Dialectical behavioural therapy

Written by Katherine Nicholls
Katherine Nicholls
Counselling Directory Content Team

Last updated 5th August 2022 | Next update due 4th August 2025

Dialectical behavioural therapy (DBT) is a type of talking therapy designed to help you manage difficult emotions. It aims to help you learn how to accept and regulate these emotions so that you're able to change any behaviour that may be harmful or unhealthy.

What is DBT?

Based on CBT, dialectical behavioural therapy looks to help those who experience emotions very intensely. The approach was developed in the late 80s by psychologist Marsha M. Lineham. Originally created to help people with borderline personality disorder, DBT is now used to help a number of mental health challenges.

In this video, dialectical behaviour therapist Jason Ward explains what DBT is, including what to expect from the approach and how to find a therapist. 

First, let’s look at what ‘dialectics’ means. This essentially means balancing opposing positions and seeing how they can go together. For example, in DBT you will be working towards finding a balance between acceptance (accepting your emotions and who you are) and change (making positive changes to your behaviour and life).

To help create this balance, acceptance and change techniques are used.

Acceptance techniques

These techniques look at helping you understand yourself and why you might do the things that you do (for example, drinking too much or self-harm). Rather than blaming yourself and telling yourself that you’re wrong, or a bad person for the way you behave, a DBT therapist will help you understand why you’ve turned to these behaviours.

For some, the behaviours are the only way they’ve been able to deal with intense emotions. This technique helps you understand that to your mind, these behaviours make sense.

Change techniques

Once you have a greater understanding of why you behave in certain ways, you can look to make positive change. The techniques used here help to replace unwanted behaviours with more positive behaviours. For example, you can start to challenge negative thought patterns and learn how to develop a more balanced approach.

Is DBT therapy for me?

As Dr Gregory Warwick explains in his article, What is dialectical behaviour therapy?

"DBT is primarily used for people who have a diagnosis or symptoms of BPD or emotionally unstable personality disorder. However, recent studies have shown it to be effective with depression, bulimia, binge-eating, bipolar disorder, PTSD, and substance abuse, but the body of evidence remains limited."

If you feel the approach may be the one for you, the best thing to do is ask the therapist. They can explain more about the approach and how they use it within their practice, and together you can agree on the next steps forward.

Characteristics of DBT

DBT is support-orientated and so, it works to help people identify their strengths. It is cognitive-based, which means it helps to identify thoughts and beliefs that could be making things harder. Finally, DBT is collaborative. It's a joint effort between client and therapist.

There are usually two main components in DBT, individual sessions and weekly group sessions. In the individual sessions, the focus is typically on problem-solving any issues that have come up in the last week. In the group sessions, you’ll work with a therapist and others to work on skills from the four modules of DBT.

The four modules of DBT


This is an essential part of all skills learnt in group sessions. Mindfulness helps you to observe your thoughts, and be present and grounded in the moment.

Interpersonal effectiveness

These skills will help you learn how to cope with personal conflict, how to say no and how to ask for what you need. On the surface, these may sound like simple skills, but they are ones many of us struggle with.

Distress tolerance

Rather than seeking to change a distressing event, DBT helps you understand, accept and tolerate distress better. The aim is to be able to manage pain and builds on your mindfulness work. Crisis survival strategies you may learn include self-soothing, distraction, weighing up pros and cons and ‘improving the moment’.

Emotion regulation

For people who experience emotions intensely, this is essential. Skills you may learn include; identifying and labelling your emotions, increasing positive emotional events and taking opposite action. You’ll also look at what’s stopping you from changing your emotions.

What to expect from DBT

There are four stages of treatment in dialectical behavioural therapy. There’s no set timeline for each stage and these will be led by you, depending on your goals.

Stage 1

In the first stage, you may feel as if you are ‘out of control’. You may be engaging in harmful behaviours like drug use and problem drinking, self-harm, or other self-destructive behaviours. The aim of this stage is to help you move from feeling out of control to understanding what's going on and knowing how to control your behaviour.

Stage 2

While you may now have greater control over your behaviour, you may still be suffering internally. This could be down to past trauma. The aim of this stage is to identify what that trauma may be and how to overcome it.

Stage 3

Here the challenge is to define what your goals in life are. You’ll work to build self-respect and how to experience and process emotions in a manageable way.

Stage 4

For some, a final stage may be required. If appropriate, stage 4 looks towards spiritual development; helping people to feel more fulfilled and connected to a ‘greater whole’.

Finding a DBT therapist

On Counselling Directory, we have over 700 DBT therapists based across the UK who are ready to help you. If you're interested in DBT or think this approach is right for you, you can start your journey via our search tool and browsing our therapists' profiles.

When you find someone you resonate with, simply send them an email via our contact form explaining the help you're looking for.

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