Dialectical behaviour therapy (DBT) explained

Living with intense emotions can be exhausting. One moment you’re fine, and the next you’re overwhelmed by unexplainable feelings that you just can’t seem to control. But there’s a way to slow things down and understand what’s happening inside, one small skill at a time.   

Dialectical Behaviour Therapy, or DBT, is a type of therapy that aims to balance one’s emotions and logic through healthy and sustainable life skills. This article will help you better understand what DBT is, the skills it teaches, who it can help, and what to expect in a session.

What is DBT?

Dialectical Behaviour Therapy (DBT) is a type of talking therapy that helps people who struggle with overwhelming emotions. DBT was initially created to help individuals diagnosed with borderline personality disorder (BPD), but it has since been adapted to support a wide range of mental health challenges, such as suicidal ideation, self-harm, PTSD, addiction, depression, and eating disorders.

DBT is typically facilitated by DBT-trained mental health professionals, such as psychologists or psychiatrists, psychiatric nurses, or social workers who have received specific training in DBT methods.

The core skills taught in DBT

In DBT, you’ll learn practical skills that can help you understand your emotions and handle distressing situations. These include:

• Mindfulness - staying present and aware of your thoughts, feelings, and actions without trying to change or control them.

• Distress tolerance - managing painful emotions in the moment, especially when you can’t fix the situation right away. You’ll learn DBT techniques like distraction and self-soothing to help you get through those tough situations.

• Emotion regulation - understanding and managing strong emotions, rather than being overwhelmed by them.

• Interpersonal effectiveness - learning how to express yourself clearly, set boundaries, ask for what you need, and maintain healthy relationships, without sacrificing self-respect.

These DBT skills aren't learned overnight. They take time and consistent practice, but they're built to be useful and applied in everyday life.

The benefits of DBT

Many people who go through DBT notice significant improvements in their mental health and daily functioning. Research shows that DBT can reduce:

• Self-harm

• Suicidal thinking

• Depression

• Anxiety

• Feelings of hopelessness. 

The same study also found that nearly 75% of people who completed DBT no longer met the criteria for BPD five to six years later. Over time, DBT tends to help people develop more emotional intelligence, more stable moods, and better coping strategies for stress.

Other findings have shown that DBT patients experienced greater reductions in parasuicidal behaviour and issues related to impulse control, such as binge eating, gambling, and reckless driving. Many people also report feeling more confident in their relationships, making healthier everyday choices, and spending less time in a hospital or crisis care.

Misconceptions about DBT

Let’s clear up a few common misunderstandings and look at what DBT is really about.

Myth: DBT is only helpful for BPD

Fact: DBT was first designed for BPD, but it’s now used for many different conditions, including depression, PTSD, anxiety, and addiction. You don’t need a BPD diagnosis to benefit from dialectical behaviour therapy.

Myth: DBT is just another version of CBT

Fact: While DBT does stem from cognitive behaviour therapy (CBT), they are different in key ways. CBT focuses on challenging unhelpful thoughts to change behaviour. DBT adds a strong emphasis on radical acceptance, mindfulness, and managing intense emotions, especially for people who feel overwhelmed or emotionally reactive. It’s not just about thinking differently; it’s about living more mindfully and staying regulated in high-stress moments.

Myth: DBT is too overwhelming and complex

Fact: It’s true that DBT involves several skills to learn. But the skills themselves are straightforward, and DBT therapists are trained to guide you through them step by step. There's no pressure to learn all the skills at once. Progress in DBT happens gradually, at a pace that works for you.

Myth: DBT is too expensive, like most therapy

Fact: While therapy can be costly, DBT may be more accessible than you think. In Australia, Medicare rebates and private health insurance can help cover the cost, especially if you have a Mental Health Treatment Plan. Some clinics also offer group-based DBT, which can be more affordable than one-on-one sessions. Also, telehealth sessions tend to be more affordable than in-person sessions.

Is DBT right for me?

While only a mental health professional can say for sure if DBT is the best fit for you, it tends to be especially helpful for certain challenges. 

By default, DBT was originally created for people diagnosed with BPD, particularly those who experience suicidal thoughts, have a history of suicide attempts, or struggle with self-harming behaviours. 

That said, it’s also been adapted to support people dealing with other difficulties, like:

• Intense and unpredictable emotions

• Impulsive behaviours such as binge eating, gambling, or reckless driving

• Long-standing issues in relationships

• Emotional distress that hasn’t improved with other types of therapy

• Conditions like PTSD, depression, or disordered eating

If any of that sounds familiar, whether it’s your experience or someone you care about, DBT could be something to look into.

Still, DBT isn’t the right fit for everyone. Even if you ask for DBT, your psychologist or therapist might decide it’s not the most suitable option for your current situation and mental health challenges. 

In case your therapist assesses that DBT isn’t the right fit, approaches like Acceptance and Commitment Therapy (ACT) or Compassion-Focused Therapy (CFT) may be worth exploring, especially if you're drawn to mindfulness, values-based living, or building a more compassionate relationship with difficult emotions.

As always, consulting with a qualified mental health professional is the first step to getting the right diagnosis and therapy techniques.

References:

• Alba, M. C., Bailey, K. T., Coniglio, K. A., Finkelstein, J., & Rizvi, S. L. (2022). Risk management in dialectical behavior therapy: Treating life-threatening behaviors as problems to be solved. Psychotherapy (Chicago, Ill.), 59(2), 163-167. https://doi.org/10.1037/pst0000376

• Chapman A. L. (2006). Dialectical behavior therapy: current indications and unique elements. Psychiatry (Edgmont), 3(9), 62-68. https://pmc.ncbi.nlm.nih.gov/articles/PMC2963469/

• Hernandez-Bustamante, M., Cjuno, J., Hernández, R. M., & Ponce-Meza, J. C. (2024). Efficacy of dialectical behavior therapy in the treatment of borderline personality disorder: A systematic review of randomized controlled trials. Iranian journal of psychiatry, 19(1), 119-129. https://doi.org/10.18502/ijps.v19i1.14347

• Stanford, P. (2010). The effect of dialectical behaviour therapy on clients diagnosed with borderline personality disorder in a rural setting of NSW, Australia. Retrieved from www.heti.nsw.gov.au/__data/assets/pdf_file/0017/442214/pamela-stanford-final-report.pdf