What Is DBT? 10 Expert Answers On The Internet's Most Searched Dialectical Behavior Therapy Questions

You might know why you get anxious, why you push people away, why you reach for substances, why you shut down or explode. You may have spent years in therapy uncovering all of that. Yet the same patterns keep showing up again and again.

That gap between insight and actual change is exactly where dialectical behavior therapy, or DBT, lives.

In this episode, licensed psychologist and DBT expert Dr. Kiki Fehling sits down with host Terry McGuire to answer the internet's most searched questions about DBT. She shares why DBT became her life's work, how it helped her through her own depression, suicidal thoughts, and even a heart attack, and why she calls DBT skills "life skills" that almost anyone could benefit from.

1. What is dialectical behavior therapy (DBT) and how does it work?

DBT is a practical roadmap for managing big emotions.

Dr. Fehling explains DBT as a form of cognitive behavioral therapy (CBT) that combines traditional behavioral techniques, acceptance practices, mindfulness, and a large toolbox of coping skills. At its core, DBT is designed to help people understand, regulate, and work with their emotions when those emotions are causing real problems in daily life.

We evolved to feel emotions because they help us. When we understand what we are feeling and why, emotions guide decisions, motivate change, and help us connect with others. DBT starts from that truth. Instead of treating emotions as the enemy, it teaches you how to read them accurately and respond in ways that move you toward a life you actually want.

DBT is also very action oriented. Insight is respected, but it is not the finish line. If you already know your history, patterns, and triggers yet still feel stuck, DBT asks a different question, now that you know all this, what do you do with it? The therapy focuses on changing specific behaviors, building new habits, and practicing skills until they become part of your everyday life.

What does “dialectical” mean in DBT?

Dialectics means two things can be true at the same time.

"Dialectical" is not a word most of us use at brunch. In DBT, it describes a worldview that recognizes that two seemingly opposite things can both be true. You might love someone and be furious with them. You might be grateful for your life and still feel deep pain. You might dislike parts of yourself and still have real strengths.

For people who struggle with intense emotions, thinking often becomes all or nothing. I love you or I hate you. I am a complete failure or I am fine. DBT helps you move from that rigid either or thinking to a more flexible both/and approach. Instead of "I hate myself," it becomes "there are things I dislike about myself and things I value, and I can work on both."

This both/and lens shows up everywhere in DBT. You are encouraged to accept reality as it is and at the same time work to change the parts that are not working. That tension - acceptance and change together - is one of the most powerful pieces of DBT.

How do acceptance and change fit together?

Radical acceptance makes change possible and less painful.

Acceptance in DBT is not about liking a painful situation or giving up. It is about dropping the extra layer of suffering that comes from fighting reality. Dr. Fehling shares a personal example from grad school, when she was in a long distance relationship and refused to accept that she did not live with her partner. That non acceptance made her miserable where she was and kept her from building a life in her own city.

Through radical acceptance, she softened into the facts, she lived where she lived, she cared about this person, and they could figure it out over time. Acceptance relieved some of the emotional pressure and opened up more options, from making friends locally to improving daily life. Ironically, once she stopped fighting reality, her circumstances changed too.

DBT treats acceptance as both valuable on its own and also a starting point for change. When you are no longer locked in a tense battle with "this should not be happening," you have more energy and clarity to problem solve. You are in the pain, not the extra suffering, and from that steadier place, change is more likely to stick.

2. Who can benefit from DBT, especially with anxiety, depression, and substance use?

DBT is built for emotion dysregulation, and that shows up in many diagnoses.

DBT was originally developed for people with borderline personality disorder, a condition marked by intense emotional ups and downs, impulsive behaviors, unstable relationships, and confusion about self image. At first, this might make DBT sound very specialized. Over time, though, research has shown DBT can help with PTSD, anxiety, depression, eating disorders, substance use disorders, and more general emotional difficulties.

The common thread is emotion dysregulation - having a hard time managing and recovering from strong emotions. If your feelings tend to get very big, very fast, and pull you toward choices you later regret, you are in DBT territory. That might look like explosive anger, panic attacks, self harm, binge eating, or using substances to cope.

So while DBT has a strong evidence base for specific conditions, its core goal is broader, to help you understand your emotions, tolerate distress, and act in line with your values instead of your urges in the moment.

