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Dialectical Behavior Therapy, or DBT, was developed by psychologist Marsha Linehan in the late 1980s for people who experience emotions intensely — people for whom standard talk therapy was not enough. If you have ever felt as though your emotions are more powerful and harder to manage than other people’s, that you go from zero to one hundred faster than you would like, or that your relationships tend to be turbulent and painful, DBT may be the right fit for you. It is a practical, skills-based therapy that teaches you to handle life’s most difficult moments without making things worse.

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What it is

DBT is a structured form of cognitive-behavioral therapy that balances two things that can feel like opposites: accepting yourself exactly as you are right now, and committing to changing behaviors that are causing harm or getting in the way of the life you want. The word “dialectical” refers to this balance — holding two seemingly contradictory ideas at the same time. DBT is built around four skill modules, each addressing a different area of life where intense emotions can cause problems.

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How it works

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The four DBT skill modules

Mindfulness is the foundation of all DBT skills. It involves learning to observe your thoughts, feelings, and sensations in the present moment without judgment. In DBT, mindfulness is not about relaxation — it is about developing awareness of your inner experience so that you can make conscious choices rather than react automatically. Core mindfulness skills include observing, describing, and participating fully in the present moment.
Distress tolerance skills are for crisis moments — times when emotions are at their peak and you need to get through the moment without doing something that makes things worse. These skills include crisis survival techniques (like the TIPP skills: Temperature, Intense exercise, Paced breathing, and Progressive relaxation), radical acceptance, and finding ways to distract or self-soothe when you cannot immediately solve a problem.
Emotion regulation skills help you understand and manage your emotional life over the longer term. You will learn to identify and label emotions accurately, understand what function each emotion serves, reduce your vulnerability to overwhelming emotions (through sleep, nutrition, and physical health), and increase positive experiences in your life. These skills help you change emotional responses you want to change, not just survive them.
Interpersonal effectiveness skills address how to navigate relationships in ways that meet your needs while maintaining your self-respect and the respect of others. You will learn structured approaches for asking for what you need, saying no to what you do not want, and managing conflict — without sacrificing the relationship or your sense of self.

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The dialectical stance

A central concept in DBT is radical acceptance — fully accepting reality as it is, without judgment, even when it is painful. This is not the same as approval. It means acknowledging that fighting against facts does not change them, and that acceptance is often the first step toward change.

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What to expect in sessions

DBT can be delivered in different formats. Standard comprehensive DBT includes both individual therapy sessions and skills training groups. At Guzman & Baker, your therapist will work with you in individual sessions and may incorporate DBT skills directly into your one-on-one work, tailoring the approach to your specific needs.
Full DBT programs typically involve both individual therapy and a skills group that meets weekly. Your therapist will discuss what format makes sense for your situation and goals.
In individual DBT sessions, you and your therapist will typically review your week, identify any behaviors or urges you want to address, and apply DBT skills to specific situations. Your therapist may ask you to complete a diary card between sessions to track emotions, urges, and skill use.

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Who it helps

DBT was originally developed for borderline personality disorder (BPD), and remains the gold-standard treatment for it. Over time, research has shown it to be effective for a range of conditions involving emotional intensity, including:
  • Borderline personality disorder
  • Chronic suicidal thinking or self-harm behaviors
  • Eating disorders, especially binge eating and bulimia
  • Substance use disorders
  • Post-traumatic stress disorder
  • Depression with emotional dysregulation
  • Adolescents with intense emotional and behavioral difficulties
DBT is also used with adolescents — including a family component that helps parents and teens learn skills together.

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At Guzman & Baker

Our therapists who use DBT bring both the structure of this evidence-based approach and genuine care for the whole person sitting across from them. DBT can feel intense — it asks a lot of you — but it also gives a great deal back.
You do not need a diagnosis of borderline personality disorder to benefit from DBT skills. If you struggle with intense emotions, impulsive behaviors, or turbulent relationships, these skills were built for you.
Your therapist will introduce skills gradually, practice them with you in session, and help you figure out how to apply them in the real situations that are most challenging in your life.