What is Dialectical Behavior Therapy

Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) is a type of psychotherapy that was originally developed in the 1980s by Dr. Marsha Linehan, a psychology researcher at the University of Washington. DBT blends cognitive-behavioral therapy (CBT) techniques with concepts of mindfulness, distress tolerance, and emotion regulation.

DBT was initially created to treat borderline personality disorder but has since been adapted to treat other mental health conditions involving emotional dysregulation. The “dialectical” part refers to the therapy’s emphasis on balancing acceptance and change. DBT aims to help people learn and use new skills to regulate emotions while also accepting themselves, other people, and the world as it is.

The main components of DBT include weekly individual therapy, weekly group skills training, phone coaching, and therapist consultation team meetings. DBT takes a collaborative approach between patient and therapist, with an emphasis on validating emotions while also guiding change in unhelpful thinking patterns and behaviors. This blend of validation plus change is the “dialectical” philosophy behind DBT.

Who is DBT For?

Dialectical Behavior Therapy (DBT) was originally developed in the late 1980s by psychologist Marsha M. Linehan to treat borderline personality disorder (BPD). People with BPD often struggle to regulate their emotions, thoughts, and behaviors. They may engage in self-harm, have turbulent relationships, or experience intense mood swings.

DBT aims to give those with BPD new skills for managing emotions, distress, and relationships. Through its skills training component, DBT teaches clients mindful awareness, emotion regulation, distress tolerance, and interpersonal effectiveness. With practice over time, these skills can lead to better control over impulsivity and unstable relationships.

Over the years, DBT has been adapted to treat other mental health conditions beyond just BPD. Research shows DBT can also help reduce symptoms for:

  • Depression
  • Substance abuse
  • Eating disorders
  • Post-traumatic stress disorder (PTSD)

The key is that DBT seems most effective for disorders where emotional dysregulation is a central feature. The skills training teaches clients how to cope with intense emotions in a healthier way.

DBT Skills Training

A core component of DBT is skills training, which teaches clients skills in 4 key areas:


Mindfulness skills help clients practice being fully present and aware in the moment, without judgment. This allows them to make wise, responsive choices, rather than reacting automatically. Mindfulness skills include observing, describing, and participating fully.

Distress Tolerance

Distress tolerance skills help clients withstand difficult emotions and crises without resorting to impulsive or destructive behaviors. Clients learn crisis survival strategies and self-soothing techniques to get through pain without making it worse.

Emotion Regulation

Emotion regulation skills teach clients how to understand, name, and change intense emotions that are causing problems. Clients learn to reduce vulnerability to emotion mind, decrease emotional suffering, and increase positive emotional experiences.

Interpersonal Effectiveness

Interpersonal effectiveness skills help clients communicate effectively and set healthy boundaries in relationships. Clients learn to be assertive without being aggressive, and how to balance relationships and self-respect.


The Mindfulness module in DBT focuses on being fully present and aware of the moment. It teaches clients how to observe their thoughts, feelings, and experiences without judging them. Mindfulness helps people become more aware of what they are doing in the present, rather than being caught up in worries about the past or future.

Practicing mindfulness can help reduce impulsiveness and emotional reactivity. Often when we have strong negative emotions, we react in the moment without thinking. Mindfulness allows some space between an emotion arising and our reaction. It helps people pause, observe what is happening, and then choose how to respond, rather than automatically reacting.

Mindfulness skills include practices like observing your breathing, taking note of sights/sounds/smells around you, and bringing a non-judgmental attitude to your inner experiences. Through regular mindfulness meditation and the incorporation of mindfulness into daily activities, clients build the muscle of being present. This allows them to respond more thoughtfully rather than impulsively when difficult emotions arise.

Distress Tolerance

Distress tolerance skills help clients cope with stress in a healthy way instead of resorting to self-destructive behaviors. DBT teaches clients techniques to manage painful emotions and urges without making the situation worse.

Some distress tolerance techniques include:

  • Distraction – Focusing attention on neutral or positive stimuli to take the mind off the distressing emotion. This could involve going for a walk, listening to music, reading, or calling a friend.
  • Self-soothing – Doing something physically comforting to calm down when emotionally escalated. Examples are taking a warm bath or shower, curling up under a blanket, and sipping hot tea.
  • Pros and cons – Making a list of the benefits and disadvantages of tolerating emotional distress versus acting on urges. This helps clients make wise decisions when overwhelmed.
  • TIPP – Using Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation to quickly reduce emotional escalation.
  • Radical acceptance – Acknowledging a situation fully, without judging or resisting it. This helps reduce suffering.
  • Willingness – Being open to experiencing emotions without trying to change them. This prevents making situations worse by avoidance or suppression.

