Dialectical Behaviour Therapy (DBT)

What is DBT?

Dialectical behaviour therapy (DBT) was developed by Marsha Linehan in the late 1980s, originally for people with borderline personality disorder (BPD) who had not responded to other treatments. It has since been adapted for a wide range of emotional difficulties.

The word "dialectical" refers to balancing two things that seem like opposites. In DBT, the central dialectic is: you are doing the best you can right now, and you can work toward doing better. This balance of acceptance and change runs through everything in DBT.

How it works

DBT combines elements of CBT with mindfulness practices drawn from Zen Buddhist traditions. It is more structured than most therapies and typically includes multiple components:

• Individual therapy -- weekly sessions focused on your specific challenges, using a diary card to track emotions and behaviours between sessions
• Skills group -- a weekly group (usually 2 to 2.5 hours) where you learn and practise the four core skill modules
• Phone coaching -- brief between-session contact when you need help applying skills in a crisis
• Therapist consultation team -- your therapist meets regularly with other DBT therapists for support and quality assurance

Not everyone needs the full programme. Many therapists offer DBT-informed individual therapy or skills-only groups.

The four skill modules

Mindfulness

The foundation of all other skills. Mindfulness in DBT means paying attention to the present moment without judgement. You learn to observe your thoughts and feelings without being controlled by them.

Distress tolerance

Skills for surviving crisis moments without making things worse. These are not about feeling better; they are about getting through intense emotions without turning to harmful behaviours. Techniques include distraction, self-soothing and radical acceptance.

Emotion regulation

Skills for understanding your emotions, reducing vulnerability to intense emotions and changing emotions you want to change. You learn to name what you are feeling, understand what triggers it and develop strategies for shifting emotional states.

Interpersonal effectiveness

Skills for asking for what you need, saying no and maintaining self-respect in relationships. These draw on assertiveness training and help you navigate conflict without damaging relationships or abandoning your own needs.

Who is it best suited to?

DBT has strong evidence for:

• Borderline personality disorder (BPD)
• Self-harm and suicidal behaviour
• Eating disorders (particularly binge eating and bulimia)
• Substance use disorders
• Chronic emotional instability
• Intense anger or mood swings
• Difficulty maintaining relationships

It is particularly helpful if you experience emotions more intensely than those around you and struggle to regulate them. NICE recommends DBT as a treatment for BPD.

How it differs from other approaches

DBT is more structured and intensive than most therapies. Where standard CBT focuses primarily on changing thoughts, DBT gives equal weight to acceptance. Where person-centred therapy follows your lead, DBT has a clear curriculum of skills to learn.

The combination of individual therapy and group skills training is distinctive. You are learning concrete, teachable skills, not just talking about your difficulties.

The evidence

DBT is one of the most extensively researched treatments for BPD and self-harm. Linehan's original 1991 trial showed significant reductions in self-harm and hospital admissions. A 2019 meta-analysis by DeCou and colleagues confirmed DBT's effectiveness for reducing suicidal behaviour across multiple studies. It is recommended by NICE for BPD and is available through some NHS services.