Dialectical Behavioral Therapy (DBT)

What is Dialectical Behavioral Therapy?

DBT is a form of cognitive behavioral therapy (CBT) developed by Dr. Marsha M. Linehan to help people struggling with intense emotions, impulsive behavior and unstable relationships. It was originally used to treat borderline personality disorder, but has since been adapted to address numerous mental health conditions.

DBT enhances the ability to work through difficult situations by combining the principles of CBT with mindfulness techniques and dialectical philosophy, which emphasizes the interconnectedness and paradoxical nature of opposing ideas. DBT embraces the fact that two seemingly contradictory concepts can be equally true without canceling each other out, helping individuals strike a balance between learning how to accept themselves as they are and acknowledging the need for change.

It helps shift one’s mindset from choosing between acceptance or change, to recognizing that both acceptance and change are necessary for growth.

How Does Dialectical Behavior Therapy Work?

One of the core theories of DBT is that some people are more prone to react intensely in emotional situations and take longer than others to calm down. They tend to have extreme mood swings and see the world in black and white. They find it hard to cope with such intense emotional surges, which can cause problems in their daily lives and relationships.

DBT provides a way to deal with these issues in a strategic way. During treatment, clients are taught how to cope with negative emotions, thoughts and behaviors to improve things like mindfulness, emotional regulation, interpersonal relationships and distress tolerance. Together, these skill areas are the four main pillars of DBT.

Four Pillars of Dialectical Behavior Therapy

Acceptance

Acceptance is the acknowledgment of reality as it is, rather than trying to fight or deny painful events and emotions. This doesn’t mean approving or endorsing what happened, but by accepting things as they are, clients can begin to develop effective solutions for moving forward and making change possible.

Mindfulness: Mindfulness is the cornerstone of DBT and emphasizes being present in the moment. This helps clients learn to understand, accept and observe their emotions without judgment and focus on the here and now in a calm, collected way. Mindfulness helps individuals develop a more balanced sense of self, which can help with intense emotions and reactivity.
Distress tolerance: Distress tolerance focuses on tolerating and minimizing the distress felt when faced with negative emotions. It teaches clients how to accept the current situation and cope with negative situations using healthier behaviors.

Change

Once a client has become familiar with the idea of acceptance, they will pair it with change. DBT teaches people that they are OK as they are, but helps them build the skills needed to shift their thinking, emotions and behavior in a more positive direction.

Emotional regulation: Emotional regulation teaches clients how to navigate difficult or powerful emotions more effectively. By learning how to cope with intense feelings, clients become less vulnerable to negative moods and have more positive experiences.
Interpersonal effectiveness: Interpersonal effectiveness helps clients understand their relationships with others and handle conflict appropriately. It teaches them how to get what they want from others while sticking to their values, maintaining relationships and fostering the independence they need to move forward in the world.

What Should Dialectical Behavioral Therapy Accomplish?

DBT should be effective in helping clients to maintain control of their overwhelming emotions and learn to manage them more effectively. It also helps them to learn to handle distress in healthier ways. DBT emphasizes learning to tolerate emotional pain and better cope with negative situations. These skills help our clients to live happier and healthier lives.

Many different types of people are taught DBT skills: from those who are stressed out with work, to those struggling with parenthood, to adolescents who harm themselves in dealing with their stress. All walks of life are able to benefit from these skills. Dialectical behavioral therapy skills are positive life skills from which anyone can benefit.

What to Expect During DBT at Avalon Malibu

At Avalon Malibu, our therapists reinforce positive, adaptive behaviors as they occur. The emphasis is on teaching clients to manage emotional trauma rather than taking them out of the present crisis. Together, therapists and clients work to improve basic social skills by learning distress tolerance, reality acceptance, emotional regulation, and mindfulness.

Using DBT, we also focus on reducing destructive behaviors by teaching our clients clear and healthy ways to adapt and cope with their challenges and feelings of frustration or lack of power. Another focus is mindfulness — research has shown that problem-solving occurs when attention is fully focused on the present moment. There are two areas affected by stress: short-term memory and the ability to process information quickly.

Mindfulness in DBT includes meditation practices, where the client observes the experience of the present moment without judgment or impulsive action. These observations have been shown to reduce stress and increase concentration when practiced consistently. As a result, clients learn to recognize emotions in themselves and others, tolerate difficult emotions, and engage others more effectively for healthier relationships.

Dialectical Behavioral Therapy Group Work

Sometimes people have suffered painful childhood experiences that they cannot cope with. They find it hard to sleep without nightmares, or they feel angry or sad much of the time. They may abuse substances to get by. In relationships, they often feel misunderstood, hurt, angry or afraid that others don’t or won’t like them.

