Dialectical behavior therapy (DBT) is a specific therapy modality developed to treat individuals with borderline personality disorder and suicidal behavior. However, its use has been expanded, and it may be beneficial for treating other conditions, like substance use disorders [1].

Origins of DBT
Marsha Linehan developed dialectical behavior therapy (DBT) in the 1970s and 1980s to treat individuals with borderline personality disorder (BPD) and chronic suicidal behavior [2].Linehan originally focused on alleviating suicidal behavior, but federal grant funders required her to identify a diagnosis for which DBT could be used. Because BPD is linked to suicidality, Linehan selected this condition to be the focus of treatment [3].
DBT originally began with a trial-and-error approach. Linehan focused on teaching problem-solving strategies to those with BPD, but many of them lashed out because they found the treatment to be overwhelming and invalidating. So, Linehan adapted her strategy to be more accepting of clients and to recognize that progress would be slow. DBT has roots in behaviorism, but it has integrated other components, such as mindfulness [3].
How does DBT work?
The fundamental theory underlying DBT is that the DBT therapist must balance accepting the client with promoting change. Rather than expecting quick, linear change, the therapist accepts the client for who they are while also helping the client to change problematic behaviors. This is the dialectical nature of DBT– balancing opposing forces of acceptance and change [2] [3].
Within this dialectical approach, the therapist focuses on teaching clients to develop “radical acceptance” of both their painful emotions and their past experiences that have led to dysfunctional behaviors. Rather than asking clients to change negative emotions, DBT teaches them to make behavioral changes so they can tolerate distress in a more functional way [2].
What skills does DBT teach?
Skills training is a key component of DBT treatment. In standard DBT, individual therapy sessions are complemented by group sessions during which the DBT therapist provides skills training. DBT skills training addresses the following four areas [3][4]:
- Mindfulness: Core mindfulness training helps people to accept their emotions without judging them and attune to the present moment. Mindfulness teaches clients to be aware of their emotions, and it often uses the strategy of “observe and describe” to help people become more aware of their emotional states.
- Emotion regulation: These skills teach people to identify their emotions and cope with them in healthy ways. In DBT sessions, clients learn to regulate emotions without engaging in harmful or impulsive behavior. For instance, they may learn to do deep breathing or pause before responding. Emotion regulation training begins by teaching people what emotions mean and how to identify them and then moves toward teaching new ways of responding when faced with a negative emotion.
- Interpersonal effectiveness: Learning interpersonal effectiveness skills means developing strategies for interacting with others and managing conflict. These skills can teach people how to be assertive, as well as how to form healthy friendships.
- Distress tolerance: Finally, distress tolerance skills teach individuals with BPD and related conditions to manage crisis situations in a more functional way. With distress tolerance skills, people can recognize when they are in distress and deal with intense negative emotions without acting impulsively or otherwise making the situation worse. Distress tolerance skills focus on self-soothing and delaying gratification rather than coping by engaging in self-harm or substance misuse, for example.
Who can benefit from DBT?
DBT was originally designed to treat individuals with borderline personality disorder and suicidal behavior [1], but its use has grown. It is now used for a range of other conditions, which are described below in more detail.
Eating Disorders
Eating disorder behaviors have been theorized to be attempts to regulate emotions or achieve a sense of control. As such, they may be amenable to DBT, which focuses on teaching distress tolerance and healthy coping skills. Individuals who are struggling with disordered eating may find that DBT teaches them more adaptive ways of managing stress and painful emotions [5].
Depression
DBT is sometimes used in the treatment of depression. Because DBT teaches mindfulness and interpersonal skills, it can be beneficial for those struggling with long-term depression. DBT can be helpful for overcoming relationship problems and psychological inflexibility, both of which can worsen depression symptoms [6].
Bipolar Disorder
Individuals living with bipolar disorder experience distinct mood states, including periods of depression and mania. During these states, they may have difficulty managing emotions. Manic episodes, in particular, can involve impulsive behavior and difficulty with emotion regulation. Given these facts, DBT skills can be beneficial for people diagnosed with bipolar disorder [7].
