What is Dialectic Behavioural Therapy (DBT)?

25 Mar

Dialectical Behaviour Therapy (DBT) is an effective, evidence-based treatment for people who suffer from emotional dysregulation, impulsivity, chronic suicidality, and unstable relationships. It was originally developed to help people with Borderline Personality Disorder (BPD), but over time, it has been adapted to treat a range of mental health challenges, including eating disorders, PTSD, substance use disorders, binge eating disorders, depression, and anxiety.

At its core, DBT is about both acceptance and change: accepting painful emotions while also working to change unhelpful patterns. It teaches practical skills that help people manage distress, regulate emotions, build healthier relationships, and improve overall well-being.

But for many, DBT is more than just a therapy, it’s life-changing.

The Origins of DBT: Marsha Linehan’s Story

DBT was developed in the 1980s by Dr. Marsha Linehan, a psychologist who had a personal connection to the struggles faced by people with BPD.

In her early years, Linehan was diagnosed with a severe psychiatric disorder, spent years in hospitals, and struggled with self-harm, suicidal thoughts, and emotional dysregulation. She later revealed that she herself had BPD, though at the time, there was little understanding of the condition.

Through her own experiences, Linehan recognised that traditional therapies weren’t working for people with extreme emotional distress. Many therapists took a strictly change-based approach that works for many other conditions, but this often made patients with BPD feel invalidated. On the other hand, too much acceptance-based therapy (simply reassuring people that their feelings were valid) left them stuck without real tools for change.

So, she created something new: a therapy that balanced acceptance with change. This dialectic (finding the middle ground between two opposites) became the foundation of DBT.

How DBT Works

DBT is unique because it is skills-based, meaning people don’t just talk about their problems—they actively learn how to handle emotions and difficult situations in healthier ways.

DBT is typically delivered in two main formats:

DBT Skills Groups – where people learn and practice skills together in a supportive group setting. These are usually led by a therapist and follow a structured curriculum. These programs often go for many weeks and even months, and can include phone coaching, where individuals can reach out to their therapist between sessions for guidance on using DBT skills—in the moment.

Individual Therapy – One-on-one sessions with a DBT-trained therapist who helps apply skills to real-life situations, address personal struggles.

The Four Core Modules of DBT

DBT is built on four key skill areas, all of which help people handle emotions and relationships more effectively.

1. Mindfulness – “Be present, not reactive.”

Mindfulness is about learning to observe thoughts and feelings without being controlled by them. Many people with BPD (or similar struggles) react to emotions so quickly that they don’t even realise they have a choice in how to respond. Mindfulness helps slow things down and build self-awareness.

Example Skill: “Observe and Describe” – Instead of immediately reacting to anger, you pause and say: “I notice that my heart is racing, and I’m feeling frustrated.” This simple act of stepping back creates space for better decision-making.

2. Distress Tolerance – “Surviving emotional storms without making things worse.”

Many people with emotional dysregulation struggle to cope with distress without resorting to unhealthy behaviours (e.g., self-harm, impulsive decisions, substance use). Distress Tolerance skills help people ride out intense emotions without acting on them.

Example Skill: “TIPP” (Temperature, Intense Exercise, Paced Breathing, Progressive Muscle Relaxation) – If you’re overwhelmed with emotion, you can quickly ‘cool down’ by splashing cold water on your face, doing jumping jacks, slowing your breathing, or tensing and relaxing your muscles. These activites change your body’s physiology and activate your parasympathetic nervous system, reducing distress short-term so you can stay in control.

3. Emotion Regulation – “Changing emotions in the desired direction.”

Emotion regulation skills help people identify, understand, accept, and challenge their emotional responses instead of being controlled by them. It teaches how to reduce emotional vulnerability, balance mood swings, and build emotional resilience.

Example Skill: “Opposite Action” – If you feel overwhelming sadness and the urge to isolate, but your emotions don’t ‘fit the facts’—do the opposite of what your emotion is urging you to do. Call a friend, go outside, or do something uplifting. This will help shift your emotional state in a lighter direction.

4. Interpersonal Effectiveness – “Build healthier relationships with boundaries and communication.”

Many people with BPD struggle with maintaining stable relationships, feeling too dependent or feeling that their relationships are ‘hanging by a thread’. This module teaches how to express needs, set boundaries, and navigate conflicts without damaging relationships.

Example Skill: “DEAR MAN” (Describe, Express, Assert, Reinforce, Mindful, Appear confident, Negotiate) – This structured communication tool helps people ask for what they need without feeling guilty or aggressive.

Who Can Benefit from DBT?

Although DBT was created for BPD, it has been shown to be highly effective for:

Depression & Anxiety – Helping with emotional regulation and self-compassion
PTSD & Trauma Survivors – Managing intense emotions and distressing memories
Substance Use Disorders – Learning new ways to cope without self-destructive behaviours
Eating Disorders – Addressing impulsive and emotional eating patterns
Self-Harm & Suicidality – Teaching practical strategies to cope with overwhelming distress

But more than just treating psychopathology, DBT skills are extremely useful for everybody! All of us could benefit from increased mindfulness, emotional acceptance, and interpersonal skills.

Final Thoughts: Why DBT Works

DBT is more than just therapy—it’s a set of life skills. It doesn’t focus on what’s wrong with a person but instead helps them develop the tools they need to handle emotions, relationships, and distress in healthier ways.

For many people, DBT provides a way to sit with emotions instead of avoiding them, skills to handle stress without destructive coping mechanisms, and the ability to communicate needs and set boundaries in relationships

If you or someone you love struggles with emotional dysregulation, DBT could be a game-changer.

Next Steps

If you think DBT might help, consider finding a DBT group or Therapist in your area. If you want a place to start looking, several of our clinical psychologists at Mind Project in Kogarah have specialised skills in DBT.
If you want some free resources right now. Have a look at our free DBT resources.

Remember, you are not alone.