Dialectical Behaviour Therapy (DBT) is a type of talking therapy based on Cognitive Behavioural Therapy (CBT). It’s used to help people manage intense emotions, reduce self-destructive behaviours and improve relationships. Although originally developed for BPD, it is now used more widely to treat a range of mental health challenges, from ADHD to C-PTSD.
Through a DBT course, you will start to understand your complex feelings, learn skills to manage them in daily life and even make positive changes.
Below, we’ll go into more depth about what DBT stands for, the four main areas it covers, how it works and whether it is the right therapy for you.
DBT stands for Dialectical Behaviour Therapy.
But what does “dialectical” mean?
‘Dialectical’ simply means balancing two opposite ideas and understanding how both can be true at the same time. This often means learning to accept yourself as you are while also trying to change yourself for the better.
An example of this could be saying “I’m doing my best” while also saying “I need to do better.” Instead of forcing yourself to choose one over the other, DBT encourages people to say both at the same time.
Another example could be a friend cancelling plans last minute. You might feel angry and also understand their reason. A ‘dialectical’ view means you can feel both emotions without getting stuck.
DBT is a behavioural therapy just like the better-known CBT. This means it focuses on helping you understand your behaviours so you can change the problematic ones and make improvements to your life.
While this can include talking through your problems and thought patterns, the most important part is learning the practical skills that will help you respond differently to various obstacles in everyday life. These skills help you choose different ways of responding to situations, ultimately giving you more control over your life.
For example, if you have a short temper and tend to lash out quickly when overwhelmed, DBT teaches you skills to tolerate distress and regulate your emotions more effectively. Alternatively, if you find it difficult to maintain positive relationships, DBT teaches skills to help you communicate more clearly and effectively, able to set boundaries without ending in an argument.
You can’t wave a magic wand and fix all your problems after just one session, though. Like all skills, whether it’s learning to ride a bike or speak a new language, you need practice to master them so you can use them in your everyday life.
The main goal of DBT is to give you the tools you need to avoid the unhealthy behaviours you might rely on, and instead use DBT skills to replace them with more positive ones that give you more confidence, stability and control over your life.
DBT was developed in the 1980s by Dr Linehan to treat people with Borderline Personality Disorder, especially those who struggled with self-harm and thoughts of suicide. In 1991, a randomised controlled trial proved that DBT significantly reduced parasuicidal behaviours and hospitalisations when compared to standard treatments. A subsequent two-year follow-up study further confirmed DBT’s effectiveness, showing it halved the likelihood of suicide attempts.
Since then, it has expanded to help people with all sorts of conditions. While DBT can treat a wide range of issues, it won’t benefit everyone, and it’s important to be aware of what conditions DBT does treat.
DBT helps people with:
Therapy isn’t a one-size-fits-all approach, though. So although DBT has been effective for many people struggling with these problems, it isn’t guaranteed to help everyone. Nevertheless, as more people discover the wide-ranging benefits of DBT, it’s becoming increasingly popular with the NHS and private therapy.
DBT is a therapy that teaches you four types of skills to improve your life: mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. By mastering skills in these four areas, you have a better chance of managing the thoughts and emotions that tend to overwhelm you, especially if you suffer from something like BPD or ADHD.
Mindfulness is all about being aware of your surroundings, grounded in the present moment and prevented from spiralling.
We all lead hectic lives these days. From the moment we wake up to the moment our heads finally hit the pillow, we have countless countless tasks to deal with – getting through work, cooking dinner, doing chores, replying to messages, looking after the kids… Even things we enjoy each evening take a lot of brainpower, whether it’s settling down with a good book, new TV show or a favourite video game.
With so much going on, it’s not surprising that our minds aren’t focused on the present. We don’t take time to admire the outdoors, savour our breakfast or appreciate how well we might be feeling. We’re too busy figuring out how to get through an endless to-do list!
Like meditation, mindfulness calms your mind and lets you focus on the present moment, without stressful thoughts interfering and causing anxiety. You learn to observe your thoughts and feelings from a distance without fear of judgement to break the cycle of negative thought patterns.
Over time, mastering these skills will help you manage your emotions more effectively, cope with stress more easily and improve your relationships.
Mindfulness is taught using a range of exercises, such as Thought Defusion, Mindful Breathing, Wise Mind and Letting Go of Judgements.
Distress Tolerance is all about coping with intense, distressing emotions without making the situation worse.
Life can get pretty overwhelming sometimes. We all get days where there’s too much to do – everything seems to be competing for your attention at once, emotions run high, and it can feel impossible to think clearly without snapping!
Or sometimes, all it takes is just one single event to ruin everything… A heated argument with a friend, a break-up, losing your job, or just an unexpected tragedy that knocks you sideways.