The distress tolerance module equips clients to healthfully endure stress and control impulses that could worsen circumstances. It provides alternatives to self-harm and other dysfunctional coping mechanisms. With practice, clients gain skills to ride out intense emotions without acting rashly or making problems worse.

Emotion Regulation

Emotion regulation teaches strategies to manage emotions and change emotional responses. This module focuses on identifying triggers, reducing vulnerability to emotional triggers, and developing skills to manage intense emotions.

Some emotion regulation skills include:

  • Observing and describing emotions – Identifying and labeling emotions helps to manage them better. Noticing bodily sensations, actions, and situations associated with different emotions can increase awareness.
  • Reducing vulnerability – Working to get enough sleep, proper nutrition, and exercise can help stabilize mood and reduce emotional reactivity. Avoiding drugs, alcohol, and destructive behavior also lowers vulnerability.
  • Opposite action – Doing the opposite of the urge in intense moments can help change emotion. For example, smiling or moving when feeling depressed, or relaxing when feeling rageful.
  • Paced breathing – Slow, deep breathing can rapidly reduce emotional intensity by activating the parasympathetic nervous system. Counting breaths or following a breathing rhythm helps pace breathing.
  • Progressive muscle relaxation – Systematically tensing and relaxing muscle groups reduces arousal. Paired with breathing exercises, it helps relieve anxiety, anger, and irritability.
  • Vacation visualization – Imagining a peaceful, happy memory helps distance from current distress. Adding sensory details enhances the vacation effect.
  • Half-smile and willing hands – Forcing a half-smile and relaxing hands, even when not feeling it, can help change emotion through embodiment.
  • Temperature change – Using cold water or ice can instantly calm emotions, while warm water or sun can energize and improve mood.
  • Pleasant activity scheduling – Planning and engaging in positive activities provides distraction and improves mood. Activities that connect with values and give a sense of mastery work best.

The emotion regulation module equips individuals with concrete skills to understand, accept, and transform difficult emotions when they are most needed.

Interpersonal Effectiveness

Interpersonal effectiveness skills focus on building and maintaining relationships, being assertive, and balancing priorities and demands. Clients learn how to:

  • Decide which priorities should come first and which demands can wait
  • Ask for what they need and say no to unwanted requests
  • Have difficult conversations while maintaining respect
  • Build relationships based on mutual understanding and compromise
  • Validate others while standing up for their own needs

DBT teaches interpersonal skills using DEARMAN:

  • Describe the situation objectively and stick to the facts
  • Express why this is an issue and how you feel about it
  • Assert your needs and what must change while acknowledging the other person’s feelings
  • Reinforce or provide positive consequences for the person if they agree
  • Stay Mindful of the present interaction, notice conflicting urges
  • Appear confident, keep your head high, and make eye contact
  • Negotiate and be willing to compromise if needed

The goal is to build positive relationships based on assertive communication and balancing the needs of yourself and others. DBT clients practice applying these skills to situations like setting boundaries, making requests, managing conflict, and repairing relationships.

Other Components of DBT

In addition to skills training, DBT includes other key components:

Individual Therapy

Individual therapy is an important part of DBT. During these one-on-one sessions, the therapist works with the client to apply the DBT skills they’ve learned to their unique situation and specific behavioral and emotional challenges. The therapist provides validation while also coaching the client through making positive changes.

Phone Coaching

Clients in DBT have access to their therapist by phone between sessions. This allows them to receive in-the-moment coaching for applying their skills when they need it most. Having this extra support can be invaluable when emotions spike or challenging situations arise.

Therapist Consultation Team

DBT therapists participate in a consultation team. This provides support for dealing with their own reactions and maintaining motivation. Consulting with colleagues helps DBT therapists stay energized so they can continue providing clients with compassionate, nonjudgmental care. The team approach enhances the quality of treatment each client receives.

Effectiveness of DBT

Dialectical Behavior Therapy (DBT) has been the focus of significant research demonstrating its effectiveness as a treatment for various disorders, especially borderline personality disorder (BPD). Multiple studies have shown that DBT leads to:

  • Reduced frequency of self-harm and suicide attempts
  • Lower rates of emergency room visits and psychiatric hospitalizations
  • Increased use of adaptive coping skills for dealing with stress
  • Improved emotional regulation and ability to manage intense emotions
  • Enhanced social adjustment and interpersonal relationships

In one key study, 1 year of DBT treatment led to a significant decline in suicide attempts, from 1.8 attempts per month before starting DBT down to just 0.3 attempts per month after completing treatment. The risk of making a suicide attempt decreased by half after just 6 months of DBT. Several other studies have replicated these findings, with DBT consistently linked to fewer self-harm behaviors and suicide attempts compared to other types of therapy.