Anxiety Disorders
DBT has also been used to treat anxiety disorders, including generalized anxiety disorder. DBT teaches mindfulness-based skills, which can be beneficial for calming anxiety. It can also assist people with regulating emotions during anxious states [8].
Substance Use Disorders
Some addiction psychology experts have theorized that substance use disorders develop as a result of people using substances to escape from negative emotions. Based on research, there is truth to this theory, as negative emotions tend to come before substance misuse. Therefore, DBT skills training can be beneficial for treating substance use disorders, as emotion regulation skills can help people choose healthier coping strategies when they are faced with stress or emotional pain [9].
Other Personality Disorders
DBT skills aren’t just beneficial for treating borderline personality disorder. Other Cluster B personality disorders, such as narcissistic personality disorder, also involve difficulties with emotion regulation. So, DBT skills training can be beneficial for treating other personality disorders that involve emotion regulation deficits [10].
How effective is DBT?
Fortunately, researchers have conducted numerous studies to ensure that DBT is effective in treating a range of mental health conditions. Since DBT was designed to treat BPD, it’s important to evaluate whether it’s effective for this purpose. A meta-analysis that reviewed several studies concluded that DBT is effective for treating symptoms of BPD [11].
BPD is not the only condition for which DBT has been found to be effective. Research has also suggested that DBT is acceptable and beneficial for those with substance use disorders. DBT can reduce substance misuse and improve emotion regulation abilities in those with these conditions [9]. Research on the use of DBT in eating disorder treatment has also been promising, showing that this modality is highly effective for both reducing eating disorder episodes and symptoms of depression [5].
Finally, research on individuals with bipolar disorder has suggested that DBT is effective for treating this condition as well. Research evidence shows that BPD can be beneficial for improving core symptoms of bipolar disorder, and it’s feasible for treating populations with this condition [7]. Based on the body of research, there is evidence that BPD is effective in treating a range of mental health disorders.
Dialectical Behavior Therapy vs. Cognitive Behavior Therapy
Dialectical behavior therapy (DBT) and cognitive behavior therapy (CBT) both have roots in behaviorism, meaning they seek to change unhelpful behaviors. However, there are differences between the two. CBT focuses on helping people change negative or distorted thoughts and beliefs, which in turn changes their emotions, and then allows for behavioral change [12].
DBT also focuses on changing behaviors, but it does so in a different manner than CBT. The focus of DBT is not on changing unhelpful thoughts but rather on learning to regulate emotions in a healthier way. By learning skills for managing painful emotions and distress, people with BPD and other mental health conditions can change harmful, impulsive patterns of behavior. DBT adds the additional components of mindfulness and interpersonal skills training, and it is a newer modality than CBT [12].
Both DBT and CBT have been extensively studied, and there are benefits associated with CBT. However, for individuals with BPD, DBT appears to be superior. A recent meta-analysis that reviewed the results of multiple studies found that CBT was no better than no treatment at all for treating borderline personality disorder. However, DBT was found to be effective in treating BPD [11].
Finding a DBT Therapist
If you’re living with symptoms of BPD or another mental health condition that leads to problems with managing emotions and stress, DBT could be helpful for you. Should you choose to seek out a DBT therapist, it’s important to find someone who is qualified to provide this treatment modality. Contact a local community mental health center or private counseling practice and inquire if they have any therapists on staff who are trained in DBT.
All therapists should be willing to provide you with information about their training, credentials, and usual treatment modalities. A therapist who is trained in DBT will understand this modality, and they’ll have a degree and professional licensure, such as that of a psychologist, clinical social worker, or professional counselor. When you begin treatment with a DBT therapist, they will build a relationship with you that is based on trust and mutual understanding. Part of this relationship-building process involves the therapist explaining the DBT treatment process to you. A DBT therapist will also make you feel accepted so you’re comfortable engaging with them in the treatment process.
