What is Dialectical Behavior Therapy (DBT)?

Overview

Dialectical Behavior Therapy, or DBT, is a branch of Cognitive Behavioral Therapy (CBT) focusing on helping people manage their emotions effectively (Cleveland Clinic, 2025). It began in the 1980s after being developed by American psychologist Marsha Linehan, who viewed standard CBT as insufficient for treating chronic self-harm and suicidal behaviors (Akre, 2025).

DBT is founded on the idea of dialectics, which means combining opposing forces into a balanced whole. This approach is central to DBT, as it guides individuals to recognize and think in terms of dualities rather than strict black-and-white categories. For example, DBT skills focus on both acceptance and change (two opposing forces). Likewise, therapists accept clients as they are while also supporting the need for change to achieve their goals (University of Washington, 2025).

What Conditions can it Treat?
According to the CDC (2025), DBT has proven to be effective for treating and managing a wide range of mental health conditions, including:
Borderline personality disorder (BPD).
Self-harm.
Suicidal behavior.
Post-traumatic stress disorder (PTSD).
Substance use disorder.
Eating disorders, specifically binge eating disorder and bulimia.
Depression.
Anxiety.

Behavior Skills of DBT: How it Really Works
DBT has four central behavior skill modules. This includes: 1) mindfulness, 2) emotional regulation, 3) distress tolerance, and 4) interpersonal effectiveness (University of Washington, 2025).



Figure 1: The Four Central Behavior Skills Modules of DBT (CONCEPT Continuing and Professional Studies, 2025)
Mindfullness
Mindfulness refers to the practice of being fully aware and present in the moment. In DBT, mindfulness can be broken down into three parts: the rational mind, the emotional mind, and the wise mind (Symmetry Counseling, 2018). The rational mind approaches knowledge intellectually, the emotional mind uses only emotions to make decisions, and the wise mind allows us to create a healthy balance between both the rational and emotional mind. Additionally, mindfulness in DBT can also teach us “what” and “how” skills. According to the DBT Center of Orange County (2016), the “what” skill technique teaches us how to “observe without judgment or attachment, describe­­­­­ your internal experience just as it is, and fully participate in the present moment without self-consciousness or hesitation” (para. 3). This can help us embrace the present moment and focus on one thing at a time. Similarly, the “how” skills refer to the mindset you bring into the “what” skills. There are 3 key aspects of the “how” skills, termed as 1) non-judgement, 2) one-mindful, and 3) effective (DBT Tools, 2025). Taking a “non-judgmental” approach means focusing on the consequences of behavior and objectively describing the facts without labeling people or situations as good, bad, right, or wrong. “One-mindful” refers to keeping your mind fully present by letting go of past distractions and future worries, and staying actively engaged in the current moment with full awareness. Being “effective” is about focusing on what helps you reach your goal, rather than stressing about being right (DBT Tools, 2025). As a whole, mindfulness in DBT is useful for helping individuals build greater self-awareness, emotional balance, and intentional focus in their daily lives. By practicing mindfulness consistently, individuals can respond more thoughtfully to challenging situations rather than reacting impulsively.


Emotional Regulation
Emotional regulation is the DBT module explaining how emotions function and teaches skills to manage them effectively (DBT Tools, 2025). Emotions are an important part of the human experience, as they serve as signals that communicate information about our environment and internal states; they help us understand how we are responding to situations and guide our decisions and behaviors. As a DBT skill, emotional regulation helps individuals reduce their vulnerability to negative emotions, avoid being controlled by intense feelings, and cultivate positive emotional experiences. The goals of emotional regulation includes recognizing and naming our emotions, understanding their causes, reducing the frequency of unpleasant emotions, decreasing our vulnerability to intense emotional reactions, and ultimately lessening emotional suffering. By learning to regulate emotions effectively, we can respond to challenges in healthier ways and improve overall well-being (DBT Tools, 2025). Specifically, DBT offers several skills to support emotional regulation. The “STOP” acronym helps individuals pause and respond mindfully rather than react impulsively. Next, “opposite action” encourages acting opposite to the urge prompted by an emotion when the emotion is not justified by the situation. Another acronym, “ABC PLEASE,” focuses on maintaining physical and emotional health to reduce vulnerability to emotions. Similarly, skills such as “build mastery,” which involves engaging in activities that increase confidence and competence, and “cope ahead,” which helps individuals plan for emotionally challenging situations, support effective emotional regulation. Moreover, “positive self-talk” helps reframe thoughts and encourage constructive thinking. Combined together, these skills equip individuals to manage emotions effectively and navigate difficult experiences with greater control (DBT Tools, 2025).

