Dialectical Behavior Therapy (DBT): Evidence-Based Therapy That Builds Real-Life Skills

Dialectical Behavior Therapy (DBT) is a highly structured, evidence-based therapy designed to help people who experience intense emotions or relationship difficulties. Originally developed in the early 1990s by Marsha Linehan, DBT has become one of the most researched and effective treatments in modern psychology.

Linehan developed DBT while searching for more effective treatments for individuals experiencing chronic emotion dysregulation, suicidality, and patterns later conceptualized as Borderline Personality Disorder (BPD) (Linehan, 1993).

Today, decades of research show that DBT is effective not only for BPD, but also for depression, anxiety, trauma-related conditions, neurodivergence, and broader emotion regulation difficulties (Harley et al., 2008; Afshari et al., 2022, Bohus et al., 2020; Bemmouna et al., 2022; Rizvi et al, 2024).

DBT vs. CBT: Same Roots, Different Focus

Dialectical Behavior Therapy is a form of behavioral therapy, meaning it belongs to the same family as Cognitive Behavioral Therapy (CBT). Like CBT, DBT examines the connection between thoughts, emotions, and behaviors, a framework established by CBT scholar Judith Beck (Beck, 2011). However, DBT differs from traditional CBT in several important ways (Linehan, 1993).

Cognitive Behavioral Therapy (CBT)

CBT focuses primarily on:

• Identifying distorted or unhelpful thoughts

• Changing behaviors through cognitive restructuring

• Testing beliefs through behavioral experiments (Beck, 2011)

Dialectical Behavior Therapy (DBT)

DBT emphasizes:

• Skills training for managing intense emotions

• Learning how to respond effectively during emotional crises

• Balancing acceptance and change (Linehan, 1993).

This skills-based structure makes DBT especially effective for people who feel emotionally overwhelmed or who have tried therapy before without lasting results.

The Core of DBT: Acceptance and Change

The word dialectical means that two seemingly opposite ideas can both be true at the same time. In DBT, this principle is expressed through the balance of acceptance and change strategies (Linehan, 1993).

• Acceptance means acknowledging reality as it is in the present moment.

• Change means actively working to modify behaviors, emotional responses, or environments that contribute to suffering.

Rather than choosing one over the other, DBT teaches how to hold both at the same time; a stance shown to reduce emotional reactivity and increase psychological flexibility (Mehlum et al., 2021; Webb et al., 2016; Segal et al., 2025).

Real-life example

You may feel frustrated by a stressful work environment and want it to change. At the same time, constantly fighting the reality of the situation can intensify emotional pain. DBT skills help you accept what is happening now while also taking effective steps toward change, such as setting boundaries, regulating emotions, or problem-solving (Linehan, 1993).

This integration of acceptance-based strategies and behavioral change is the foundation of DBT.

Dialectical Behavior Therapy is one of the most empirically supported treatments for individuals experiencing intense emotional distress.

Research conducted by Marsha Linehan has consistently shown that DBT is associated with:

• Significant reductions in suicidal behaviors and self-harm (Linehan et al., 2006)

• Decreased psychiatric hospitalizations (Linehan et al., 2006)

• Improved emotion regulation skills, identified as a key mechanism of change (Neacsiu et al., 2010)

• Lower treatment dropout rates compared to treatment-as-usual, demonstrated in a meta-analysis (Kliem et al., 2010)

  
  

This combination of acceptance-based and change-oriented strategies has been shown to increase psychological flexibility and reduce emotional reactivity (Linehan et al., 2006; Neacsiu et al., 2014).

Who Can Benefit From DBT?

Borderline Personality Disorder: DBT has been shown to reduce suicidal behaviors, self-harm, emotional instability, and psychiatric hospitalization while improving emotional regulation and interpersonal functioning (Linehan et al., 2006).

Attention-Deficit/Hyperactivity Disorder (ADHD): For adults with ADHD, DBT-based skills training has been associated with improved emotion regulation, reduced impulsivity, and better management of intense emotional responses (Hirvikoski et al., 2011).

Autism Spectrum Disorder (ASD): DBT-informed approaches have been shown to support emotional awareness, distress tolerance, and coping with overwhelming emotional experiences in autistic adults (Conner et al., 2022).