Group DBT sessions usually discuss how to apply the information learned during treatment to the client’s personal problems. These sessions teach clients a set of skills that work in coping with a range of difficult situations. The group is set up differently than ordinary group sessions and often resembles a classroom, with handouts, lectures, people taking notes, and discussions. Because of this, DBT is not like traditional group therapy.

A facilitator leads the groups in a focused and safe environment in which to learn and grow. Clients bring what they have learned in group to their individual DBT sessions, where discussion centers around how to personally apply the skills and information.

Who Can Benefit From Dialectical Behavior Therapy?

DBT is particularly well established as a treatment approach for borderline personality disorder and severe emotional dysregulation. The National Institute of Mental Health identifies DBT as one of the psychotherapies used to treat BPD and notes that it teaches mindfulness and skills for managing intense emotions, reducing self-destructive behaviors, and improving relationships.

DBT may also be incorporated into treatment for individuals experiencing other conditions or behavioral difficulties involving emotion regulation, impulsivity, interpersonal conflict, or ineffective coping.

Depending on the individual's clinical needs, DBT-informed treatment may be useful for people experiencing:

Borderline personality disorder
Severe emotional dysregulation
Anxiety
Depression
Trauma-related symptoms
PTSD
Substance use disorders
Impulsive behaviors
Difficulty managing anger
Interpersonal difficulties
Self-destructive behavioral patterns

DBT is not automatically appropriate for everyone. A qualified mental health professional should determine whether DBT or DBT-informed interventions are appropriate as part of an individual's overall treatment plan.

At Avalon Malibu, we’ve seen firsthand the difference that DBT can make in the lives of our clients. By teaching individuals how to apply the principles of DBT to their everyday lives, our experienced clinicians can help you or someone you love learn how to manage difficult emotions or situations and move toward a healthier way of being. If you’re struggling with mental health concerns, substance abuse or trauma, call us today at 888-958-7511 to learn more about our programs and find out if they’re right for you.

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DBT for Anxiety

Anxiety can create a cycle in which uncomfortable thoughts and physical sensations trigger avoidance, reassurance-seeking, impulsive behaviors, or other attempts to escape distress.

DBT can help individuals develop a different relationship with anxious thoughts and sensations. Rather than immediately trying to eliminate anxiety, clients learn to recognize what they are experiencing, tolerate uncomfortable feelings, regulate their emotional response, and choose a behavior that is consistent with their long-term goals.

Mindfulness can help clients recognize anxious thoughts without automatically treating them as facts. Distress-tolerance skills can help during periods of acute anxiety, while emotion-regulation strategies can address factors that increase vulnerability to emotional overwhelm.

DBT may therefore complement other evidence-based anxiety treatments, such as Cognitive Behavioral Therapy (CBT), exposure-based approaches, medication management, and trauma-informed therapy when clinically appropriate.

DBT for Depression

Depression can involve more than persistent sadness. Individuals may experience emotional numbness, hopelessness, withdrawal, low motivation, irritability, interpersonal difficulties, or difficulty managing overwhelming emotions.

DBT can provide practical tools for recognizing emotional patterns and responding to difficult experiences without becoming completely controlled by them. Skills involving mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness can complement other treatments for depression.

For individuals receiving residential treatment, DBT can also help translate therapeutic concepts into daily behaviors by encouraging healthy routines, interpersonal engagement, emotional awareness, and more effective coping strategies.

DBT for Trauma and PTSD

Trauma can affect emotional regulation, relationships, sense of safety, and the ability to respond to stress. Individuals with PTSD may experience intrusive memories, avoidance, hypervigilance, sleep disturbances, emotional distress, or difficulty regulating reactions to reminders of past experiences.

DBT skills can be particularly useful for developing emotional stability and distress-tolerance abilities. These skills may help create a foundation for deeper trauma-focused treatment when clinically appropriate.

DBT does not replace trauma-focused therapies when those treatments are indicated. Instead, DBT skills may complement approaches such as EMDR and other trauma-informed therapies by helping clients develop the emotional-regulation and coping skills needed to engage safely and effectively in treatment.

At Avalon Malibu, treatment for trauma and PTSD is individualized. The clinical team determines which therapeutic approaches are appropriate based on each client's history, symptoms, stability, and treatment goals.

DBT for Substance Use Disorders and Addiction

Substance use can sometimes become a way of managing emotional pain, stress, anxiety, trauma, interpersonal conflict, or other difficult experiences. When substance use becomes a primary coping mechanism, individuals may have difficulty tolerating distress without alcohol or drugs.

