Dialectical behaviour therapy for wellbeing

Dialectical behaviour therapy (DBT) is a highly structured, evidence-based form of psychotherapy designed to help people manage overwhelming emotions and behaviours that feel out of control. Originally developed by Dr. Marsha Linehan in the 1980s to treat Borderline personality disorder (BPD), DBT has since been adapted to support individuals facing a wide range of emotional, relational, and behavioural difficulties.

At its core, DBT offers a powerful framework for understanding emotional suffering and, more importantly, for building the skills to reduce it. Whether you’re struggling with impulsivity, intense mood swings, relationship conflict, self-harming behaviours, or chronic feelings of emptiness, DBT provides practical tools to help you navigate life with more stability, clarity, and confidence.

What is DBT?

Dialectical behaviour therapy is a specialised type of behavioural therapy that balances two key elements: acceptance and change. The word “dialectical” refers to the idea of holding two seemingly opposite ideas at the same time, for example: “I am doing the best I can” and “I want to do better.” DBT helps clients to hold this tension in a compassionate way, without falling into all-or-nothing thinking or self-criticism.

Unlike traditional talking therapy, DBT is skills-based, meaning clients are taught specific techniques to manage distress, regulate emotions, and improve relationships. It is especially helpful for people who feel stuck in self-defeating patterns and need more structure and guidance than insight alone can provide.

A full DBT programme typically includes:

• Individual therapy to focus on motivation, personal goals, and applying skills in daily life
• Group skills training to learn and practise DBT skills in a supportive setting
• Phone coaching for real-time support in moments of crisis (in some formats)
• A therapist consultation team to keep practitioners grounded and effective

However, many therapists (like myself) integrate DBT skills into one-to-one counselling, tailoring the approach to your individual needs and drawing on elements from other therapeutic models when helpful.

What can DBT help with?

Although DBT was initially developed for individuals diagnosed with BPD, research and clinical practice have shown it to be highly effective for a much wider range of difficulties, especially those involving emotional dysregulation. Here are some of the key issues DBT can help with:

Borderline personality disorder (BPD)

DBT is the gold-standard treatment for BPD, a condition characterised by emotional instability, fear of abandonment, impulsive behaviours, identity disturbance, and intense relationship patterns. DBT helps reduce self-harm, suicidal thoughts, and emotional reactivity, while supporting individuals to build a life that feels more stable and fulfilling.

Emotion dysregulation

Many people, whether or not they have a formal diagnosis, struggle with regulating emotions. You may find yourself overwhelmed by sadness, rage, shame, or anxiety; reacting impulsively, or unable to return to baseline after an emotional upset. DBT teaches practical skills to recognise, understand, and manage emotions more effectively to return within your window of tolerance. 

Self-harm and suicidality

For those who turn to self-injury or experience suicidal thoughts as a way of coping, DBT offers non-judgmental support and safer alternatives. It focuses on helping clients survive emotional crises, reduce harm, and develop the capacity to face pain without engaging with destructive behaviours.

Eating disorders

DBT has been adapted for individuals struggling with eating disorders, particularly binge eating and bulimia, where emotional distress plays a central role. Skills in distress tolerance, mindfulness, and emotion regulation can help break cycles of restriction, binging, purging, or emotional eating.

Substance use and addictive behaviours

For people using substances or other compulsive behaviours (like sex, porn, gambling or shopping) to escape emotional pain, DBT can help by building alternative coping strategies and developing a deeper understanding of emotional triggers and behavioural urges.

Complex trauma and PTSD

While not a trauma therapy in itself, DBT is often a foundational step for individuals with complex trauma who need help stabilising before engaging in deeper trauma processing. It builds emotional safety, resilience, and grounding skills to manage flashbacks, dissociation, and reactivity. Most trauma-informed therapies are structured in phases, with the initial stage focused on building emotional resources and stabilisation to support later trauma processing. DBT aligns particularly well with this first phase, offering practical tools to enhance emotional regulation and resilience.

Relationship difficulties

DBT includes a specific module on interpersonal effectiveness that helps clients communicate more clearly, assert their needs, set boundaries, and reduce interpersonal conflict. This can be transformative for people who struggle with conflict, fear of rejection, or people-pleasing tendencies.

Anxiety, depression, and mood instability

Even outside of more complex diagnoses, DBT can be very helpful for managing intense mood swings, persistent anxiety, or low motivation. It combines emotional insight with tools for action, making it especially effective for individuals who feel stuck or overwhelmed by their inner world.

What are the core skills in DBT?

DBT is structured around four key modules:

1. Mindfulness: Cultivating present-moment awareness and the ability to observe thoughts, feelings, and urges without judgment
2. Distress tolerance: Learning how to survive emotional pain in the short term without making the situation worse
3. Emotion regulation: Understanding emotions, reducing emotional vulnerability, and increasing positive emotional experiences
4. Interpersonal effectiveness: Strengthening communication, asserting boundaries, and maintaining self-respect in relationships

DBT provides practical tools that you can use every day, especially during emotionally difficult moments. Many clients report that DBT finally gives them the “what” and “how” to do things differently, which they felt were missing in talk therapy alone. 

Final thoughts

If you feel overwhelmed by your emotions, find yourself stuck in destructive patterns, or struggle to maintain stable relationships, you’re not alone, and there is help.

DBT is a practical, compassionate, and evidence-based approach designed for people just like you. Rather than asking you to suppress or avoid your emotions, DBT helps you work with them. It validates the pain you are experiencing while supporting you in building a more grounded, empowered, and connected life.

Whether you're seeking DBT in its full programme form or as part of an integrative therapeutic approach, this modality offers hope and real tools for change.

This article offers an overview of DBT and the range of difficulties it can help with. As a fully trained DBT practitioner, I draw on my experience of setting up and facilitating DBT skills groups in a residential treatment centre for addictions and eating disorders in South Kensington. I currently provide one-to-one DBT sessions at the Priory and, where appropriate, integrate DBT skills alongside other therapeutic approaches in my private practice, both online and in Fitzrovia, London.