![A balanced space where structure and acceptance meet](https://viacara.com/img/content/approaches-dbt-feature-light.webp) # Dialectical Behaviour Therapy (DBT) Learn how DBT works, what its four skill modules teach and what NICE says about it for people with borderline personality disorder. ## What is DBT? Dialectical behaviour therapy (DBT) was developed by Marsha Linehan in the late 1980s, originally for people with borderline personality disorder (BPD) who had not responded to other treatments. It has since been adapted for a wide range of emotional difficulties. The word "dialectical" refers to balancing two things that seem like opposites. In DBT, the central dialectic is: you are doing the best you can right now, **and** you can work toward doing better. This balance of acceptance and change runs through everything in DBT. ## How it works DBT combines elements of [CBT](https://viacara.com/approaches/cbt/) with mindfulness practices drawn from Zen Buddhist traditions. It is more structured than most therapies and typically includes multiple components: - **Individual therapy**: weekly sessions focused on your specific challenges, using a diary card to track emotions and behaviours between sessions - **Skills group**: a weekly group (usually 2 to 2.5 hours) where you learn and practise the four core skill modules - **Phone coaching**: brief between-session contact when you need help applying skills in a crisis - **Therapist consultation team**: your therapist meets regularly with other DBT therapists for support and quality assurance Not everyone needs the full programme. Many therapists offer DBT-informed individual therapy or skills-only groups. ![The balance between change and acceptance](https://viacara.com/img/content/approaches-dbt-mid-light.webp) DBT holds two truths at once: you are doing the best you can, and you can do better ## The four skill modules Four areas of *DBT skills* - **Mindfulness** Noticing present experiences without judgement. - **Distress tolerance** Getting through distress without adding further problems. - **Emotion regulation** Understanding emotions and changing emotional responses. - **Interpersonal effectiveness** Expressing needs and maintaining self-respect in relationships. A therapist teaches skills across these areas. Skills training is one part of a full DBT programme. ### Mindfulness The foundation of all other skills. Mindfulness in DBT means paying attention to the present moment without judgement. You learn to observe your thoughts and feelings without being controlled by them. ### Distress tolerance Skills for surviving crisis moments without making things worse. These are not about feeling better; they are about getting through intense emotions without turning to harmful behaviours. Techniques include distraction, self-soothing and radical acceptance. ### Emotion regulation Skills for understanding your emotions, reducing vulnerability to intense emotions and changing emotions you want to change. You learn to name what you are feeling, understand what triggers it and develop strategies for shifting emotional states. ### Interpersonal effectiveness Skills for asking for what you need, saying no and maintaining self-respect in relationships. These draw on assertiveness training and help you navigate conflict without damaging relationships or abandoning your own needs. Source: [Behavioral Tech: emotion regulation](https://viacara.com/approaches/dbt/#ref-6) ## Who is it best suited to? DBT is used for: - Borderline personality disorder (BPD) - Self-harm and suicidal behaviour - Eating disorders (particularly binge eating and bulimia) - Substance use disorders - Chronic emotional instability - Intense anger or mood swings - Difficulty maintaining relationships It is designed for people who experience emotions more intensely than those around them and struggle to regulate them. For women with BPD for whom reducing recurrent self-harm is a priority, NICE says to consider a comprehensive DBT programme. ## How it differs from other approaches DBT is more structured and intensive than most therapies. Where standard [CBT](https://viacara.com/approaches/cbt/) focuses primarily on changing thoughts, DBT gives equal weight to acceptance. Where [person-centred therapy](https://viacara.com/approaches/person-centred/) follows your lead, DBT has a clear curriculum of skills to learn. The combination of individual therapy and group