Dialectical Behavior Therapy (DBT)

Reviewed by the HeyPsych Medical Review Board

Board-certified psychiatrists and mental health professionals

Published September 16, 2026•Updated September 16, 2026

Indications

Primary Indications

Borderline Personality DisorderSuicidalitySelf HarmBinge Eating DisorderPtsd

Mechanism

DBT combines acceptance strategies (mindfulness, validation) with change-oriented strategies (behavioral skills, problem-solving). The dialectical approach emphasizes balancing acceptance and change. Skills modules include mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, which together target emotional instability and maladaptive behaviors.

Protocol

Preparation

Initial assessment, goal setting, and commitment to treatment.

Procedure

Weekly individual therapy sessions focusing on behavior analysis and skill application.
Weekly group skills training covering mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
Phone coaching for real-time skills support.
Therapist consultation team meetings to maintain fidelity.

Frequency: Typically weekly individual and weekly group sessions.

Duration: Standard DBT programs last 6–12 months.

Total Treatment Time: Approx. 12 months, with possible extension.

Session Structure

Pre-Session

Diary card review of behaviors and skills practice.

Treatment Phase

Target behaviors through chain analysis, practice DBT skills.

Post-Session

Homework assignments and skill application plans.

Expected Outcomes

Immediate

Increased awareness of emotional states
Improved coping strategies

Short Term

Reduction in self-harm behaviors
Improved distress tolerance

Long Term

Improved interpersonal functioning
Sustained emotional regulation
Reduced suicidal ideation

Side Effects

common

Emotional discomfort during exposure to painful memories

uncommon

Temporary increase in distress when learning new skills

rare

Dropout due to intensity of treatment demands

Contraindications

absolute

Severe untreated psychosis
Severe cognitive impairment

relative

Low motivation for structured skills training

Patient Selection

ideal candidates

Individuals with borderline personality disorder
Patients with chronic suicidality or self-injury
Adolescents with emotional dysregulation

screening required

Comprehensive psychiatric evaluation
Risk assessment for suicidality/self-harm

Training Requirements

practitioner

Licensed therapists trained in DBT through formal certification programs

facility

Mental health clinics, hospitals, private practices, telehealth

Research Evidence

Key Studies

Linehan MM et al. (2006). Two-year randomized controlled trial of DBT for borderline personality disorder. Arch Gen Psychiatry.
Kliem S, Kröger C, Kosfelder J. (2010). DBT for borderline personality disorder: A meta-analysis using random effects. J Consult Clin Psychol.

Limitations

Resource intensive; requires high patient commitment; dropout rates can be significant.

Cost Considerations

typical session cost: $100–$250 per session

total treatment cost: Can range from $5,000–$15,000 depending on program length

insurance coverage: Often covered for BPD or high-risk diagnoses

cost effectiveness: High when considering reductions in hospitalization and crisis service use

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Integration Support

Concurrent Therapies

Medication management
Support groups
Trauma-focused therapy for comorbid PTSD

Special Populations

Clinical Notes

DBT emphasizes both acceptance and change, requiring strong commitment from clients.
Therapist consultation team is a key component to prevent burnout and maintain fidelity.
Skills generalization to everyday life is critical for success.

This treatment information is for educational purposes only. Treatment decisions should be made in consultation with qualified healthcare professionals based on individual circumstances, symptoms, and medical history. Do not attempt treatment without professional guidance.

Interested in this treatment?

This information is for educational purposes. Always consult with a qualified healthcare provider before starting any new treatment.

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