Dialectical Behavior Therapy
Also known as: DBT, dialectical therapy
Dialectical Behavior Therapy (DBT) is a comprehensive, multimodal psychosocial intervention developed by Marsha M. Linehan to treat individuals with Borderline Personality Disorder (BPD) and chronic suicidality. Combining cognitive-behavioral principles with dialectical philosophy and Zen principles, DBT is delivered through individual therapy, skills training, phone coaching, and therapist consultation and has become the gold-standard treatment for BPD.
Key highlights
- Gold-standard evidence base for reducing self-harm and suicidality in BPD with effect sizes comparable to psychopharmacology
- Comprehensive, multimodal approach addresses multiple treatment targets simultaneously
- Explicit coaching and between-session contact increase engagement and skill transfer
- Therapist consultation team prevents burnout and improves therapist adherence and effectiveness
- Portable skills applicable across diverse contexts; clients maintain gains post-treatment
Intuition
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How it works
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When to use it
DBT is the first-line, evidence-based treatment for Borderline Personality Disorder, particularly when suicidality or self-harm is present. It is also increasingly applied to other conditions involving emotion dysregulation (PTSD, eating disorders, substance use, bipolar disorder). DBT requires high clinician training and ongoing consultation and is resource-intensive; it is most suitable for clients with stable housing and moderate motivation to engage in a one-year commitment.
Strengths & limitations
- Gold-standard evidence base for reducing self-harm and suicidality in BPD with effect sizes comparable to psychopharmacology
- Comprehensive, multimodal approach addresses multiple treatment targets simultaneously
- Explicit coaching and between-session contact increase engagement and skill transfer
- Therapist consultation team prevents burnout and improves therapist adherence and effectiveness
- Portable skills applicable across diverse contexts; clients maintain gains post-treatment
- Resource-intensive; requires trained therapist, skills coaches, and consultation team; costly for healthcare systems
- One-year commitment may be onerous for some clients; high attrition in early phases
- Therapist training and certification lengthy and expensive; limited availability in some regions
- May inadvertently reinforce crisis-seeking behavior if phone coaching is overused without hierarchy adherence
- Limited evidence for DBT adapted for adolescents; pediatric versions still under development
Common pitfalls
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Applications
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Frequently asked
Why is DBT so intensive compared to standard therapy?
Individuals with BPD have historically experienced poor outcomes in standard therapy with high dropout and continued self-harm. DBT's intensity (multiple weekly contacts, consultation team, skills training) is designed to provide the structure and support needed for sustainable change.
What is the 'dialectic' in Dialectical Behavior Therapy?
Dialectics refers to the synthesis of opposing truths. In DBT, the dialectic is acceptance (you are doing the best you can, you are valued) AND change (you need to change to reach your goals). This paradoxical stance prevents both rejection and enabling.
Can someone do DBT if they do not have Borderline Personality Disorder?
Yes. DBT is increasingly used for other conditions involving emotion dysregulation, including PTSD, eating disorders, and substance use. However, standard DBT protocols are most extensively researched for BPD.
How long does DBT treatment typically last?
Standard DBT is typically one year minimum, though some clients benefit from extended treatment. The duration depends on presenting problems, progress on behavioral targets, and individual goals.
Sources
- 1.Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.ISBN 9780898621784
- 2.Linehan, M. M., Korslund, K. E., Harned, M. S., et al. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiatry, 72(5), 475–482.
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Cite this page
ScholarGate. (2026, June 3). Dialectical Behavior Therapy. ScholarGate. https://scholargate.app/clinical-psychology/dialectical-behavior-therapy