What Is Dialectical Behavior Therapy? Understanding DBT and How It Works

If you’re struggling with intense emotions or a mood disorder, finding the right therapy can present several challenges. Acronyms such as CBT, DBT, and ACT can mean very little to someone who is new to navigating a mood disorder diagnosis. However, by understanding different treatments and their unique approach to addressing mental health problems, you can better understand your therapeutic options and set yourself up for a sustained life of fulfillment and purpose. 

Dialectical behavior therapy (DBT) is an evidence-based technique that many therapists use, which can help you with emotional regulation, interpersonal relationships, and promote self-care. Here’s a breakdown of DBT and how you can benefit from its skill development and approach.

What Is DBT?

DBT is a type of therapy based on the principles of cognitive behavioral therapy (CBT). It aims to help you manage intense feelings by teaching you how emotions affect behaviors, while balancing self-acceptance with motivation for positive change. 

This balancing act is the “dialectical” aspect of DBT — the coexistence of two opposing concepts that are both true simultaneously. DBT was created by psychologist Dr. Marsha Linehan to treat borderline personality disorder (BPD), but has since been used to treat people struggling with a host of other mood disorders and intense emotions.

DBT vs. other therapies: comparing care approaches

One way to understand the unique benefits of DBT and how it can promote emotional stability is by comparing it to other therapeutic approaches. Here’s a breakdown of what that looks like:

• DBT vs. CBT: While DBT is based on the principles of cognitive behavioral therapy (CBT) and both are structured and skills-based, DBT emphasizes emotional regulation, distress tolerance skills, and acceptance strategies alongside change techniques, whereas CBT primarily focuses on changing negative thoughts and behaviors.
• DBT vs. psychotherapy: Traditional psychotherapy often explores past experiences and unconscious processes over extended periods, while DBT is more present-focused, skills-based, and typically follows a structured format with defined treatment components and goals.
• DBT vs. ACT: Though both incorporate mindfulness and acceptance, acceptance and commitment therapy (ACT) focuses more broadly on psychological flexibility and values-based action, whereas DBT provides more concrete skills training and structure.
• DBT vs. MBT: Both address emotion regulation, but DBT offers a more comprehensive skills training approach, while mentalization-based therapy (MBT) focuses specifically on understanding mental states.

Although each therapy style presents its own advantages, research consistently demonstrates that DBT is particularly effective for individuals with BPD, significantly reducing self-destructive behaviors, suicidal ideation, and hospitalizations while decreasing reliance on outpatient mental health services ¹.

How Does DBT Work?

To understand how DBT works, a more in-depth analysis is required to see how its core components promote mood management and what a DBT course typically includes.

The dialectical framework: acceptance, change, and the “wise mind”

The dialectical aspect of DBT centers on balancing self-acceptance with the desire for change. This balance extends to various aspects of therapy, informing how DBT therapists help reframe thought patterns and beliefs.

The “wise mind” concept exemplifies this balance. It recognizes two distinct mentalities: the emotional mind — guided by intuition, emotions, and feelings — and the rational mind — guided by logic and facts. By conceptualizing these as separate but complementary entities, DBT helps you recognize when one dominates the other. Through practice, you learn to integrate both perspectives, accessing a balanced state that draws on both emotional wisdom and rational thought processes.

What are the four skills of DBT?

There are four DBT skills that dialectical behavior therapists will use to improve your emotional regulation skills, including: 

• Mindfulness emphasizes present-moment awareness and helps you maintain control of your attention.
• Distress tolerance teaches crisis survival strategies and radical acceptance.
• Emotional regulation will help you identify, understand, and subsequently change emotional responses.
• Interpersonal effectiveness strengthens relationships with others and yourself by improving communication skills and teaching new skills to navigate conflict.

The format of DBT treatment

DBT utilizes several formats including individual and group sessions, and by implementing multiple components, DBT therapists can effectively help you achieve results. Here’s what those components look like, and what you can expect from each session ²:

• Individual therapy sessions typically recur weekly and last 50 to 60 minutes. During sessions, you may be assigned emotional observation homework whereby you’ll use a diary card to track negative behaviors.  
• DBT group therapy skills training is where you’ll meet weekly — typically for 1.5 to 2.5 hours — and review homework with the support of others and the guidance of a therapist. Care will be adjusted based on your progress. 
• Phone coaching for implementing lessons and crisis management help you practice dbt skills learned in group and individual therapy into your daily life and provide support in moments of severe emotional distress.  
• DBT consultation team meetings are not something you as a patient will participate in, but help to coordinate care and review cases among licensed mental health professionals.

It’s important to remember that different DBT formats will have varying durations, and not every package will include the same components. However, this offers insight into the conventional DBT package model.

