Dialectical Behavior Therapy (DBT): Your Path to Managing Intense Emotions

Why DBT Matters for You

If you often feel overwhelmed by intense emotions, DBT helps you understand where feelings come from and how to respond without escalating harm. If your relationships are tumultuous, DBT’s interpersonal effectiveness⁶ module shows how to ask for what you need and set limits. 

When impulsivity or urges toward self-harm or substance use show up, DBT offers new skills to pause, choose, and act in line with your goals, a pathway to a life worth living.

Core Principles of DBT

Dialectics: Embracing Contradictions

DBT teaches that two truths can be valid at once: you can accept yourself fully and work to change. This balanced stance counters all-or-nothing thinking and supports sustainable growth.

Mindfulness: Living in the Present Moment

Mindfulness in DBT⁷ means noticing thoughts, feelings, and sensations without judgment. This creates space between a trigger and your response—key for people managing BPD,⁸ PTSD,⁹ or substance use disorders.¹⁰

Acceptance and Change: A Dual Approach

DBT blends acceptance (e.g., radical acceptance) with targeted cognitive-behavioral interventions that shift unhelpful behaviors. You learn to face reality as it is while taking steps to improve it.

The Four Pillars (Modules) of DBT Skills Training

Dialectical behavior therapy (DBT) offers practical, evidence-based skills that help people manage emotions, cope with distress, and improve relationships. These skills are often taught in treatment programs, group sessions, or individual therapy. They can also be practiced in daily life to build resilience and support recovery. Below are the four main categories of DBT skills, along with their key strategies.

Mindfulness

Mindfulness¹¹ is at the heart of DBT. It helps patients stay grounded in the present moment, notice their experiences, and respond with clarity instead of reacting impulsively.

• “What” skills: These include observing, describing, and participating. Observing means simply noticing what is happening around and within you. Describing involves putting words to your experiences (“My heart is racing” or “I feel worried”). Participating means fully engaging in the moment, whether you are talking with a friend or focusing on a task.
  
• “How” skills: These describe the way to practice mindfulness. Nonjudgmentally means noticing without labeling something as “good” or “bad.” One-mindfully means doing one thing at a time with full attention. Effectively means focusing on what works in the situation, rather than what “should” be happening.
  

Together, these skills build awareness and reduce the pull of unhelpful thought patterns.

Distress Tolerance

These skills focus on surviving crisis moments without making things worse. Instead of avoiding or acting impulsively, patients learn ways to tolerate distress until emotions settle.

• TIPP: This stands for temperature (cooling the body, such as with cold water), intense exercise (short bursts of movement), paced breathing, and paired muscle relaxation. These strategies calm the nervous system quickly.
  
• ACCEPTS: This acronym stands for activities, contributing, comparisons, emotions, pushing away, thoughts, and sensations. These distraction strategies help redirect the mind during overwhelming moments.
  
• Self-soothing and “improve the moment”: Self-soothing uses the five senses to comfort yourself, while improving the moment might include visualization, prayer, or relaxation exercises.
  
• Radical acceptance: This involves fully accepting reality as it is, even if it is painful. Acceptance does not mean approval, but it reduces suffering caused by resisting what cannot be changed.
  

Emotion Regulation

Emotion regulation skills help patients understand their feelings and respond in healthier ways. Instead of being controlled by emotions, these tools support balance and stability.

• Core skills: These include naming emotions (labeling them clearly), checking the facts (making sure feelings fit the situation), using opposite action (doing the opposite of what an unhelpful urge suggests), and problem-solving.
  
• PLEASE: This acronym reminds patients to care for their body and mind. It stands for treating physical illness, balanced eating, avoiding intoxicants, getting good sleep, and regular exercise. When physical health is cared for, emotional regulation becomes easier.
  

These skills reduce vulnerability to intense emotions and build a stronger sense of well-being.

Interpersonal Effectiveness

DBT also teaches strategies for healthy relationships. These skills help patients ask for what they need, set boundaries, and maintain self-respect.

• DEAR MAN, GIVE, FAST: These acronyms guide effective communication. They focus on being clear about needs, maintaining positive connections, and respecting both yourself and others.
  
• Building and repairing relationships: Patients practice these skills in group sessions, family settings, school, or work. The goal is not only to improve current relationships but also to strengthen confidence in handling future interactions.
  

By practicing mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, you can develop healthier ways of coping with challenges and strengthen your overall well-being. These strategies take practice, but over time they can bring lasting change and stability.

