Dialectical Behavioral Therapy (DBT)

DBT combines teaching change-focused skills, prominent in cognitive behavioral therapy (CBT), with acceptance-focused skills, such as mindfulness and distress tolerance. DBT is a comprehensive program that involves weekly individual and group sessions, usually lasting between 6 months and 1 year.

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Key takeaways

• DBT is a talking therapy that teaches change-oriented skills (emotional regulation and interpersonal skills) and acceptance-oriented skills (mindfulness and distress tolerance).
• Comprehensive DBT usually takes 6 to 12 months to complete. Both group skills sessions and individual therapy take place once a week, with in-the-moment phone support available between sessions.
• Many providers offer modified DBT to meet your specific needs. When searching for a therapist, determine the type of DBT they offer and always ensure they are appropriately trained and licensed in your state.

Understanding dialectical behavioral therapy

Dialectical behavioral therapy (DBT) was created in the 1980s by psychologist Marsha Linehan. She initially designed the program for women struggling with intense mental health difficulties revolving around emotional dysregulation, self-harm, and suicidal behaviors. From a medical perspective, these individuals had a diagnosis of borderline personality disorder (BPD). ^[1]

DBT aims to support individuals who struggle with emotional regulation in managing these feelings and changing behaviors that impact their quality of life. This is achieved by learning and practicing a broad toolkit of skills. Crucially, change is balanced with supporting the validity of emotions and encouraging self-acceptance. ^{[1] [2]}

The term ‘dialectic’ refers to the fact that two opposites can be true at the same time. This is the core approach of DBT, helping individuals to accept the reality of their behaviors and actions, whilst supporting positive changes through learnt practical skills. ^{[2] [3]}

How does it work?

Comprehensive DBT is a program, usually delivered over a period of 6 to 12 months, containing four key components: ^[4]

• Group skills training - These weekly sessions, lasting 2-3 hours, focus on teaching behavioral skills.
• Individual therapy - Taking place once a week for an hour, these are one-on-one sessions focused on applying learnt skills to personal challenges and daily experiences.
• Phone coaching and support - Individuals can phone their therapist during agreed-upon hours for in-the-moment support with using skills.
• Therapist consultation team - Your therapist will have weekly sessions with colleagues for personal and professional support.

Many practitioners offer a modified version of DBT. This may be a shorter program that only involves individual therapy or focuses on a specific challenge (such as substance addiction).

DBT vs. CBT

DBT incorporates the core components of cognitive behavioral therapy (CBT). This includes change-oriented interventions that focus on emotional regulation and interpersonal skills. DBT has some additional unique aspects: ^[4]

• A focus on acceptance and validity of feelings
• Mindfulness practice
• Distress tolerance skills
• Multiple content delivery methods (including individual, group, and phone support)
• A focus on patients with BPD and complex emotional regulation difficulties (usually resistant to CBT).

What is DBT used for?

DBT was first developed and widely validated for the treatment of BPD. Multiple studies have confirmed its effectiveness in reducing the frequency and severity of suicide attempts, limiting inpatient hospitalization days, improving social functioning, and lessening impulsive anger responses. ^[5]

Studies have also indicated that DBT can effectively treat other populations and mental health conditions. This includes people with BPD and co-occurring substance use disorder (showing a significant reduction in addiction behaviors) and older persons with depression or an eating disorder. ^[5]

Because DBT incorporates several other evidence-based behavioral interventions, many practitioners use it to support people with a broad range of mental health conditions. ^[5]

Benefits of DBT

People who undertake DBT report numerous benefits: ^{[5] [6]}

• Improved life satisfaction
• Better coping skills
• Better social functioning
• Fewer angry outbursts
• Improved mood
• Reduced self-harming
• Fewer suicide attempts
• Improved abstinence from substances (when delivered alongside medical detox and addiction programs)
• Less time in treatment and improved adherence to medication therapies

Skills developed in DBT

The skills taught in DBT can be categorized into four key areas: ^[4]

• Mindfulness - being fully aware and present in the moment. This includes learning to focus on one thing at a time.
• Distress tolerance - learning to manage difficulties (especially things that cannot be immediately changed).
• Interpersonal effectiveness - managing healthy social relationships, balancing your wants and needs with those of others.
• Emotional regulation - understanding emotions and using strategies to change unwanted responses and behaviors.

Does it work for everyone?