Major Depressive Disorder: DBT has demonstrated effectiveness in reducing depressive symptoms, emotional avoidance, and rumination, particularly in individuals with treatment-resistant depression (Lynch et al., 2007).

Generalized Anxiety Disorder: DBT has been shown to reduce anxiety symptoms in people diagnosed with generalized anxiety disorder in a randomized controlled trial (DBT vs. CBT), with both treatments showing significant reductions in anxiety and depression symptoms post-treatment and at follow-up (Harley et al., 2008).

Postpartum and Perinatal Mental Health Challenges: DBT-informed perinatal skills groups have shown significant improvements across symptom domains and clinically meaningful improvements in emotion dysregulation in perinatal participants (pregnancy through first year postpartum (Agako et al., 2023).

Children and Adolescents with Emotion Dysregulation: DBT for adolescents has been associated with reductions in self-harm, suicidal behaviors, and emotional reactivity, as well as improvements in family and peer relationships(Miller et al., 2007; McCauley et al., 2018).

Chronic Suicidal Ideation or Self-Harm Behaviors: Across studies, DBT has consistently demonstrated reductions in suicide attempts, self-harm frequency, and crisis-driven hospitalizations(Linehan et al., 2015).

Across Populations

Across populations, DBT has been shown to:

• Improve emotion regulation (Gratz & Roemer, 2004)

• Strengthen interpersonal effectiveness (Linehan, 1993)

• Increase psychological flexibility, a transdiagnostic factor identified (Aldao et al., 2010)

Frequently Asked Questions About DBT (FAQ)

What is DBT therapy used for?

DBT is used to treat emotion dysregulation, suicidal thoughts, self-harm behaviors, anxiety, depression, trauma-related symptoms, and relationship difficulties (Linehan, 1993).

How is DBT different from regular therapy?

DBT is more structured and skills-focused. It teaches practical tools that can be used in daily life, rather than relying on insight alone (Linehan, 1993).

How long does DBT treatment last?

Comprehensive DBT typically lasts 12 months, depending on individual goals, symptom severity, and treatment needs (Linehan et al., 2006).

Is DBT only for Borderline Personality Disorder?

No. Research shows DBT is effective for many conditions beyond BPD, including depression, anxiety, ADHD, and autism

Can DBT be done online?

Yes. Clinical adaptations and pilot studies increasingly show that DBT can be delivered effectively via telehealth platforms when the full model is maintained (Wilks et al. 2017).

Ready to Explore DBT?

If you’re struggling with intense emotions, relationship challenges, or patterns that feel hard to break, DBT offers a clear, evidence-based path forward.

At Eastside DBT NYC, we provide comprehensive, skills-based DBT tailored to each individual’s needs. Whether you’re new to therapy or looking for a more structured, research-supported approach, we’re here to help.

📩 Contact us today to schedule a consultation or learn more about whether DBT might be a good fit for you.

References

Afshari, B., Jafarian Dehkordi, F., Asgharnejad Farid, A. A., Aramfar, B., Balagabri, Z., Mohebi, M., Mardi, N., & Amiri, P. (2022). Study of the effects of cognitive behavioral therapy versus dialectical behavior therapy on executive function and reduction of symptoms in generalized anxiety disorder. Trends in Psychiatry and Psychotherapy, 44, e20200156.https://pmc.ncbi.nlm.nih.gov/articles/PMC10039721/ 

Agako, A., Burckell, L., McCabe, R. E., Frey, B. N., Barrett, E., Silang, K., & Green, S. M. (2023). A pilot study examining the effectiveness of a short-term, DBT-informed, skills group for emotion dysregulation during the perinatal period. Psychological Services, 20(3), 697–707.https://pubmed.ncbi.nlm.nih.gov/35420859/ 

Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217–237.https://pubmed.ncbi.nlm.nih.gov/20015584/ 

Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.https://www.guilford.com/excerpts/beck4_old_ch1.pdf 

Bemmouna, D., Coutelle, R., Weibel, S., et al. (2022). Feasibility, acceptability and preliminary efficacy of dialectical behavior therapy to treat emotion dysregulation in autistic adults without intellectual disability exhibiting self-harm and/or suicidal behavior. Borderline Personality Disorder and Emotion Dysregulation.https://pmc.ncbi.nlm.nih.gov/articles/PMC8501315/ 

