Cincinnati Therapy for Trauma, Anxiety, and LGBTQ-Affirming Care

What is Dialectical Behavioral Therapy and Do I Need it?​

 

I find that DBT is helpful for any person who is struggling with at least three of these five areas (struggling in one or two areas can be targeted in traditional therapy):

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1. socially/interpersonally - struggles within relationships you have peers, authority figures, romantic partners and/or family members

2. behaviorally - problematic behaviors, urges, and/or addictions

3. cognitively - thinking errors and cognitive distortions

4. Identity - struggling with who you are as a person

5. Emotionally - difficulties managing emotions more than peers

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What is DBT?

Dialectical Behavior Therapy (DBT) is an evidence-based form of psychotherapy that helps people manage intense emotions, improve relationships, and reduce harmful behaviors. Originally developed by psychologist Marsha Linehan in the 1980s, DBT builds on Cognitive Behavioral Therapy (CBT) but adds a key concept: the balance between acceptance and change.

The word “dialectical” refers to bringing together two seemingly opposite ideas—accepting yourself as you are while also working toward meaningful change. This balance is especially helpful for individuals who feel overwhelmed by emotions or stuck in patterns like impulsivity, self-harm, or conflict in relationships.

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DBT was originally created to treat chronic suicidality and borderline personality disorder; however, in recent decades it has been found to be an evidenced based treatment for most all mental health disorders!   DBT is a structured approach to treatment which allows you to gain knowledge in an efficient way.  DBT teaches skills across four modules: interpersonal effectiveness (communication skills), distress tolerance (short-term and long-term crisis skills), emotional regulation (how to manage emotions), and mindfulness skills (ways to stay present in life). 

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DBT is structured and skills-based. Rather than focusing only on insight or processing, it teaches concrete tools to help people regulate emotions, tolerate distress, and navigate interpersonal situations more effectively. It is typically delivered through a combination of:

• Individual therapy

• Group skills training

• Between-session coaching (in some programs)

At its core, DBT is about helping people build a life that feels worth living by increasing emotional stability and behavioral control.

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Who benefits from DBT?

DBT is particularly effective for individuals who experience intense emotions or struggle with emotional regulation. While it was originally developed for people with Borderline Personality Disorder (BPD), its use has expanded significantly.

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People who benefit most from DBT often:

• Feel emotions very strongly or quickly

• Have difficulty calming down once upset

• Engage in impulsive or self-destructive behaviors

• Experience unstable relationships

• Struggle with chronic stress or crises

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DBT can also be helpful for individuals who have tried other forms of therapy and felt misunderstood or invalidated. Its emphasis on validation—acknowledging that your experiences make sense—can feel especially supportive for clients who have historically felt dismissed.

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Additionally, DBT works well for:

• Teens and adults

• Individuals in high-stress life circumstances

• Clients needing structured, skills-based therapy

Research shows DBT is particularly effective at reducing self-harm, suicidal behaviors, and emotional dysregulation.

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Conditions DBT treats

Although DBT was initially designed for Borderline Personality Disorder, it is now widely used to treat a range of mental health conditions—especially those involving emotional dysregulation.

Common conditions treated with DBT include:

• Borderline Personality Disorder (BPD)

• Post-Traumatic Stress Disorder (PTSD)

• Depression

• Anxiety disorders

• Substance use disorders

• Eating disorders (especially binge eating and bulimia)

• Self-harm and suicidal ideation

DBT is especially helpful when symptoms include:

• Intense mood swings

• Difficulty coping with stress

• Impulsive or risky behaviors

• Chronic feelings of emptiness or instability

Because DBT focuses on skills rather than diagnosis alone, it can also benefit individuals who may not meet full diagnostic criteria but still struggle with emotional regulation, relationships, or coping.

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​​What is expected of me in DBT?

 

DBT is a more intense level of treatment than you might be accustomed to in traditional therapy. Here is what you will need to do:

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1. Sign up for DBT skills class

2. Attend weekly therapy with a therapist on the team or another therapist at Inclusive Counseling. You must have had a minimum of 12 therapy sessions prior to starting skills class. 

3. Track your moods and urges weekly on a diary card or diary card app and report them to your individual therapist.

4. Purchase DBT Skills Training Manual 

5. Attend weekly skills class for one year

6. Do the homework assigned in skills class each week and process it in your individual therapy appointment

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It took far longer than one year to get to where you are. It will take time and effort to achieve your life worth living!

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What a DBT session looks like

DBT is more structured than many traditional talk therapies. A typical DBT program includes both individual sessions and skills training groups, each serving a different purpose.

1. Individual therapy

In one-on-one sessions, the therapist and client:

• Review the past week (often using diary cards to track emotions and behaviors)

• Identify problem behaviors and triggers

• Apply DBT skills to real-life situations

• Prioritize safety concerns (such as self-harm) first

Sessions are highly goal-oriented and focus on problem-solving and skill application rather than just discussion.

2. Skills training group

DBT groups function more like a class than traditional group therapy. Clients:

• Learn new skills each week

• Practice applying them

• Complete homework between sessions

3. Coaching (with some therapists)

Some DBT therapists offer between-session coaching (phone or messaging) to help clients apply skills in real-time during crises. Overall, DBT is active and collaborative. Clients are expected to practice skills outside of sessions, making it a very hands-on and practical form of therapy.

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DBT skills modules

DBT is built around four core skill modules. These modules teach the tools clients use to manage emotions, navigate relationships, and cope with distress.

1. Mindfulness

Mindfulness is the foundation of DBT. It focuses on being present in the moment without judgment.

Skills include:

• Observing thoughts and feelings

• Describing experiences accurately

• Staying present rather than reacting impulsively

Mindfulness helps create space between an emotion and a reaction, allowing for more intentional responses.

2. Distress Tolerance

Distress tolerance teaches how to cope with painful situations without making them worse.

Skills include:

• Crisis survival strategies

• Radical acceptance

• Self-soothing techniques

These skills are especially useful during high-intensity emotional moments when immediate relief is needed.

3. Emotion Regulation

Emotion regulation focuses on understanding and managing emotions more effectively.

Clients learn how to:

• Identify and label emotions

• Reduce emotional vulnerability

• Change emotional responses when needed

This module is central to DBT because many clients struggle with overwhelming or unpredictable emotions.

4. Interpersonal Effectiveness

This module teaches how to navigate relationships while maintaining self-respect.

Skills include:

• Asking for what you need

• Setting boundaries

• Saying no effectively

• Managing conflict

These skills help improve communication and reduce relationship stress.

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Together, these four modules provide a comprehensive toolkit for handling life’s challenges. They are typically taught in a structured sequence and practiced repeatedly over time.

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