What Is Dialectical Behavior Therapy?

Dialectical Behavior Therapy (DBT) was developed in the late 1980s by psychologist Marsha Linehan to treat individuals with chronic suicidal thoughts and self‑harm behaviors. It is a structured, evidence‑based therapy that combines cognitive‑behavioral techniques with mindfulness practices drawn from Zen Buddhism. The core dialectic—finding a balance between acceptance and change—helps clients validate their experiences while actively working to alter maladaptive patterns. DBT has since been adapted for a wide range of mental health conditions, including borderline personality disorder, eating disorders, substance use disorders, and mood disorders.

DBT skills training is a key component of the full treatment model. Unlike standard talk therapy, DBT emphasizes concrete, teachable skills that clients practice between sessions. Research consistently shows that DBT reduces hospitalizations, self‑harm, and emotional crises. For many people, learning these skills transforms their relationship with intense emotions and interpersonal conflicts.

Who Can Benefit from DBT Skills Training?

While DBT was originally designed for borderline personality disorder, its utility has expanded dramatically. People who experience high emotional sensitivity, frequent mood swings, impulsive behavior, or chronic relationship difficulties often find DBT helpful. Common conditions treated with DBT include:

  • Borderline Personality Disorder (BPD): DBT is the gold‑standard treatment for BPD, reducing self‑harm, suicide attempts, and hospitalizations.
  • Eating Disorders: Binge eating disorder and bulimia nervosa respond well to DBT’s distress tolerance and emotion regulation skills.
  • Substance Use Disorders: DBT helps individuals manage cravings and high‑risk situations without turning to substances.
  • Mood Disorders: Depression, bipolar disorder, and anxiety often involve emotional dysregulation that DBT directly addresses.
  • Trauma‑Related Disorders: For individuals with PTSD or complex trauma, DBT skills can stabilize emotions before deeper trauma processing begins.

Even people without a formal diagnosis can benefit from DBT. The skills are practical for anyone who wants to handle stress better, communicate more effectively, or build a calmer inner life.

How DBT Skills Training Works

Full DBT includes four modes: individual therapy, group skills training, phone coaching, and therapist consultation team. Skills training specifically happens in a group setting, though many therapists integrate skills into individual sessions. The curriculum is divided into four modules:

Mindfulness

The foundation of all DBT skills. Mindfulness teaches you to live in the present moment, observe thoughts and feelings without judgment, and reduce reactivity. Core practices include “wise mind”—a balanced state between emotion mind and reasonable mind—and “what” skills (observe, describe, participate) plus “how” skills (nonjudgmentally, one‑mindfully, effectively).

Distress Tolerance

Life inevitably brings painful moments. Distress tolerance skills help you survive crises without making things worse. Techniques include self‑soothing with senses, distraction (ACCEPTS), improving the moment (IMPROVE), and accepting reality (radical acceptance). These skills are not about fixing problems but about getting through acute distress intact.

Emotion Regulation

This module builds your ability to understand, experience, and change emotional responses. You learn to identify triggers, reduce vulnerability with the “PLEASE” acronym (treat Physical illness, balance Eating, avoid mood‑altering drugs, balance Sleep, get Exercise), and increase positive emotions. Opposite action—acting opposite to the urge that an emotion drives—is a powerful tool for shifting emotional states.

Interpersonal Effectiveness

These skills help you ask for what you need, say no, and maintain relationships while preserving self‑respect. The DEAR MAN acronym guides clear communication: Describe, Express, Assert, Reinforce, stay Mindful, Appear confident, Negotiate. Additional skills include GIVE (Gentle, Interested, Validate, Easy manner) and FAST (Fair, no Apologies, Stick to values, Truthful).

Types of DBT Skills Training Programs

Not all DBT programs look the same. Understanding the variations helps you choose the right fit.

Comprehensive DBT Programs

These include all four modes: weekly individual therapy, weekly group skills training, as‑needed phone coaching, and therapist consultation. Programs typically last six months to a year. They are offered by specialized clinics, community mental health centers, and some private practices. Comprehensive DBT is the most evidence‑based format.

