Dialectical Behaviour Therapy(DBT)
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Overview
Dialectical Behaviour Therapy is a comprehensive, evidence-based psychological therapy originally developed by Marsha Linehan for people with severe emotional dysregulation and chronic suicidality, particularly borderline personality disorder (BPD). It combines behavioural change strategies with acceptance-based approaches drawn from Zen mindfulness practice. DBT is structured as a programme rather than a standalone individual therapy.
The “dialectical” in DBT refers to the balance between acceptance and change — validating the person’s experience while also working toward meaningful behavioural change. DBT is not simply skills training; it is a multi-component treatment system.
What this therapy focuses on
Improving emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness. DBT addresses life-threatening behaviours first, then therapy-interfering behaviours, then quality-of-life issues, in a clear hierarchy.
What sessions are usually like
Full DBT programme includes four components: individual therapy, skills group, between-session coaching, and therapist consultation team
Individual sessions: 50–60 minutes weekly
Skills group: 2–2.5 hours weekly, typically runs for 24–32 weeks
Between-session phone/text coaching for crisis support
Programme-based: typically 12 months minimum for standard DBT
Session profile
Common uses and suitability
What problems it is commonly used for
Who this therapy may suit best
- People with severe emotional dysregulation
- Individuals with chronic self-harm or suicidal behaviour
- Those who need both validation and practical skills
- People who benefit from structured programmes with multiple support components
When it may need adapting or may not be suitable
- Active psychosis without stabilisation
- Unable to commit to programme structure (attendance at both individual and group)
- Where a full DBT programme is not available, DBT skills-informed approaches are not equivalent to comprehensive DBT
Where this therapy may not be enough
DBT is designed for emotional dysregulation and self-harm; it is not a first-line treatment for conditions without significant dysregulation (e.g., specific phobias, straightforward depression). Programme availability is limited in many areas.
What happens in therapy
Diary Card
A daily tracking sheet where you record your emotions, urges, and skills used — reviewed each session.
Behavioural Chain Analysis
Working through step by step what led up to a difficult behaviour, to understand it and find where change could happen.
DBT Skills Modules
Four sets of practical skills taught in group: being present (mindfulness), coping with crisis (distress tolerance), managing emotions (emotion regulation), and improving relationships (interpersonal effectiveness).
Validation Strategies
Your therapist actively acknowledges that your feelings and experiences make sense, even while working toward change.
Evidence Base
Guideline support
Strong for BPD and self-harm. NICE CG78 (borderline personality disorder) includes DBT among recommended psychological therapies. Multiple international guidelines recommend DBT for BPD.
Strength of evidence
Strong for BPD, self-harm reduction, and emotional dysregulation. Multiple RCTs demonstrate significant reductions in self-harm, hospital admissions, and improvements in functioning.
Limitations
Programme fidelity is critical; outcomes depend on delivery of the full multi-component model. Partial DBT or skills-only groups do not replicate the evidence for comprehensive DBT. Resource-intensive to deliver.
Evidence claims by condition
DBT is one of the most recommended treatments for BPD, helping reduce self-harm and improve emotional stability.
DBT helps people find safer ways to cope with overwhelming emotions, reducing self-harm.
Resources & Printables
For Adults
For Teenagers (12–17)
For Parents & Caregivers
Practitioner & Training Notes
Typical professional background
Clinical psychologists, psychiatrists, specialist therapists, and mental health nurses within DBT programmes.
Recognised training routes
Intensive DBT training through Behavioral Tech (Linehan Institute) or equivalent accredited programmes. Requires team-based delivery with ongoing consultation team participation. Training includes Foundation and Intensive levels.
Registration considerations
No single register; practitioners are typically registered with their core profession (HCPC, NMC, etc.) and hold certified DBT training.
Source Registry
Link and cite.
Link and paraphrase.
Last evidence review: January 2026. All sources are verified and checked on a scheduled cadence.