Dialectical behavior therapy (DBT) is a scientific form of psychotherapy that helps people experiencing certain mental challenges to achieve better outcomes and improve their relationships with others. DBT teaches people the skills and techniques they need to give themselves the kind of life they want.  

People without any form of mental illness can also benefit from this type of therapy. DBT was developed in the 1980s for people with borderline personality disorder and suicidal ideations. The idea was to equip the people with new skills to handle difficult emotions and reduce friction in their relationships. 

DBT has successfully treated patients suffering from depression, bulimia, PTSD, bipolar disorder, and drug abuse.  

According to an AI analysis by the crowdsourcing platform StuffThatWorks, DBT ranks as the most effective treatment for borderline personality disorder. The borderline personality community on StuffThatWorks has more than 20,000 contributors. 

The Difference Between CBT and DBT 

DBT is not to be confused with CBT. Cognitive-behavioral therapy (CBT) is a type of psychotherapy used to tackle a wide variety of mental disorders. It is also known as talk therapy.  

CBT lets patients talk about issues in a bid to help them frame the issues properly. This therapy is based on the assumption that your emotions are a product of your thoughts. Therefore, the idea is to get you to control your thoughts instead of the other way around.  

CBT is a broad psychotherapeutic class, and DBT is considered a type of CBT. DBT, unlike CBT, attempts to get patients to confront the ill emotions and handle them by making better choices. In a nutshell, CBT focuses on altering your thoughts, while DBT aims to transmit coping skills.  

What Is Borderline Personality Disorder? 

Borderline Personality Disorder (BPD) is a personality disorder that makes victims feel like they are on an emotional rollercoaster. This condition is also known as Emotionally Unstable Personality Disorder (EUPD). It is marked by consistently changing feelings about oneself.  

The National Institute of Health defines BPD as a serious mental disorder marked by a pattern of ongoing instability in moods, behavior, self-image, and functioning.  

About 1.6% to 5.9% of Americans suffer from some form of this disorder. BPD frequently occurs together with another disorder, so it is often missed or misdiagnosed.  

BPD patients struggle to cope, feel, and manage relationships. They can be extremely sensitive and are easily triggered. Their expressive volatility often leads to rash behavior once upset.  

Substance abuse, eating disorders, reckless driving, careless spending, and other impulsive actions are often associated with BPD. The tendency to self-harm or commit suicide is often pronounced in patients with BPD. 

Primary symptoms of BPD include: 

  • Fear of rejection or abandonment (imagined or real) 
  • Unclear or shifting self-image 
  • Chronic feelings of emptiness 
  • Unstable personal relationships 
  • Impulsive and reckless behavior 
  • Self-harm and suicidal behavior 
  • Extreme mood swings 
  • Irritability, anxiety, and general emotional instability 
  • Uncontrolled anger 
  • Paranoia and feelings of suspicions.  

Causes of BPD 

Borderline Personality Disorder is often a combination of one or more of the following factors: 

  • Genetics  

There is a genetic angle to most mental disorders. An individual is likely to get BPD if a family member or close relative has suffered from the condition.  

  • Environment  

Environmental factors like abuse, distress, stigma, and neglect, especially when experienced in childhood, can trigger BPD later in life.  

  • Brain Structure 

People with smaller brains are likelier to develop BPD. A smaller brain means that there are more active parts. A person’s childhood can affect how these functional areas affect emotions and behavior. 

  • Chemical Imbalances in the Brain 

Fluctuations in the levels of chemical messengers in the brain, such as serotonin, can trigger BPD.  

Types of BPD 

American psychologist Theodore Millon classified BPD into four types:  

  • Discouraged BPD 

Discouraged PBD is marked by needy and codependent behavior. Individuals with this kind of BPD are often angry and disillusioned. They harbor an intense desire to be accepted and can self-harm as a coping mechanism. Discouraged BPD sufferers tend to slide into depression easily.  

  • Impulsive BPD 

Individuals with this condition are full of vigor and charisma. However, they get bored quickly, as they are thrill-seekers. They want to be at the center of things and often get into fights. Their need for constant excitement often leads them to risky behavior like alcohol or substance abuse. 

  • Petulant BPD 

Petulant BPD is characterized by impatience, unpredictability, irritability, and stubbornness. Individuals with this kind of BPD are passive-aggressive and unwilling to admit wrong. They can also self-harm to get their way.  

  • Self-destructive BPD     

True to the name, people suffering from this type of BPD are likely to engage in various kinds of self-destructive acts. They are self-loathing, bitter, and lack a sense of identity. They can hurt themselves or engage in reckless behavior to feel something.  

How Does DBT Work? 

Dialectical behavioral therapy is typically made up of individual sessions with a therapist and group sessions. There may also be phone coaching sessions if required. The patient and therapist work together to find a balance between opposing perspectives. The primary objective is to teach the patient to live in the present and develop skills for dealing with their emotions and relationships.  

There are four main DBT techniques: 

  • Core Mindfulness 

Being mindful means focusing on the present moment. The patient is taught to forget about the past and not to worry about the future. Mindfulness helps you to stay calm and prevents impulsive thinking or behavior.  

  • Distress Tolerance 

Distress tolerance sessions help patients avoid the urge to soothe themselves with harmful substances or reckless behavior. The patient learns techniques such as distraction, self-soothing, risk-benefit analysis, and self-soothing to help them endure the distress instead of trying to escape.  

  • Emotional Regulation 

Patients learn skills to manage potentially destructive emotions. First, they are taught to identify emotions like anger or bitterness. Then, they learn to tolerate and change them whenever they arise.  

  • Interpersonal Effectiveness 

Interpersonal effectiveness focuses on helping patients build better relationships. They learn to be assertive without being offensive. They learn about boundaries, respect, and dealing with complex personalities.  

How Can DBT Help Those with Borderline Personality Disorder 

Dialectical Behavioral Therapy was designed to help patients with BPD resolve their inner conflicts and bring change. The therapist tries to validate the patient’s behavior, making them amenable to treatment.  

Validation is required because the patient typically finds change distressing. The therapist first tries to convince the patient that their actions are understandable within their context. Then, they proceed to make the patient see that there are better ways of resolving those conflicts.  

DBT sessions last about two hours weekly for up to six months. Treatment times may vary depending on specific needs and patients’ progress. Patients may be required to perform tasks outside the sessions to aid treatment. These tasks may include homework, role-playing, and learning new ways of forming bonds with others.  

DBT is also used to treat other mental ailments besides BPD, including eating disorders, depression, PTSD, and drug abuse. Up to 86% of DBT patients experience some improvement in their symptoms after therapy.   


DBT has brought positive outcomes for many people. If you feel that you or a loved one could benefit from DBT, get in touch with a licensed professional. Your therapist will discuss treatment goals with you and tell you what to expect.  

DBT sessions are often lengthy and intense. You want to find a therapist you trust and with whom you can build a long working relationship.