A Guide to Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) helps individuals manage emotions by teaching mindfulness skills that promote awareness and acceptance of their thoughts, behaviors, and experiences. It is especially beneficial for adolescents and adults struggling with anxiety, depression, eating disorders, PTSD, and other mental health challenges. This guide explores the core principles of DBT and provides practical steps for finding a qualified therapist.

What Is Dialectical Behavior Therapy (DBT)?

Dialectical behavior therapy (DBT) DBT is a structured, evidence-based therapy that helps individuals manage emotions, improve relationships, and develop healthier thought patterns. It is especially effective for those struggling with emotional dysregulation, impulsivity, or difficulty coping with stress. ^[1]

Unlike traditional talk therapy, DBT combines cognitive-behavioral therapy (CBT) with mindfulness techniques, allowing individuals to recognize unhelpful thought patterns, challenge them, and replace them with effective coping strategies.

What Does DBT Offer?

DBT provides concrete skills that individuals can apply in their daily lives. Its structured, skills-based nature makes it easier for many participants to create lasting change. ^[2]

DBT offers four key skill areas:

• Mindfulness: Enhances self-awareness and helps individuals stay present in the moment. By learning to observe thoughts and emotions without judgment, mindfulness reduces emotional reactivity and increases overall clarity.
• Distress Tolerance: Focuses on building resilience in high-stress situations. Individuals develop strategies to manage discomfort without resorting to harmful behaviors like self-harm, substance use, or emotional outbursts.
• Emotional Regulation: Teaches individuals how to recognize, understand, and manage intense emotions. This skill set is particularly valuable for those who experience mood swings or overwhelming emotional reactions.
• Interpersonal Effectiveness: Improves communication and relationship skills by helping individuals set boundaries, express needs assertively, and navigate conflicts in a healthy way.

What to Expect from DBT

Through individual therapy, group skills training, and crisis coaching, DBT helps individuals build emotional resilience and achieve a more balanced, fulfilling life. ^[3]

With consistent practice and support, individuals can:

• Enhance problem-solving skills for a more constructive approach to conflict and adversity.
• Manage distress and regulate emotions in healthier ways.
• Develop stronger communication and relationship skills for more meaningful connections.
• Reduce impulsive or harmful behaviors such as self-harm, substance use, or emotional outbursts.
• Increase mindfulness and self-awareness to respond thoughtfully rather than react impulsively.

How Common is DBT?

Since its development in the late 1980s, DBT has become one of the most widely used and researched therapeutic approaches for treating individuals with emotional dysregulation. Originally designed for individuals with borderline personality disorder (BPD), DBT has since been adapted for a wide range of mental health conditions.

Today, DBT is widely available through private practice therapists, mental health clinics, and inpatient and outpatient treatment centers. Many hospitals, universities, and specialized therapy programs also offer DBT as a core component of their mental health services. Whether working with a licensed DBT therapist, joining a group skills-training course, or using digital resources for additional support, DBT offers a well-established, practical path to emotional well-being. ^[4]

Key Elements of DBT Therapy

While specific details may vary based on the therapist, treatment center, or whether sessions are conducted individually or in a group setting, DBT programs generally include four key components:

• Pre-Assessment – Before beginning DBT, a therapist conducts an evaluation to determine whether this approach is suitable. This step helps set expectations and allows both the therapist and client to clarify treatment goals.
• Individual Therapy – In one-on-one sessions, individuals work with a therapist to identify emotional triggers, develop coping mechanisms, and set goals for improving emotional regulation.
• Skills Training – Many DBT programs incorporate group sessions focused on skill-building. These sessions cover four key areas:
  • Mindfulness: Learning to stay present in the moment and accept emotions without judgment.
  • Distress Tolerance: Building resilience in times of crisis without resorting to harmful behaviors.
  • Emotional Regulation: Understanding and managing intense emotions effectively.
  • Interpersonal Effectiveness: Enhancing communication skills to build healthier relationships.

