training and whether they offer the full model or an adapted version.

How Long Does Therapy Take?

Standard DBT programs are often structured around a defined course, commonly cited as approximately one year in research settings, but treatment length varies according to the person, severity, goals, clinician, and treatment setting.

Therapy vs. Medication

DBT is a psychotherapy and does not replace medication management for co-occurring conditions such as depression or bipolar disorder. Combined treatment involving both DBT and medication is common in clinical practice; decisions about medication should be made with a qualified prescribing healthcare professional.

What Conditions Is It Used For?

Borderline Personality Disorder

A personality disorder marked by a pattern of instability in relationships, self-image, and emotions, along with impulsivity.

Non-Suicidal Self-Injury

A condition involving deliberate, self-inflicted damage to body tissue without suicidal intent, often used as a way to cope with intense emotional distress.

Bulimia Nervosa

An eating disorder involving recurrent episodes of binge eating followed by compensatory behaviors such as self-induced vomiting or excessive exercise.

Binge-Eating Disorder

An eating disorder involving recurrent episodes of eating unusually large amounts of food with a sense of loss of control, without regular compensatory behaviors.

Related Therapy Types

Cognitive Behavioral Therapy (CBT)

A structured, time-limited psychotherapy that helps people identify and change unhelpful thought patterns and behaviors that contribute to emotional distress.

Mentalization-Based Treatment (MBT)

A structured therapy that helps people improve their capacity to understand their own and others’ mental states, commonly used for borderline personality disorder.

Transference-Focused Psychotherapy (TFP)

A structured psychodynamic therapy for personality disorders that uses the therapeutic relationship itself as a central tool for understanding and changing relational patterns.

Schema Therapy

An integrative therapy that identifies and addresses deep-rooted, self-defeating patterns (schemas) formed in childhood, often used for chronic and personality-level difficulties.

Medical Information Disclaimer

Ratel Health provides general educational information and does not provide medical diagnosis, treatment, or individualized medical advice. Information on this page is not a substitute for evaluation or care from a qualified healthcare professional. Do not use this information to diagnose yourself or another person, or to start, stop, or change treatment or medication without consulting an appropriately qualified healthcare professional.

References

  • American Psychological Association. Clinical Practice Guidelines.
  • American Psychiatric Association. Practice Guidelines.
  • National Institute of Mental Health. Psychotherapies.