DBT can help address some of the behavioral and emotional patterns that contribute to substance use. Distress-tolerance skills can provide alternatives during moments of intense craving or emotional distress. Emotion-regulation skills can help individuals understand and manage difficult feelings, while mindfulness can increase awareness of triggers before they automatically lead to substance use.

DBT can therefore be a valuable component of an integrated addiction treatment program, particularly when substance use occurs alongside emotional dysregulation or other mental health conditions.

At Avalon Malibu, DBT may be incorporated into treatment for alcohol and substance use disorders alongside addiction psychotherapy, psychiatric care, family therapy, relapse-prevention planning, and other evidence-based approaches.

DBT vs. CBT: What Is the Difference?

Dialectical Behavior Therapy and Cognitive Behavioral Therapy are both evidence-based behavioral therapies, and they share several principles. However, they place different emphasis on certain therapeutic goals.

CBT generally focuses on identifying and changing unhelpful thoughts and behaviors. It can be highly effective for conditions such as anxiety and depression and is widely used across mental health treatment.

DBT incorporates cognitive behavioral principles but places particular emphasis on acceptance, mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. It was originally developed for individuals with severe emotional dysregulation and borderline personality disorder.

The two approaches are not necessarily competing treatments. A clinician may incorporate elements of both depending on a client's diagnosis, symptoms, treatment history, and goals.

At Avalon Malibu, treatment is individualized rather than determined by a single therapeutic model. DBT may be used alongside CBT, EMDR, trauma-informed therapy, psychiatric care, family therapy, and other appropriate treatments.

DBT and Psychiatric Medication

DBT is a psychotherapy, not a medication. Medication may nevertheless be part of a comprehensive treatment plan when an individual has a co-occurring psychiatric condition or specific symptoms that may benefit from pharmacological treatment.

For example, a psychiatrist may evaluate whether medication is appropriate for conditions such as depression, anxiety, bipolar disorder, or other psychiatric concerns occurring alongside emotional dysregulation.

For borderline personality disorder specifically, NIMH notes that medication is not a first-line treatment for the disorder itself, although medication may sometimes be used as an adjunct to psychotherapy to address specific symptoms or co-occurring conditions.

At Avalon Malibu, medication decisions are individualized and overseen by qualified psychiatric professionals. Medication management, when indicated, is integrated with psychotherapy rather than viewed as a replacement for therapeutic work.

Family Therapy and DBT

Emotional dysregulation can affect an entire family. Loved ones may struggle to understand sudden changes in mood, intense reactions, impulsive behaviors, interpersonal conflict, or repeated crises.

Family involvement can help everyone develop a clearer understanding of emotional regulation and communication. Family members may learn how to respond more effectively, establish healthy boundaries, communicate clearly, and avoid unintentionally reinforcing unhelpful behavioral patterns.

When clinically appropriate, family therapy at Avalon Malibu can complement DBT by helping clients and their loved ones apply healthier communication and interpersonal skills outside of the therapy environment.

NIMH notes that therapy for caregivers and family members can be helpful when someone is living with borderline personality disorder, including by helping loved ones understand the condition and develop strategies for supporting treatment.

Applying DBT Skills in Everyday Life

The value of DBT comes from applying its skills outside of therapy. Clients can practice DBT principles in situations that occur at home, at work, in relationships, and during periods of stress.

Examples include:

During an argument:
Interpersonal-effectiveness skills can help a person pause, identify what they need, and communicate without escalating the conflict.

During intense anxiety:
Mindfulness and distress-tolerance skills can help someone recognize anxious thoughts and physical sensations without immediately reacting to them.

During a craving:
Distress-tolerance and mindfulness skills can create an opportunity to recognize the craving, tolerate the discomfort, and choose a healthier response.

During overwhelming sadness or anger:
Emotion-regulation skills can help identify the emotion, understand factors contributing to it, and respond intentionally rather than impulsively.

When setting a boundary:
Interpersonal-effectiveness skills can help someone communicate a clear boundary while maintaining self-respect and preserving important relationships.

These skills become more useful with practice. Residential treatment provides an environment where clients can learn, practice, receive feedback, and refine these strategies before returning to their everyday lives.

What Research Says About DBT

DBT has one of the most established research bases among specialized psychotherapies for borderline personality disorder. NIMH identifies DBT as an evidence-based psychotherapy for BPD, while the American Psychological Association describes its theoretical foundation and application across difficult-to-treat conditions.

The Linehan Institute notes that research has also supported DBT applications beyond BPD, including substance use disorders, depression, PTSD, and eating disorders.

