What is Dialectical Behaviour Therapy (DBT)?

When emotions feel overwhelming, it can be difficult to think clearly, make decisions, or connect with others. Dialectical Behaviour Therapy (DBT) was developed to address these challenges by combining strategies of acceptance and change.

Dialectical Behaviour Therapy (DBT) is a form of cognitive behavioural therapy (CBT) that focuses on teaching four key skills: emotional regulation, interpersonal effectiveness, distress tolerance, and mindfulness. By developing these skills, individuals can learn how to manage intense emotions, cope with stress, improve relationships, and stay grounded in the present moment.

What is Dialectical Behaviour Therapy?

Dialectical behaviour therapy (DBT) is a type of talk therapy where individuals learn practical skills to manage emotions, improve relationships, tolerate distress, and develop greater self-acceptance.

DBT is a form of cognitive behavioural therapy (CBT) that focuses on balancing acceptance and change. Similar to CBT, DBT also involves changing unhelpful thoughts and behaviours. In addition, it helps people cultivate self-compassion and resilience so they can lead a more meaningful life.

What Can Dialectical Behaviour Therapy Treat?

DBT is used to treat a wide range of mental health conditions. While it originally focused on borderline personality disorder (BPD), research has shown benefits for conditions such as depression, substance use, post-traumatic stress disorder (PTSD), and eating disorders.

A 2017 review on the clinical effectiveness of DBT for adults with mental health conditions found that dialectical behaviour therapy was at least as effective as other established treatments for several mental health conditions, and in some cases offered additional advantages in reducing self-harm and improving emotional regulation.

DBT is well established for treating borderline personality disorder (BPD). A 2014 study conducted to measure the effectiveness of DBT for borderline personality disorder found that 77% of patients experienced significant improvements in BPD symptoms after one year of DBT treatment.

How Does Dialectical Behaviour Therapy Work?

DBT is typically delivered in two main ways: through individual and group sessions facilitated by psychologists.

One-on-one sessions with DBT-trained psychologists

Individual sessions with a DBT psychologist generally run for 45 to 60 minutes. During these one-on-one sessions, a DBT psychologist will discuss specific challenges (e.g. relationships, self-image) and any behaviours that are negatively impacting the client’s life.

Clients are encouraged to record their emotions and actions throughout daily life using tools like diary cards, and share them during the session. This helps psychologists track the progress of the therapy and identify patterns, triggers, and opportunities for growth.

DBT group sessions with other participants

DBT may also involve group sessions focusing on skills training and role-play. A DBT-trained psychologist will teach essential skills covering mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation within the group setting and provide opportunities for participants to practice with one another.

These DBT skills can also be taught in individual sessions when group participation is not available.

Skills and Strategies Used in Dialectical Behaviour Therapy

There are four main components of Dialectical Behaviour Therapy – each addresses a different aspect of an individual’s mental health.

Mindfulness

Practising mindfulness allows individuals to be more aware and present in the moment. It enables people to respond more thoughtfully to situations and reduce impulsive reactions.

Skills to exercise mindfulness include:

Observe – taking a step back to observe the surroundings using all five senses, building awareness of thoughts and feelings without trying to change them.
Describe – putting feelings into words to help clarify emotions and support communication.
Participate – fully engaging in the present moment with openness and focus.

Distress tolerance

Distress tolerance is about learning how to handle painful emotions during a crisis without resorting to harmful behaviour. It enables people to get through the moment safely until the intensity of emotions decreases.

Skills that develop distress tolerance include:

Pros and Cons – Creating a pros and cons list to clearly outline the comparison between short-term relief and long-term outcomes, to support wiser choices.
TIPP – a 4-step process for managing strong emotions
- Temperature – cooling the body (e.g. holding ice, taking a cold shower) to decrease heart rate and emotional intensity
  Intense exercise – performing high-intensity physical activity (e.g. star jumps, running, skipping) to release built-up stress and excess energy as well as calm the body
- Paced breathing – slowing the breath and breathing in deeply through the nose for five seconds before breathing out through the mouth to activate the body’s relaxation response
- Progressive muscle relaxation – systematically tightening and releasing muscles from the top to the bottom of the body helps to release tension and bring awareness back to the body

Interpersonal effectiveness

Interpersonal effectiveness is about improving the ability to communicate clearly and effectively with others to form healthy relationships.

Interpersonal effectiveness skills in DBT include:

The DEAR MAN technique: used to ask for what you want or say no effectively
- Describe – clearly stating what you want
- Express – sharing how you feel using “I” statements
- Assert – assert your needs confidently and clearly
- Reinforce – explaining positive outcomes of the change
- Mindful – stay in the moment despite what you feel
- Appear confident – maintain positive body language
- Negotiate – be open to discussion for a shared outcome

The GIVE technique: used to maintain and strengthen relationships
- Gentle – refrain from attacking or judgmental statements
- Interested – actively listen to the other person
- Validate – acknowledge the other person’s feelings and opinions
- Easy manner – maintain a friendly tone

Emotional regulation

Emotional regulation helps individuals recognise, reduce, and manage intense emotions to avoid overwhelm and respond to situations in healthier ways.

Emotional regulation skills include:

Ride the Wave: Instead of trying to control or suppress an emotion, allow yourself to feel it and let it fade naturally over time. Emotions are temporary, and even negative ones will eventually feel less intense.
Radical Acceptance: When faced with a crisis, it can be difficult to come to terms with it. Radical acceptance involves accepting every aspect of the situation, regardless of how bad or distressing it may be. Accepting the situation as it is prevents additional mental distress from trying to deny it.

Psychologists teach individuals many other DBT skills, depending on what works best for their mental health issues and personal circumstances. If you or a loved one frequently struggles with negative thinking patterns or intense emotions, DBT is a proven treatment for many people. At New Vision Psychology, we have a team of registered and clinical psychologists experienced in dialectical behaviour therapy. Book a counselling session at any of our psychology clinics in Burwood, Chatswood, Castle Hill, Hurstville, and the Sydney CBD.