Bohus, M., Kleindienst, N., Hahn, C., et al. (2020). Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) compared with cognitive processing therapy (CPT) in complex presentations of PTSD in women survivors of childhood abuse: A randomized clinical trial. JAMA Psychiatry, 77(12), 1235–1245.https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2768029 

Harley, R., Sprich, S., Safren, S., Jacobo, M., & Fava, M. (2008). Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. The Journal of Nervous and Mental Disease, 196(2), 136–143.https://pubmed.ncbi.nlm.nih.gov/18277222/ 

Hirvikoski, T., Waaler, E., Lindström, T., Bölte, S., & Jokinen, J. (2011). Reduced ADHD symptoms in adults with ADHD after structured skills training based on dialectical behavior therapy. Journal of Attention Disorders.https://pubmed.ncbi.nlm.nih.gov/20537641/ (PubMed record may vary by indexing; if your DOI link was used before, keep that off per request.)(If you prefer, I can replace this with the most stable official journal page.)

Kliem, S., Kröger, C., & Kosfelder, J. (2010). Dialectical behavior therapy for borderline personality disorder: A meta-analysis using mixed-effects modeling. Journal of Consulting and Clinical Psychology, 78(6), 936–951.https://pubmed.ncbi.nlm.nih.gov/21114345/ 

Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.

Linehan, M. M., Comtois, K. A., Murray, A. M., et al. (2006). Two-year randomized controlled trial of dialectical behavior therapy vs general psychiatric management for borderline personality disorder. Archives of General Psychiatry, 63(7), 757–766.https://pubmed.ncbi.nlm.nih.gov/16818865/ 

Linehan, M. M., Korslund, K. E., Harned, M. S., et al. (2015). Dialectical behavior therapy for high suicide risk in individuals with borderline personality disorder: A randomized clinical trial and component analysis. JAMA Psychiatry, 72(5), 475–482.https://pubmed.ncbi.nlm.nih.gov/25806661/ 

Lynch, T. R., et al. (2007). Dialectical behavior therapy for treatment-resistant depression. Journal of Consulting and Clinical Psychology.https://psycnet.apa.org/record/2007-02282-000 (If this is not the exact Lynch record you intended, send me the title line and I’ll correct it.)

McCauley, E., Berk, M. S., Asarnow, J. R., et al. (2018). Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: A randomized clinical trial. JAMA Psychiatry.https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2685324 

Mehlum, L. (2021). Mechanisms of change in dialectical behaviour therapy for people with borderline personality disorder. Behaviour Research and Therapy.https://pubmed.ncbi.nlm.nih.gov/32979766/ 

Miller, A. L., Rathus, J. H., & Linehan, M. M. (2007). Dialectical behavior therapy with suicidal adolescents. Guilford Press.

Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M. (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Journal of Consulting and Clinical Psychology.https://pmc.ncbi.nlm.nih.gov/articles/PMC2914145/

Neacsiu, A. D., Eberle, J. W., Kramer, R., Wiesmann, T., & Linehan, M. M. (2014). Dialectical behavior therapy skills for transdiagnostic emotion dysregulation: A pilot randomized controlled trial. Behaviour Research and Therapy.https://pubmed.ncbi.nlm.nih.gov/24974307/

Rizvi, S. L., et al. (2024). The state of the science: Dialectical behavior therapy. Annual Review of Clinical Psychology.https://pubmed.ncbi.nlm.nih.gov/39443064/

Segal, O., et al. (2025). The benefits of radical acceptance of reality as a standalone strategy (paper discussing radical acceptance training and emotion downregulation). Current Psychology.https://link.springer.com/article/10.1007/s12144-025-07286-0

Webb, C. A., Beard, C., Kertz, S. J., et al. (2016). Differential role of CBT skills, DBT skills, and psychological flexibility in predicting depressive versus anxiety symptom improvement. Behaviour Research and Therapy.https://pubmed.ncbi.nlm.nih.gov/27057997/

Wilks, C. R., et al. (2017). Internet-delivered dialectical behavioral therapy skills training for suicidal and heavy episodic drinkers: Protocol and preliminary results of a randomized controlled trial. JMIR Research Protocols.https://pubmed.ncbi.nlm.nih.gov/29070480/