In search of new ways to mindfully manage distress? DBT can teach you how to cope with painful emotions

Dialectical behavior therapy, the main treatment for borderline personality disorder, can help anyone learn skills to navigate emotional turmoil.

• DBT was originally developed to help people with thoughts of suicide manage overwhelming distress. 
• DBT teaches you to replace unhelpful behaviors with skills like mindfulness and distress tolerance.
• Along with self-harm and suicidal thoughts, DBT can treat PTSD, anxiety, eating disorders, and more.

If you struggle to manage painful emotions or experiences like stress, anger, and rejection, dialectical behavior therapy (DBT) can help.

The word "dialectical" means embracing two seemingly opposite ideas. In DBT, that often means working on accepting yourself as you are while also having the motivation to change, according to Dr. Sam Zand, a licensed psychiatrist, co-founder and chief medical officer at Better U, and founder of Anywhere Clinic.

Psychologist Marsha Linehan developed DBT in the 1970s to treat people dealing with suicidal ideation. Experts largely consider DBT the gold standard for treating borderline personality disorder (BPD) — but the approach has also proved helpful for treating a wide range of other mental health conditions and symptoms. 

Read on to learn about the many conditions DBT can help treat, plus how to try it yourself.

Who can benefit

Studies have shown DBT may prove helpful for the following conditions and symptoms:

BPD

This personality disorder is characterized by:

• Sensitivity to rejection and abandonment 
• An unstable self-image
• Difficulty regulating emotions
• Tumultuous relationships with others 

DBT can help address all of these issues by providing skills to cope with difficult emotions in a more positive way, according to Shelby Milhoan, a licensed clinical professional counselor in private practice.

A 2020 review found DBT to be more effective at reducing the severity of BPD symptoms and improving someone's ability to engage in daily activities and socialization than other types of therapy.

Self-harm

If you use self-injury as a way to cope with overwhelming and painful emotions, DBT can teach you safer and more effective self-soothing strategies, says Danielle McGraw, a licensed clinical psychologist and owner of Flourish Mental Wellness. 

Techniques like journaling about your feelings or distracting yourself by listening to music or going for a walk can help you get through a crisis without engaging in self-harm.

A 2021 review found adolescents who received DBT treatment experienced moderate reductions in self-harming behavior, compared to the control group. What's more, rates of self-harm continued to decrease to the follow-up point one year later.

Thoughts of suicide

DBT considers suicide an effort to solve a problem — usually, intolerable emotional pain. By teaching behavioral skills for dealing with that pain, DBT can help reduce suicidal thoughts and urges.

A 2021 review found that DBT helps prevent both suicide attempts and hospitalization for suicidal ideation.

Eating disorders

Disordered eating habits such as restricting, binge eating, and purging can often be a way of avoiding or coping with intense emotions, such as fear after losing a job or sadness about a breakup.

But DBT can help: According to one 2017 review, 89% of participants stopped binge eating by the end of 20 weeks of DBT treatment.

According to McGraw, most research on DBT for eating disorders has specifically focused on the treatment of binge eating disorder and bulimia nervosa. But a 2014 review found that DBT can also help reduce behaviors related to anorexia nervosa, like severe food restriction, dieting, and over-exercising.

Post-traumatic stress disorder (PTSD)

McGraw says DBT can teach strategies for coping with PTSD like staying grounded, regulating emotions, and tolerating distress in triggering situations.

"DBT can also teach you how to assess whether the emotion you're experiencing fits the facts of a situation, which is an important part of trauma therapy," she adds.

One 2020 study involving women who survived childhood abuse found that DBT helped reduce the intensity of a range of PTSD symptoms and behaviors, including dissociation and self-harm.

Anxiety

Not much research to date has explored DBT for anxiety. 

However, a small 2020 study including people with generalized anxiety disorder found that DBT improved anxiety and helped reduce emotion dysregulation and boost mindfulness more effectively than cognitive behavioral therapy (CBT).

DBT can provide distress tolerance skills that come in handy when panic and anxiety strike, Milhoan says. Examples of those distress tolerance skills include: 

• Tapping into your five senses to ground yourself when you feel your emotions spiraling out of control
• Taking a minute to practice deep breathing before reacting or responding in a triggering situation.

Depression

Since DBT focuses on emotional regulation, it may help people with depression manage mood fluctuations.  