Research also indicates that DBT improves interpersonal functioning and reduces the instability associated with BPD. Participants often show improved control of anger, less emotional volatility, and more stable relationships after completing DBT. The focus on mindfulness, distress tolerance, and interpersonal skills leads to better coping and enhanced social adjustment.

Overall, multiple meta-analyses and systematic reviews conclude that DBT is highly effective at treating borderline personality disorder when compared to other psychological treatments. The empirical evidence clearly demonstrates that DBT helps reduce dysfunctional behaviors and improves clients’ well-being.

Finding a DBT Therapist

When searching for a DBT therapist, it’s important to find someone specifically trained in delivering DBT. The full DBT model includes individual therapy, skills training groups, therapist consultation teams, and phone coaching. Not all therapists advertise themselves as DBT therapists, so be sure to ask about their specific training and experience with DBT.

Consider whether you want to work with a therapist one-on-one or join a DBT skills group. Individual therapy allows you to focus completely on your own goals and challenges, while a group provides support from others facing similar struggles. A comprehensive DBT program includes both individual and group work.

Look for signs that a therapist adheres to the full DBT model developed by Dr. Marsha Linehan. Ask whether they belong to a DBT consultation team, which helps validate that they are practicing DBT properly. Work with a licensed mental health professional who can demonstrate experience delivering DBT. Finding the right fit is important to get the most out of this evidence-based treatment.

flexibility in scheduling appointments, making it easier for everyone to fit therapy sessions into their busy lives. Online telehealth therapy also provides a sense of anonymity and privacy, allowing individuals to feel more comfortable sharing their thoughts and emotions.

With its numerous advantages, online telehealth therapy is an effective and valuable option for those seeking mental health support.

Key Takeaways

  • Convenience and flexibility: Online therapy allows individuals to access therapy from the comfort of their own homes and offers various communication options, saving time and energy by eliminating the need to commute.
  • Increased accessibility: Online therapy provides therapy services to people in remote areas and helps individuals with limited mobility receive therapy without traveling long distances. It also allows individuals to connect with specialized therapists who may not be available locally, providing equal access to therapy services regardless of location.
  • Privacy and confidentiality: Online therapy conducts therapy sessions remotely, ensuring privacy and confidentiality. It eliminates concerns about running into familiar people in waiting rooms and creates a greater sense of privacy compared to traditional therapy settings. Online platforms used for telehealth therapy sessions are designed to be secure and compliant with privacy regulations, providing a confidential and private environment for individuals to discuss their mental health concerns.
  • Reduced travel time and costs: Online therapy eliminates the need for travel, saving time and money. It also minimizes transportation expenses associated with therapy sessions.

Online Therapy Leads to More Convenience and Flexibility

Online therapy offers greater convenience and flexibility for individuals seeking mental health support. With the advancement of technology, therapy can now be accessed from the comfort of one’s own home, eliminating the need for travel and reducing the associated stress. Online telehealth therapy, also known as teletherapy, allows individuals to connect with therapists through video calls, phone calls, or even text messages, providing a wide range of options to suit different preferences and needs.

One of the benefits of online therapy is the ability to schedule sessions at a time that is convenient for both the therapist and the client. This flexibility allows individuals to fit therapy into their busy schedules, without having to rearrange their entire day or take time off work. Additionally, online therapy eliminates the need to commute to a therapist’s office, saving valuable time and energy.

Another advantage of online therapy is the increased accessibility it offers. People in remote areas or those with limited mobility can now access therapy services without having to travel long distances. This is particularly beneficial for those who live in rural or underserved areas, where finding a therapist nearby may be challenging.

Telehealth Therapy Gives Access to Specialized Therapists

Access to specialized therapists is a key advantage of telehealth therapy. In the online era, patients can now receive treatment from highly skilled therapists who may not be located in their local area. This opens up a world of possibilities for individuals seeking specialized mental health care.

