What is DBT? A Complete Guide to DBT

DBT (Dialectical Behavior Therapy) is an evidence-based form of cognitive behavioral therapy that teaches four core skill sets — mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness — to help people manage intense emotions, reduce self-destructive behaviors, and build a life that feels worth living.

Originally developed in the late 1980s by psychologist Dr. Marsha Linehan to treat chronically suicidal individuals with borderline personality disorder, DBT has since become one of the most well-researched therapies in mental health, with proven effectiveness across a wide range of conditions.

If you’ve been searching for a therapy that does more than just talk through problems — one that actually gives you practical tools you can use the moment a wave of emotion hits — DBT may be what you’re looking for. In this guide, I’ll walk you through exactly what DBT is, how it works, who it helps, and how it differs from other types of therapy.

1. DBT Therapy at a Glance

Element	What It Means
Full Name	Dialectical Behavior Therapy
Developed By	Dr. Marsha Linehan, University of Washington (late 1980s)
Type of Therapy	A specialized form of cognitive behavioral therapy (CBT)

2. What Does “Dialectical” Mean in DBT?

The word “dialectical” is what makes DBT different from standard CBT. In philosophy, a dialectic is the idea that two opposing things can both be true at the same time — and that the truth lives in holding both.

In therapy, the central dialectic looks like this: “You are doing the best you can with what you have right now — and you need to do better, work harder, and grow.” Both are true. Neither cancels the other out.

DBT starts from a different place. Your emotions make sense given what you’ve lived through. And — also — you have the capacity to learn new ways of coping that don’t cost you your relationships, your job, or your safety.

3. Who Developed DBT? A Brief History

DBT was created by Marsha Linehan, PhD, a clinical psychologist at the University of Washington. In the 1980s, Linehan was trying to use standard cognitive behavioral therapy with people who experienced chronic suicidal thoughts and self-harm — many of whom met criteria for borderline personality disorder (BPD).

Standard CBT wasn’t working. The relentless focus on changing thoughts and behaviors felt invalidating to her patients, who often dropped out of treatment or got worse. Linehan realized she needed to add something traditional CBT lacked: radical acceptance. By weaving in mindfulness practices drawn from Zen Buddhism and a deep emphasis on validation, she created a therapy that could hold both acceptance and change at the same time.

The first major clinical trial of DBT was published in 1991 and showed striking reductions in suicide attempts, self-harm, and hospitalizations. Since then, DBT has been adapted and tested for dozens of other conditions and is now considered the gold-standard treatment for emotion dysregulation.

4. The Four Core Skills of DBT

Comprehensive DBT teaches four interconnected skill modules. Most clients learn these in a weekly skills group, then practice applying them in individual therapy.

1. Mindfulness

Mindfulness is the foundation of all the other DBT skills. It’s the practice of paying attention to the present moment – your thoughts, feelings, body sensations, and surroundings — without judgment.

In DBT, mindfulness isn’t about meditating for an hour on a cushion. It’s about learning to notice when your emotions are taking over so you can choose how to respond instead of reacting on autopilot. A key DBT concept is Wise Mind — the state where your emotional mind (intuition, feelings) and your rational mind (logic, facts) work together.

2. Distress Tolerance

Distress tolerance skills are crisis-survival tools. They’re what you reach for when an emotion is so intense that you feel like you might do something you’ll regret — drink, lash out, self-harm, send the text, quit the job.

These skills don’t fix the problem. They get you through the next 15 minutes without making things worse. Examples include:

• TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) — physiological techniques that rapidly lower emotional intensity
• Radical Acceptance — choosing to fully accept reality as it is, rather than fighting what cannot be changed
• Distraction and self-soothing — engaging the senses to ride out an emotional wave

3. Emotion Regulation

Emotion regulation skills help you understand your emotions, reduce vulnerability to intense emotions, and change emotions that don’t fit the facts of the situation.

This module includes skills like:

• PLEASE (treat Physical illness, balance eating, avoid mood-Altering substances, balance Sleep, get Exercise) — taking care of your body to reduce emotional vulnerability
• Opposite Action — when an emotion isn’t justified by the facts, doing the opposite of what the emotion urges
• Checking the Facts — testing whether your emotional reaction matches the actual situation

4. Interpersonal Effectiveness

Interpersonal effectiveness is about navigating relationships — asking for what you need, saying no, and maintaining self-respect, all while keeping the relationship intact.

The signature skills here are:

• DEAR MAN — a step-by-step framework for asking for something or saying no
• GIVE — skills for maintaining the relationship during a difficult conversation
• FAST — skills for keeping your self-respect during interactions

5. What Does DBT Treat?

DBT was originally developed for borderline personality disorder, but decades of research have shown it’s effective for a much broader range of issues — essentially, any condition where intense emotions, impulsivity, or interpersonal difficulty are central.

DBT has strong evidence for treating:

• Borderline personality disorder (BPD) — the original and most-researched application
• Chronic suicidal thoughts and self-harm
• Emotion dysregulation that doesn’t meet criteria for a specific diagnosis
• Post-traumatic stress disorder (PTSD), especially complex trauma
• Eating disorders, particularly binge eating and bulimia
• Substance use disorders (an adaptation called DBT-SUD)
• Treatment-resistant depression and anxiety
• ADHD with significant emotional reactivity
• Bipolar disorder, as an adjunct to medication

If you find yourself swinging between emotional extremes, struggling with relationships that feel chaotic, or using behaviors like substance use, food, or self-harm to manage feelings, DBT skills can help, regardless of whether you have a formal diagnosis.

