What is Dialectical Behavior Therapy?
Dialectical Behavior Therapy (DBT) is a comprehensive, evidence-based psychotherapy developed to treat individuals with chronic suicidality, borderline personality disorder (BPD), and severe emotional dysregulation. DBT combines cognitive restructuring with acceptance, mindfulness, and shaping, synthesizing opposing therapeutic approaches into a unified framework. The term “dialectical” refers to the central tension the therapy addresses: balancing acceptance of clients’ current reality with the imperative for change. DBT required a theoretical framework that could integrate the principles of Zen and other contemplative practices with behaviorism, which emerged with a chance encounter with the philosophical concept of dialectics, which highlights the process of synthesizing oppositions.
The therapy is structured around four core skill modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Mindfulness and distress tolerance are acceptance-oriented skill modules, while emotion regulation and interpersonal effectiveness are change-oriented skills. Standard DBT delivery includes individual weekly therapy sessions, group skills training, between-session phone coaching, and therapist consultation teams.
Origins & Lineage
In the late 1970s, Marsha M. Linehan attempted to apply standard Cognitive Behavior Therapy (CBT) to the problems of adult women with histories of chronic suicide attempts, suicidal ideation, urges to self-harm, and self-mutilation. However, she found that traditional CBT did not sufficiently meet the needs of these individuals, as it did not fully address the intense emotional pain experienced by them.
DBT was developed in the late 1980s by psychologist Marsha M. Linehan, who earned her Ph.D. in clinical psychology from Loyola University in 1971. She drew from these experiences, her academic knowledge, and her Zen practice to create a therapy that effectively addressed the needs of individuals with BPD and other conditions characterized by emotional dysregulation. Linehan herself had experienced psychiatric hospitalization as a young woman, which informed her commitment to developing effective treatment for populations considered untreatable.
DBT was born in 1991 when Linehan and her colleagues published the results of their first randomized controlled trial demonstrating the treatment’s efficacy in reducing suicidal behaviors and improving other outcomes among adult women diagnosed with borderline personality disorder. In 1993, Linehan published her DBT treatment manual and skills-training manuals, which were used in her 1991 outcome study. The foundational texts are Cognitive-Behavioral Treatment of Borderline Personality Disorder (1993) and Skills Training Manual for Treating Borderline Personality Disorder (1993), both published by Guilford Press.
How It’s Practiced
Dialectical behavior therapy is a modular and hierarchical treatment consisting of a combination of individual psychotherapy, group skills training, telephone coaching, and a therapist consultation team.
Individual therapy sessions are typically weekly, lasting 40-60 minutes. The therapist may give homework assignments, tasking people to observe their emotions over the course of a week and practice DBT skills in their everyday lives. Homework often involves recording one’s daily emotions and actions on a “diary card,” which the therapist reviews during each session.
Group skills training is conducted in a classroom-style format rather than traditional group therapy. These sessions typically meet weekly for 1-2 hours at a time. The format tends to be a classroom-type setting where a leader and co-leader develop exercises and activities for participants to engage in. The standard DBT training schedule begins with two weeks of mindfulness training followed by five- to seven-week training modules in distress tolerance, interpersonal effectiveness, and emotion regulation. A two-week module of mindfulness training is interspersed between each five- to seven-week module. In all, it takes around six months to complete the skills training modules following the standard DBT schedule.
Phone coaching allows clients to contact their therapist between sessions for brief consultations when applying skills to real-life crises. Therapist consultation teams meet regularly to support clinicians in maintaining treatment fidelity and managing the demands of working with high-risk clients.
Dialectical Behavior Therapy Today
Since the introduction of Linehan’s treatment manuals in 1993, dialectical behavior therapy has been widely disseminated throughout multiple therapeutic settings and applied to a variety of diagnoses. While originally developed for BPD, DBT now treats various conditions including depression, anxiety, PTSD, eating disorders and substance use.
Today, individuals encounter DBT through comprehensive outpatient programs offered by mental health clinics, private practice therapists trained in the modality, and intensive outpatient or partial hospitalization programs. The time it takes for someone to complete a DBT treatment program varies, depending on individual treatment goals and response to the therapy. In general, outpatient DBT requires at least six months of treatment, but it often takes a year or longer to complete.
Many practitioners now offer DBT skills groups without the full comprehensive model, making skills training accessible to broader populations. The Linehan Institute and organizations like Behavioral Tech provide training and certification for clinicians. Self-help resources, including workbooks based on Linehan’s handouts, allow individuals to practice skills independently, though these do not constitute comprehensive DBT.
Common Misconceptions
Many people assume that Dialectical Behavior Therapy is designed exclusively for individuals with Borderline Personality Disorder. While it is true that DBT was initially developed to treat BPD, it has since been adapted and proven effective for treating a wide range of mental health conditions.
Some believe it’s the same as CBT, while others think it’s just about suppressing emotions. In fact, DBT explicitly validates emotions as providing important information rather than advocating suppression. Because of the focus on behavior change and accountability, some people might misinterpret DBT as a cold, harsh, or punitive kind of therapy. In reality, DBT is deeply compassionate.
This perceived rigidity has led some mental health practitioners to refer to programs as either adherent-to-the-model or not-DBT. This “either/or” thinking is not in alignment with DBT, which advocates for a “both/and” mindset. Unfortunately, adherence to the model can feel restrictive and is not actually in the spirit of how DBT was originally conceived. DBT’s modular structure allows for adaptation across settings and populations, though comprehensive DBT includes all four modes of treatment.
DBT is not a quick fix or a passive process—it requires active participation, homework completion, and sustained engagement over months. It is not exclusively for women, despite early research focusing on female populations.
How to Begin
For individuals seeking DBT, the most effective entry point is finding a comprehensive DBT program that includes both individual therapy and group skills training. The DBT-Linehan Board of Certification maintains a directory of certified providers. Many insurance plans cover DBT due to its evidence base.
For self-study, Linehan’s DBT Skills Training Handouts and Worksheets, Second Edition (Guilford Press, 2015) provides the client-facing materials used in skills groups. The companion DBT Skills Training Manual, Second Edition (2015) is designed for clinicians but offers detailed explanations of each skill. Linehan’s memoir Building a Life Worth Living (2020) provides context on the therapy’s development from lived experience.
Prospective clients should inquire whether a program offers all four DBT modes, the clinician’s training background, and the expected duration of treatment. Skills-only groups may be available for those not requiring comprehensive DBT but seeking to build emotion regulation capacity.