Standalone Skills Training Groups

Many agencies offer DBT skills groups without individual therapy or phone coaching. These groups cover the same curriculum but may be less intensive. They work well for people who need coping skills but do not meet criteria for full DBT or who already have a therapist. However, for severe symptoms, a comprehensive model is recommended.

Online DBT Programs

Telehealth has made DBT more accessible. Many therapists offer individual and group DBT sessions via video. Specialized platforms like BetterHelp have DBT‑trained clinicians, though you must specifically request DBT. Other options include dedicated DBT apps and websites that provide structured lessons and worksheets. Online programs can be self‑paced or cohort‑based.

Intensive Outpatient and Partial Hospitalization Programs

For severe cases, IOP or PHP programs use DBT as a core treatment. These programs offer multiple hours of therapy per day, combining group skills training with individual therapy and medication management. They serve as a step down from inpatient care.

Workshops and Retreats

Weekend workshops and retreats focus on specific DBT modules. These are useful for a concentrated learning experience, though they do not replace ongoing therapy. Organizations such as the Behavioral Tech Institute offer trainings for both clients and clinicians.

Where to Find DBT Skills Training

Finding a Qualified DBT Therapist

The best starting point is a therapist who has received intensive training in DBT and participates in a consultation team. Look for these credentials:

  • DBT‑Linehan Board of Certification (DBT‑LBC): A list of certified clinicians who meet rigorous training and supervision standards. Search their directory at dbt‑lbc.org.
  • Behavioral Tech Institute: Offers a therapist locator for clinicians who have completed their intensive training.
  • Psychology Today Therapist Directory: Filter by “Dialectical Behavior Therapy” under treatment approach. Many listings include whether the therapist offers DBT groups.
  • Your Insurance Provider: Call the member services number or use the online portal to find in‑network therapists who specialize in DBT. Note that not all therapists listed as “DBT” are fully trained—ask about their specific training.

When you contact a potential therapist, ask about their DBT training, whether they attend a consultation team, and what components they offer (individual, group, coaching). A qualified DBT therapist will answer clearly and honestly.

DBT Clinics and Programs

Many cities have DBT‑specific clinics. University medical centers often have DBT outpatient programs. Examples include:

  • UCLA DBT Clinic – Los Angeles, CA
  • Yale DBT Clinic – New Haven, CT
  • The Linehan Institute – Seattle, WA (Marsha Linehan’s original research clinic)

For a broader list, consult the NAMI website or state mental health department directories. National organizations like NAMI often have local chapters that can recommend programs.

Online Resources and Apps

If in‑person options are scarce or you prefer a starting point, try these:

  • DBT Skills App – Teaches mindfulness, distress tolerance, emotion regulation, and interpersonal skills through interactive exercises and diary cards. Available on iOS and Android.
  • DBT Self Help (website and app) – Offers free worksheets, videos, and tracking tools. Developed by a DBT‑trained therapist.
  • TherapyAid – An online directory that allows filtering by remote DBT therapists.
  • Reddit communities like r/dbtselfhelp offer peer support and shared resources. While not therapy, these can reduce isolation and provide practical tips.

Choosing the Right DBT Program for You

Selecting the right fit involves evaluating several factors. This section helps you weigh your options.

Level of Support Needed

If you have active self‑harm, suicidal ideation, or frequent crises, a comprehensive DBT program with phone coaching is crucial. For milder emotional struggles, a skills group alone may suffice. Be honest with yourself about the severity of your symptoms.

Therapist Qualifications

Not every therapist who says “DBT” actually delivers it with fidelity. Look for clinicians who:

  • Completed an intensive DBT training (e.g., Behavioral Tech’s Foundational Training).
  • Participate in a weekly DBT consultation team.
  • Use a structured curriculum and homework (e.g., diary cards).
  • Offer phone coaching if needed.

Cost and Insurance

DBT can be expensive, especially comprehensive programs. Check your insurance for out‑of‑network benefits. Many community mental health centers offer sliding‑scale fees. Some DBT training groups cost less than individual therapy—ask about group rates. If you’re uninsured, look for low‑cost clinics or university training clinics (e.g., doctoral programs in psychology).

