Dialectical Behaviour Therapy (DBT)

Like other forms of CBT, the central premise of DBT is that we can reduce our suffering if we modify our thoughts and actions.

Many mental health conditions are accompanied by strong — and often unpleasant — emotions. DBT puts these experiences at the centre of the therapeutic experience, helping us to recognise and accept the feelings as part of our experience.

This may seem counterintuitive, but accepting the way we feel doesn’t mean we can’t also strive to change. When we use DBT, we are working on the premise that we can accept our experience as a valid part of our story, while also taking steps to change our lives for the better.

There are four key components of DBT, and these work together to help people overcome their problems and challenges. These components can be grouped into two categories — activities geared towards improving our acceptance skills (mindfulness and distress tolerance) and activities designed to help us change the way we think, feel, or behave (emotion regulation and interpersonal effectiveness).

The first component is mindfulness. Sometimes used as a standalone therapy in its own right, mindfulness helps us connect with the present moment. It teaches us to acknowledge our thoughts and feelings without getting lost in them.

Instead of fighting against our thoughts, mindfulness helps us to observe them without judgement, minimising the power they hold over us.

The second acceptance skill DBT helps build is distress tolerance. Many mental health conditions involve a degree of distress, and this can be something that’s challenging to get to grips with.

By its nature, distress is uncomfortable. It’s not something most people would actively seek out, yet it’s a common feature of life. Learning distress tolerance skills can help you cope with these feelings, equipping you with strategies to help you overcome these challenging moments.

Emotion regulation helps us manage our feelings. The emotions we feel are mostly involuntary — we don’t actively decide how to respond to a distressing event.

Emotion regulation skills help us better respond to these involuntary feelings, letting go those that don’t serve us and embracing those that do.

It’s not about squashing our negative emotions — all emotions are valid — it’s about changing how we respond to those feelings.

We don’t exist in isolation but are surrounded by people. Interpersonal effectiveness skills help us manage our relationships with others to understand how to:

DBT is useful for any conditions or experiences that involve intense, unwanted emotions. Here are some we have found the most effective:

Self-harm often arises as a way to cope with strong emotions. DBT has been found effective in helping reduce self-harm behaviours, particularly in young people.

There are many ways DBT can help if you’re trying to stop self-harming. It can help you learn other ways to regulate your emotions. It can also help you build the skills you need to open up to others and tolerate feelings of distress without hurting yourself.

DBT was originally developed to help those at risk of suicide, and it is still one of the most popular and successful applications today.

There are many reasons people consider suicide. Often, the feelings of distress have become too much for one to bear — and ending their life can feel like the only way out.

Learning how to sit with these feelings of distress, while maintaining hope that change is possible, can be powerful.

In addition to coping better with the feelings of distress, DBT helps people develop more adaptive coping mechanisms — such as emotional regulation or learning the interpersonal skills necessary to have an honest conversation about how they are feeling.

Like self-harm, substance abuse is often used as a means to escape from distressing feelings. The four skills developed through DBT can support people through challenging times, reducing the chances of a relapse, as well as helping people tackle their addictions in the first place.

Borderline personality disorder (BPD) is characterised by unstable relationships, self-destructive behaviours, anger management issues, and negative self-thoughts.

All of these can result in intense, negative emotions, which may be difficult to overcome using other forms of therapy. DBT provides a structured way for people with BPD to live a meaningful life despite the challenging emotions they’re feeling.