What is Dialectical Behavior Therapy and How Does it Work?

When your emotions dominate your every choice or you’re engaging in self-destructive habits, traditional therapy may not always be enough. However, you’re not out of options. 

Dialectical behavioral therapy, or DBT, combines talk therapy and behavioral therapy to help patients manage negative emotions and learn interpersonal and communication skills. In this article, we’ll answer, “What is Dialectical Behavior Therapy,” explain how it works, and see what the research has to say.

What Skills Does DBT Teach?

DBT is based on skills training, where clients practice different strategies to deal with intense emotions and relationship challenges. There are four skill areas DBT focuses on: 

• Mindfulness
• Distress Tolerance
• Emotion Regulation
• Interpersonal Effectiveness 

Let’s break each of these down: 

Mindfulness

Mindfulness teaches you to ground yourself in the present moment with judgment. This is taught as two sets of skills: 

• “What” Skills – What do I do to be mindful? 
  • Observe: Notice what’s happening internally and externally without trying to change it.
  • Describe: Put words to what you’re experiencing. 
  • Participate: Fully engage in the moment with your whole attention. 
• “How” Skills – How do I practice mindfulness effectively? 
  • Non-judgmentally: Don’t label anything either good or bad. Just notice.
  • One-mindfully: Focus on one thing at a time. 
  • Effectively: Do what works, not what feels good in the moment. 

Unlike other therapies that use mindfulness to gain insight or detach from thoughts, DBT uses mindfulness to build emotional awareness and acceptance of your emotions. 

Distress Tolerance

Distress tolerance is your ability to handle emotional pain without making things worse. These skills help you manage stressful situations without acting impulsively or self-destructively. 

A common tool this module uses is the TIP skill, which uses body-based techniques to change your physical response to overwhelming emotions:

T – Change your body’s Temperature (e.g., splash cold water on your face)

I – Engage in Intense exercise to release energy

P – Practice Paced breathing to slow your heart rate

P – Try Paired muscle relaxation to release tension

These techniques work by quickly calming your nervous system so you can think clearly and respond more rationally. 

Emotional Regulation

Emotional regulation involves learning how to understand, manage, and respond to your emotions without letting them control you. This module teaches you how to: 

• Identify what you’re feeling and where it comes from
• Check the facts on whether your emotions are based on assumptions or reality
• Problem-solve rather than react impulsively
• Reduce emotional vulnerability by taking care of your body and mind
• Use opposite action by doing the opposite of what your emotion urges you to do when that urge isn’t helpful 

Interpersonal Effectiveness 

Interpersonal effectiveness skills teach you how to better approach relationships by helping you speak up, set boundaries, and build healthier connections. DBT breaks this down into three skill sets: 

DEAR MAN – Ask for what you need or say no

• Describe the situation
• Express your feelings
• Assert what you want
• Reinforce the outcome

• Stay Mindful of your goal
• Appear confident
• Negotiate if needed

GIVE – Strengthen relationships with kindness and validation

• Be Gentle
• Show Interest
• Validate the other person
• Use an Easy manner

FAST – Maintain your self-respect in conversations

• Be Fair
• Don’t over-Apologize 
• Stick to your values
• Be Truthful

These skills can be beneficial for people who either avoid confrontation or express themselves in ways that push others away. DBT teaches that effective communication requires you to regulate your emotions.

Does DBT Work? 

DBT does work, and the evidence speaks for itself: 

• Studies show that short-term and standard DBT reduce suicidal thoughts and behaviors in people with BPD. Benefits last up to two years after treatment ends. 
• Radically Open DBT is for those who are emotionally restrained, perfectionistic, or socially withdrawn. One study found that this type of DBT led to significant reductions in depressive symptoms and improvements in relationships. 
• Across different diagnoses (e.g., BPD, anxiety, and depression), DBT has been shown to reduce chronic anger, regardless of age or treatment length. 
• In qualitative studies, participants described DBT as life-changing. Years after completing treatment, many reported stronger and more meaningful relationships. 

How Long Does DBT Take to Work? 

DBT isn’t going to be a quick fix. It’ll take time and patience before you notice a difference. However, research shows that patients may be able to feel benefits in as little as six months. 

In one study comparing six months of DBT to a full year of treatment, both groups showed improvement in self-harm behaviors, mental health symptoms, and coping skills. Surprisingly, the six-month group actually improved faster than the twelve-month group, possibly due to the shorter timeframe creating a sense of urgency and motivation for the client and the therapist. 

That said, everyone’s experience with DBT is different. It may take longer for you to see any changes, but it could also take only a few months. The more effort you put into your treatment, the more you’re likely to get out of it.

Get Expert DBT Treatment at Mission Harbor Behavioral Health

If you feel like your emotions have more control over you than you do over them, DBT may be able to help. It can help calm down your nervous system and help you find ways to act rationally rather than impulsively based solely on your emotions in the moment. 

To learn more or to begin treatment, contact the compassionate mental health professionals at Mission Harbor Behavioral Health. We’re here to answer your questions and find a treatment plan that works best for you.