Format: In‑Person vs. Online

In‑person DBT allows for a more contained therapeutic environment and easier phone coaching availability. Online DBT offers flexibility and access for rural or mobility‑limited individuals. Research indicates that online DBT is effective for many people. The choice depends on your comfort with technology, privacy considerations, and local availability.

Self‑Help and Supplementary Resources

Even if you are in therapy, self‑study can accelerate progress. Here are high‑quality resources:

Books

  • DBT Skills Training Manual (Second Edition) by Marsha M. Linehan – The definitive manual for therapists and a deep resource for clients.
  • The DBT Skills Workbook by Matthew McKay, Jeffrey C. Wood, and Jeffrey Brantley – Practical exercises for each module.
  • DBT Made Simple by Sheri Van Dijk – A clear overview for clients and practitioners.

Online Communities

Peer support can complement professional treatment. Look for:

  • DBT Reddit community – Active discussions, progress sharing, and skill practice.
  • Facebook groups (e.g., “DBT Skills Support Group”) – Moderate‑to‑large groups with daily posts.
  • Discord servers dedicated to DBT – Real‑time chat and accountability.

Warning: Peer support should never replace therapy. Use these for practice and validation, not crisis intervention.

Workshops and Webinars

Organizations like Behavioral Tech and the American Psychological Association offer occasional webinars on DBT skills. Many are free or low‑cost.

Preparing for DBT Skills Training

Starting DBT requires commitment. Here are practical steps to get ready:

  • Set realistic expectations. Skills take months to internalize. Relapses are normal; DBT calls them “behavioral reinforcers.”
  • Commit to homework. Weekly diary cards and skill practice are essential. Most programs require at least 30 minutes of practice per day.
  • Arrange support. Inform close friends or family about the time commitment. Some programs ask for a signed commitment contract.
  • Gather materials. You may need a binder, worksheets, and a notebook. Many programs provide a workbook.
  • Communicate with other providers. If you have a psychiatrist or primary care doctor, let them know you’re starting DBT. Coordination improves care.

Overcoming Barriers to Access

Many people face obstacles to DBT: cost, location, waitlists, or lack of awareness. Below are strategies for common barriers.

Financial Barriers

  • Check for sliding‑scale or pro‑bono clinics in your area.
  • Look into community mental health centers that receive state funding.
  • Consider training clinics at universities—services are often low‑cost.
  • Ask about payment plans or reduced group rates.

Geographic Barriers

  • Use telehealth. Many states allow therapists to practice across state lines, and national platforms like BetterHelp connect you with DBT‑trained clinicians.
  • Join an online DBT skills class (cohort‑based, live).
  • Travel to a nearby city for a weekend workshop to get started, then continue online.

Waitlists

  • Ask to be placed on a cancellation list.
  • During the wait, start self‑study with a workbook and free online resources. You can build foundational mindfulness and distress tolerance skills.
  • Consider a less intensive option like a weekly group while waiting for a comprehensive program.

Signs of a Good DBT Skills Training Program

Not all programs that claim to be DBT are high‑quality. Look for these indicators:

  • Structured curriculum covering all four modules sequentially.
  • Use of diary cards or daily tracking.
  • Homework assignments and in‑session role‑plays.
  • Active teaching—not just discussion.
  • Clear policies on crisis contact and phone coaching availability.
  • Therapists who model mindfulness and validate struggles.
  • Consistency with the Linehan model. Many effective programs adapt DBT, but fidelity matters for severe cases.

Starting Your DBT Journey

The decision to seek DBT skills training is a courageous step toward managing emotional challenges and building a life worth living. Whether you choose a comprehensive program, an online group, or a self‑paced workbook, the key is consistent practice and self‑compassion. DBT teaches that failure is data—a chance to try a different skill. Over time, the skills become automatic, and you develop greater resilience and peace. Begin by using the resources in this article: search directories, read a book, or join a community. Every small step builds momentum.