DBT

Dialectical behaviour therapy

For emotions that arrive too fast and too hard. It teaches four concrete skill sets: distress tolerance, emotion regulation, mindfulness, relationships.

What it is

DBT was built by Marsha Linehan for people the existing therapies were missing: those whose emotions ran so intense that any attempt at "let's examine that thought" failed before it began. If the emotional wave takes you from calm to unbearable in thirty seconds, you don't have time to fill in a thought record.

"Dialectical" means holding two apparently contradictory truths at once: you are doing the best you can right now AND you need to do more. Therapies that insist only on change land as invalidating. Those that insist only on acceptance leave the life unchanged. DBT refuses to choose.

It isn't a therapy "for borderline", though that is where it began and where its evidence is strongest. It is for anyone who recognises the pattern: fast, intense emotions that are hard to bring down, followed by behaviours they then regret.

How it works

DBT teaches skills, in four modules.

Mindfulness — noticing what's happening inside without acting on it immediately. The foundation of the other three.

Distress tolerance — what you do in the minutes when emotion peaks and every decision is a bad one. Physical techniques, deliberately simple: cold water on the face, a short burst of intense exercise, breathing out longer than in. They don't solve the problem; they keep you intact until the wave passes.

Emotion regulation — reducing baseline vulnerability (sleep, food, movement) and acting opposite to the urge: when shame says hide, you show up.

Interpersonal effectiveness — how to ask for something, how to refuse, how to keep the relationship and your self-respect at the same time.

What a session looks like

Standard DBT has two parallel components: a weekly individual session and a skills group, also weekly, which runs like a course — with a manual, exercises and homework. Many programmes add the option of contacting your therapist between sessions, at moments of crisis, for a short coaching call.

In the individual session you work with a diary card: you log emotions, urges and skills used, daily. When a difficult episode occurs, you analyse it minute by minute — what triggered it, what you felt, what you did, what could have intervened. It's called chain analysis and it is the backbone of the method.

Many practices offer only the individual component, "DBT-informed". That is useful, but it isn't full DBT — ask directly what you're getting.

What it works for

Borderline personality disorder
Self-harm and recurrent suicidal urges
Intense emotional dysregulation
Impulsivity with repeated consequences
Binge eating

How long it takes

The standard programme runs about a year: the four skills modules are covered in two six-month cycles. Shortened variants of 16-24 weeks exist for more delimited problems. It is a large time investment, and it's fair to know that upfront.

What the evidence says

DBT is the best-evidenced treatment for borderline personality disorder and is recommended as such by NICE. Linehan's randomised trials and subsequent replications showed significant reductions in self-harming behaviours and hospitalisations. The evidence has since extended to binge-type eating disorders and to emotional dysregulation more broadly.

When it is NOT the right choice

DBT asks for a commitment not everyone can make right now: two meetings a week, homework, a daily diary. If your problem is a delimited anxiety or mild depression, it's disproportionate — CBT gets there with far less. It also isn't right if you'd refuse the group component outright, because that is where the skills are taught. And if psychotic symptoms are prominent, psychiatric treatment comes first.

Problems treated with this method

anxiety depression trauma

Frequently asked questions

Is DBT only for borderline personality disorder?

No. That's where it was developed and where its evidence is strongest, but the skills work for any form of emotional dysregulation. Many programmes now teach them in contexts with no connection to a personality diagnosis. You don't need the clinical label to benefit from the module.

Can I really call my therapist between sessions?

In full DBT programmes, yes — but with a precise purpose and clear limits. The call is for skills coaching in a moment of crisis: "which skill do I use right now?". It isn't an extra session and it isn't for processing. The rules are set explicitly at the start, including the hours your therapist is available.

Other approaches

Cognitive behavioural therapyThe most heavily researched method in psychotherapy. It works on the link between thought, emotion and behaviour, with homework between sessions.EMDR therapyA trauma method using bilateral stimulation. It doesn't require narrating the event in detail — which is why it is bearable when talking isn't.Psychodynamic therapyThe modern descendant of psychoanalysis. It looks for the pattern repeating beneath the symptom, not just the symptom. Longer, deeper, no homework.Acceptance and commitment therapyIt doesn't try to change your thoughts, but your relationship to them. The goal isn't to feel good, it's to live by your values even when you don't.Systemic family therapyIt treats the family as a system, not one person as the fault. One member's symptom is often the solution the system found to a problem nobody names.Emotionally focused therapy for couplesThe best-evidenced couples method. It doesn't teach communication techniques — it untangles the cycle where one pursues and the other withdraws.Gestalt therapyIt works with what's happening now, in the room, not the story about the past. Experiential and direct — you'll do things, not just talk about them.Person-centred therapyNo techniques, no homework, no interpretations. It bets everything on the relationship — and research shows the relationship is the best predictor of outcome in all of psychotherapy.Mindfulness-based cognitive therapyA structured 8-week group programme. Built specifically to prevent relapse into depression — not to treat an episode in progress.Schema therapyFor lifelong patterns, not recent symptoms. It combines CBT, attachment and experiential techniques — built for the cases where classical CBT wasn't enough.Play therapyFor children who don't yet have the language of emotion. Play is the medium in which a six-year-old says what they can't explain — and parents are part of the process.

Not sure what fits you?

That's normal — most people don't know, and choosing the method is the therapist's job, not yours. A 15-minute call is enough to find out.

Book a free call Find a therapist working with dialectical behaviour therapy