Dialectical Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is one of the most effective therapies to treat mental health issues and addiction utilizing the two opposing, or dialectical, ideas of acceptance and change to encourage lasting recovery.

What Is Dialectical Behavior Therapy (DBT)?

Dialectical Behavior Therapy (DBT) is a type of cognitive behavioral therapy, also known as talk therapy, that tries to identify and change negative thinking patterns and pushes for positive behavioral changes. In short, DBT provides teens and young adults with the skills to effectively cope with stress as well as monitor and regulate emotions, decrease conflict, improve relationships with others, focus on the present and live in the moment.

Teen Mental Health and Addiction Treatment from Potomac Programs

The History of Dialectical Behavior Therapy (DBT)

DBT was developed in the 1980s by Dr. Marsha Linehan, Ph.D. and colleagues when they discovered that cognitive behavioral therapy (CBT) alone did not work as well as expected after seeing patients experience extremely intense negative emotions that were difficult to manage due to a lack of validation and acceptance from their therapist, which is essential for change. Building on CBT principles, Dr. Linehan and her team added techniques and developed a treatment that would meet the unique needs of patients, now known as Dialectical Behavior Therapy (DBT) .

How Does Dialectical Behavior Therapy Work?

The term “dialectical” refers to the idea that two opposing ideas can be true at the same time. Using this approach to therapy, there is always more than one way to approach a situation. The therapist works with seemingly opposing strategies, which are to accept your child exactly the way they are and at the same time work toward changing negative behaviors.

While DBT and CBT are similar in many ways, DBT adds a focus on validation and acceptance along with efforts to change. The therapist works to balance out acceptance and change while working to gradually teach new skills, such as mindfulness, interpersonal effectiveness, emotion regulation strategies and distress tolerance, all of which will help your child cope more effectively in their everyday life.

DBT Treatment Targets

Preteens, teens and young adults who receive DBT typically have multiple issues that require treatment. So, DBT uses a hierarchy of treatment targets to help the therapist determine the specific order in which issues or problems should be addressed.

  • 1

    Life-Threatening Behaviors

    First and foremost, behaviors that could lead to your child's death are targeted, including: suicide communications, suicidal ideation and all forms of suicidal or non-suicidal self-injury.

  • 2

    Therapy-Interfering Behaviors

    This includes any behavior that interferes with your child receiving effective treatment such as: coming late to sessions, cancelling appointments or not being open to working toward treatment goals.

  • 3

    Quality of Life Behaviors

    This includes any other type of behavior that interferes with your child having a reasonable quality of life—such as: disorders, relationship problems and financial or housing crises.

  • 4

    Skills Acquisition

    This refers to the need for your child to learn new skillful behaviors to replace ineffective or negative behaviors helping them achieve their goals.

DBT Skills

Your child learns DBT skills from four behavioral skill modules, with two acceptance-oriented skills (mindfulness and distress tolerance) and two change-oriented skills (emotion regulation and interpersonal effectiveness), defined as follows:


How to be fully aware and present in each moment.

Distress Tolerance

How to tolerate pain in difficult situations, instead of changing it.


How to change emotions and decrease their own vulnerability to the painful emotions that they want to change.

Interpersonal Effectiveness

How to ask for what they want and practice saying “no,” while maintaining their self-respect and relationships with others.

These DBT skills allow your child to effectively cope with and appropriately handle stressful situations rather than responding in a negative or self-destructive way, especially for those who may have a tendency to self-harm or who are suicidal.

Types of Dialectical Behavior Therapy Settings

When your child is undergoing DBT at Potomac Programs, they can expect to participate in three types of therapeutic settings:

DBT Individual Therapy

DBT Indiviual TherapyIndividual therapy consists of one-on-one treatment sessions between your child and a therapist and is focused on enhancing motivation, reviewing and working through issues your child experienced over the prior week, emphasizing problem-solving behavior and the application of DBT skills within their daily life. Additional areas of discussion may include learning how to address obstacles that might arise down the road and working toward ways to improve basic social skills and their life in general.

DBT Phone Coaching

DBT Phone CoachingPhone coaching allows your child to call their therapist in between individual therapy sessions to receive coaching at the times when they need help the most. Phone coaching is focused on providing in-the-moment coaching to assess the situation, identifying effective and feasible goals for coping with the moment, and making a plan on how to utilize the skills they’ve learned to navigate difficult situations that arise in their everyday lives.

DBT Skills Training Group Therapy

Family Group Dialectical Behavior Therapy (DBT) Session to Treat DepressionDBT skills training is typically delivered in a group format and is focused on enhancing your child's capabilities by teaching them behavioral skills. The group is run like a class where the group leader teaches the skills and assigns homework to your child to practice using the skills in their everyday lives.

The Effectiveness of Dialectical Behavior Therapy

According to the National Institutes of Health (NIH), DBT has been proven to be an effective treatment in controlled clinical trials, the most rigorous type of clinical research, and is known as the gold-standard first-line treatment for borderline personality disorder (BPD) today.

While the majority of research to date has focused on the effectiveness and success rates of DBT for people with borderline personality disorder (BPD) who struggle with thoughts of suicide and self-harm, research also suggests that DBT has also been successful in the treatment of many different conditions that involve difficulty regulating emotions, unstable relationships or impulsive behaviors including:

  • Depression
  • Anxiety
  • Substance Use
  • Self-Harm
  • Hopelessness
  • Anger Issues
  • Attention-Deficit / Hyperactivity (ADHD)
  • Post-Traumatic Stress (PTSD)

DBT can bring about improvement for preteens, teens and young adults who have complex and severe disorders that may seem hopeless and usually resist treatment. Evidence that DBT is helpful is seen in reduced suicidal and self-injury behavior, reduced hospital visits and inpatient stays, improved social functioning and in being less likely to drop out of treatment.

How to Tell if DBT is Right for Your Family

The best way to figure out which type of therapy treatment is best for your family is to talk with one of our mental health professionals. They will consider the symptoms, treatment history, and goals you outline for what you and your child want out of therapy to recommend the best next steps specific to your situation.

If you think DBT may be an effective treatment for your family, we'd like to invite you to contact us and speak with one of our DBT therapists at Potomac Programs.