Written By Scott Meyer, MA, LPC and Eden Himidian, LCSW, PMH-C, RYT
In this article we’ll pull back the curtain on Dialectical Behavior Therapy, or DBT. We’ll discuss what DBT is, why it exists, and what it might look like if you ever decide to give it a try. Let’s jump in.
What does DBT stand for?
DBT stands for Dialectical Behavior Therapy. The word “dialectical” isn’t one most of us use every day, so it may sound intimidating. But it’s really just a fancy way of saying two seemingly opposite things can be true at the same time. For example:
- I love my family and they sometimes drive me up the wall
- I’m doing the best I can and I need to do better
- I can accept an uncomfortable situation and seek to create change
DBT is all about holding space for those kinds of tensions and learning how to live with them without becoming overwhelmed or stuck.
Background and how it works
DBT is a form of therapy originally developed by psychologist Marsha Linehan to help people who were feeling chronically overwhelmed by intense emotions, often leading to self-destructive behaviors. Initially, it was created to support people with borderline personality disorder, but over time it’s proven helpful for all kinds of challenges: depression, anxiety, eating disorders, trauma, chronic shame, emotion regulation difficulties – you name it. (O’Bryan, 2023)
DBT is not about labeling you; it’s about empowering you through acceptance and validation. At its core, it helps us better understand and manage our emotions, respond to distress instead of react to it, and build emotional stability. (O’Bryan, 2023)
Dialectics help us balance acceptance and change. We can accept where we are in any given moment, and use skills to act more effectively moving in line with our values.
DBT is often used in individual and group therapy formats. While it can be structured and focused, it’s not rigid or cold. In fact, it’s so flexible that many therapists incorporate elements of DBT into their work even if you’re not in a formal DBT program.
This approach is skill-based, aimed at helping you build a sort of emotional toolbox. You learn skills in 4 modules: Mindfulness, Distress Tolerance, Emotional Regulation, and Interpersonal Effectiveness. Skills from each of these modules can help you navigate difficult emotions and situations effectively versus turning to behaviors that might actually make them worse in the long run. The goal is to increase your ability to tolerate short term pain in an effort to reduce long term suffering, all while building the life you truly want to be present in.
Before we dive into each of the four DBT modules, let’s take a look at the behavior side of Dialectical Behavior Therapy. One of the main tools DBT uses is called a diary card. A diary card helps you track a behavior you’d like to change; something that isn’t working for you anymore. On it, you record both the urges you feel to engage in that behavior and the times you actually do. At the same time, you track the healthier coping strategies you’re learning in DBT and whether they’re helping you resist those urges. (DBT Self Help, n.d.)
The key here is to do this with a nonjudgmental stance, like a scientist collecting data. When you review your diary card with your therapist, you look at what led up to the behavior: what triggered the urge, what thoughts and feelings came up, and what choices you made. This process is called behavior chain analysis, and it helps you spot the points where you might have been able to take a different path. The goal isn’t to criticize yourself, but to understand the sequence so you can make new choices in the future.
Back to those four modules. As Maya Angelou is known to have said, “Do the best you can until you know better. Then when you know better, do better.” The four DBT modules teach skills to help folks act more effectively in line with their values.
1. Mindfulness
You’ve probably heard of this one; DBT mindfulness isn’t necessarily about sitting cross-legged on a mountaintop chanting “om” (though if that’s your thing, do your thing). It’s about learning to pay attention to the present moment without judgment. Mindfulness helps us notice our thoughts, feelings, and urges without automatically acting on them.
In this module, we learn about our different mind states: Wise Mind, the balanced middle ground between Emotion Mind and Reasonable Mind. Then we practice skills for what to do (observe, describe, participate) and how to do it (nonjudgmentally, one-mindfully, effectively).
In DBT, mindfulness is both a formal practice and a stance we bring to daily life. On one hand, mindfulness can look like meditation exercises that help strengthen the “attention muscle” in the brain. The more we practice noticing and returning our attention, the stronger our ability to focus becomes over time.