How does DBT help with anxiety?

DBT teaches you to face fear with skills instead of avoidance.

Anxiety often leads to two big patterns, endless worry and avoidance. You think about what might go wrong, then slowly build a smaller and smaller life so you do not have to face those feared situations. DBT targets both sides, the racing mind and the shrinking life.

On the coping side, DBT offers concrete skills to manage worry thoughts and the physical symptoms of anxiety, things like grounding, paced breathing, and mindfulness so you can stay present when your body feels on high alert. On the behavioral side, DBT uses exposure and a core skill called opposite action. Instead of obeying the urge to avoid, you gradually move toward the things that scare you, with support and strategies to help you tolerate the discomfort.

It is not easy. As Terry says in the episode, "that sounds so scary," and Dr. Fehling agrees. But over time, as you approach what you fear instead of running from it, your brain learns that you are more capable and safer than your anxiety suggests. Your world can expand again.

How does DBT help with depression?

DBT helps you gently rebuild connection and meaning.

Depression tends to pull you inward. You feel exhausted, hopeless, and unmotivated. You isolate from people, stop doing things that once mattered, and life can feel flat and pointless. DBT looks carefully at what depression makes you want to do - usually withdraw and shut down - and then invites small, compassionate experiments in the opposite direction.

That can mean slowly reconnecting with activities that once brought pleasure or meaning, challenging harsh and hopeless thoughts when that is appropriate, and using emotion regulation skills to get through the heaviness of simple tasks. Getting out of bed can feel like climbing a mountain when you are depressed. DBT respects that reality and asks, how can we break this mountain into smaller, more doable steps for you right now.

The focus is on flexibility rather than perfection. You and your therapist work together to meet you where you are and move at a pace that feels sustainable, always tied back to what matters most to you.

How does DBT help with addiction and substance use?

DBT addresses both the urge to use and the pain underneath.

Many people use substances to manage intense emotional pain. The drink, the pills, or the drug become the fastest way to numb, escape, or quiet overwhelming feelings. DBT recognizes this and takes a two layer approach.

First, it gives you alternative tools to cope in the moment so that substances are not your only option. You learn distress tolerance skills, ways to ride out cravings, regulate your body, and get through urges without acting on them. You also explore the specific situations, thoughts, and emotions that tend to lead up to using, so you can intervene earlier.

Second, once there is enough stability to begin reducing or stopping use, DBT helps you address the deeper issues under the addiction, often trauma, shame, or chronic emotional invalidation. Instead of just taking away your main coping strategy, it tries to replace it with healthier skills and then gently work on the original wounds.

3. How is DBT different from traditional talk therapy?

DBT is collaborative, structured, and focused on doing, not just understanding.

When many people picture therapy, they imagine lying on a couch while a quiet therapist occasionally asks, "How does that make you feel?" That style of insight oriented or psychodynamic therapy can be helpful, and it is still valuable in many settings. DBT, though, looks and feels different.

In DBT, your therapist is active and collaborative. As Dr. Fehling tells her clients, "I am an expert in DBT, and you are an expert in you." You bring your goals, values, and lived experience. The therapist brings a framework, skills, and experience with patterns they have seen many times. Together you figure out where you want your life to go and how to get there.

What does a skills based therapy session actually look like?

Sessions dig into real moments and break them down step by step.

Instead of only exploring distant childhood memories, DBT spends a lot of time on what is happening right now. One of the first things a DBT therapist will ask is, what is happening in your life that you like, and what is happening that you do not like, in very specific behavioral terms. What are you doing that you wish you did not do? What are you not doing that you wish you could do?

Once you identify a target behavior, like self harm, binge eating, drinking, or explosive arguments, DBT uses a tool called chain analysis. You and your therapist walk through one episode in detail, sometimes spending almost the entire session unpacking a five minute window. What happened right before, what did you notice in your body, what thoughts flashed by, what emotions showed up, what urges followed, what did you do next?

Terry compares it to a string of holiday lights. When one bulb goes out, everything after it goes dark, but to fix it you have to test each bulb until you find the short. Chain analysis does the same with behavior. Every small moment between the trigger and the outcome is a chance to do something differently. DBT then plugs in specific skills at those points, from emotion naming and mindfulness to boundary setting, distraction, or problem solving.