An important distinction is that DBT skills training is not necessarily the same thing as comprehensive DBT. Standard comprehensive DBT can involve multiple components, including individual therapy, skills training, between-session coaching, and therapist consultation. Programs may also appropriately incorporate selected DBT skills without claiming to provide the complete comprehensive DBT model.

Avalon Malibu should describe the specific DBT services actually provided rather than implying that every client receives every component of comprehensive DBT. This distinction improves both clinical accuracy and credibility.

DBT in a Private Residential Treatment Environment

Learning emotional-regulation skills can be particularly meaningful when clients have the opportunity to practice them within a structured residential environment.

Avalon Malibu provides an intimate setting where clients can step away from many of the external pressures that may have contributed to emotional dysregulation and focus on treatment. Private accommodations, peaceful gardens, oceanfront surroundings, private beach access, chef-prepared meals, physical fitness, mindfulness, and wellness activities provide a supportive environment alongside clinical care.

The luxury environment is not intended to replace psychotherapy. Instead, comfort, privacy, healthy nutrition, sleep, movement, and access to restorative outdoor spaces can help create conditions in which clients can focus on the difficult work of treatment.

For individuals learning DBT skills, everyday residential experiences can also provide opportunities to practice mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness in real situations.

What to Expect From DBT at Avalon Malibu

DBT at Avalon Malibu is incorporated into individualized treatment based on each client's clinical needs. The exact structure and frequency of DBT interventions may vary according to diagnosis, treatment goals, length of stay, and the overall treatment plan.

Depending on the individual, DBT-informed treatment may include:

Individual psychotherapy
DBT skills training
Mindfulness practice
Emotion-regulation work
Distress-tolerance strategies
Interpersonal-effectiveness skills
Group therapy
Family therapy
Psychiatric evaluation and medication management when appropriate
Relapse-prevention planning
Wellness and experiential activities

Clients are encouraged to practice skills repeatedly so that they become more accessible during difficult situations.

The goal is to develop practical tools that can be used when emotions become intense, relationships become challenging, cravings arise, or unexpected stress occurs.

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Frequently Asked Questions About DBT

What does DBT stand for?

DBT stands for Dialectical Behavior Therapy. It is an evidence-based psychotherapy developed by Dr. Marsha Linehan.

What is DBT used to treat?

DBT was originally developed for borderline personality disorder and severe emotional dysregulation. It is also used in various settings for problems involving emotional regulation, substance use, depression, PTSD, and other mental health concerns.

What are the four DBT skills?

The four primary DBT skills areas are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Is DBT the same as CBT?

No. DBT incorporates cognitive behavioral principles but places greater emphasis on acceptance, mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness.

Can DBT help with anxiety?

DBT skills may help individuals develop greater awareness of anxious thoughts and improve their ability to tolerate and regulate difficult emotions. DBT may be combined with other evidence-based anxiety treatments when clinically appropriate.

Can DBT help with depression?

DBT may be incorporated into treatment for individuals experiencing depression, particularly when emotional dysregulation or ineffective coping strategies are also present.

Can DBT help with PTSD?

DBT skills can support emotional regulation and distress tolerance in people with trauma-related symptoms. Trauma-focused treatments may also be incorporated when clinically appropriate.

Can DBT help with addiction?

DBT can be incorporated into treatment for substance use disorders, particularly when emotional dysregulation, impulsivity, or difficulty tolerating distress contributes to substance use.

Is DBT a medication?

No. DBT is a psychotherapy. Medication may sometimes be used alongside DBT to address co-occurring psychiatric conditions or specific symptoms.

How long does DBT take?

The length of DBT treatment varies significantly. Comprehensive DBT is often structured over an extended period, while residential programs may incorporate selected DBT skills into shorter individualized treatment plans. The Linehan Institute notes that a complete DBT skills curriculum is commonly delivered over approximately 24 weeks in standard skills-training formats.

Is DBT only for borderline personality disorder?

No. Although DBT was developed for BPD and remains strongly associated with its treatment, DBT and DBT skills are now used more broadly for several mental health and behavioral concerns.

Does DBT involve family therapy?

Family involvement may complement DBT when clinically appropriate. Family therapy can help loved ones understand emotional dysregulation, improve communication, establish boundaries, and support recovery.

Is DBT available at Avalon Malibu?

Avalon Malibu incorporates DBT into individualized treatment plans when clinically appropriate. DBT may be combined with other psychotherapies, psychiatric care, family therapy, and wellness programming.

What makes residential DBT different from outpatient DBT?

Residential treatment provides a structured environment where clients can focus on recovery and practice therapeutic skills throughout the day. The appropriate level of care depends on each person's clinical needs.