One of our favorite exercises is called The Worrying Mind. In this practice, you count backwards, 10, 9, 8, 7, and so on, until you reach one. Then, you simply start back over at 10. The only goal is to keep your mind on the task at hand. When your mind inevitably wanders, the exercise is to notice it (with as little judgment as possible) and gently bring yourself back to counting. For example, if you catch yourself counting forward and realize you’ve made it to 100, you just notice that, and return to the exercise. You can set a timer for three or five minutes (or longer) and use that time to practice keeping your attention grounded in this simple task.
Mindfulness in DBT is also about adopting a mindful stance in everyday life. This means approaching ordinary activities with intentional awareness. For example, you might choose one daily activity, like washing the dishes, to do mindfully. We’ve all had the experience of washing dishes on autopilot, but a mindful approach means engaging all five senses: noticing what you see, feel, hear, smell, and even taste. Just like in meditation, when your mind drifts elsewhere, the practice is to notice that drift and gently bring your attention back to the present moment.
2. Distress Tolerance
We all have an optimal ‘window’ of tolerating distress. This is where we may feel stress, like things are difficult, but manageable, we can navigate the stress and uncomfortable emotions without spiraling emotionally. When we move outside of this window for instance, above it, where we might feel into a state of hyperarousal, you might feel frantic or panicked. This is when we can use distress tolerance techniques to keep us from getting any more escalated. If you think of your level of distress on a scale from 1-10, distress tolerance skills are most effective when you are between a 7-9. These are crisis survival skills; we are not trying to make the moment better, we are trying to survive the crisis until it passes.
When you find yourself in this range, distress tolerance skills include:
- Distraction (i.e. redirecting attention elsewhere until the “temperature” lowers)
- Self-soothing (i.e. taking a calming bath)
- Radical acceptance (i.e. learning to accept things as they are, regardless of our feelings about them, so we can stop fighting reality and start coping)
- TIPP (A set of skills for calming the nervous system quickly through temperature, intense exercise, paced breathing, and progressive muscle relaxation )
These tools don’t make pain disappear, but they can make it more bearable and keep you grounded through tough moments. When it comes to managing more difficult emotions once we’re more regulated, then we can turn to our emotional regulation skills.
3. Emotion Regulation
Especially when emotions are intense or unfamiliar, it’s easy to feel overwhelmed by them. Emotion regulation skills teach you how emotions work, how to make sense of them, and how to manage them more skillfully instead of being ruled by them.
You’ll learn:
- Why emotions aren’t bad (even the really uncomfortable ones)
- How to reduce vulnerability to emotional chaos (think: sleep, nutrition, boundaries)
- How to shift emotions that don’t serve you
It’s not about never feeling angry or sad. It’s about not being pulled around by your emotions so frequently or intensely (Linehan, 2015).
One of the basic skills in the Emotion Regulation module is the P.L.E.A.S.E. skill. It teaches us to take care of our basic needs to help reduce our vulnerability to extreme emotions.
4. Interpersonal Effectiveness
Interpersonal effectiveness skills help you ask for what you need, set boundaries, say no without guilt, and keep your self-respect in the process (Linehan, 2015). Here you might learn acronyms to help you remember how to handle tough conversations – like DEAR MAN, GIVE, and FAST. They might sound silly at first, but they’re surprisingly memorable and empowering. Over time, they start to feel natural and can make a big difference in how you relate to others and to yourself.
When it comes to interpersonal effectiveness in DBT, it can be helpful to think about the “scale of distress” we explored in distress tolerance. Distress tolerance skills are most useful when you’re at a 7-9 out of 10, really struggling to stay grounded. Interpersonal effectiveness skills, on the other hand, work best when you’re more regulated, around 1-3 out of 10. These skills take practice and intention, and you’ll want to be in Wise Mind before you use them. Once you’re ready, skills like DEAR MAN can help you set boundaries or get your needs met in a clear, respectful way.
