A Complete Guide to Dialectical Behavior Therapy (DBT)

How DBT Started

Dialectical behavior therapy (DBT) was created by Dr. Marsha Linehan in the late 1980s when she and colleagues discovered that cognitive behavioral therapy (CBT) was not an effective treatment for those suffering from borderline personality disorder (BPD) (Budak & Kocabaş, 2019). Since then, DBT has been modified and adapted to treat many disorders and behavioral issues, such as eating disorders, depression, and adolescence-related angst. 

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), BPD is diagnosed when a clear pervasive pattern of instability between relationships, self-image, emotions and impulse control issues begin in early adulthood and is clearly interfering with a person’s regular day-to-day life (American Psychological Association, 2013). Only about 1.6% of the population is diagnosed with BPD, yet many are misdiagnosed or ineffectively treated for this disorder (APA). And so DBT came to be.

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Linehan indicated four fundamental problems in patients with BPD, which are: self-confusion, impulsivity, emotional dysregulation, and interpersonal chaos. The skills needed to overcome these problems are: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness

Essentially, Linehan created a CBT with direct focus on dialectics, meaning change and acceptance, and Zen practices, which encourage awareness of the accepted change. This was done particularly for those with BPD because these individuals, on a cognitive level, cannot maintain any of these skills that seemingly come naturally to those without BPD. 

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DBT Beyond BPD

Today DBT is used for more than effectively treating those with BPD. The following studies are a few of hundreds of examples how DBT can help a struggling individual or group get their lives to where they need to be. 

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No matter the underlying cause or issue, there appears to be a common theme amongst those receiving DBT treatment: they almost always report becoming aware of their problems is the most effective aspect of DBT. This awareness, or being mindful, of their thoughts and actions is the key to overcoming any problem.

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Mindfulness and DBT

Many find focusing on mindfulness more than the other aspects of DBT to be most rewarding. Again, the purpose of mindfulness in DBT is to experience the world in a positive way to overall decrease suffering. Negative emotions such as depression, anxiety, anger, shame, and insecurities can all be addressed and changed using mindfulness.

The most promising part of taking the mindfulness skills out of DBT and creating an isolated program solely meant to increase awareness is that it will take much less time to achieve and utilize compared to fully committing to a DBT program. Warlick et al. (2020) noted that DBT programs should typically take a few months up to a year; by directing attention to mindfulness alone, an “accelerated” course could potentially lessen this time commitment to a few weeks. That’s not to say distress tolerance, emotional regulation, and interpersonal effectiveness are not vital components to DBT, because they are. But for most of us, the simple task of truly paying attention to our own thoughts and behaviors could be just what we need to make the right kind of changes in our lives.

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Practice DBT with LIFE Intelligence

LIFE Intelligence is a science-backed self therapy app designed to help you make all the right changes in your life. Whether it’s to break a bad habit you’re unsure how you developed or to regulate your emotions, LIFE will guide you through 9 missions (topics) to better you. Mission 2.4 is designed to develop self-awareness both internally (how you view and feel about yourself) and externally (how you view and feel about others). This development of self-awareness is exactly what DBT hopes to achieve.

In addition to self-awareness, LIFE can also help you regulate your emotions, another key component of DBT. At any given time of the day, you can check in with the wheel of emotions. This tool helps you assess your current mood and record past moods. This is so eventually you may begin to notice a pattern: are you irritable in the morning? Do you feel sad just past sunset? What time of day are you most energized? Tracking these emotions and understanding the context of them is essential to regulate them. 

You don’t need a reason to make your life a happier one. Let LIFE Intelligence help you become happier.

Rebecca Patterson
March 25, 2021


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596 

Brown, T. A., Cusack, A., Anderson, L., Reilly, E. E., Berner, L. A., Wierenga, C. E., Lavender, J. M., & Kaye, W. H. (2019). Early versus later improvements in dialectical behavior therapy skills use and treatment outcome in eating disorders. Cognitive Therapy & Research, 43(4), 759–768.  

Budak, A. M. Ü., & Kocabaş, E. Ö. (2019). Dialectical behavior therapy and skill training: Areas of use and importance in preventive mental health. Current Approaches in Psychiatry / Psikiyatride Guncel Yaklasimlar, 11(2), 192–204.  

Huntjens, A., van den Bosch, L. M. C. W., Sizoo, B., Kerkhof, A., Huibers, M. J. H., & van der Gaag, M. (2020). The effect of dialectical behaviour therapy in autism spectrum patients with suicidality and/ or self-destructive behaviour (DIASS): study protocol for a multicentre randomised controlled trial. BMC Psychiatry, 20(1), 1–11.  

Mitchell, R., Roberts, R., Bartsch, D., & Sullivan, T. (2019). Changes in mindfulness facets in a dialectical behaviour therapy skills training group program for borderline personality disorder. Journal of Clinical Psychology, 75(6), 958–969.  

Mochrie, K. D., Lothes, J., Quickel, E. J. W., John, J., & Carter, C. (2019). From the hospital to the clinic: The impact of mindfulness on symptom reduction in a DBT partial hospital program. Journal of Clinical Psychology, 75(7), 1169–1178.

Navarro-Haro, M. V., Botella, C., Guillen, V., Moliner, R., Marco, H., Jorquera, M., Baños, R., & Garcia-Palacios, A. (2018). Dialectical behavior therapy in the treatment of borderline personality disorder and eating disorders comorbidity: A pilot study in a naturalistic setting. Cognitive Therapy & Research, 42(5), 636–649.  

Pardo, E. S., Rivas, A. F., Barnier, P. O., Mirabent, M. B., Lizeaga, I. K., Cosgaya, A. D., Alcántara, A. C., González, E. V., Aguirre, B., & Torres, M. A. G. (2020). A qualitative research of adolescents with behavioral problems about their experience in a dialectical behavior therapy skills training group. BMC Psychiatry, 20(1), 1–10.

Warlick, C. A., Huffman, J. M., Poquiz, J. L., Moffitt-Carney, K. M., Krieshok, T. S., DeLong, L., Schellenger, B., Leonard, J., & Nelson, J. (2020). A pilot investigation of positive psychology instruments and dialectical behavior therapy treatment outcomes. Journal of Mental Health Counseling, 42(4), 356–373.  

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