skills training is distinctive. You are learning concrete, teachable skills, not just talking about your difficulties. ## The evidence DBT is one of the most extensively researched treatments for BPD and self-harm. Linehan's original 1991 trial showed significant reductions in self-harm and hospital admissions. A 2019 meta-analysis by DeCou and colleagues confirmed DBT's effectiveness for reducing suicidal behaviour across multiple studies. NICE says to consider a comprehensive DBT programme for women with BPD for whom reducing recurrent self-harm is a priority, and it is available through some NHS services. On this page [What is DBT?](https://viacara.com/approaches/dbt/#what-is-dbt) [How it works](https://viacara.com/approaches/dbt/#how-it-works) [The four skill modules](https://viacara.com/approaches/dbt/#the-four-skill-modules) [Who is it best suited to?](https://viacara.com/approaches/dbt/#who-is-it-best-suited-to) [How it differs from other approaches](https://viacara.com/approaches/dbt/#how-it-differs-from-other-approaches) [The evidence](https://viacara.com/approaches/dbt/#the-evidence) Related [Cognitive Behavioural Therapy (CBT)](https://viacara.com/approaches/cbt/) [EMDR Therapy (Eye Movement Desensitisation and Reprocessing)](https://viacara.com/approaches/emdr/) [Mindfulness-Based Cognitive Therapy](https://viacara.com/approaches/mindfulness-based-therapy/) [Understanding Different Approaches](https://viacara.com/guides/understanding-approaches/) [Eating and Body Image](https://viacara.com/support/eating-and-body-image/) Thanks for your interest. We're not taking on new clients at the moment. ## Looking for *DBT* support? We ask what matters to you, then find professionals who fit. Leave your email and we'll let you know as soon as we're ready for you. This conversation helps us find you the right support. What you share helps us understand what you're looking for and find someone who fits. Your email keeps you updated on what's happening next and isn't shared with anyone we introduce you to. [Privacy policy](https://viacara.com/privacy/) [Terms of service](https://viacara.com/terms/) ## References 1. Linehan, M. M., Armstrong, H. E., Suarez, A., Allmon, D. & Heard, H. L. (1991). *Cognitive-behavioral treatment of chronically parasuicidal borderline patients*. Archives of General Psychiatry. [doi:10.1001/archpsyc.1991.01810360024003](https://doi.org/10.1001/archpsyc.1991.01810360024003) 2. Panos, P. T., Jackson, J. W., Hasan, O. & Panos, A. (2014). *Meta-analysis and systematic review assessing the efficacy of dialectical behavior therapy (DBT)*. Research on Social Work Practice. [doi:10.1177/1049731513503047](https://doi.org/10.1177/1049731513503047) 3. Linehan, M. M. (2015). *DBT Skills Training Manual*. Guilford Press. 4. DeCou, C. R., Comtois, K. A. & Landes, S. J. (2019). *Dialectical behavior therapy is effective for the treatment of suicidal behavior: A meta-analysis*. Behavior Therapy. [doi:10.1016/j.beth.2018.03.009](https://doi.org/10.1016/j.beth.2018.03.009) 5. NICE (2009). *Borderline personality disorder: recognition and management (CG78)*. [nice.org.uk](https://www.nice.org.uk/guidance/cg78) 6. Behavioral Tech Institute (2019). *The Role of Emotion Regulation in DBT (Part 2)*. [behavioraltech.org](https://behavioraltech.org/role-of-emotion-regulation-dbt-part-2/) ## Related ### [Cognitive Behavioural Therapy (CBT)](https://viacara.com/approaches/cbt/) Learn how CBT works, what happens in sessions and what NICE says about it, and read about its forms for sleep, pain and self-help. ### [EMDR Therapy (Eye Movement Desensitisation and Reprocessing)](https://viacara.com/approaches/emdr/) Learn how EMDR works, what happens in sessions and why it is recommended for trauma and PTSD. ### [Mindfulness-Based Cognitive Therapy](https://viacara.com/approaches/mindfulness-based-therapy/) Learn how mindfulness-based cognitive therapy (MBCT) works, why NICE recommends it to stop depression returning and how it differs from MBSR. ### [Understanding Different Approaches](https://viacara.com/guides/understanding-approaches/) A plain-English guide to the main therapeutic approaches including CBT, person-centred therapy, psychodynamic and integrative methods. ### [Eating and Body Image](https://viacara.com/support/eating-and-body-image/) A hard relationship with food or your body is common and treatable. Find support that runs alongside your GP and NHS care.