Distress Tolerance
The third behavior skill of DBT is distress tolerance, which teaches us to accept and manage pain without exasperating symptoms through avoidance or impulsive actions (University of Washington, 2025). The skills taught for distress tolerance are especially useful in crisis situations, as they encourage acceptance of reality and reduce overall suffering. One key tool includes “ACCEPTS,” an acronym for activities, contributions, comparisons, emotions, pushing away, thoughts, and sensation, which help redirect focus and cope with negative feelings (DBT Tools, 2025). Likewise, “TIP” strategies—another acronym for temperature, intense exercise, and paced breathing—help change body chemistry to reduce the intensity of strong emotions. Additionally, “self-soothing” skills involve comforting and enjoyable activities to engage the five senses, such as appreciating nature, listening to music, savoring pleasant smells and tastes, or enjoying calming touch experiences. Another distress tolerance acronym, “IMPROVE,” helps to make a moment better through imagery, meaning, prayer, relaxation, focusing on one thing, taking a mental vacation, and offering oneself encouragement (DBT Tools, 2025). Other distress tolerance strategies include “pros and cons,” which help weigh the positive and negative aspects of decisions to avoid acting on impulses, and “problem solving,” which guides individuals through a structured process to identify, plan, and evaluate solutions for problems within their control (DBT Tools, 2025). Moreover, the “radical acceptance” skill teaches full mental, emotional, and physical acceptance of reality, letting go of resistance and bitterness while acknowledging limits, causes, and the inherent value of life despite unavoidable pain (DBT Tools, 2025). As a whole, practicing these tools regularly equips individuals to respond thoughtfully to challenges, tolerate discomfort, build resilience, and handle difficult situations with greater calm and clarity.

Interpersonal Effectiveness
The goals of interpersonal effectiveness in DBT are to efficiently communicate needs and maintain healthy boundaries (DBT Tools, 2025). These skills aim to strengthen existing relationships, build new and satisfying connections, and disengage from unhealthy or toxic relationships. A central aspect of interpersonal effectiveness is balance, which is used to find equilibrium between change and acceptance. This balance allows individuals to preserve self-respect while fostering healthier, more rewarding interactions (DBT Tools, 2025). Interpersonal effectiveness skills are not innate and must be learned, as emotions and automatic negative thoughts (ANTs) often interfere with relationship-building or ending toxic connections (DBT Tools, 2025). Therefore, DBT provides structured skill-building activities to help individuals communicate effectively and maintain healthy boundaries. These include the acronyms “DEAR MAN” for asserting needs clearly, “GIVE” for maintaining positive relationships, and “FAST” for preserving self-respect. Additionally, “boundary building” skills are taught to establish and maintain limits in relationships. Practicing these skills enables individuals to interact more effectively, handle conflicts constructively, and create healthier, more balanced connections (DBT Tools, 2025).



DBT at Restore and Renew

Many of our therapists are trained in DBT and are familiar with incorporating these skills into their practice with clients. We offer in-person appointments in East Lansing and Brighton, Michigan, as well as offer telehealth sessions throughout all of Michigan. If you are interested in receiving services, please contact us by one or more of the following methods:

Phone: 734-489-1182
Email: Hello@restorerenewcounseling.com
Website: https://restorerenewcounseling.com/contact#/



References

Akre, K. (2025). Dialectical Behaviour Therapy. https://www.britannica.com/topic/dialectical-behaviour-therapy
Cleveland Clinic. (2025). Dialectical Behavior Therapy (DBT). https://my.clevelandclinic.org/health/treatments/22838-dialectical-behavior-therapy-dbt
CONCEPT Professional Studies. (2025). The Four Central Behavior Skills Modules of DBT [Figure 1]. Palo Alto University. https://concept.paloaltou.edu/

DBT Center of Orange County. (2016). Practicing DBT “What” Skills. https://www.dbtcenteroc.com/practicing-dbt-what-skills/
DBT Tools. (2025). DBT Tools. https://dbt.tools/index.php
Symmetry Counseling. (2018). DBT Modules Explained. https://symmetrycounseling.com/psychologist-chicago/dbt-modules-explained-module-1-and-2/
University of Washington. (2025). Dialectical Behavior Therapy. Behavioral Research & Therapy Clinics, University of Washington. https://depts.washington.edu/uwbrtc/about-us/dialectical-behavior-therapy/#:~:text=There%20are%20four%20components%20of,arise%20in%20their%20everyday%20lives.