Reacting to these things in the heat of the moment will usually only make things worse. Snapping at a partner, quitting your job in anger, or resorting to harmful habits for a brief escape can all create far worse problems later down the line.
Of course, you’re not thinking about those future problems. You’re thinking about the here-and-now. That’s where Distress Tolerance comes in. Instead of running from those feelings of distressing or overreacting to them, Distress Tolerance teaches you to sit with your emotions and regain control so you can make better choices you don’t regret.
Distress Tolerance skills give you the tools you need to ride out those emotional storms safely. It teaches you how to calm your body, soothe your mind, and find the best way to help you tolerate distress until those feelings pass – because they will pass. These skills are particularly useful during any crisis where fixing the problem straight away isn’t possible, but surviving it is.
DBT guides you to master practical ways to handle high-stress moments so you can stop yourself from behaving impulsively and recover faster from emotional setbacks.
Distress Tolerance is taught using a range of exercises, including TIPP (Temperature, Intense Exercise, Paced Breathing & Progressive Relaxation), Self-Soothe, Radical Acceptance and IMPROVE the Moment.
Emotion Regulation is all about understanding and managing your emotions in a healthy way to ensure they don’t take charge of you.
Emotions are powerful. They can influence your whole life, from how you think, behave and even connect with others. But they can also be unpredictable and overwhelming – one moment you’re absolutely fine, but the next you’re flooded with frustration or anxiety. When emotions become too intense or impossible to control, it might lead to impulsive actions, burnout or strained relationships.
Have you ever tried to push those emotions away or ignore them completely? That’s totally normal – but it usually backfires. Bottling up those feelings only makes them stronger and forces us into a cycle of guilt, anger or shame… unless we have skills to combat that.
Emotion Regulation teaches you how to recognise the emotions you’re experiencing, understand where they’re coming from, and respond to them in ways that actually help. These skills help you manage mood swings so you can think more clearly and stay in control. Over time, you’ll experience more emotional stability, confidence and even self-respect.
Emotion Regulation is taught through a range of DBT strategies, such as Opposite Action, Building Positive Experiences, Checking the Facts, and ABC PLEASE (Accumulate Positive Emotions, Build Mastery, Cope Ahead, and take care of Physical health, Eating, Avoid mood-altering substances, Sleep, and Exercise).
Interpersonal Effectiveness is all about learning how to communicate your needs more clearly, helping you to maintain healthy relationships and set boundaries.
We all have moments where we feel misunderstood or taken advantage of. It can feel difficult to speak up, and you might find yourself agreeing to things you don’t want to do just to avoid upsetting people, or even apologising for everything under the sun – even things that aren’t your fault! This can burn you out over time, leaving you resentful and feeling like your needs don’t matter.
Non-stop people pleasing, staying quiet during arguments, over-explaining to avoid conflict… It can all be exhausting. So imagine being able to express yourself calmly and confidently instead, knowing exactly how to handle disagreements without feeling guilty and ask for something without panicking. That’s what Interpersonal Effectiveness can do for you.
Interpersonal Effectiveness teaches you how to communicate assertively, listen carefully and maintain self-respect even during difficult conversations. These skills help you discover the balance between meeting your own needs and respecting others’, so your relationships become healthier and more genuine.
Interpersonal Effectiveness is taught through various DBT strategies, including DEAR MAN (Describe, Express, Assert, Reinforce, Mindful, Appear confident, Negotiate), GIVE (Gentle, Interested, Validate, Easy manner) and FAST (Fair, no Apologies, Stick to your values, Truthful).
DBT works by encouraging you to accept yourself and the challenges you face while also embracing positive change. Accepting your struggles as they are and embracing change might sound like opposite ideas, but it’s that “dialectical” balance of acceptance and change that makes DBT so powerful.
There are multiple ways to access DBT, but it is generally a therapy that teaches you new ways of thinking and behaving across individual sessions with a therapist, skills training in groups and exercises in between sessions. These will help you apply DBT tools in real life so you can understand yourself better, control impulsive reactions, and handle stressful situations more calmly for a more stable and fulfilling life.
A full DBT programme combines several key parts of DBT that are central to effective treatment. These include a pre-assessment, one-to-one therapy sessions, group skills training and sometimes crisis coaching via phone.
There are several places that offer DBT, but only a few providers like Online DBT and Dr Jo Gee Psychotherapy include a full DBT programme.
Before starting DBT, you’ll usually have an initial assessment to make sure that DBT is the right treatment for you and your needs. A therapist will talk through the programme with you, explaining how DBT works and helping you decide if it feels like the right approach. If you have any questions, this is the time to ask.
This assessment phase is also the therapist’s opportunity to truly understand your goals and everything you’d like to achieve with DBT, so make sure you are as open and honest as possible.
