Dialectical behavior therapy (DBT) is a form of cognitive behavioral therapy that helps people manage and regulate intense emotions and stress and acquire healthy interpersonal skills. Dialectical behavior therapy is particularly helpful for people with borderline personality disorder, anxiety, depression, drug and alcohol abuse, and other mental health issues. DBT therapy may be used in both individual and group therapy sessions.

What to Expect in Dialectical Behavior Therapy

female counselor takes notes and talks to male patient in dialectical behavior therapyIn a DBT therapy program, a specially trained therapist helps the client develop practical skills — an emotional toolbox of sorts — for processing trauma and managing daily stress. This toolbox includes mindfulness and other strategies that have been found effective in improving stress tolerance and regulating emotion.

Aspects of dialectical behavior therapy may include:

Mindfulness – An evidence-based technique, mindfulness is the practice of calmly staying in the here and now by paying attention to breathing, physical sensations, emotions, and one’s environment, without judging the subjective experience. In fact, a key tenet of DBT is that mindfulness can only be attained when one has learned to observe and describe without judgment. Mindfulness helps reduce stress and disordered thinking and can be particularly helpful in calming the emotions experienced by individuals struggling with anxiety, depression and borderline personality disorder.

Accepting Negative Thoughts and Emotions – A key component of DBT is unconditional acceptance by the therapist, who is supportive and validating while helping the client make their way toward better choices. In an environment of unconditional acceptance, clients develop key insights into long-standing emotional patterns and learn to accept over-reactive emotional patterns as understandable but ultimately counter-productive coping mechanisms. They then begin the rewarding process of addressing self-defeating thoughts and behaviors and learning to control extreme emotional responses to stress and interpersonal interactions.

Emotion Regulation – DBT also addresses the emotional extremes that can accompany some mental health disorders. People with issues like borderline personality disorder can fluctuate between happiness and sadness or contempt regularly. In dialectical therapy, the counselor teaches the client to recognize emotional triggers, understand the consequences of emotions and resulting actions, learn to stop letting their emotions dictate their lives and behaviors, and acquire healthy coping skills to deal with difficult circumstances.

Developing Interpersonal Skills – Specially trained DBT therapists help clients work on communication and social skills. They learn how they might be projecting onto others or manipulating situations, and how this harms relationships. Clients learn skills like setting healthy boundaries, being assertive and managing conflict. DBT teaches simple but effective strategies for making requests, saying no, and generally navigating the rocky shoals of interpersonal communication.

Distress Tolerance – DBT teaches people to calmly recognize, accept and find meaning in difficult situations and their impact, rather than immediately becoming distraught or overwhelmed by emotion. The goal is to learn to tolerate distress in order to make smart decisions, rather than reacting brashly from emotion, which often leads to self-destructive behavior. Clients learn practical skills for distracting themselves from the immediate emotion, and they learn self-soothing strategies and how to turn their thoughts in a new direction.