6. DBT vs. CBT: What’s the Difference?

DBT is technically a type of cognitive behavioral therapy, but the differences are significant enough that most clinicians treat them as distinct approaches.

Feature	CBT	DBT
Primary Focus	Changing unhelpful thoughts and behaviors	Balancing acceptance and change
Best For	Anxiety, depression, phobias, OCD	Emotion dysregulation, BPD, self-harm, chronic suicidality
Format	Usually individual therapy	Individual + group + phone coaching + team
Mindfulness	Sometimes included	Central to every skill
Validation	Background element	Equal partner to change strategies
Length	Often 8–20 sessions	Typically 6–12+ months for comprehensive DBT
Skills Training	Sometimes	Always — structured curriculum

The short version: if your main struggle is intrusive worry or a specific fear, standard CBT may be enough. If your emotions feel like a tidal wave you can’t ride, and that’s affecting your relationships, your safety, or your daily functioning, DBT is likely the better fit.

7. What Does DBT Treatment Actually Look Like?

Comprehensive DBT — the kind originally developed by Linehan and shown to work in clinical trials — has four components that work together:

1. Weekly Individual Therapy

You meet one-on-one with a DBT therapist (usually weekly) to work on your specific goals, apply the skills to your life, and address whatever came up that week. Sessions follow a target hierarchy: life-threatening behaviors first, then therapy-interfering behaviors, then quality-of-life issues.

2. Weekly Skills Group

A 2–2.5 hour weekly group (typically 6 months to a year) where you learn the four skill modules from a workbook. Skills group runs more like a class than a process group — there’s a curriculum, homework, and skill practice between sessions.

3. Phone Coaching Between Sessions

Brief, in-the-moment coaching calls with your individual therapist when you’re in a crisis and need help applying a skill. This isn’t a therapy session — it’s a 5–10 minute “what skill can you use right now?” check-in.

4. Therapist Consultation Team

Your DBT therapist meets weekly with other DBT therapists. This part is invisible to you, but it’s essential — it keeps your therapist effective, accountable, and from burning out while doing intense work.

Not every practice offers all four components, and many people benefit from DBT-informed therapy that uses the skills and principles within standard individual therapy. The right format depends on the severity of what you’re working on.

How Long Does DBT Therapy Take?

A standard comprehensive DBT program runs 6 to 12 months, with many people continuing for a second year to deepen the skills. The skills group curriculum cycles through all four modules in roughly 6 months.

That said, DBT-informed individual therapy can be shorter and tailored to your goals. Some people come in wanting help with one specific area — emotion regulation around a difficult relationship, for example — and we work on the relevant skills without a yearlong commitment.

The honest answer is: it depends on what you’re working on. We’ll talk about that in our first session.

Is DBT Therapy Effective? What the Research Says

DBT is one of the most rigorously studied psychotherapies in existence. Across hundreds of randomized controlled trials:

• For borderline personality disorder, DBT consistently reduces suicide attempts, self-harm, and psychiatric hospitalizations more than treatment-as-usual.
• For chronic emotion dysregulation, DBT improves emotional control, reduces impulsivity, and increases the use of healthy coping skills.
• For PTSD, eating disorders, and substance use, adapted versions of DBT show outcomes comparable to or better than other gold-standard treatments.
• Skills gains tend to be durable — people continue to use DBT skills years after treatment ends.

DBT isn’t a magic bullet, and it asks a lot of you — it’s a working therapy, with homework, practice, and active engagement between sessions. But for the conditions it’s designed to treat, the evidence is strong.

Signs DBT Therapy Might Be Right for You

You might be a strong candidate for DBT if you recognize yourself in any of these:

• Your emotions feel bigger and longer-lasting than other people’s seem to be
• You go from zero to a hundred — small triggers produce intense reactions you struggle to control
• Your relationships feel chaotic, with cycles of closeness and conflict
• You use behaviours like substance use, food, self-harm, impulsive spending, or risky sex to manage feelings
• You’ve been told you have, or you suspect you have, borderline personality disorder
• You experience chronic thoughts of suicide or self-harm, even when things are objectively okay
• You’ve tried other forms of therapy and felt invalidated by the focus on “just changing your thoughts”
• You want a therapy that gives you concrete tools you can use, not just insight

If you read that list and felt something click, DBT — or DBT-informed therapy — is worth exploring.

Finding a DBT Therapist in Atlanta

Not every therapist who lists “DBT” on their profile has comprehensive DBT training. When you’re evaluating a potential DBT therapist, it’s reasonable to ask:

• Where did you receive your DBT training?
• Do you offer comprehensive DBT or DBT-informed individual therapy?
• Do you have experience with my specific concerns (BPD, trauma, eating disorders, etc.)?
• What does treatment typically look like in your practice?

A good DBT therapist will welcome these questions, not bristle at them.

In my own practice, I’ve been working with DBT for years, both with clients who meet criteria for borderline personality disorder and with people whose emotion dysregulation shows up in less obvious ways. I integrate
DBT skills into individual therapy and tailor the approach to your specific situation.

Learn more about my DBT therapy services in Atlanta

I see clients in-person in Metro and North Atlanta, and via secure telehealth throughout the state of Georgia.

Frequently Asked Questions About DBT Therapy