- Chapman, A. L. (2006). Dialectical behavior therapy. Psychiatry (Edgmont), 3(9), 62-68. https://pmc.ncbi.nlm.nih.gov/articles/PMC2963469/
- Yale Medicine. (n.d.). Dialectical behavior therapy (DBT). Available at: https://www.yalemedicine.org/conditions/dialectical-behavior-therapy-dbt
- Linehan, M. M., & Wilks, C. R. (2015). The course and evolution of dialectical behavior therapy. The American Journal of Psychotherapy, 69(2), 91-239. https://psychiatryonline.org/doi/10.1176/appi.psychotherapy.2015.69.2.97
- Valentine, S. E., Bankoff, S. M., Poulin, R. M., Reidler, E. B., & Pantalone, D. W. (2015). The use of dialectical behavior therapy skills training as stand-alone treatment: A systematic review of the treatment outcome literature. Journal of Clinical Psychology, 71(1), 1-20. https://onlinelibrary.wiley.com/doi/10.1002/jclp.22114
- Vuillier, L., Greville-Harris, M., Talbot, C. V., May, L., & Moseley, R. L. (2024). Early evaluation of a DBT-informed online intervention for people with eating disorders. Journal of Eating Disorders, 12(1), 9. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-024-00974-5
- Gilbert, K., Codd, R. T. III, Hoyniak, C., Tillman, R., Baudinet, J., Pires, P. P., Hempel, R., Russell, I., & Lynch, T. R. (2023). Processes of change in a randomized clinical trial of radically open dialectical behavior therapy (RO DBT) for adults with treatment-refractory depression. Journal of Consulting and Clinical Psychology, 91(2), 71–81. https://psycnet.apa.org/doiLanding?doi=10.1037%2Fccp0000795
- Jones, B. D. M., Umer, M., Kittur, M. E., et al. (2023). A systematic review on the effectiveness of dialectical behavior therapy for improving mood symptoms in bipolar disorders. International Journal of Bipolar Disorders, 11(6). https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-023-00288-6
- Malivoire, B. L. (2020). Exploring DBT skills training as a treatment avenue for generalized anxiety disorder. Clinical Psychology: Science and Practice, 27(4), Article e12339. https://psycnet.apa.org/doiLanding?doi=10.1111%2Fcpsp.12339
- Warner, N., & Murphy, M. (2022). Dialectical behaviour therapy skills training for individuals with substance use disorder: A systematic review. Drug and Alcohol Review, 41(2), 501-516. https://onlinelibrary.wiley.com/doi/10.1111/dar.13362
- Neacsiu, A. D., & Tkachuck, M. A. (2016). Dialectical behavior therapy skills use and emotion dysregulation in personality disorders and psychopathy: A community self-report study. Borderline Personality Disorder and Emotion Dysregulation, 3(6). https://bpded.biomedcentral.com/articles/10.1186/s40479-016-0041-5
- Cristea, I. A., Gentili, C., Cotet, C. D., Palomba, D., Barbui, C., & Cuijpers, P. (2017). Efficacy of psychotherapies for borderline personality disorder: A systematic review and meta-analysis. JAMA Psychiatry, 74(4), 319–328. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2605200
- Afshari, B., et al. (2022). Study of the effects of cognitive behavioral therapy versus dialectical behavior therapy on executive function and reduction of symptoms in generalized anxiety disorder. Trends in Psychiatry and Psychotherapy, 44, 1-7. https://www.scielo.br/j/trends/a/5yQbwLBpLHJ6WcByX5QxLTq/?lang=en
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Our Medical Affairs Team is a dedicated group of medical professionals with diverse and extensive clinical experience who actively contribute to the development of our content, products, and services. They meticulously evaluate and review all medical content before publication to ensure it is medically accurate and aligned with current discussions and research developments in mental health. For more information, visit our Editorial Policy.
MentalHealth.com is a health technology company guiding people towards self-understanding and connection. The platform provides reliable resources, accessible services, and nurturing communities. Its purpose is to educate, support, and empower people in their pursuit of well-being.