  • Expanded Options: Virtual therapy allows patients to connect with therapists who specialize in niche areas or specific treatment modalities that may not be available to them locally. Whether it’s trauma-focused therapy, cognitive-behavioral therapy, or dialectical behavior therapy, online platforms offer a wider selection of specialized therapists to choose from.
  • Overcoming Barriers: The COVID-19 pandemic has highlighted the importance of telehealth therapy in overcoming barriers to access. Virtual sessions eliminate geographical limitations, making it easier for individuals in rural or remote areas to connect with specialized therapists. Additionally, those with physical disabilities or transportation limitations can now receive the care they need from the comfort of their own homes.
  • Quality Care: With online telehealth therapy, patients can access highly qualified therapists regardless of their location. This ensures that individuals receive the best possible care and expertise, even if they live in areas where specialized therapists are scarce.

Virtual Therapy Increases Privacy and Confidentiality

Virtual therapy offers individuals seeking mental health support the advantage of increased privacy and confidentiality. With online telehealth therapy, also known as telemental health, therapy sessions can be conducted remotely through video calls or phone calls, allowing patients to receive the care they need from the comfort and privacy of their own homes.

Privacy and confidentiality are essential when it comes to mental health treatment. Virtual therapy ensures that personal information and sensitive discussions remain secure. Patients can access therapy sessions through a secure internet connection, reducing the risk of unauthorized individuals overhearing or accessing their sessions.

In a traditional therapy setting, there may be concerns about running into someone familiar in the waiting room or bumping into someone on the way to or from the therapist’s office. With virtual therapy, these concerns are eliminated, providing individuals with a greater sense of privacy.

Confidentiality is also enhanced in virtual therapy. Mental health professionals adhere to strict ethical guidelines and legal obligations to protect patient information. Online platforms used for telehealth therapy sessions are designed to be secure and compliant with privacy regulations.

Telehealth Therapy Means Reduced Travel Time and Costs

Telehealth therapy offers the advantage of minimizing travel time and expenses for individuals seeking mental health support. With the availability of online therapy, patients no longer have to spend time and money commuting to and from their therapist’s office. This convenience allows individuals to schedule therapy sessions without the added stress of transportation logistics.

Here are three key ways in which telehealth therapy reduces travel time and costs:

  • Eliminates the need for travel: Online therapy eliminates the need for patients to travel to a physical location, saving them time and money on transportation expenses.
  • Flexible scheduling: The ability to attend therapy sessions from the comfort of one’s own home means that individuals can schedule sessions at times that are convenient for them, without having to factor in travel time.
  • Access to specialized services: Telehealth therapy allows individuals to access mental health counseling and anxiety health counseling, even if they live in remote areas where such services may not be readily available. This eliminates the need for long-distance travel to seek out specialized health services.

Availability During Emergencies or Crisis

During emergencies or crises, individuals can rely on the convenience and accessibility of online therapy to receive mental health support without the added stress of travel time and costs. Online telehealth therapy offers a solution for individuals who may be unable to access in-person therapy due to emergencies or crises. It allows individuals to connect with qualified therapists and receive the necessary support from the comfort of their own homes.

The availability of online telehealth therapy during emergencies or crises ensures that individuals can receive timely mental health support when they need it the most. Whether it’s a natural disaster, a health crisis, or a personal emergency, online therapy provides a lifeline for those in distress. It eliminates the need to travel to a therapist’s office, which can be particularly challenging during emergencies, where transportation may be limited or unsafe.

Moreover, online telehealth therapy offers a sense of continuity and stability during times of crisis. Therapists can provide ongoing support and guidance, helping individuals navigate their mental health challenges in real time. This availability of therapy can be crucial in preventing further deterioration of mental health and promoting resilience in the face of adversity.

The Serenity Psychotherapy Group understands the importance of availability during emergencies or crises. They offer online telehealth therapy services to ensure individuals have access to the mental health support they need, regardless of the circumstances. With their experienced therapists and commitment to providing quality care, individuals can rely on Serenity Psychotherapy Group for support during challenging times.

Elimination of Physical Barriers Benefits Individuals

The elimination of physical barriers through online telehealth therapy allows individuals to access mental health support conveniently and effectively. This form of therapy has numerous benefits that can greatly improve the well-being of individuals.

Here are some key advantages of online telehealth therapy:

  • Accessibility: Online therapy eliminates geographical limitations, allowing individuals to access mental health support from anywhere with an internet connection. This is particularly beneficial for those living in remote areas or individuals with limited mobility.
  • Convenience: Online therapy offers flexibility in scheduling appointments, as individuals can have sessions from the comfort of their own homes. This eliminates the need for travel and reduces the time and cost associated with commuting to a physical therapy location.
  • Privacy: Online therapy provides a confidential and private environment for individuals to discuss their mental health concerns. This can be especially beneficial for those who may feel uncomfortable seeking therapy in person or worry about being seen entering a mental health clinic.