How DBT Is Delivered

Effective DBT treatment usually includes four coordinated modes:

• Individual therapy: Weekly sessions with a clinician trained in DBT (often called DBT therapy). You and your therapist analyze patterns, rehearse DBT skills training, and track progress using a diary card.
  
• Skills training group: A classroom-style group therapy format (sometimes called a skills training group) where patients learn and practice the four modules together.
  
• Phone coaching: Brief, real-time support to apply skills during crises—before self-harm or substance use occurs.
  
• Consultation team: A weekly meeting where DBT therapists support each other, maintain adherence, and refine interventions. (Some teams train through organizations like Behavioral Tech, founded by Linehan, to uphold evidence-based standards.)
  

Programs may run in outpatient clinics, intensive outpatient tracks, partial hospitalization programs, or inpatient units. Ask about the availability of phone coaching, how the diary card is used, and whether the therapist participates in a consultation team to ensure model fidelity.

Who Can Benefit From DBT?

Originally built for borderline personality disorder, DBT now supports people with:

• Chronic suicidal ideation, suicidal behavior, and self-injury
  
• Eating disorders (e.g., bulimia, binge eating)
  
• Substance use disorders
  
• Post-traumatic stress disorder and trauma-related symptoms
  
• Depression, anxiety, ADHD, and adolescent emotion dysregulation
  

If you’ve tried CBT or other psychotherapy without lasting relief, DBT’s blend of validation, acceptance, and structured change may be a strong fit.

Is DBT Right for You?

DBT may be helpful if you:

• Experience intense emotions or emotion dysregulation
  
• Struggle with impulsivity, self-harm behaviors, or urges to use substances
  
• Face rocky relationships or fear of abandonment
  
• Want practical, skills-based tools you can use daily
  
• Are ready to learn and practice new skills¹² between therapy sessions
  

Finding Qualified DBT Providers

When contacting DBT providers, ask about:

• Full program components (individual therapy, skills training group, phone coaching, consultation team)
  
• Training (e.g., through Behavioral Tech) and supervision
  
• Use of the diary card and treatment hierarchy (life-threatening behaviors first)
  
• Experience with your concerns (e.g., BPD, PTSD, eating disorders, substance use disorders, adolescent care)
  
• Setting (community health care, private practice, hospitalization options if needed), fees, and insurance
  

A qualified mental health professional—whether in psychology, psychiatry, or counseling—will be transparent about training, structure, and outcomes.

Your Path Forward With DBT

DBT is active and collaborative. It asks you to practice daily, use your diary card, try phone coaching when needed, and show up for group sessions. Expect small steps and celebrate them: using distress tolerance instead of self-harm, choosing opposite action over avoidance, or applying DEAR MAN to navigate a tough conversation. Over time, these moments add up to stability, stronger relationships, and a true life worth living.

Quick Glossary

• DBT (dialectical behavior therapy): An evidence-based psychotherapy that blends validation and change to manage intense emotions.
  
• Modules: Mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness.
  
• Diary card: A daily tracker for emotions, urges, and dbt skills training practice.
  
• Consultation team: A therapist support meeting to ensure dbt treatment fidelity.
  
• CBT (cognitive behavioral therapy): A related cognitive-behavioral treatment approach; DBT is a specialized form.
  
• BPD (borderline personality disorder): A condition with emotion dysregulation, impulsivity, and heightened risk for suicidal behavior.
  

How to Get Started

Ready to explore DBT? 

Connecting with a qualified clinician can help you learn new skills, reduce risk, and improve quality of life—one step at a time. Search DBT treatment providers in your area today.

FAQs

Q: What is dialectic behavioural therapy?

A: “Dialectic behavioural therapy” is the British spelling of dialectical behavior therapy (DBT). DBT is an evidence-based psychotherapy that blends acceptance (mindfulness and validation) with change strategies (behavioral skills) to help people manage intense emotions, reduce harmful behaviors, and improve relationships.

Q: What is the difference between CBT and DBT?

A: Cognitive behavioral therapy (CBT) teaches you to notice and change unhelpful thoughts and behaviors. DBT is a specialized form of CBT that adds a strong focus on acceptance and real-life skills practice. It typically includes four skills modules, weekly individual therapy, a classroom-style skills group, between-session phone coaching, and a therapist consultation team that supports quality care.

Q: What are the four skills of DBT?

