Some emotions feel impossible to manage. They come on fast, hit hard and leave you reacting in ways you later regret. If you have been told you are “too sensitive” or if your emotional responses regularly interfere with your relationships, your work or your ability to function, Dialectical Behavior Therapy may help.
DBT is a structured, skills-based approach to therapy that teaches you how to manage intense emotions, tolerate distress and interact with others more effectively. At Artisan Counseling, our licensed counselors use DBT principles in individual counseling to help clients build the skills they need to create stability in their lives.
Dialectical Behavior Therapy was developed in the 1980s by psychologist Marsha Linehan. It was originally designed to treat individuals with borderline personality disorder, particularly those experiencing chronic suicidal ideation and self-harm. Since then, its applications have expanded significantly.
The word “dialectical” refers to the idea that two things that seem to be in opposition can both be true at the same time. In DBT, the central dialectic is between acceptance and change. You learn to accept yourself and your experience as it is right now while also working toward meaningful change in how you think, feel and behave.
DBT combines elements of cognitive behavioral therapy with concepts from mindfulness and acceptance-based practices. What sets it apart is its emphasis on building concrete, teachable skills that clients can practice and apply in real time.
Research supports DBT as an effective approach for a range of concerns. Studies published in the American Journal of Psychiatry and Behaviour Research and Therapy have demonstrated its effectiveness in reducing self-harm, improving emotional regulation and decreasing hospitalizations among individuals with serious mental health conditions.
DBT is organized around four skill modules. Each one addresses a different area of functioning. In therapy, you learn and practice these skills over time, applying them to the specific situations you face.
Mindfulness is the foundation of DBT. It involves learning to pay attention to the present moment without judgment. Many people spend most of their time caught up in thoughts about the past or worries about the future. Mindfulness teaches you to observe what is happening right now, including your thoughts, emotions and physical sensations, without reacting automatically.
In DBT, mindfulness is broken into “what” skills (observing, describing, participating) and “how” skills (non-judgmentally, one-mindfully, effectively). These are practiced in session and between sessions until they become part of how you respond to daily situations.
Distress tolerance skills help you get through painful moments without making things worse. This does not mean ignoring pain or pretending everything is fine. It means learning to survive a crisis without turning to destructive behaviors such as substance use, self-harm, explosive anger or impulsive decisions.
Specific techniques taught in this module include distraction strategies, self-soothing using the five senses, improving the moment through imagery or meaning, and evaluating the pros and cons of acting on an urge. These skills are designed for use in situations where you cannot immediately change what is causing you distress.
Emotion regulation skills help you reduce your vulnerability to intense emotions and change emotional responses when they are not serving you. This module teaches you to identify and label your emotions, understand what triggers them and take steps to shift your emotional state when needed.
Skills in this area include reducing emotional vulnerability through basic self-care (sleep, nutrition, exercise, illness management), building positive experiences, acting opposite to the emotion when the emotion does not fit the situation, and checking the facts before responding.
Interpersonal effectiveness skills focus on how you communicate and maintain relationships. Many clients who benefit from DBT report difficulty asking for what they need, saying no, dealing with conflict or maintaining self-respect in interactions with others.
This module teaches specific strategies for making requests, setting boundaries and managing conflict while preserving the relationship and your own sense of self-worth. The skills are practical and can be applied to relationships with partners, family members, coworkers and friends.
DBT was originally designed for borderline personality disorder, but research has since shown it to be effective for a broader range of concerns. You may benefit from DBT if you are dealing with:
DBT is also helpful for people who do not have a specific diagnosis but who recognize that their emotional responses are causing problems in their daily lives. If you frequently feel overwhelmed by your emotions or if your coping strategies tend to create more problems than they solve, DBT skills may be relevant to your treatment.
At Artisan Counseling, DBT skills are incorporated into individual therapy sessions. Here is what the process generally looks like.
Assessment. Your counselor will begin by learning about your history, your current concerns and the patterns you want to change. Together, you will identify the areas where DBT skills are most needed.
Skill introduction. Your counselor will teach you specific DBT skills, one module at a time. Each skill is explained, demonstrated and then practiced in session. Your counselor may use worksheets, role-playing or real-life examples to help you apply the skills.
Between-session practice. DBT is a practice-based approach. Your counselor may ask you to track your emotions, practice a specific skill during the week or complete a worksheet that reinforces what you worked on in session. The goal is to move from learning the skills to using them automatically.
Ongoing application. As you build your skill set, sessions focus more on applying the skills to specific situations in your life. Your counselor will help you troubleshoot challenges, address barriers and continue building on what is working.
Progress review. Your counselor will check in regularly to assess how the skills are working for you and adjust the approach as needed. Some clients complete DBT-focused work in a defined period of time, while others continue to integrate the skills into longer-term therapy.
Sessions are typically 50 to 60 minutes, held weekly or biweekly, and are available in person or through telehealth.
No. While DBT was originally developed for BPD, it is now used for a range of concerns including anxiety, depression, trauma, eating disorders and chronic emotional instability. You do not need a specific diagnosis to benefit from DBT skills.
Both approaches are structured and skills-based. CBT focuses primarily on identifying and changing thought patterns. DBT includes cognitive techniques but places greater emphasis on emotional regulation, distress tolerance and acceptance. DBT also incorporates mindfulness as a core component.
Not necessarily. At Artisan Counseling, DBT skills are taught within individual therapy sessions. If group-based DBT becomes available, your counselor can discuss that option with you.
The length of treatment depends on your concerns and goals. A full course of DBT skill training typically takes several months, though many clients begin using the skills effectively within the first few weeks.
Yes. Practicing skills between sessions is an important part of DBT. This may include tracking emotions, completing worksheets or applying a specific technique during a difficult moment.
Yes. Several of our counselors offer DBT-informed individual therapy through telehealth for clients located in Virginia.
DBT is a recognized form of therapy and is typically covered by most insurance plans. Contact your insurance provider or our office at 757.503.2819 to verify your benefits.