This process helps you build self awareness over time. At first, you might only be able to say "I do not know, I just ended up at the bar again." With support, you learn to notice the earlier flickers in the chain. That awareness is not the final goal, but it is a powerful step toward change.

4. What does full or “comprehensive” DBT look like in real life?

Comprehensive DBT is a big commitment, and that is part of why it works.

If you enroll in full DBT as it was originally designed, you are signing up for a fairly intensive program. Dr. Fehling explains that comprehensive DBT usually includes:

• Weekly individual therapy focused on your specific goals and behaviors

• Weekly DBT skills group, often 90 minutes to 2 hours, where you learn and practice skills with others

• Between session phone coaching, where your therapist is available to help you use skills in the heat of real life situations

• A DBT consultation team, where your therapist meets with other DBT providers to get support and keep the treatment on track

A full round of skills training typically takes about six months. Many people, especially those dealing with self harm, severe emotion dysregulation, or chronic substance use, stay in DBT for 12 to 18 months. That can feel like a huge emotional, time, and financial commitment.

Dr. Fehling acknowledges that openly. It is a lot. It can also be more efficient in the long run, especially for people who have already spent years in less structured therapies without much change. DBT packs a great deal of action and support into that time frame, and for many, that intensity is exactly what finally shifts long standing patterns.

Importantly, not everyone needs full DBT. Most people do not. Part of the early work with a DBT therapist is honestly assessing whether comprehensive treatment is the right fit for your needs and your current life circumstances.

5. What if you cannot access full DBT? Can you still benefit?

You do not need perfect conditions to start using DBT skills.

Therapy is expensive, DBT programs are not available everywhere, and life schedules are complicated. So a big question is, if you cannot do the full twice a week plus phone coaching program, is there any point in trying to learn DBT skills on your own or in a lighter format?

Dr. Fehling's answer is hopeful; yes, many people can benefit from DBT-informed approaches. Some therapists offer DBT-informed individual therapy, teaching skills one-on-one without the whole program structure. There are also DBT skills groups offered online, run by qualified clinicians, which can be more affordable or accessible.

Research suggests that even partial DBT - such as attending a skills group for 12 weeks - can reduce symptoms like anxiety, depression, anger, and general emotion dysregulation for many people. Learning and practicing the skills matter, even if you are not in a textbook-perfect program.

Self-guided learning is another piece of the middle ground. Workbooks, skills cards, and books like Dr. Fehling's can introduce core concepts and exercises. On their own, they are not a substitute for treatment if you are in crisis, but they can give you language, tools, and a sense of agency while you are on a waitlist or looking for care.

Think of it as a spectrum. At one end is comprehensive DBT, which tends to be most effective for those with severe, chronic struggles like BPD, PTSD with high-risk behaviors, or repeated suicide attempts. In the middle is DBT-informed individual therapy and skills groups. On the other end is self-directed learning. Wherever you can start, learning DBT skills is likely to offer at least some relief and a sense of direction.

6. What are the four core DBT skills and why do they matter?

DBT is not just one tool, it is a whole toolkit that includes:

• Mindfulness - Learning to be present in the moment, exactly as it is, without piling on judgments
• Emotion regulation - Helps you understand your feelings, decide what to do with them, and reduce your overall emotional vulnerability
• Distress tolerance - Gives you concrete ways to survive the most challenging moments without making things worse
• Interpersonal effectiveness - Focuses on relationships, boundaries, asking for what you need, and protecting your self-respect

What makes DBT powerful is how all four modules fit together.

You cannot ask for what you need (interpersonal effectiveness) if you do not even know what you feel (mindfulness and emotion regulation). You cannot make a healthy choice in a crisis if you have no safe way to get through the night (distress tolerance). Together, these skills are less about becoming perfect and more about becoming better at being a human with emotions.

7. How does mindfulness in DBT actually work in everyday life?

In DBT, mindfulness means being present, on purpose, and noticing what is happening without judgment. Dr. Fehling teaches what DBT calls the “what skills” of mindfulness: observe, describe, and participate.