The structure of conventional DBT treatment

The conventional approach of DBT treatment typically follows a four-step process: 

1. Behavioral dysregulation: To start, DBT teaches you how to reduce self-destructive behaviors through skill-based practices.
2. Processing emotions and experiences: While your behavior may be better regulated after stage one, you may still struggle with extreme emotions. The second step of DBT will address traumatic experiences and problems experienced within childhood to improve your emotional functioning. 
3. Building ordinary happiness and addressing life problems: This stage helps you cope with everyday challenges to put you on the path toward mentally healthy living.
4. Finding deeper meaning and fulfillment: The final step of DBT helps you to find connection and live a life of happiness through discovering spiritual meaning.

It’s important to note that not all DBT programs follow this exact sequence. The stages are not strictly sequential, and there may be issues that require repeated work throughout different stages of treatment. Additionally, you may decide that the fourth stage focusing on spiritual fulfillment isn’t necessary for your treatment goals.

What is the 24-hour rule in DBT?

The 24-hour rule in DBT is a guideline that helps you manage intense emotions without acting on them. It gently encourages you to wait a full day before acting on strong emotional urges, particularly those that might lead to harmful behaviors or impulsive decisions. This waiting period allows emotions to naturally subside in intensity and gives you time to use your DBT skills to respond more effectively and with a level head.

During these 24 hours, you are encouraged to practice learned skills for distress tolerance and emotion regulation while considering the potential consequences of acting upon your impulses. This rule helps create space between strong emotions and actions, promoting more mindful decision-making and reducing potentially regrettable behaviors.

What Mental Illnesses Is DBT Good For? Conditions DBT Can Treat

While initially created to help those struggling with BPD, DBT can help those with various other disorders, including addiction. Here are some other ways that a DBT course can support mental health.

DBT for borderline personality disorder (BPD)

DBT has been shown to be significantly effective for BPD treatment — research shows that it has a 50% success rate at reducing suicidal behaviors for those who struggle with this mood disorder ³. BPD is a personality disorder characterized by impulsivity and struggles to regulate emotions, which can significantly impact the stability of relationships, self-worth, self-image, and your ability to distinguish between reality and emotions.

DBT combats these struggles by addressing emotional instability, identity confusion, impulsivity, self-harm tendencies, suicidal behaviors, and relationship difficulties. Through its comprehensive approach combining acceptance and change strategies, DBT provides patients with practical skills they can apply in their day-to-day to create stability and improve their overall quality of life.

DBT for substance use disorders

DBT has also been proven effective for treating substance use disorders (SUD), particularly when partaking in DBT skills training and for those with co-occurring disorders. Furthermore, DBT skills training has proven to have high retention rates compared to standard treatment groups, emphasizing this approach’s ability to keep people engaged ⁵.

DBT can support those struggling with addiction by helping them manage overwhelming emotions that may lead them to self-medicate with substances. It can also help them manage cravings, repair relationships damaged by substance use, and withstand strong cravings without acting on them. During a DBT course, therapists will also support you as you implement its skills in daily life.

DBT for other mental health conditions and struggles

While its main applications are helping those with BPD or SUD, DBT has been proven effective to treat several other conditions and mental health struggles, including:

• Eating disorders (particularly binge eating and bulimia).
• Post-traumatic stress disorder (PTSD).
• Major depressive disorder (MDD).
• Attention deficit and hyperactivity disorder (ADHD). 
• Bipolar disorder. 

Additionally, DBT can also be used to treat psychological problems that may not meet the criteria for a clinical diagnosis, including:

• Intense emotions and anger management issues.
• Relationship conflicts and communication problems.
• Self-destructive behaviors.
• Struggles with work-life balance or work-related stress. 
• Unhealthy perfectionist tendencies. 
• Stress management. 

The Benefits and Limitations of DBT

While DBT has proven highly effective for many individuals, it’s important to understand both its strengths and potential limitations. Here’s what the research reveals about DBT’s advantages and limitations to help you make informed treatment decisions.

What are the pros of using DBT?

DBT stands out among therapeutic approaches for its robust scientific validation across numerous clinical trials and real-world implementations, offering several distinct advantages:

• Strong research support for reducing harmful behaviors: Multiple controlled trials have demonstrated DBT’s effectiveness in reducing self-harm behaviors and suicidal ideation, with one study showing an 87.5% full remission rate for SUD compared to 33.3% in control treatments ⁶ .
• Practical, skills-based approach: DBT provides concrete and actionable techniques clients can implement immediately in their daily lives, making it particularly valuable for crisis management and long-term coping skills.
• Comprehensive treatment model: Unlike some therapeutic approaches that focus on single domains, DBT addresses emotional regulation, distress tolerance, interpersonal effectiveness skills, and mindfulness skills simultaneously, creating a more holistic approach.
• Sustained treatment gains: Research indicates that many clients maintain improvements after completing DBT ⁵.
• Effectiveness across populations and conditions: Studies demonstrate DBT’s efficacy across diverse populations and comorbid conditions ⁷.