A: DBT skills training covers four modules you practice in and between sessions:

• Mindfulness: Notice the present moment without judgment.
  
• Distress tolerance: Get through crises safely without making things worse.
  
• Emotion regulation: Understand, name, and shift emotions effectively.
  
• Interpersonal effectiveness: Ask for what you need, set limits, and keep self-respect.
  

Q: What does DBT treat?

A: DBT was created for borderline personality disorder (BPD) and now helps with a wide range of mental health conditions linked to emotion dysregulation, including post-traumatic stress disorder (PTSD), eating disorders (such as bulimia nervosa and binge eating), substance use disorders, depression, anxiety, and problems like self-harm and suicidal ideation.

Q: Who benefits from dialectical behavior therapy?

A: People who experience intense emotions, impulsivity, frequent conflict in relationships, or urges toward self-injury or substance use often benefit from DBT. Many adolescent and adult programs are available in outpatient clinics, intensive outpatient settings, and inpatient units.

Q: Can you do dialectical behavior therapy on your own?

A: You can learn DBT skills from reputable workbooks and videos, and many people find that helpful. Still, full DBT is a structured program with individual therapy, skills training group, phone coaching, and a therapist consultation team. If you have safety concerns (like suicidal thoughts or self-harm), working with a trained clinician is strongly recommended.

Q: How much does DBT therapy cost?

A: Costs vary by location, provider training, and program type. Factors include:

• Setting: Individual outpatient sessions vs. group-based programs or higher levels of care.
  
• Insurance: In-network benefits, deductibles, and copays.
  
• Program scope: Whether services include skills groups and phone coaching.
  Ask about sliding-scale fees, insurance coverage, and program scholarships.
  

Q: Is DBT effective for treating BPD?

A: Yes. DBT is an evidence-based treatment for BPD.¹³ Studies show it reduces suicidal behavior, self-injury, emergency visits, and hospitalizations while improving quality of life, emotion regulation, and relationships.

Q: Can trainees effectively deliver DBT for individuals with BPD?

A: They can—when they receive formal DBT training, weekly supervision, and participate in a DBT consultation team within a program that follows the model. Adherence to the structure (individual therapy, skills group, phone coaching, and consultation) matters as much as the therapist’s level of experience.

Q: How to seek DBT treatment

A: Look for providers who offer an adherent DBT program. Ask:

• Do you offer all four modes (individual therapy, skills training group, phone coaching, consultation team)?
  
• How are diary cards used?
  
• What ages do you serve (adolescent vs. adult)?
  
• What’s the typical length and schedule?
  
• What insurance do you accept or what are the fees?
  

Q: How long does it take to see results from DBT?

A: It varies. Many patients notice early gains—such as better crisis coping or fewer impulsive behaviors—within several weeks of consistent skills practice. Broader changes in mood stability, relationships, and everyday functioning usually build over months.

Q: How long does dialectical behavior therapy typically last?

A: A common course runs six months to one year. Many programs teach the full set of skills over about 24 weeks and then repeat the cycle to help you deepen practice and apply skills to new situations.

Q: How long does a typical DBT program last?

A: Program length depends on your goals and risk level. Standard outpatient DBT often lasts 6–12 months; some patients continue longer for maintenance or transition to less intensive care once goals are met.

Q: When is someone ready to step down from DBT or reduce intensity?

Indicators might include: sustained reduction in life-threatening behaviors, regular use of DBT skills in daily life, ability to manage emotions with lower crisis frequency, meeting therapy goals, and stability in interpersonal areas. The article’s emphasis on “readiness” and gradual transition is good. Clinically, this is a collaborative decision based on risk assessment, client readiness, and therapist judgment.

Q: What to do if a patient doesn’t feel ready to step down even if clinical markers are met?

Approach that hesitation empathically. Use DBT’s validation stance: acknowledge fear of relapse or loss of support. Gradually plan a phased reduction rather than an abrupt ending. Encourage ongoing skills groups or “graduate” classes so clients maintain connection and support.

Q: How does planning differ with the first treatment episode versus an individual with multiple prior attempts?

A: For first-time clients, you might plan a “standard” DBT duration (6–12 months) with expected progression. For clients with multiple failed treatments or high complexity, you may plan for extended duration, booster phases, possible repeated curriculum rounds, or more intensive supervision. Use prior history to inform pacing, risks, relapse prevention strategies, and need for adjunctive interventions (e.g. trauma work, substance use integration).