What is DBT?

Dialectical Behavior Therapy or DBT was originally developed by Marsha Linehan to work with clients who are dysregulated and engage in maladaptive coping, but is now used in a variety of treatment settings.


DBT has become one of the main modalities for a lot of therapists, and most treatment centers working with clients with eating disorders. It can be used with a variety of issues – I personally think we should teach it in school because I think everyone should learn these skills!

It focuses on four different sets of skills – distress tolerance, mindfulness, emotion regulation, and interpersonal effectiveness. 

There are a lot of great things about DBT, but one of my favorites is that it encourages genuineness in your therapist – before that, therapists were mostly supposed to be impartial and not express too much of their own opinions but let the clients come to their own conclusions. 

There is a need for that, but I see my role as someone to bounce things off of and know you will get an authentic and honest response from someone who is outside of the situation – even if I am not really objective (since I am always on your side, even when I am playing devil’s advocate!).


There are many different approaches that we use as therapists, and most of us use more than one to make sure that our clients get the treatment that is the best fit for them. You may have heard some of the many acronyms – CBT, DBT, ACT, MI, MBSR, TF-CBT, RO-DBT, EMDR, ERP, SFBT, IPT – to name a few. For many years CBT (Cognitive Behavioral Therapy) has been the modality of choice and the basis for most therapists’ education. 

When Marcia Linehan published a book on DBT (Dialectical Behavior Therapy) in 1993, it was part of the first wave of different therapies based on “evidence based practice” that has become the gold standard for treatment of mental health disorders since. DBT incorporates cognitive behavioral therapy with elements of mindfulness and acceptance from Zen Buddhist practice.

The goal of DBT is to help the most difficult clients and situations feel better and to learn skills that manage reactivity more effectively.  Originally developed for borderline personality disorder or highly suicidal clients, it has found to be effective amongst a much wider variety of populations and concerns.

Learning DBT

The different skills of DBT are Distress Tolerance, Mindfulness, Emotion Regulation, and Interpersonal Effectiveness. Each of these builds on and overlaps with the other skills sets. 

  • Distress Tolerance helps you develop skills that let you make decisions about what you want to do instead of reacting to situations.
  • Mindfulness helps you be aware of what is going on with yourself and the world in a way that is non-judgmental.
  • Emotion Regulation helps you identify and manage your emotions effectively.
  • Interpersonal Effectiveness helps you be assertive and set boundaries with others so that you can negotiate and get your needs met in all of your relationships. 

Using DBT does not mean that you have borderline personality disorder. The therapy has expanded over the years to treat eating disorders, depression, and any kind of negative reactivity. There is even a subset of DBT called Radically Open DBT that was developed specifically for people with issues of ‘overcontrol’ like anorexia, chronic depression or anxiety. 

I choose DBT as my primary modality because it emphasizes the importance of genuineness, openness, and honesty in the client/therapist relationship and those values are incredibly important to me in both my professional and personal life. Sometimes, this makes for a more confrontational or directive relationship, but I find that most clients appreciate a direct approach. DBT pushes you to challenge yourself and your beliefs about the world so you do not get stuck in a rut. 

Want to know more?

For a little more DBT info, stay tuned for the She Hulk Blog!

38 second video What is Dialectical Behavior Therapy or DBT?