Conditions DBT Can Help With

Choosing the right therapist is key to making progress with DBT. A qualified provider should not only have expertise in DBT but also an approach that fits your needs and communication style. Before starting your search, take time to identify your specific mental health challenges. DBT is most effective for those struggling with emotional dysregulation, impulsivity, or self-destructive behaviors. ^[5]

DBT is widely used to support individuals facing a variety of mental health challenges, including:

• Depression: DBT helps individuals manage persistent sadness, low energy, and hopelessness by providing structured tools to recognize emotional triggers, shift negative self-talk, and regain a sense of control through small, manageable changes.
• Anxiety: DBT’s mindfulness techniques help individuals reduce excessive worry and tension by staying present and breaking cycles of anxious thoughts. It is especially useful for generalized anxiety, panic attacks, and obsessive-compulsive tendencies.
• Borderline Personality Disorder (BPD): Originally designed for BPD, DBT helps individuals manage extreme emotional sensitivity, unstable relationships, and impulsivity. It provides concrete skills to stabilize emotions, reduce fear of abandonment, and improve self-image.
• Post-Traumatic Stress Disorder (PTSD): DBT teaches coping strategies to manage distressing memories, flashbacks, and emotional numbness caused by trauma. It helps individuals process emotions in a way that prevents damage to relationships and daily life.
• Eating Disorders: DBT helps individuals recognize and process emotions rather than suppressing them or using disordered eating as a coping mechanism. It promotes self-acceptance and healthier emotional responses.
• Substance Use Disorders: DBT supports individuals with co-occurring substance use and mental health conditions by focusing on small, achievable goals rather than immediate, lifelong sobriety, making lasting change more attainable.
• Suicidal Ideation & Self-Harm: DBT directly addresses suicidal thoughts and self-harm by providing alternative coping strategies and practical tools to manage emotional distress, especially in adolescents and young adults.
• Attention-Deficit Hyperactivity Disorder (ADHD): DBT improves focus, impulse control, and frustration tolerance through mindfulness and emotional regulation techniques, helping individuals succeed in academic, professional, and personal settings.

In-Person and Online Therapy

Both in-person and online DBT therapy have advantages, but in-person sessions provide a more immersive experience. Face-to-face interaction allows for clearer communication, deeper engagement, and a structured environment that separates treatment from daily distractions. A therapist can pick up on body language and subtle expressions, offering additional insight that may be harder to convey online. While virtual therapy offers flexibility and accessibility, in-person sessions often enhance focus, accountability, and overall effectiveness for those who can attend regularly. ^[6]

In-Person DBT

• Allows therapists to observe body language and nonverbal cues.
• Provides a structured setting outside the individual’s home, which can help with focus.
• Offers a direct and personal connection with the therapist, which some people find more engaging.

Online DBT

• More accessible for individuals with busy schedules or limited local resources.
• Removes barriers like transportation, making it easier to maintain consistency.
• Equally effective as in-person therapy for most individuals, according to research.

Finding a DBT Therapist

Online directories are a valuable resource for finding a qualified DBT therapist. They provide key details such as credentials, specialties, contact information, and client reviews, making it easier to compare options. The DBT-Linehan Board of Certification Directory is a strong starting point, listing therapists withspecialized DBT training. Other reputable directories include MentalHealth.com Network, Psychology Today, GoodTherapy, and local mental health center databases. These platforms offer search filters to refine options by location, insurance, and treatment focus.

• DBT-Linehan Board of Certification Directory – Lists certified DBT therapists who have completed intensive training.
• MentalHealth.com Network – Offers a comprehensive database of mental health professionals, including DBT specialists, with filters for location, insurance, and expertise.
• Psychology Today – Allows users to search for therapists based on specialties, location, and insurance coverage.
• Good Therapy – Features a directory of licensed therapists specializing in DBT, along with resources on mental health and therapy approaches.

When researching therapists, review their credentials, experience, and patient feedback to ensure they align with your needs. Using multiple directories and contacting therapists directly can help you find the right provider more effectively.

