Dialectical Behaviour Therapy (DBT)

What is Dialectical Behaviour Therapy?

Dialectical Behaviour Therapy (DBT) is a structured, evidence-based psychological treatment designed to help people who experience difficulties managing emotions, relationships and behaviours, particularly when emotions become intense, overwhelming or difficult to regulate.

DBT was originally developed by psychologist Dr Marsha Linehan for people experiencing chronic suicidal thoughts and behaviours and Borderline Personality Disorder (BPD). Over time, DBT has been researched and adapted for a much broader range of psychological difficulties where emotion dysregulation plays an important role.

At its core, DBT helps people develop practical skills to understand emotions, manage distress, improve relationships and make more effective choices, while also addressing the patterns of thinking and behaviour that may be contributing to ongoing difficulties.

DBT combines strategies from behavioural and cognitive therapies with principles of mindfulness, acceptance and validation.

Rather than simply asking someone to “think differently”, DBT recognises that behaviours usually make sense when we understand the circumstances in which they developed.

Treatment therefore balances two important ideas:

Acceptance – developing a greater understanding and acceptance of yourself, your experiences and your current circumstances.

Change – learning new skills and changing behaviours that are interfering with your relationships, wellbeing or quality of life.

This balance between acceptance and change is one of the defining features of Dialectical Behaviour Therapy.

Who Can DBT Help?

DBT may be particularly helpful for people who experience emotions very intensely or find that emotions can quickly become overwhelming.

People seeking DBT may describe feeling emotionally “out of control”, reacting strongly to situations, struggling to recover after becoming upset, or engaging in behaviours that provide immediate relief but create additional difficulties later.

DBT is particularly well established as a treatment for Borderline Personality Disorder (BPD) and chronic suicidality and self-harm.

DBT-informed approaches and adaptations are also used with people experiencing a range of difficulties, including:

– significant emotion dysregulation
– recurrent self-harm
– suicidal thoughts or behaviours
– difficulties associated with Borderline Personality Disorder
– intense or unstable relationships
– impulsive behaviours
– difficulties managing anger
– trauma-related difficulties
– eating disorders and disordered eating
– substance-use difficulties
– depression and anxiety where emotion regulation difficulties are prominent
– difficulties tolerating distress or uncertainty
– interpersonal difficulties
– difficulties understanding, expressing or regulating emotions.

Not everyone experiencing these difficulties requires comprehensive DBT. Assessment is an important part of determining whether DBT, another psychological therapy, or a combination of approaches is likely to be most appropriate.

What Does DBT Treatment Involve?

Comprehensive DBT is more than attending a DBT skills group.

It is a structured treatment program involving several coordinated components, sometimes referred to as the modes of DBT.

A comprehensive DBT program generally includes:

Individual DBT Therapy

Individual therapy is usually provided weekly and is an important part of comprehensive DBT.

Individual sessions focus on understanding the specific behaviours, emotions and situations creating difficulties in the person’s life.

Rather than discussing problems only at a general level, DBT therapists frequently examine particular situations in detail.

For example:

– What happened?

– What were you thinking and feeling?

– What happened in your body?

– What did you feel like doing?

– What did you actually do?

– What happened afterwards?

This process is known as behavioural analysis or chain analysis.

Understanding the sequence of events allows the therapist and client to identify where different skills or responses could potentially change the outcome next time.

Individual DBT therapy also helps clients apply the skills learned in DBT skills training to situations occurring in their everyday lives.

DBT Skills Training

Skills training is another central component of DBT.

Rather than assuming people should automatically know how to regulate intense emotions, tolerate distress or navigate complicated relationships, DBT explicitly teaches these abilities.

DBT skills are generally organised into four major areas:

Mindfulness

Mindfulness involves learning to intentionally notice what is happening in the present moment without immediately reacting to it or judging the experience.

Mindfulness skills help people become more aware of their thoughts, emotions, physical sensations and urges.

This creates an opportunity to respond deliberately rather than automatically.

An important DBT concept is Wise Mind – the integration of emotional experience and rational thinking.

The aim is not to eliminate emotion or rely entirely on logic. Instead, DBT helps people develop the ability to consider both emotion and reason when deciding how to respond.

Distress Tolerance

Sometimes a situation cannot immediately be changed.

Distress tolerance skills help people manage intense emotional experiences and crises without making the situation worse.

This can be particularly important when someone experiences powerful urges to act impulsively, self-harm, use substances, withdraw completely, lash out at others or engage in another behaviour that may provide short-term relief but create longer-term consequences.

Distress tolerance is not about pretending that painful situations are acceptable.

It is about developing ways to survive difficult moments safely and effectively while deciding what to do next.

Emotion Regulation

Emotion regulation skills help people understand emotions and develop more effective ways of responding to them.

Clients learn about the purpose of emotions, factors that increase emotional vulnerability and strategies that can influence the intensity and duration of emotional responses.

Emotion regulation work may include learning to:

– identify and label emotions
– understand what emotions are communicating
– recognise patterns that increase emotional vulnerability
– reduce vulnerability to intense emotions
– check whether emotional interpretations fit the facts
– respond differently when an emotional urge is likely to be ineffective
– increase positive and meaningful experiences
– develop greater emotional resilience.

The goal is not to stop experiencing emotions.

Emotions provide important information and are a normal part of being human.

The aim is to develop greater flexibility and choice in how we respond to them.

Interpersonal Effectiveness

Relationships can become particularly difficult when emotions are intense.

Interpersonal effectiveness skills help people communicate more clearly, establish boundaries, manage conflict and ask for what they need while considering both the relationship and their own values and self-respect.

