Dialectical behavior therapy (DBT) is a type of talk therapy (psychotherapy). It’s based on cognitive behavioral therapy (CBT), but it’s specially adapted for people who experience emotions very intensely.
Cognitive behavioral therapy (CBT) is a type of talk therapy that helps people understand how thoughts affect emotions and behaviors.
“Dialectical” means combining opposite ideas. DBT focuses on helping people accept the reality of their lives and their behaviors, as well as helping them learn to change their lives, including their unhelpful behaviors.
Dialectical behavior therapy was developed in the 1970s by Marsha Linehan, an American psychologist.
Dialectical behavior therapy (DBT) is especially effective for people who have difficulty managing and regulating their emotions.
DBT has proven to be effective for treating and managing a wide range of mental health conditions, including:
It’s important to note that the reason DBT has proved effective for treating these conditions is that each of these conditions is thought to be associated with issues that result from unhealthy or problematic efforts to control intense, negative emotions. Rather than depending on efforts that cause problems for the person, DBT helps people learn healthier ways to cope.
A therapist can be a psychiatrist (a medical doctor who can prescribe medications), psychiatric nurse, psychologist, social worker or family therapist.
Finding the right therapist is often a time-consuming task, and DBT therapy isn’t any different. Try not to become discouraged. Talk to people you trust to give you a referral for a therapist who uses dialectical behavior therapy, whether it’s your primary healthcare provider or a friend or family member.
You can also search for therapists online through local and state psychological associations.
Be sure that any therapist you’re interested in seeing is a state-certified and licensed mental health professional and that they treat your area of concern (for example, eating disorders, borderline personality disorder, self-harm, etc.).
Most therapists’ websites list the conditions and problems they treat. If you have questions, call or email the therapist’s office before you choose.
It may be helpful to ask a potential DBT therapist the following questions:
The main goal of therapists who use dialectical behavior therapy (DBT) is to strike a balance between validation (acceptance) of who you are and your challenges and the benefits of change. Your therapist will help you learn new skills to improve emotion regulation.
The structure of dialectical behavior therapy can vary some from therapist to therapist, but, in general, DBT involves these four types of sessions:
Your therapist may offer an assessment before starting DBT. They’ll determine how suitable DBT is for you by asking you questions and explaining how DBT works. If you decide that DBT is the right therapy for you, they’ll ask you to commit to the treatment and the length of treatment.
Individual DBT therapy involves weekly sessions with your therapist. Each session lasts about 40 minutes to 60 minutes.
Individual DBT therapy sessions have the following goals:
Your therapist will likely ask you to keep a diary to track your emotions and actions and to look for patterns of behavior. You’ll bring this diary with you to your sessions so you and your therapist can decide what to work on for each session.
In these sessions, your therapist will teach you skills in a group setting. This isn’t to be confused with group therapy, in which you discuss your problems with others. Think of it more like a teaching and learning session in a classroom setting.
DBT skills aim to help enhance your capabilities in day-to-day life. The four skills your therapist will teach include:
DBT often involves telephone crisis coaching to support you in your daily life. This means you can call your therapist at certain times for support between sessions.
Examples of when you may need to call your therapist include:
However, your therapist will set clear boundaries about when you can call them, such as during an agreed-upon range of time during the day.
Crisis coaching functions on an as-needed basis. The calls are usually brief, and they shouldn’t replace the work of individual or group sessions.
Dialectical behavior therapy (DBT) has been proven to help people with their mental health conditions in several studies. For people with borderline personality disorder, in particular, DBT results in:
However, DBT isn’t for everyone, and it can be very difficult. DBT is more likely to work for you if you:
Dialectical behavior therapy (DBT) usually takes at least six months to a year. However, each person is unique, and mental health conditions are complex. You shouldn’t expect to be completely free of symptoms or no longer have problematic behaviors after one year of DBT.
Many therapists believe that the treatment for borderline personality disorder, in particular, can often take several years.
Try not to get discouraged by how long it may take to be able to better manage your emotions and have a better quality of life. The important thing is that you’re seeking help. Any progress is good progress.
It’s important to go to all of your scheduled individual DBT therapy sessions and group skill training sessions.
If you’re experiencing a crisis, such as feeling suicidal, and can call your therapist, do so.
If your therapist is unavailable, call the Suicide and Crisis Lifeline at 988. Someone will be available to talk with you 24 hours a day, seven days a week. You can also call 911 or go to the nearest emergency room.
A note from Cleveland Clinic
Dialectical behavior therapy (DBT) is an effective treatment to help people who experience very intense, negative emotions. Although it may be difficult and time-consuming to find the right DBT therapist for you, it’s important to keep trying. The sooner you can start therapy — and stay committed to it — the sooner you’ll have an improved quality of life.
Last reviewed by a Cleveland Clinic medical professional on 04/19/2022.