What Is Dialectical Behavior Therapy (DBT)? Understanding the Skills and Philosophy

A path toward steadiness and change.

Dialectical Behavioral Therapy (DBT) Overview

What Is Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is an evidence-based approach that helps people regulate intense emotions, tolerate distress, and navigate relationships more effectively.

Below is a practical guide to the core DBT skills, with links to deeper articles you can explore and apply in daily life.

DBT Background

Dialectical Behavior Therapy (DBT) is an evidence-based form of psychotherapy designed to help people manage intense emotions, reduce distress, and build more effective ways of coping. Originally developed to support individuals experiencing chronic emotional dysregulation, DBT combines practical skills with acceptance-based strategies to promote change without judgment. Rather than focusing only on symptom reduction, DBT emphasizes building a life that feels more balanced, meaningful, and sustainable.

Dialectical Behavioral Therapy (DBT) was developed by Marsha Linehan, PhD. It’s a well developed, complex, skill-based therapy designed for people who struggle with persistent mental health disorders. DBT is a synthesis of Eastern mindfulness skills with Western cognitive-behavioral skills. The overall goal is to teach people behaviors and attitudes – skills – that foster non-judgmental acceptance of the self and life events while, at the same time, striving for appropriate behavioral changes.

Linehan first developed the DBT skills set in the late 1980’s for those who suffered from Borderline Personality Disorder (BPD). For those of you in the know, you know that BPD, like other personality disorders, is a long-term illness whose symptoms are resistant to therapy and medication. The intractability of this disease causes much suffering and can even leave a person disabled and unable to productively work.

BPD is a devastating diagnosis. Persons with BPD suffer from chronic low self-esteem, broken relationships and para-suicidal and suicidal behaviors. BPD is characterized by extreme mood swings, persistent feelings of abandonment and hostility towards the self and others.

Linehan’s DBT program has been shown in research and clinically to reduce emotional pain and self-harming behaviors in those who suffer from BPD. Over several decades this work has gradually spread to include persons who suffer with other chronic and difficult to treat mental health disorders, such as obsessive-compulsive disorder, depression, anxiety and panic disorder.

Linehan's Training Manual is available on Amazon, where you can read about the concepts. It's a very dense book, though, meant for clinicians!

DBT skills are organized into four core areas and are taught in this framework. DBT is a very well respected, well researhed, intensive therapy.

You can also explore how these skills work together in a more visual, body-based way in The DBT House.

Overview of Skills Based Dialectical Behavior Therapy (DBT)

DBT is a skills-based, long-term therapy requiring a collaborative commitment between client and therapist. The DBT curriculum runs six months. A full cycle of DBT is considered a year long consisting of two six-month programs. The goal is for the individual to build a broad base of skills to choose from when swamped by negative thoughts and strong emotion. By spreading the training out over a year, people have time to acquire and reinforce the skills until they generalize and become part of their daily behavioral patterns.

DBT is taught in group format. The purpose of a DBT group is to learn and practice skills and to review skills homework. The DBT group is not a traditional therapy group where one processes emotion and events. The therapist running the group is a facilitator and supportive teacher and not an insight-oriented therapist. The facilitator enlists the cooperation of the group members in maintaining the group structure. Clients are encouraged to purse their own individual therapy to both reinforce the DBT skills and to process their emotions.

DBT is taught to the group in four modules. Each module teaches four large sets of skills and lasts approximately five weeks. Homework is assigned weekly and reviewed at the next class.

Here is the link to the Linehan book of worksheets for homework. Sometimes clients like to buy this book so they have access to all of the homework sheets. There are a lot of homework exercises available. The facilitator picks and chooses from the available homework exercises as there is such a rich assortment.

DBT skills are organized into four core areas. Each set of skills supports a different aspect of emotional and relational life.

The Four Core DBT Skill Areas

Mindfulness

Core mindfulness skills involve learning to focus on the present moment and living in a way that helps soothe the nervous system, body, and mind. This includes awareness of the present moment and non-judgment.

Mindfulness has been heavily researched and found to be effecacious. If mindfulness was a drug, there would be a billboard on every highway selling mindfulness !

→ Explore:

• Wise Mind – Walk the Middle Way

• DBT “What” Skills

Distress Tolerance

DBT Distress Tolerance skills are about getting through difficult moments without making things worse.

Wise Mind and Radical Acceptance are the foundational skills of Distress Tolerance.

→ Explore:

• STOP & TIPP Skills

• Self-Soothing Using the Five Senses

• Radical Acceptance

Emotion Regulation

The Emotion Regulation skills help a person build up a base of positive experiences and regulate emotion on a daily basis. Emotion Regulation is about understanding and managing emotional responses.

• ABC PLEASE Skills

• Emotion Regulation Overview

Interpersonal Effectiveness

Interpersonal Effectivenbess skills are about interacting with others in such way that preserves respect for both the self and the other person. Interpersonal Effectiveness is about navigating relationships, boundaries, and communication.

→ Explore:

• Interpersonal Effectiveness Skills

Within an integrative mental health approach, DBT skills support emotional regulation by working with both cognitive and nervous system processes.

And, be gentle with yourself, DBT skills are not meant to be used perfectly, but practiced over time. You can explore each skill area above to find what supports you in this moment.