What Is DBT? Understanding Dialectical Behaviour Therapy and Its Benefits

When emotions feel overwhelming and behaviors seem out of your control, DBT offers concrete skills to help. This structured, skills-based therapy teaches you to notice what you are feeling, tolerate distress without making things worse, regulate emotions, and communicate effectively, all while building acceptance and change simultaneously.

Dialectical Behaviour Therapy (DBT) was created by Marsha Linehan in the 1970s after her own struggles with mental health. DBT was designed for people who did not necessarily find support and relief with standardized Cognitive Behavioural Therapy (CBT). It offers an alternative approach emphasizing acceptance and change working together.

DBT uses the foundational knowledge of biosocial theory, essentially that our biology and our environment interact with each other. Just like someone may be biologically vulnerable to certain allergies triggered by their environment, we can apply this concept to our emotions. Some people are more emotionally sensitive by nature, and certain environments can intensify that sensitivity.

A key concept within DBT is that if we want to work on changing our emotions or thoughts, we first have to practice noticing them with mindfulness. You cannot regulate what you are not aware of. This focus on awareness before change distinguishes DBT from approaches that jump straight to behavior modification.

Learn more about Marsha Linehan and DBT development.

DBT has five core skill-building components: mindfulness, distress tolerance, emotional regulation, interpersonal effectiveness, and walking the middle path. Each skill set addresses different challenges you might face.

Mindfulness

The foundation of all DBT skills. Mindfulness involves practicing noticing what you are feeling and thinking without judgment. It is about being present with your experience rather than automatically reacting to it. Through mindfulness, you create space between stimulus and response, the pause where choice lives.

Distress Tolerance

Struggling with acting impulsively? Distress tolerance skills help you build a bit of space before reacting. These are crisis survival skills, ways to get through overwhelming moments without making the situation worse. Think of these as your emergency toolkit for when emotions spike and you need to ride out the wave without doing something you will regret.

Emotional Regulation

Struggling with day-to-day mood management? Emotional regulation skills help you work with emotions regularly rather than only in times of crisis. These skills help you understand what you are feeling, why you are feeling it, and how to either change the emotion or cope with it more effectively. This is about ongoing emotional fitness, not just emergency response.

Interpersonal Effectiveness

Not knowing what to ask for or how to say it? Interpersonal effectiveness skills teach you how to communicate needs, set boundaries, and maintain relationships while maintaining self-respect. These skills help you be effective in getting what you want while preserving relationships and your sense of self.

Walking the Middle Path

Struggling with ongoing conflict with family or other people? Walking the Middle Path skills address finding compromise and balance. This module is particularly helpful for families, teaching dialectical thinking, holding two seemingly opposite things as true simultaneously. For example: You are doing the best you can and you need to try harder. Both can be true.

DBT is for individuals who struggle with harmful behaviors affecting their life. This can include self-harm, avoidance, anger outbursts, or other behaviors that create problems even though they might temporarily relieve distress.

DBT helps with anxiety, mood instability, self-criticism, and relationship struggles. If you find yourself doing things you do not want to do, saying things you do not mean, or feeling controlled by your emotions, DBT provides concrete skills to change these patterns.

The therapy is particularly effective when emotions feel overwhelming, when you go from zero to sixty quickly, when you struggle to calm down once upset, or when your emotional reactions do not match the situation. DBT teaches you to work with emotional intensity rather than being controlled by it.

While DBT was originally developed for borderline personality disorder, research now supports its use for a wide range of concerns including eating disorders, substance use, depression, anxiety, and PTSD. The skills are universally applicable to anyone wanting better emotional regulation and more effective behaviors.

DBT sessions are talk therapy-based, similar to other behavioral therapies. Typically, sessions start with some sort of mindfulness practice, a brief exercise to help you get present and grounded before diving into the work.

Then you discuss building skills in the areas where you are struggling. This might involve worksheets or homework, especially if tracking and practicing skills between sessions helps you remember to use them. The homework is not busywork. It is about building new neural pathways through repetition and practice.

If working with a young person under the age of 18, caregiver involvement in sessions is recommended. This creates connection and allows skill-building to happen within the relationship, not just individually. When families learn DBT skills together, they develop a common language for managing conflict and supporting each other.

Fair warning: DBT does have a tendency to be a bit wordy and uses a lot of acronyms. PLEASE (for checking the facts), DEAR MAN (for interpersonal effectiveness), TIPP (for crisis survival), the list goes on. It can feel overwhelming at first, but these acronyms serve as memory aids once you learn them. And you do not need to learn everything at once.

The structured, skills-based nature of DBT means you know what you are working on. Unlike some therapies that can feel amorphous, DBT provides clear frameworks and specific techniques to practice. This clarity appeals to many people who want concrete tools, not just insight.

What does DBT stand for?

DBT stands for Dialectical Behaviour Therapy, created by Marsha Linehan in the 1970s. It was designed for people who did not find relief with standard Cognitive Behavioural Therapy (CBT), using mindfulness and skills-based approaches to work with emotions and behaviors.

What are the core DBT skills?

DBT has five core skill-building components: mindfulness (noticing thoughts and feelings), distress tolerance (managing impulses and crises), emotional regulation (working with emotions day to day), interpersonal effectiveness (communication and boundaries), and walking the middle path (finding compromise and balance).

Who can benefit from DBT?

DBT helps individuals struggling with harmful behaviors affecting their life, self-harm, avoidance, anger outbursts, anxiety, mood instability, self-criticism, and relationship difficulties. It is particularly effective when emotions feel overwhelming or when behaviors seem out of control.

What happens in a DBT session?

DBT sessions are talk therapy-based. Typically sessions start with mindfulness practice, then focus on building skills in areas where you are struggling. This may involve worksheets or homework to help practice skills between sessions. For those under 18, caregiver involvement is recommended.

Is DBT different from CBT?

Yes. While both are evidence-based therapies, DBT was specifically created for people who did not respond to standard CBT. DBT emphasizes mindfulness, acceptance, and emotion regulation alongside behavior change, using a biosocial model that considers both biology and environment.

DBT offers concrete, learnable skills for working with overwhelming emotions and changing harmful behaviors. Through mindfulness, distress tolerance, emotional regulation, interpersonal effectiveness, and dialectical thinking, you can build a more balanced relationship with your emotions and develop more effective ways of responding to life's challenges.

The skills might seem wordy at first, but they work. With practice, they become second nature, tools you can reach for whenever you need them.