Effective for Remote or Rural Areas

Online telehealth therapy is particularly effective for individuals in remote or rural areas. In these areas, access to mental health services can be limited due to geographical distance, lack of transportation, and a shortage of mental health professionals. However, online telehealth therapy provides a solution to these challenges by allowing individuals in remote or rural areas to receive therapy from the comfort of their own homes.

Telehealth therapy refers to the delivery of therapy services through online platforms, such as video conferencing or phone calls. This allows individuals in remote or rural areas to connect with mental health professionals who may be located in urban or metropolitan areas. The benefits of online telehealth therapy for remote or rural areas are numerous.

Firstly, it eliminates the need for individuals to travel long distances to access therapy services. This is particularly beneficial for those who live in remote areas where mental health professionals may not be readily available. Additionally, online telehealth therapy reduces the cost associated with transportation, as individuals can attend therapy sessions from the convenience of their own homes.

Secondly, online telehealth therapy provides a wider range of options for individuals in remote or rural areas. They can choose from a larger pool of mental health professionals who specialize in different areas of therapy. This ensures that individuals can receive the most appropriate and effective treatment for their specific needs.

Finally, online telehealth therapy offers increased flexibility in scheduling appointments. This is especially valuable for individuals in remote or rural areas who may have limited access to transportation or have demanding work or family responsibilities. With online telehealth therapy, individuals can schedule sessions at times that are convenient for them, reducing barriers to accessing therapy.

Frequently Asked Questions

How Does Online Telehealth Therapy Compare to Traditional In-Person Therapy in Terms of Effectiveness?

Online telehealth therapy has become increasingly popular and accessible in recent years.

When comparing its effectiveness to traditional in-person therapy, several factors must be considered. Research has shown that online therapy can be just as effective as face-to-face therapy in treating various mental health conditions.

It offers convenience, cost savings, and increased accessibility for individuals who may have difficulty attending in-person sessions. Additionally, online therapy allows for greater flexibility in scheduling and eliminates geographical barriers, making it a viable option for many individuals seeking therapy services.

Can Online Telehealth Therapy Be Covered by Insurance?

Online telehealth therapy can be covered by insurance depending on the individual’s insurance plan and the specific services provided. Many insurance companies have started to recognize the benefits of online therapy and have expanded their coverage to include telehealth services.

However, individuals need to check with their insurance provider to determine if online telehealth therapy is covered and what specific requirements need to be met to receive reimbursement.

What Are Some Potential Drawbacks or Limitations of Online Telehealth Therapy?

Some potential drawbacks or limitations of online telehealth therapy include:

  • The lack of in-person interaction, which may reduce the ability to read nonverbal cues and establish rapport.
  • Technical issues such as poor internet connection or video/audio quality can also disrupt the therapeutic process.
  • Privacy and confidentiality concerns may arise if the therapy sessions are conducted in a shared or public space.

Therapists and clients need to address these limitations and find ways to mitigate them for effective online therapy.

How Does the Process of Finding a Specialized Therapist for Online Telehealth Therapy Work?

The process of finding a specialized therapist for online telehealth therapy involves several steps.

First, individuals can research and explore online directories that list therapists who offer telehealth services.

They can also seek recommendations from their primary care physician or trusted friends and family.

Once a potential therapist is identified, individuals can schedule an initial consultation to discuss their needs and determine if the therapist is a good fit.

It is important to ensure that the therapist is licensed and experienced in providing online therapy before starting the sessions.

Are There Any Specific Technological Requirements or Equipment Needed for Participating in Online Telehealth Therapy?

To participate in online telehealth therapy, there are certain technological requirements and equipment needed. These may include a stable internet connection, a computer or mobile device with a webcam and microphone, and a secure platform for video conferencing.

Additionally, it is important to have a private and quiet space where confidentiality can be maintained during therapy sessions. These requirements ensure that clients can have a seamless and secure therapeutic experience.


In conclusion, online telehealth therapy offers numerous benefits that make it a valuable and accessible option for individuals seeking mental health support.

It provides convenience, flexibility, and access to specialized therapists. Additionally, it offers increased privacy and confidentiality, reduces travel time and costs, and is available during emergencies or crises.

Furthermore, it eliminates physical barriers, making it effective for remote or rural areas. Overall, online telehealth therapy is a cost-effective and convenient solution for individuals seeking professional health support. 

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