What are the cons of using DBT?

Despite its proven effectiveness, it’s important to recognize that DBT, like any treatment approach, comes with practical limitations that should be considered when evaluating its suitability for individual needs, including: 

• Significant time commitment: Standard comprehensive DBT typically requires a one-year commitment with multiple weekly sessions, which may be prohibitive for some individuals with work or family obligations.
• Therapist expertise may be hard to find: The effectiveness of DBT depends heavily on providers having specialized training and adhering to the model’s principles, yet many practitioners may have limited formal training in the approach.
• Not one-size-fits-all: Some conditions may require modified DBT approaches or integration with other treatments, particularly for complex trauma, severe psychosis, or certain personality disorders.
• Medication considerations: While DBT focuses on behavioral skills, many clients with conditions like bipolar disorder or severe depression benefit from combined medication management alongside DBT.
• Accessibility challenges: Comprehensive DBT programs can be expensive, with limited insurance coverage, and are often unavailable in rural areas or regions with limited mental health resources.
• Resource-intensive approach: DBT requires substantial resources to implement properly, including specialized therapist training, weekly individual sessions, group skills training, and therapist consultation teams, making it less accessible for many healthcare settings with limited budgets or staff.

DBT has faced some controversy as a therapeutic modality due to several practical challenges: it requires intensive resources and significant time commitments from both patients and providers, it may lack flexibility for certain individuals’ needs, and it can be difficult to implement across all clinical settings. Additionally, some question whether its effectiveness extends beyond BPD treatment and whether its clinical benefits justify the substantial resources required for proper implementation.

How To Find DBT Treatment

To find qualified DBT treatment, search for therapists certified through resources like Psychology Today’s directory, university hospital referrals, or recommendations from your primary care doctor or your insurance company. When evaluating providers, ask about their specific DBT training, consultation team participation, and experience treating your mental health concerns to find the right therapist. 

Consider whether a comprehensive or a less intensive approach best suits your needs and financial situation. Insurance companies and websites typically have sliding scale fees, or if it’s deemed too expensive for you, check out community mental health centers for affordable alternatives.

At Neuro Wellness Spa, we have a team of therapists that are trained to treat mental health concerns with DBT in a compassionate, effective, and personalized approach. Our care integrates evidence-based dbt techniques with individualized plans to help clients develop practical skills for managing emotions and improving their overall quality of life.

How Neuro Wellness Spa Can Support Mental Wellness With DBT

At Neuro Wellness Spa, we offer comprehensive DBT as a cornerstone of our integrative approach to mental health treatment. Our specially trained DBT therapists help clients develop essential skills in emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness within a supportive therapeutic environment. 

We recognize that lasting healing involves addressing both psychological and physiological aspects of mental health, which is why our DBT program can be seamlessly combined with other evidence-based treatments such as TMS therapy, medication management, and CBT. This multidimensional approach allows us to create personalized treatment plans that address the unique needs of each client while providing practical tools for long-term emotional resilience. Contact Neuro Wellness Spa today to discover how our DBT program can be part of your comprehensive path to improved mental wellbeing and a more fulfilling life.

References

1. Hernandez-Bustamante, M., Cjuno, J., Hernández, R. M., & Ponce-Meza, J. C. (2023). Efficacy of dialectical behavior therapy in the treatment of borderline personality Disorder: A systematic review of randomized controlled trials. Iranian Journal of Psychiatry. https://doi.org/10.18502/ijps.v19i1.14347

2. Dialectical Behavior Therapy (DBT). (2024, October 25). Yale Medicine. https://www.yalemedicine.org/conditions/dialectical-behavior-therapy-dbt

3. Hylland, K. (2024, October 3). Stats around DBT: evidence, success rates, and impact. DBT-UK. https://dbt-uk.com/stats-around-dbt-evidence-success-rates-and-impact/

4. Dimeff, L. (2008). Dialectical Behavior therapy for Substance abusers. Addiction Science & Clinical Practice, 4(2), 39–47. https://doi.org/10.1151/ascp084239

5. Valley Forge Medical Center and Hospital. (n.d.). The power of DBT in substance use treatment. https://www.vfmc.net/blog/dialectical-behavior-therapy-dbt-for-substance-use

6. Harned, M. S., Chapman, A. L., Dexter-Mazza, E. T., Murray, A., Comtois, K. A., & Linehan, M. M. (2008). Treating co-occurring Axis I disorders in recurrently suicidal women with borderline personality disorder: A 2-year randomized trial of dialectical behavior therapy versus community treatment by experts. Journal of Consulting and Clinical Psychology, 76(6), 1068–1075. https://doi.org/10.1037/a0014044