Clients learn strategies for:

– asking for what you need
– saying no effectively
– setting and maintaining boundaries
– managing interpersonal conflict
– balancing their own needs with the needs of others
– maintaining relationships
– maintaining self-respect
– communicating more effectively.

The aim is not to teach people to avoid disagreement.

Healthy relationships sometimes involve disagreement, negotiation and boundaries. DBT helps people approach these situations more effectively.

Between-Session Coaching

Comprehensive DBT may include access to brief coaching between therapy sessions.

The purpose of coaching is not to provide another therapy session outside the scheduled appointment.

Instead, coaching helps clients use DBT skills when they are actually needed.

For example, someone may understand a distress-tolerance skill during therapy but struggle to remember or apply it when experiencing intense distress several days later.

Brief coaching can help the person identify and use an appropriate skill in that moment.

The goal is progressively increasing the client’s ability to use DBT strategies independently in everyday life.

The DBT Consultation Team

An often overlooked component of comprehensive DBT is the therapist consultation team.

DBT clinicians working within comprehensive programs regularly participate in a DBT consultation team.

The consultation team supports clinicians to maintain adherence to DBT principles, think carefully about complex clinical situations and provide consistent, effective treatment.

In DBT, the consultation team is considered an important part of supporting the therapist to provide high-quality treatment.

DBT Is a Behavioural Therapy

Although DBT teaches many practical skills, DBT is not simply a skills course.

It is fundamentally a behavioural treatment.

This means therapists work collaboratively with clients to understand what influences behaviour and what consequences may unintentionally maintain patterns over time.

Behaviours that appear confusing or “self-destructive” from the outside may have developed because, at some point, they served an important function.

For example, a behaviour may temporarily:

– reduce emotional distress
– help someone escape an overwhelming situation
– communicate distress when words feel inadequate
– create a sense of control
– reduce feelings of numbness
– obtain reassurance or connection.

Understanding the function of a behaviour does not mean that the behaviour needs to continue.

Instead, understanding why it works in the short term helps us identify healthier alternatives that can meet the same need without producing the same longer-term consequences.

Validation and Change

Validation is central to DBT.

Many people entering DBT have spent years being told that they are “too emotional”, “overreacting”, “attention seeking”, “difficult” or that they should simply “get over it”.

DBT takes a different approach.

A therapist may validate that a person’s emotional response makes sense given their experiences, biology, learning history and current circumstances while simultaneously helping them recognise that their current response may not be working effectively.

Both can be true:

“It makes sense that you feel this way.”

and

“We may need to find a different way of responding.”

This balance is fundamental to DBT.

What Does “Dialectical” Mean?

The word dialectical refers to recognising that seemingly opposite ideas can both contain truth.

DBT moves away from rigid either/or thinking towards a more flexible both/and perspective.

For example:

I am doing the best I can and I need to learn new ways of coping.

My emotions are valid and acting on every emotional urge may not be effective.

I can accept where I am right now and work towards changing my life.

This dialectical approach is woven throughout DBT treatment.

Building a Life Worth Living

DBT is not ultimately about simply reducing symptoms.

The broader aim of treatment is helping people create what DBT describes as a life worth living.

For one person, this might mean developing stable relationships.

For another, it might involve returning to work or study.

For someone else, it may mean becoming more independent, reducing self-harm, reconnecting with family, developing friendships or simply reaching a point where life no longer feels like a constant crisis.

For this reason, DBT treatment considers not only what someone wants to stop doing, but also what they want their life to become.

Comprehensive DBT vs DBT-Informed Therapy

It is important to distinguish between comprehensive DBT and therapy that uses some DBT skills or strategies.

A clinician may incorporate mindfulness, distress tolerance or emotion regulation strategies into another form of psychological therapy. This can be useful and is sometimes described as DBT-informed therapy.

However, this is different from comprehensive DBT.

Comprehensive DBT is a coordinated treatment model that typically includes:

– individual DBT therapy
– structured DBT skills training
– between-session skills coaching
– therapist participation in a DBT consultation team.

Whether someone requires comprehensive DBT or would benefit from DBT-informed individual therapy or skills training depends on their needs, goals, level of risk and clinical assessment.

How Long Does DBT Take?

The duration of DBT varies depending on the program and the needs of the individual.

Comprehensive DBT commonly requires a significant commitment because developing new behavioural patterns and learning to apply skills consistently takes time.

Treatment usually begins with assessment and preparation.

During this stage, the clinician and client discuss the person’s difficulties, goals, treatment expectations and whether DBT is an appropriate treatment.

If DBT is recommended, the therapist will explain the structure of the program and what will be expected from both the client and treatment team.

Is DBT Right for Me?

DBT can be highly effective, but it is not necessarily the right treatment for every person experiencing psychological distress.

A thorough assessment helps determine what is contributing to someone’s difficulties and which treatment approach is most appropriate.

At DBT Clinics Australia, our clinicians consider the person rather than simply matching a diagnosis to a treatment.

Where DBT is appropriate, we can discuss which level of DBT treatment best matches your needs, including individual therapy, skills training and comprehensive DBT programs.

We also recognise that not all difficulties with emotional or interpersonal functioning involve undercontrolled emotions.

Some people experience excessive emotional inhibition, perfectionism, rigidity, social withdrawal or difficulties with openness and social connection. In these circumstances, Radically Open Dialectical Behaviour Therapy (RO DBT) may be worth considering.

Looking for DBT Therapy?

If you are considering DBT for yourself, a family member or someone you support, the first step is an assessment.

Our clinicians can help you understand whether DBT, RO DBT or another psychological treatment is likely to best meet your needs.

DBT Clinics Australia specialises in Dialectical Behaviour Therapy (DBT) and Radically Open Dialectical Behaviour Therapy (RO DBT), with treatment available through our clinics and online.