To observe is to notice what is in your present moment awareness, while to describe is to put simple words to what you notice, such as, “I feel my heart beating faster,” or, “I am having the thought that I want to do well.”

This tiny language shift matters. Instead of “I am failing,” you say, “I am having the thought that I am failing.” You are not forcing distance; you are simply seeing that the thought is not the whole truth of the moment, it is one part of what is happening.

The third “what” skill, participate, is about throwing yourself into the moment:

If you are in class, you practice truly being in class, rather than mentally planning dinner and tomorrow’s doctor appointment. If you are talking with a friend, let that be your focus instead of replaying yesterday’s mistakes.

8. What are distress tolerance and crisis survival skills, and how do they prevent impulsive reactions?

Distress tolerance is the DBT module that teaches how to survive periods of intense emotional pain without making things worse. There are two major clusters of skills to learn here: radical acceptance skills and crisis survival skills.

The first skill is radical acceptance. Radical here means full, with your body, mind, and soul. It is the practice of acknowledging reality as it is, even when you hate it. Importantly, “acceptance does not mean approval.” It also does not mean giving up. You can accept that you are stuck in traffic, that your flight is delayed, or that it is raining on the day of the big event. You can accept a loss you never wanted. Acceptance simply says, “This is what is true right now.”

Dr. Fehling explains that pain without acceptance becomes suffering because we add rumination, worry, denial, and self-blame. However, pain with acceptance is still pain, but it is often more bearable and less frightening.

Sometimes pain is so intense that acceptance alone is not enough. That is where crisis survival skills come in. These skills are designed for situations where urges to use substances, self-harm, or act impulsively feel overwhelming.

Crisis survival skills might look like reading a novel, taking a bath, or yes, watching cat videos. They might also look like splashing cold water on your face, eating something sour, or stomping your feet on the floor to ground yourself. These skills do not fix the situation, but they interrupt the spiral and give you a few seconds of breathing room to choose your next skill.

9. How does emotion regulation help you understand and change your feelings?

If distress tolerance helps you ride out the storm, emotion regulation helps you understand the weather in the first place. These skills answer questions like:

• What am I feeling?
• Why am I feeling it?
• Is this emotion helpful right now?
• Do I want to change it, ride it out, or act on it?

For many people, the very first hurdle is naming the feeling. Dr. Fehling notes that this is common, especially in people who have lived with depression, anxiety, trauma, or in families where feelings were minimized or punished. But DBT works to make emotions easier to understand, such as by breaking them down as follows:

• Common thoughts
• Body sensations
• Urges
• Facial expressions
• Typical actions

For example, someone might start with just “I have a pit in my stomach.” They can then scan through the descriptions and realize that this body sensation often appears with sadness or shame, read the related thoughts and behaviors, and begin to say, “Oh, I am sad.”

Simply knowing “this is sadness,” rather than “something is wrong with me,” is a powerful shift.

10. How do interpersonal effectiveness and validation help you build a life worth living?

The fourth DBT module, interpersonal effectiveness, is all about relationships. These skills help you:

• Ask for what you want
• Say no
• Set and protect boundaries
• De-escalate conflict
• End relationships that are harming you
• Balance self-respect with respect for others

Most of us were never explicitly taught any of this. As children, we may have learned not to hit or bite, but rarely were we taught, “You are allowed to say no,” or “You can be assertive without being aggressive.” Many people reach adulthood feeling like they are “not adulting well,” without realizing that no one ever gave them a manual.

One of DBT’s most powerful interpersonal skills is validation. Validation is not about saying, “You are right and I agree.” It is about communicating, “Your emotions and reactions make sense, given what you have lived and what you are seeing.”

In a polarized world, validation is almost a superpower. When you validate someone, tension drops. People feel seen, which opens the door to real conversation. You might still disagree about the facts or about what should happen next, but instead of talking past each other, you create a little bridge of understanding.

Conclusion

But what DBT offers is powerful, a way to bridge the gap between "I understand why I am this way" and "I am actually living differently now." Through a blend of acceptance and change, both and instead of either or, DBT helps you build concrete skills for managing emotions, improving relationships, and making choices that line up with the life you want.

Whether you are dealing with anxiety, depression, addiction, or just feel ruled by big feelings, DBT skills can give you more options and more hope. And that is something almost all of us could use.