For example, maybe your roommate often leaves dirty dishes in the sink and you’re tired of always cleaning them. Using DEAR MAN, you could: Describe what’s happening (“I’ve noticed I’m usually the one doing the dishes”), Express how you feel (“I feel frustrated and unappreciated”), Assert what you’d like (“I’d like you to wash your own dishes”), and Reinforce why it matters (“If we both take care of our mess, it’ll feel easier to live together”). While you’re talking, stay Mindful and bring the focus back if the conversation goes off track, Appear confident by speaking steadily and making eye contact, and be open to Negotiate if they suggest a fair compromise. Practicing DEAR MAN can make it easier to stand up for yourself while keeping the relationship strong.
Does DBT Work?
Yes, but not overnight. Rest assured, DBT is a well-researched, evidence-based approach to psychotherapy with a strong track record of positive results. But that doesn’t mean it is a quick fix – nothing in psychotherapy is. You’re learning a whole new set of emotional tools, and that takes time. It’s kind of like learning to ride a bike…awkward at first, but eventually, it becomes second nature.
What some people find is that DBT gives them hope. They finally feel like they have a roadmap, a set of skills, and a way to understand themselves that makes sense. Instead of being at the mercy of their emotions or behaviors, they begin to feel like they’re in charge again.
Do I Need a Full DBT Program to Benefit?
No, you don’t need to be in a full DBT program to benefit. While DBT is offered in more structured settings like residential, PHP, or IOP programs or through a 16-week outpatient skills group, you can also gain a lot from learning DBT skills in outpatient therapy. Even when used more informally, DBT’s focus on mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness can make a big difference, especially in the context of a supportive, validating environment.
Final Thoughts
Your emotions make sense (even the gnarly ones). Your coping makes sense. DBT helps you understand how you got here, how to make sense of it, and how to chart a different path forward.
If you’re curious about DBT, reach out to us here at Wildflower or read up on it. Look for a DBT skills group in your area or review our resources below. And if you think a DBT therapist might be a good fit for you, we are here to help!
Further Exploration
If you’re interested in learning more, here a few resources we suggest:
Books
- Building a Life Worth Living: A Memoir (2020) by Marsha Linehan
- Don’t Let Your Emotions Run Your Life by Scott Spradlin
- DBT Principles in Action: Acceptance, Change, and Dialectics by Charles Swenson
The Dialectical Behavior Therapy Skills Workbook by Matthew McKay, Jeffrey C. Wood, & Jeffrey Brantley
Podcasts
- DBT Peer Connections Podcast – practical tips and real-life examples from people using DBT skills
- Therapy Chat (select episodes on DBT and mindfulness)
Websites
- Wildflower Blogs on DBT Topics – more information on DBT and how it can be used in the treatment of various concerns
- Dialectical Behavior Therapy Website – general information, skill-building, and resources
- DBT Self Help – free worksheets, diary cards, and skills explanations
Apps
- DBT Diary Card & Skills Coach (by Greentea LLC)
- MoodMission – evidence-based strategies for managing distress and building coping skills
References
Behavioral Tech Institute. (n.d.). Evidence & research. Behavioral Tech. Retrieved July 21, 2025, from https://behavioraltech.org/evidence/
DBT Self Help. (n.d.). Diary cards. DBT Self Help. https://dbtselfhelp.com/diary-cards/
Linehan, M. M. (2015). DBT® Skills Training Manual (2nd ed.). New York, NY: Guilford Press
O’Bryan, A. (2023, August 1). 15+ recommended DBT interventions, activities & techniques. PositivePsychology.com. https://positivepsychology.com/dbt-interventions/
Schimelpfening, N. (2023, November 2). Dialectical Behavior Therapy (DBT): Definition, Techniques, and Benefits. VerywellMind.com https://www.verywellmind.com/dialectical-behavior-therapy-1067402
