Dialectical Behaviour Therapy (DBT)
Some emotions don’t arrive gently. They hit like a wave, and before you’ve had a chance to think, you’ve said it, sent it or done it. Then comes the shame, and sometimes the whole cycle starts again.
DBT is a structured, skills-based therapy for people whose emotions feel bigger and faster than they can handle. It teaches practical ways to get through intense moments, stay safe and build a life that feels worth living.
What is it?
01If you’ve ever been told you’re “too much”, “too sensitive” or that you “overreact”, you’re not alone. For some people, emotions really do run hotter, rise faster and take longer to settle. That isn’t a flaw in your character. It’s something you can learn to work with.
Dialectical Behaviour Therapy, or DBT, was developed by American psychologist Marsha Linehan for people living with intense emotions, self-harm and suicidal thoughts. Years later, Linehan shared that she had been hospitalised as a teenager herself. Part of what drove her work was a promise to help others out of the same pain.
“Dialectical” means holding two things that seem opposite at the same time. In DBT, the central balance is between acceptance and change: “I’m doing the best I can, and I can learn new ways to cope.” Both are true. Neither cancels the other out.
DBT is best known as a treatment for borderline personality disorder (BPD). You don’t need that diagnosis, or any diagnosis, for its skills to be useful.
A full DBT program usually combines individual therapy, a weekly skills group, coaching between sessions, and a consultation team that supports the therapists. Some services offer the skills group on its own.
What may it help with?
02People often look into DBT when emotions feel overwhelming and the ways they’ve found to cope are starting to cost them.
Why do I go from fine to furious in seconds? Why do I do things in the moment that I regret later? Why do my relationships feel so intense, and so fragile? Why does it take me so long to come back down?
DBT is commonly explored for emotional dysregulation, overwhelm, eating patterns and complex trauma.
Most of the research has focused on borderline personality disorder, self-harm and suicidal behaviour. Adapted versions are also being studied for other experiences, including PTSD, eating disorders and for young people.
The urges and behaviours DBT works with often began as ways to survive feelings that seemed unbearable. They made sense. DBT doesn’t ask you to drop them overnight. It helps you build other options, so you have more choice.
How does it work?
03DBT teaches practical skills in four areas:
- Mindfulness. Noticing what’s happening inside and around you, without judgement. This is the foundation for everything else.
- Distress tolerance. Getting through a crisis moment without making it worse. Think of it as a toolkit for the times when you can’t fix the problem right now, but you can get through the next ten minutes.
- Emotion regulation. Understanding your emotions, what sets them off and how to become less vulnerable to being swept away by them.
- Interpersonal effectiveness. Asking for what you need, saying no, and keeping your self-respect in relationships.
Some of the skills are surprisingly physical. One well-known distress tolerance skill uses cold water on your face to help your body settle quickly when emotions spike. Others are about pausing long enough to choose your next step.
DBT puts safety first. If self-harm or suicidal behaviour is part of the picture, that’s worked on before anything else. Many programs use a diary card to track emotions, urges and the skills you’ve tried each day. It isn’t homework to be graded. It’s a way of seeing patterns you might otherwise miss.
Underneath all of it is that balance: you’re accepted as you are, and supported to change. For people who have spent years being told they’re too much, being met with that kind of understanding can mean a great deal.
“I was in hell. And I made a vow: when I get out, I’m going to come back and get others out of here.”
Marsha Linehan, The New York Times, 2011
What does the evidence say?
04DBT is an established therapy, and one of the most researched treatments for borderline personality disorder and self-harm.
A 2020 Cochrane review, one of the most rigorous kinds of review, looked at psychological therapies for borderline personality disorder. Therapies designed for BPD, most often DBT, reduced its severity by a clinically meaningful amount compared with usual care. DBT showed benefits for BPD severity, self-harm and day-to-day functioning [1].
A 2019 review found DBT reduced self-harm and suicidal behaviour, and reduced the use of crisis services. It didn’t significantly reduce suicidal thoughts. That difference matters: DBT can help people stay safer while painful thoughts take longer to ease [2].
Australia’s most recent treatment guidelines for personality disorders, published in 2026 by the University of Wollongong’s Project Air Strategy, describe psychotherapy as the treatment of choice, with strong evidence that structured therapies are the first line of treatment. DBT is one of the two structured therapies with the most research behind it [3].
Much of the DBT research has involved women, so less is known about how well it works for men and gender-diverse people.
For many people, the skills become something they draw on for the rest of their lives.
What does a session look like?
05A full DBT program usually includes:
- a weekly one-on-one session to work on your goals and whatever has happened that week
- a weekly skills group, which runs more like a class than a support group
- coaching between sessions, often by phone, so you can get help using a skill in a difficult moment
- practice tasks and a diary card
Skills groups focus on learning skills rather than sharing personal stories in detail.
Frequency, time and cost
Full programs usually run for many months, often around a year. That’s a real commitment. Some public mental health services offer DBT, and waiting lists can be long. Ask about expectations, missed sessions and costs before you start. A treatment plan needs to be workable in your actual life.
Finding the right person
DBT training matters. So does how you feel in the room. You’ll be working on some of the most painful parts of your life, so trust is important. You’re allowed to look elsewhere if the fit isn’t right.
Something to try
Next time an emotion surges, try naming it: “This is anger.” “This is shame.” Then rate it out of ten. Naming a feeling won’t make it disappear, but it can give you a moment of space between the wave and what you do next.
Risks and considerations
06“DBT-informed” isn’t the same as a full program. Many practitioners use DBT skills, and they can be genuinely helpful. The strongest research is for comprehensive programs, so ask exactly what’s included.
Groups can feel confronting at first. It’s normal to feel nervous walking in. The class-like format is designed to keep the focus on learning, not on telling your story.
Have a safety plan. In the research, DBT reduced self-harm and suicidal behaviour more clearly than it reduced suicidal thoughts. Work out with your practitioner what you’ll do and who you’ll contact if thoughts become intense. Our Need help now button is on every page.
Questions to ask a practitioner
07- Is this a comprehensive DBT program, or DBT skills only?
- What DBT training does the team have, and is there a therapist consultation team?
- Is coaching between sessions included, and when is it available?
- How do you support people in a crisis, and will we make a safety plan together?
You’ve read about it. Now what can you actually do?
You don’t need to have the perfect plan. Choose the next step that feels most useful for where you are right now.
Always speak with a qualified health professional before starting something new. If you are struggling right now, find immediate support.
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This is educational information. It is not a recommendation that this approach is right for you. Always speak with a qualified health professional.