Despite its effectiveness as a treatment method, DBT doesn’t work for everybody. Comprehensive DBT is an intensive program that requires an average of 3-4 hours of engagement per week for a minimum of 6 months. Some people struggle to manage this alongside work or other commitments. ^[4]

Each individual’s treatment needs are unique. Some people may find the solely change-focused approach of CBT more appropriate for them. Equally, some symptoms may impact an individual’s ability to meaningfully engage in therapy (for example, acute psychosis episodes in schizophrenia). ^[7]

Preparing to start DBT

It’s normal to feel nervous when getting ready to start DBT. Therapy can be a daunting prospect, involving a level of emotional vulnerability and challenge. It’s essential to remember that your therapist is there to support you, adapting to your needs and working at a pace that suits you.

You don’t need to bring any prior experience or knowledge to your first DBT session. However, you may want to consider which issues are particularly affecting your quality of life, highlighting areas you wish to focus on. Most importantly, bring an open mind and a willingness to learn.

If you want to find out more about the kind of skills you will learn in DBT, check out the resources section at the end of this article.

What to expect from your first session

Your first session will be an introduction to your lead therapist (the person you will have individual sessions with). This provides an opportunity to get to know each other and determine if your therapist seems like a good fit for you.

Your therapist will want to ask about your current difficulties and mental health symptoms. They’ll cover the structure of the DBT course, including information about both individual and group sessions. If you both agree that DBT is right for you, your therapist will ask you to commit to a certain length of treatment.

Groups and DBT skill training

Skills training, usually delivered in a group ‘classroom’ setting, focuses on expanding your behavioral skills capabilities. A therapist will introduce a topic, define the problem, and then present a skills-based solution. You’ll usually then have the opportunity to practice this skill across a range of scenarios, learning how to adapt and modify it to meet your needs. ^[4]

In the comprehensive model, skills sessions are held once a week, lasting 2 to 3 hours, and the whole curriculum is completed in approximately 6 months. Many therapists will then repeat this to reinforce and stretch your abilities, creating a full 1-year program. However, the length of the program, delivery method (individual vs. group), and which skills are taught may vary between providers, with many offering a modified DBT course developed to meet a specific need. ^[4]

Individual sessions

Individual therapy focuses on the personal application of techniques learnt in skills sessions, alongside addressing individual challenges and goals. A core part of individual therapy sessions is identifying barriers to success and supporting you to remain motivated throughout the treatment course. ^[4]

Your individual therapist also plays a crucial role in coordinating your overall treatment. Sessions typically take place once a week, lasting for approximately 1 hour. ^[4]

Ongoing support and crisis coaching

In comprehensive DBT, you can contact a therapist by phone during agreed-upon hours for immediate in-the-moment support and coaching. Your therapist will guide you through applying skills during difficult situations, providing both practical advice and reassurance. ^[4]

Some providers no longer offer a telephone coaching service. Instead, you are encouraged to make use of a ‘crisis plan’ or resource pack as a source of guidance. You will also be informed about crisis support services in your area that can assist with mental health emergencies.

Finding a DBT therapist

If you think DBT may be right for you, ask your healthcare provider about local services available in your area. They will discuss your symptoms and refer you to a trusted mental health provider. ^[7]

You can also look for a therapist independently. It’s essential to look for a therapist who is appropriately licensed in your state and has specific training in DBT. You may also want to ask them about what type of DBT they provide (whether it’s comprehensive DBT or a modified version focused on specific skills or problems). ^{[7] [8]}

To find trusted mental health providers in your area, why not take a look at our mental health services directory? Alternatively, the Association for Behavioral and Cognitive Therapies offers a directory of licensed therapists throughout the United States.

Final thought

DBT is a comprehensive talking therapy that aims to help you achieve a life worth living. Its unique approach balances change-oriented strategies with radical acceptance and self-appreciation. The skills learnt in DBT can be applied to everyday challenges, both big and small, providing you with a toolkit of strategies for self-development.

Remember, DBT is not right for everyone. Contact your healthcare provider to discuss your symptoms and determine if DBT can provide what you’re looking for.

Resources

The following resources provide an introduction to DBT teaching and skills:

• Dialectical Behavioral Therapy
• DBT Tools

Author

Olly Smith

With over 7 years of experience in frontline healthcare, Olly specializes in communicating complex health topics in an accessible way. He is passionate about empowering people through knowledge and has a particular interest in mental health.

Activity History - Last updated: March 19, 2026, Published date: March 19, 2026

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Reviewer

Jennifer Brown

Dr. Jennifer Brown is dual board-certified in family medicine and obesity medicine. She currently works for Amwell Medical Group, providing virtual primary care services, including mental health treatment.

Activity History - Medically reviewed on March 28, 2026 and last checked on March 19, 2026