Research on this potential benefit remains limited, but a 2021 review suggests DBT treatment can significantly improve depression in people with BPD. This effect was particularly significant when treatment lasted longer than four months.

Core DBT skills

DBT builds on CBT by incorporating elements of validation and mindfulness. But whereas CBT focuses primarily on changing negative thought patterns, DBT focuses on coping with and regulating extreme emotions to change your behavior and improve your relationships.

Another key component of DBT lies in coming to terms with the fact that two seemingly opposing ideas can be simultaneously true. For example, McGraw notes understanding that someone can be mad at you yet still continue to love you may help reduce distressing feelings during a relationship conflict.

DBT emphasizes replacing distress avoidance and other unhelpful behaviors — like isolation, impulsivity, self-harm, or acting out with anger — with a specific set of new skills. These skills include:

1. Mindfulness: Being present and fully aware of your thoughts and emotions without judging them

2. Emotion regulation: Identifying and affecting your own emotions in a positive way

3. Distress tolerance: Withstanding and developing resilience toward uncomfortable feelings

4. Interpersonal effectiveness: Asking for what you want and need and setting boundaries with others

What to expect 

DBT programs usually require a commitment of at least 6 months but sometimes up to a year, according to Milhoan. 

Therapy typically involves three main elements:

• Individual psychotherapy sessions: In these weekly, hour-long sessions, you'll work with your therapist on whatever symptoms you're trying to manage, and your therapist will help you navigate specific challenges.
• Group skills training sessions: In these weekly group therapy sessions, which last two to three hours, you'll learn how to practice the new behavioral skills you've identified in individual therapy by talking through imaginary or real-life scenarios with others.
• Additional phone coaching (as needed): Dr. Lauren Kerwin, a licensed psychologist in private practice, says your therapist may encourage you to call them when you have the urge to self-harm or feel particularly overwhelmed by your emotions, so they can guide you through using your DBT skills to cope. 

Kerwin says DBT always prioritizes the highest-risk behaviors first — for example, you would address behaviors pertaining to self-injury before a tendency to self-isolate.

One of the most common tools used in DBT is "diary cards," designed to help you track your daily thoughts, emotions, and behaviors in between sessions. These can be completed on paper, or digitally in an app. One section contains space for you to rate your urges to use destructive behaviors — like self-harm or substance use — while the other contains a list of DBT skills for you to check off as you practice them.

According to Dr. Andrew White, a licensed clinical psychologist and co-owner of the Portland DBT Institute, DBT therapists review the contents of these diary cards during your sessions so you can begin to understand why you engaged in destructive behaviors — including the thoughts and feelings that led to them — and what you can do instead next time. 

For example, if you started cutting after a triggering conversation with friends, your therapist might suggest alternative behaviors like changing the subject or leaving the table to do some deep breathing exercises.

How to find a therapist

Linehan founded the DBT Board of Certification, and you can use that program's search engine to find someone certified in your area.

BetterHelp, GoodTherapy, and Psychology Today all offer searchable databases, where you can filter specifically for local therapists who offer DBT.

Kerwin also suggests using Behavior Tech's Find A Therapist tool to find mental health professionals who have been trained at the Linehan-founded DBT Institute.

Limitations

One of the main limitations of DBT, according to Milhoan, is there aren't always enough therapists trained in this modality to meet the high demand for this treatment. That means you may spend some time on a waitlist. 

Also, not all insurance plans cover comprehensive DBT treatment with skills training groups. 

Kerwin says DBT may also require too much of a time commitment for some people, like parents without child care or those with a busy work schedule. That's because DBT often involves three or more hours of therapy a week between individual and group sessions, plus filling out diary cards in between.

DBT may not be effective as a standalone treatment for psychosis, because delusions and hallucinations make it difficult to put your own thoughts and emotions into perspective. However, a small 2022 study suggests DBT may help reduce some symptoms of psychosis, like paranoia.

Insider's takeaway 

DBT is a modified form of CBT designed to help you learn to regulate your emotions and cope with them in more helpful ways. 

While it's most often used to treat BPD, research has shown it can also help address depression, anxiety, PTSD, eating disorders, and self-harm.

Although many people do find DBT helpful, this approach may not be ideal for everyone. For instance, while it may prove helpful for managing emotional responses to certain triggers, it may not provide the space you need to dig deep enough into how past events affected you.