Dialectical Behavioural Therapy (DBT): What Is It?

Dialectical Behavioural Therapy (DBT) is a structured, evidence-based psychotherapy designed for people who experience intense emotions, rapid mood shifts, impulsive behaviors, or chronic difficulties in relationships. While it was originally developed to treat individuals with borderline personality disorder (BPD) and high suicide risk, DBT has since become one of the most widely researched and respected treatments for emotion dysregulation across a range of mental health conditions.

Many people first hear about DBT after struggling for years with anxiety, depression, or emotional overwhelm that doesn’t seem to improve with standard approaches. Others are introduced to DBT by a psychiatric provider after repeated crises, self-harm behaviors, or hospitalizations. Understanding what DBT actually involves can make the treatment process feel less intimidating and more empowering.

Understanding The Core Idea Behind DBT

DBT is rooted in a biosocial model, which helps explain why some individuals experience emotions more intensely and for longer periods of time. According to this model, emotional dysregulation develops from the interaction between biological sensitivity (a nervous system that reacts quickly and strongly) and environmental factors, such as chronic invalidation or lack of emotional support [2].

From this perspective, behaviors like self-harm, suicidal thoughts, or emotional outbursts are not viewed as “attention-seeking” or manipulative. Instead, DBT frames them as learned coping strategies – often the only strategies available at the time – for managing overwhelming emotional pain. The goal of treatment is not judgment or punishment, but skill-building.

The term dialectical refers to DBT’s central balance: acceptance and change. DBT teaches people how to fully acknowledge and accept their emotional experiences while also learning practical ways to change patterns that cause suffering. This balance is what makes DBT distinct from many other forms of cognitive-behavioral therapy [3].

What DBT Actually Looks Like in Practice

Unlike brief or loosely structured therapies, DBT is intentionally comprehensive. Standard DBT typically includes four coordinated components that work together to support behavior change and emotional stability [3].

Patients usually participate in weekly individual therapy sessions focused on applying DBT skills to real-life situations. Alongside this, most programs include group skills training, where DBT skills are taught in a structured, classroom-style format. These groups are not process groups; they are focused on learning and practicing specific tools.

Behind the scenes, DBT therapists participate in consultation teams to maintain fidelity to the model and reduce provider burnout. Many DBT programs also offer between-session coaching, allowing patients to receive brief guidance when they are struggling to use skills during emotionally intense moments.

While not every individual receives all components, research consistently shows that comprehensive DBT leads to the strongest outcomes for people at high risk [3].

The Skills At The Heart Of DBT

DBT is fundamentally a skills-based therapy. Rather than focusing only on insight or past experiences, it emphasizes learning practical tools that can be used in daily life. These skills are organized into four core areas [2]. 

1. Mindfulness skills form the foundation of DBT. Patients learn how to observe thoughts, emotions, and physical sensations without immediately reacting to them. Over time, mindfulness helps improve emotional awareness, reduce impulsive responses, and create a sense of stability during distress.
2. Distress tolerance skills are designed for moments of crisis. These tools focus on getting through intense emotional pain without making the situation worse. Skills may include grounding techniques, self-soothing strategies, and radical acceptance.
3. Emotion regulation skills help individuals better understand what they are feeling and why. Patients learn how sleep, nutrition, stress, and thought patterns influence emotional vulnerability, and how to increase positive emotional experiences over time.
4. Interpersonal effectiveness skills focus on communication and relationships. These tools help people ask for what they need, say no when appropriate, and navigate conflict while maintaining self-respect and important relationships.

Together, these skills aim to reduce emotional chaos and support long-term mental wellness.

Who Benefits Most From DBT?

DBT is considered a first-line psychotherapy for borderline personality disorder, supported by multiple randomized controlled trials and meta-analyses [1,3]. Studies consistently show that DBT reduces suicide attempts, self-harm behaviors, emergency department visits, and overall symptom severity in adults with BPD.

Importantly, DBT’s usefulness extends well beyond BPD. Research supports its effectiveness for individuals experiencing chronic suicidal ideation, posttraumatic stress disorder, eating disorders, substance use disorders, and severe mood instability [5].

DBT has also been adapted for adolescents (DBT-A), with changes such as shorter treatment duration, simplified language, and family involvement. Clinical trials demonstrate that DBT-A significantly reduces suicidal thoughts and depressive symptoms in high-risk youth [4,6].

What Research Shows

DBT is one of the most extensively studied psychotherapies for high-risk populations. A 2023 review in JAMA identified DBT as one of the most effective treatments for borderline personality disorder, with moderate to large effects on symptom improvement [1].

A landmark randomized clinical trial published in JAMA Psychiatry found that individuals receiving DBT had significantly fewer suicide attempts and self-harm behaviors compared with those receiving control treatments [3]. Meta-analyses further show that structured psychotherapies like DBT lead to meaningful reductions in BPD symptom severity compared with usual care [1].

More recent clinical reviews highlight DBT’s flexibility across treatment settings, including outpatient programs and integrated psychiatric care models that combine therapy with medication management [5].

How DBT And Psychiatry Work Together

While DBT is a form of psychotherapy, many people who benefit from DBT also require psychiatric care. Conditions such as major depression, anxiety disorders, bipolar disorder, or ADHD frequently co-occur with emotion dysregulation and may worsen symptoms if left untreated.

A psychiatric provider can evaluate for underlying conditions, prescribe and monitor medications, and collaborate with a DBT therapist to support comprehensive care. Medication does not replace DBT skills, but it can reduce symptom intensity and make it easier to engage fully in therapy.

Practices like Remedy Psychiatry specialize in psychiatric evaluation and medication management delivered via secure telepsychiatry. Its providers often work alongside therapists in the community to support coordinated mental health care. More information about this approach is available through Remedy’s treatment services and FAQs.

What To Expect If You Are Considering DBT

DBT is often described as challenging but highly practical. Treatment commonly lasts six to twelve months, and progress tends to occur gradually rather than all at once. Patients are expected to practice skills outside of sessions and apply them during real-world stressors.

For busy professionals or parents, combining DBT with telepsychiatry-based medication management can reduce barriers to care while still addressing complex mental health needs. Many people find that this integrated approach supports long-term stability more effectively than either therapy or medication alone.

When It May Be Time To Seek Help

You may benefit from professional evaluation if you or someone you care about is experiencing ongoing suicidal thoughts, self-harm behaviors, intense emotional swings, or repeated mental health crises. Persistent anxiety or depression that does not improve with self-help strategies is another common reason to seek care.

Early assessment by a psychiatric provider can clarify whether DBT, medication, or a combination of treatments may be helpful.

Disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice. Treatment decisions should be made in consultation with a qualified psychiatric provider or licensed mental health professional.