Dialectical Behavior Therapy (DBT) is a specialized form of cognitive-behavioral therapy (CBT) that emphasizes understanding and regulating emotions to influence thought patterns and behaviors. The term “dialectical” refers to the integration of two seemingly opposing concepts—acceptance and change (Linehan, 1993). DBT is grounded in the idea that individuals can accept themselves as they are while simultaneously working toward transformation.
Originally developed by Marsha Linehan for individuals with borderline personality disorder (BPD), DBT has since proven effective for a range of psychological issues, including depression, anxiety, substance use, and eating disorders (Linehan, 1993; McMain et al., 2009). Its strength lies in its structured approach, which combines therapeutic interventions with practical skill-building.
Key Components of DBT
DBT is typically delivered through three main modalities:
- Individual therapy: One-on-one sessions with a therapist focus on personal issues and applying DBT skills to real-life challenges.
- Group skills training: Clients meet in groups to learn and practice DBT skills, benefiting from peer support and shared experiences.
- Phone coaching: This feature allows clients to reach out to their therapist between sessions for guidance on applying DBT skills in real-time situations (Linehan, 1993).
Success in DBT largely depends on how well individuals can integrate and apply these skills in their daily lives.
The Four Core Skills of DBT
DBT focuses on four key skill sets: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.
Mindfulness
Mindfulness forms the foundation of DBT. It involves becoming fully aware of the present moment—your thoughts, feelings, and surroundings—without judgment (Linehan, 1993). This skill helps individuals recognize their emotional and mental states, encouraging balanced decision-making.
Mindfulness in DBT operates through three “mind states”:
- Emotional mind: Dominated by feelings.
- Reasonable mind: Focused on facts and logic.
- Wise mind: A balanced state that integrates reason, emotion, and intuition.
DBT teaches two sets of mindfulness practices:
- What skills (observe, describe, participate): Help increase self-awareness.
- How skills (nonjudgmentally, one-mindfully, effectively): Focus on how to act in the moment in a skillful and intentional manner (Linehan, 1993).
Interpersonal Effectiveness
This skill set teaches individuals how to assert their needs while maintaining healthy relationships. It helps them communicate effectively, set boundaries, and respect others, all while preserving self-respect and emotional balance (Linehan, 1993). For example, clients learn that expressing themselves doesn’t require aggression or people-pleasing but rather confident, respectful interaction.
Emotion Regulation
Emotion regulation involves understanding and managing intense emotions. DBT doesn’t advocate suppressing negative feelings but encourages acknowledging and responding to them in constructive ways (Linehan, 1993). This skill includes identifying emotions, reducing emotional vulnerability, and decreasing emotional suffering.
Individuals are taught to recognize primary emotions (initial responses) and secondary emotions (exaggerated responses), enabling them to respond rather than react. Techniques such as healthy eating, regular exercise, and self-care are emphasized to build emotional resilience.
Distress Tolerance
Distress tolerance equips individuals to endure and cope with crisis situations without resorting to harmful behaviors. This skill is especially important when emotions are overwhelming and logic is difficult to access (Linehan, 1993).
Key distress tolerance strategies include:
- Distraction: Temporarily shifting focus from distressing emotions.
- Improving the moment: Using visualization, prayer, or relaxation to enhance the current situation.
- Pros and cons: Evaluating the benefits and drawbacks of tolerating vs. acting on emotions.
- Self-soothing: Engaging the senses—such as listening to music or taking a warm bath—to calm oneself (Neacsiu et al., 2010).
The Goal of DBT
The primary aim of DBT is to empower individuals to build a life worth living by fostering emotional balance, healthy relationships, and a deeper understanding of the self. The combination of acceptance and change techniques helps clients move from emotional reactivity to intentional living.
DBT’s success stems from its emphasis on practice and application. The therapist serves as a guide, supporting clients through their emotional journeys and helping them draw upon their inner strength (Linehan, 1993).
Conclusion
Dialectical Behavior Therapy provides powerful tools for managing emotions, improving relationships, and promoting mental well-being. It is especially beneficial for individuals struggling with intense emotions or destructive behavior patterns. By integrating mindfulness, emotional insight, interpersonal skills, and distress tolerance, DBT supports long-term emotional growth and healing.
Seeking therapy is a courageous first step toward transformation. DBT offers a structured, evidence-based approach that not only addresses mental health challenges but also nurtures lasting personal development.
New Dimensions Can Help!
If you or someone you know is seeking emotional regulation, New Dimensions can help. We help you develop the coping skills you need to face life’s challenges. Our team of experienced therapists and psychiatrists can help you develop the skills you need to thrive.
New Dimensions is conveniently located in The Woodlands, Katy, and the Clear Lake areas of Houston. We also provide telehealth therapy for adults who reside within the State of Texas. To schedule a complimentary assessment, call us at 800-685-9796 or visit www.nddtreatment.com.
References
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
McMain, S. F., Links, P. S., Gnam, W. H., Guimond, T., Cardish, R. J., Korman, L., & Streiner, D. L. (2009). A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. American Journal of Psychiatry, 166(12), 1365–1374. https://doi.org/10.1176/appi.ajp.2009.09010039
Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M. (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy, 48(9), 832–839. https://doi.org/10.1016/j.brat.2010.05.017