DBT

Dialectical Behavior Therapy (DBT)

A skills-based therapy for emotions that arrive fast and hard, built on holding acceptance and change at the same time.

Developed by: Marsha M. Linehan, University of Washington
First set out in: Her 1993 book, Cognitive-Behavioral Treatment of Borderline Personality Disorder
Skills modules: Mindfulness · Distress tolerance · Emotion regulation · Interpersonal effectiveness
Standard programme: Individual therapy, group skills training, phone coaching, therapist consultation team

What it is

DBT began as an attempt to treat chronically suicidal clients after the standard CBT protocols of the late 1970s kept failing them. Linehan describes the result as a synthesis or integration of opposites — hence “dialectical”.

The NHS describes DBT as resting on two ideas: validation, accepting that your emotions are legitimate, and dialectics, recognising that situations are rarely absolute.

Skills training is a defined curriculum. Some settings now use the skills training on its own to address specific treatment goals.

What it looks like in session

1Weekly individual sessions alongside group skills training
2Mindfulness: non-judgmental attention to what is happening right now
3Distress tolerance: getting through an intense moment without making it worse
4Emotion regulation: understanding an emotion well enough to change its course
5Interpersonal effectiveness: asking for things while keeping the relationship and your self-respect
6Out-of-hours phone coaching, so skills get used in the moment they are needed

What the evidence says

NICE recommends DBT as the first treatment option for women with borderline personality disorder who have a history of self-harm and suicidal behaviour, according to the NHS.

The first randomised clinical trial showed reduced rates of suicidal gestures, psychiatric hospitalisations and treatment dropouts compared with treatment as usual.

A meta-analysis found DBT reached moderate effects in people with borderline personality disorder; research also covers depression, PTSD, substance use and trauma-related conditions.

Nothing here is a prediction about your own treatment.

Often used for

Emotional intensityImpulsive behaviourRelationship difficultiesSelf-harm

Wondering if DBT is right for you?

You do not have to decide in advance. We work that out together in the first session, and often use more than one method.

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Other methods we use

CBT