Dialectical behavior therapy (DBT) is a structured psychotherapy program with a strong educational focus. It aims to teach skills for managing intense emotions and navigating social relationships. Initially created to help chronic suicidal patients control self-destructive impulses, it is now the preferred treatment for borderline personality disorder, emotion dysregulation, and various psychiatric conditions. The program includes weekly group sessions and individual therapy sessions, typically spanning six months to a year.

Dialectical behavior therapy incorporates the concept of dialectics to recognize the complexity of real life and the ongoing nature of health. This involves engaging in a continuous dialogue with oneself and others, similar to the Socratic method, to balance opposing forces and explore the truth of intense negative emotions.

DBT recognizes the necessity for change within an environment of accepting circumstances and acknowledges the continual fluctuation of emotions, often conflicting, without becoming entangled in them. Therapist-instructors assist clients in comprehending and embracing the notion that thinking is inherently chaotic. DBT embodies a combination of scientific principles and practical application.

DBT specifically focuses on providing therapeutic skills in four key areas.

Mindfulness enables individuals to accept and be present in the current moment by noting the nature of emotions, which diminishes the power of emotions to direct their actions.
DBT also inculcates distress tolerance, the ability to tolerate negative emotion rather than needing to escape from it or acting in ways that make difficult situations worse.
Emotion regulation strategies give individuals the power to manage and change intense emotions that are causing problems in their life.
Last but not least, DBT teaches techniques of interpersonal effectiveness, allowing a person to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships; a core principle is that learning how to ask directly for what you want diminishes resentment and hurt feelings.

DBT utilizes numerous methods from cognitive behavioral therapy (CBT) to assist individuals in identifying and confronting distorted thinking that leads to negative emotions and unproductive actions. For instance, patients are taught to recognize when they are catastrophizing, or assuming the worst, in order to refrain from behaving as if it were true. They also examine their past and present experiences to identify instances of all-or-nothing thinking, where they perceive everything in extreme black or white terms, lacking the nuance that typically characterizes life.

Mindfulness training is an important part of DBT. In addition to keeping patients present-focused, it slows down emotional reactivity, affording people time to summon healthy coping skills in the midst of distressing situations.

Patients should maintain a diary to monitor their emotions and impulses, aiding them in recognizing their feelings, identifying challenging situations, and using the insights to manage their behavior. During one-on-one sessions, patients analyze past difficult situations and emotions and participate in problem-solving by discussing alternative behaviors that could lead to positive results. Furthermore, patients usually have the option to receive skills coaching from therapists during crises or between sessions.

DBT is based on evidence and extends beyond mental illness to enhance individuals’ quality of life. It lessens symptoms of anxiety, depression, trauma, and stress while also reducing thoughts and behaviors related to suicide and self-harm. It enhances consumers’ self-worth and self-respect.