Dialectical Behaviour Therapy (DBT) is an evidence-based psychotherapy that builds on principles of Cognitive Behavioural Therapy (CBT) while incorporating mindfulness, acceptance, and behavioural change strategies. It focuses on developing skills for managing intense emotions, tolerating distress, strengthening relationships, and responding more effectively in difficult situations.
DBT is used to treat a range of mental health concerns and may be recommended for people experiencing difficulties with emotion regulation, relationships, or coping with distress. It has a strong evidence base and has been adapted for use across a variety of treatment settings and mental health concerns.
In this article, we'll explain the core principles of DBT, the four key skills it teaches, what to expect in therapy, and who may benefit from this approach.
The Core Principles of DBT
DBT was developed by psychologist Dr. Marsha Linehan as a treatment for people living with Borderline Personality Disorder (BPD), a condition often associated with significant challenges in managing intense emotions. Since then, it has been adapted and studied for a broader range of mental health concerns while remaining grounded in its core principles of acceptance, behaviour change, and dialectical thinking.
The "D" in DBT stands for Dialectical. In DBT, dialectical thinking involves holding two seemingly opposite ideas at the same time, rather than viewing situations in all-or-nothing terms. This often means balancing acceptance and change. For example, you can accept an emotion while also choosing how you want to respond to it. Similarly, you can understand why someone behaved a certain way while also recognizing that their behaviour was hurtful or unacceptable.
This balance between acceptance and change is one of the defining features of DBT. Therapists work collaboratively with clients to validate their experiences while also supporting changes that align with their goals and values.
The "B" in DBT stands for Behavioural, reflecting the therapy's focus on understanding patterns of thoughts, emotions, and behaviours. Together, therapist and client explore what tends to trigger these patterns, what keeps them going, and where new skills or behaviours may create opportunities for change.
Understanding the DBT Treatment Options
Comprehensive DBT is the original treatment model developed by Dr. Marsha Linehan. It is typically delivered over the course of about one year and includes four components: individual therapy, DBT skills training, phone coaching, and a therapist consultation team. Much of the early research on DBT focused on this comprehensive model, particularly for people living with Borderline Personality Disorder (BPD).
Many therapists also incorporate DBT skills and principles into individual therapy, an approach commonly described as DBT-informed therapy. Depending on a person's goals, needs, and the level of support they’re looking for, either comprehensive DBT or DBT-informed therapy may be appropriate.
Research suggests that DBT skills can improve emotion regulation and support people in navigating emotionally challenging situations more effectively (1). These skills may be learned through either treatment approach.
Regardless of the treatment format, a central part of DBT is learning and practising new skills. During times of intense emotional distress, people often rely on strategies that provide short-term relief, such as avoidance, aggression, substance use, or self-injury, even though these behaviours may create longer-term difficulties. The goal of DBT is to replace these patterns with skills that can be used during emotionally difficult moments and in everyday life.
The Four Core Skills of DBT
DBT teaches skills across four core areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Research suggests that learning and using these skills may help explain improvements associated with DBT, including reductions in suicidality, non-suicidal self-injury, depression, anger, difficulties with emotion regulation, and anxiety (2,3). Together, these four skill areas form the foundation of DBT and are practised both in therapy and in everyday life.
1. Mindfulness
Mindfulness skills strengthen the ability to observe and describe thoughts, emotions, physical sensations, and experiences without judgment. Although mindfulness may feel calming for some people, in DBT its primary purpose is to strengthen awareness of present-moment experiences. Greater awareness makes it easier to respond intentionally rather than reacting automatically.
For example, during an emotionally charged situation, mindfulness might involve pausing to notice thoughts, emotions, and urges before deciding how to respond.
2. Distress Tolerance
Distress tolerance skills focus on getting through overwhelming situations without making them worse. Rather than trying to eliminate emotional pain, these skills emphasize accepting difficult realities as they are and tolerating distress without relying on behaviours that may provide short-term relief but create longer-term difficulties.
3. Emotion Regulation
Emotion regulation skills build the ability to understand, name, and respond to emotions. They also focus on reducing emotional vulnerability, making intense emotions easier to navigate, and increasing positive emotional experiences over time. These skills support people in responding to emotions in ways that align with their goals and values.
4. Interpersonal Effectiveness
Interpersonal effectiveness skills are designed to strengthen communication, support healthy boundaries, and balance relationships with self-respect. They support people in expressing their needs, navigating conflict, and saying no when appropriate without unnecessarily damaging important relationships.
For example, someone might use interpersonal effectiveness skills to communicate a boundary clearly and respectfully, while preserving an important relationship and maintaining their self-respect.
The Four Core Skills of DBT
Illustration of the four core skills of Dialectical Behaviour Therapy (DBT): mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
What to Expect in a DBT Session
DBT is an active, collaborative form of therapy. Sessions often include reviewing situations that came up during the week, identifying patterns in thoughts, emotions, and behaviours, and practising skills that can be applied outside of therapy.
Depending on the treatment format, therapists may also provide coaching, encourage skills practice between sessions, and help clients apply DBT skills to real-life situations.
What Concerns Can DBT Help Address?
DBT has been studied for a range of mental health concerns. Depending on a person's needs and the treatment setting, it may be used to support people experiencing:
- Borderline Personality Disorder (BPD)
- Anxiety disorders
- Depression
- Eating disorders
- Substance use disorders
- Post-traumatic stress disorder (PTSD)
- Difficulties managing intense emotions, including self-harm and suicidality
The specific approach may differ depending on the concern being addressed and whether someone is receiving comprehensive DBT or DBT-informed therapy (1).
Who Can Benefit from DBT?
DBT may be a good fit if you're looking for a structured, skills-based approach to therapy and want to strengthen your ability to regulate emotions, tolerate distress, navigate relationships, or respond more intentionally during challenging situations. The focus is on learning and practising skills that can be applied outside of therapy, alongside exploring thoughts and emotions.
If you're considering DBT, speaking with a therapist trained in the model can help determine whether it aligns with your goals, preferences, and therapeutic needs.
Finding the Right Support
If you need immediate support, please explore our crisis and community resources.
If you're interested in connecting with a therapist, our Care Team is happy to help. You can email us at contact@layla.care with any questions or complete our intake form to get started. We'll work with you to understand your needs and connect you with a therapist whose training, experience, and therapeutic approach align with your goals.
Disclaimer: The information in this article is intended for educational purposes only and should not be considered medical or mental health advice, diagnosis, or treatment. If you have questions about your mental health or which type of therapy may be right for you, please consult a qualified healthcare professional.
DBT Community Resources and Groups
If you are looking for DBT community resources near you, we’ve compiled a list of a few resources that you can explore here.
Sources:
- Jennifer Urbano Blackford and Rene Love. (2012). Dialectical Behavior Therapy Group Skills Training in a Community Mental Health Setting: A Pilot Study. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191933/
- Andrada D Neacsiu, et. all. (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. National Library of Medicine. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20579633;
- Andrada D Neacsiu, et. all. (2014). Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: a pilot randomized controlled trial. National Library of Medicine. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24974307
- Seth R Axelrod, et. all. (2010). Emotion regulation and substance use frequency in women with substance dependence and borderline personality disorder receiving dialectical behavior therapy. National Library of Medicine. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21091162
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