How to Prepare for a DBT Consultation

Before committing to a DBT therapist, scheduling an initial consultation is an important step. This meeting helps you assess whether the therapist’s approach aligns with your needs and gives you insight into what working with them will be like.

What to expect in the consultation:

Most initial consultations last between 15 and 30 minutes and are typically free. They may take place over the phone, via video call, or in person. During this session, the therapist will ask about your mental health history, current challenges, and therapy goals to determine if DBT is a good fit. They may also explain how their sessions are structured, including individual therapy, skills training, and any crisis support they offer.

Key questions to ask:

To get the most out of your consultation, consider asking:

• What is your experience with DBT? Do you specialize in it, or is it part of a broader practice?
• Do you offer full DBT programs, including individual therapy and skills training?
• How do you tailor DBT to individual needs?
• What can I expect in a typical session?
• What insurance do you accept, and what are your payment options?
• What are the out-of-pocket costs if insurance doesn’t cover sessions?
• Do you offer sliding-scale fees or payment plans?

Expectations for DBT Success

DBT requires commitment and consistency to be effective. Expect to attend weekly sessions, practice skills outside of therapy, and actively engage in the process. ^[7] Progress takes time, especially when working through deeply ingrained behaviors, but the skills learned in DBT can lead to lasting improvements in emotional regulation and relationships.

A good therapist will create a supportive environment while also challenging you to make meaningful changes. If the therapist doesn’t feel like the right fit, it’s okay to explore other options. Therapy is a personal journey, and finding the right professional can make all the difference.

• Research Tip: Research therapists using the MentalHealth.com Network for access to over 3,000 qualified in-person and online therapists.

How Long Does DBT Last?

Dialectical Behavior Therapy (DBT) programs typically span 6 to 12 months, with weekly sessions lasting 40 to 60 minutes. The duration can vary based on individual progress and the complexity of mental health challenges. Some individuals may require extended treatment, especially if they are addressing multiple mental health conditions.

The cost of DBT varies depending on factors such as location, therapist qualifications, and insurance coverage. Without insurance, individual therapy sessions can range from $60 to $250 per hour. Group therapy sessions typically cost between $45 and $80 per session. For a standard DBT program involving one individual session and one group session per week, the monthly out-of-pocket expense could range from $420 to $1,320. Over a 6-month period, this amounts to $2,520 to $7,920, and for a 12-month period, $5,040 to $15,840. ^[8] 

Will Insurance Cover the Costs?

Yes, many insurance plans cover Dialectical Behavior Therapy (DBT), as it’s an evidence-based treatment for various mental health conditions. Coverage specifics can vary based on your insurance provider and plan. Factors influencing coverage include the number of sessions allowed, copayments, deductibles, and whether the therapist is in-network.

If you have insurance, check with your provider to confirm what’s included. Ask about in-network DBT therapists, copays, deductibles, session limits, and whether prior approval is needed. If your plan doesn’t fully cover DBT, you may still have options, such as out-of-network reimbursement, sliding-scale fees, or payment plans offered by some therapists. Medicaid and Medicare may also provide coverage, but eligibility and benefits depend on your state and specific plan. Even if insurance doesn’t cover all costs, many individuals find DBT to be a worthwhile investment in long-term mental health and well-being.

Achieving Balance and Resilience

If you’re struggling with anxiety, depression, PTSD, BPD, or other emotional challenges, DBT offers more than just treatment, it provides real, practical tools to help you regain stability and build a healthier, more fulfilling life. Through structured guidance and skill-building, DBT can help you find emotional balance, strengthen relationships, and gain a greater sense of control over their thoughts and actions.

By identifying your needs, exploring in-person and online options, and using trusted directories, you can connect with a provider who understands your struggles and can offer meaningful support. While cost and insurance coverage can vary, many therapists offer flexible payment plans to ensure access to care. No matter where you are now, healing is within reach.

Editor’s Note: Are you or someone you know facing mental health challenges? Visit our mental health network to connect with therapists and find support for improved wellness. For emergencies, visit 988lifeline.org for immediate assistance.