You will typically meet one-to-one with your DBT therapist once a week for around 50 minutes. These sessions are highly structured and focus on:
You’ll work with your therapist to understand any obstacles getting in the way of you making progress, whether it’s difficult relationships, low mood or impulsive behaviours, and develop new skills to respond to them.
Between sessions, your therapist will also assign you “homework.” Don’t worry – you’re not expected to write an essay each week. Instead, you’ll just need to track your emotions and behaviours so your therapist can monitor your growth over time.
It’s important to stress that group DBT sessions are not the same as group therapy. They’re very different. In DBT, group sessions aren’t about sharing personal stories like it is in some traditional group therapies.
Instead, they’re structured like a classroom, focused purely on learning and practicing skills from each of the four DBT pillars:
Each week focuses on specific exercises, examples and practical tips to help you master a range of DBT skills in everyday situations.
Some of the more premium DBT programmes also offer support on the phone between sessions, often called “phone coaching” or “crisis coaching.”
Although not a requirement for everyone, having this option means you can contact your therapist for brief guidance during any moments of crisis or uncertainty between sessions. For example, if you’re overwhelmed and unsure how to use a specific DBT skill in the moment, your therapist can help you apply it safely and effectively.
DBT is not a quick fix. It won’t fix all your problems after a couple of short sessions. It’s a structured therapy that takes time to create long-lasting change.
Most full DBT programmes last six to twelve months, with weekly individual and group sessions, but this will vary between providers.
The exact duration of DBT can vary for each person as well; some notice improvements in just a few months, while others have to keep at it for longer to really master the skills and maintain progress.
DBT can feel demanding at times, especially with a time commitment like this, but the long-term benefits make it worthwhile, helping clients with emotional control, maintaining healthy relationships and improving confidence.
It’s important to know the differences between standard DBT and DBT-informed therapy when looking for a provider to ensure you get the best treatment that works for you.
Standard DBT follows the full programme developed by Dr Marsha Linehan. This will include structured individual sessions, group skills training and possible phone coaching.
DBT-informed therapy is not the full programme, but instead includes certain DBT principles and skills into a regular therapy session. This will unlikely include every part of the full DBT programme. DBT-informed therapy is often offered by therapists who are trained in DBT techniques who adapt them for individual clients or shorter-term therapy.
DBT can benefit from a broad range of people, particularly those who experience intense emotions they struggle to control. It can help anyone who:
DBT must be delivered by a qualified therapist who has been DBT-trained in order to fully benefit, especially if you fit into the descriptors mentioned above. A good therapist will guide you through the process and adjust the pace to ensure you feel supported every step of the way.
If you’re considering DBT, it’s worth exploring providers that specialise in evidence-based treatments, such as Online DBT and Dr Jo Gee Psychotherapy, which offer the full DBT programme with individual and group sessions that are specifically designed to help clients apply DBT skills in real life.
DBT (Dialectical Behaviour Therapy) is a type of talking therapy that helps you manage difficult emotions, reduce impulsive behaviours and build better relationships. It combines self-acceptance with practical skills for long-lasting change.
DBT and CBT are both behavioural therapies, but while CBT focuses on changing unhelpful thoughts and behaviours, DBT adds acceptance as an extra layer. DBT has a more balanced and compassionate approach, teaching you to accept yourself and your feelings while still working towards positive change.
No, DBT isn’t only for BPD. Although DBT was first designed to treat Borderline Personality Disorder, new research has shown it to be effective for many other conditions, including ADHD, PTSD, OCD and bipolar disorder, as well as for those suffering from addictions, self-harm or suicidal thoughts, relationships difficulties, or autism-related emotional dysregulation.
You can learn a range of DBT skills on your own, using books, videos and online courses. However, the benefits of this are limited since the full DBT programme with a trained therapist is by far the most effective option. Having professional guidance from a therapist will ensure that the skills you learn are applied correctly and that you have the emotional support you need throughout each stage of the process.
The full DBT programme combines weekly one-to-one therapy sessions with skills training groups and some at-home practice. You’ll learn practical tools for mindfulness, distress tolerance, emotion regulation and interpersonal communication, all designed to help you feel more stable and in control.
If you’re considering DBT, you’re taking the first step on a path toward a brighter future. But here are a few practical tips that are worth bearing in mind:
If you’re struggling with intense emotions you can’t control, relationship challenges that you can’t seem to fix, or an endless series of self-defeating patterns, then DBT offers practical tools to help you regain control and move forward.
With the right therapist and programme, you’ll learn to manage your emotions more effectively, improve your relationships and build a life that feels more balanced and fulfilling.
If you’d like to explore DBT in a supportive and professional environment, Online DBT and Dr Jo Gee Psychotherapy offer gold-standard, evidence-based DBT programmes for adults and adolescents.
Taking the first step can be hard – but for many, it’s the first step to a better, more fulfilling life.