Everything You Need to Know About DBT
Table of Contents
What is dialectical behavior therapy (DBT)?
Dialectical behavior therapy (DBT) is a comprehensive, evidence-based treatment that helps individuals manage difficult emotions and develop behaviors that better support their overall well-being. Originally developed to help people facing intense emotional challenges, DBT has proven especially effective for treating eating disorders, mood disorders and anxiety.
A core piece of DBT is its focus on “dialectics” — the idea that two opposing truths can exist at the same time.
“An individual can feel ambivalent about changing behaviors and getting treatment while still working toward recovery,” explains Leslee Marcom, PhD, CEDS-C, regional clinical director at Eating Recovery Center and Pathlight Mood & Anxiety Center (ERC Pathlight).
DBT embraces these mixed feelings, helping individuals accept where they are while learning practical skills to respond positively to everyday situations.
The four main skills of DBT
The four main skills of DBT are mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness.
These DBT skills are typically taught in both group and individual therapy, giving people the chance to build and practice them in real-life situations.
“At ERC Pathlight, most programs have weekly DBT group therapy sessions focused on skill development, while individual sessions focus on individualized progress and applying these skills in everyday life,” Dr. Marcom explains.
Here, we focus on the four essential DBT skills.
1. Mindfulness
Mindfulness, a core DBT skill, teaches you to be fully present in each moment without judgment. It’s about slowing down and observing your thoughts, feelings and surroundings as they are without trying to change or label them as good or bad.
Mindfulness helps individuals develop two main types of skills:
- “What” skills:
- Observe without changing anything; just notice what’s happening.
- Describe experiences in words; label feelings or name sensations.
- Participate fully in an activity; give it your complete attention.
- “How” skills:
- Focus on one thing at a time, like breathing or listening.
- Notice things as they are without labeling them “good” or “bad.”
- Do what works best for the situation rather than reacting to immediate emotions.
Practicing these DBT mindfulness exercises can help you step out of negative thought patterns that create stress and emotional strain.
See how mindfulness skills can help to reduce perfectionism.
2. Distress tolerance
While mindfulness focuses on noticing and accepting the present, distress tolerance builds on that foundation to help you navigate difficult emotions and situations without making things worse.
There are three main types of DBT distress tolerance skills:
- Crisis survival skills: These help you handle intense emotional pain without escalating it.
- Consider the pros and cons of certain actions to decide if they are worthwhile.
- Create a list of enjoyable activities to shift your focus if you feel an emotional crisis coming on.
- Use your five senses to ground yourself in the present and reduce overwhelming feelings.
- Reality acceptance skills: These help you accept things as they are, even when difficult.
- Embrace reality instead of fighting it.
- Approach situations with flexibility, letting go of resistance.
- Act in ways that reflect your core values.
- Tolerance building skills: These help strengthen your ability to handle distress over time.
- Identify early signs of emotional overwhelm so you can use your skills before reaching a breaking point.
Distress tolerance skills and DBT grounding techniques help you calm yourself in tough situations and make it easier to avoid impulsive reactions when intense feelings like anxiety, fear or anger arise.
Join us for a moment of grounding with our four square breathing exercise.
3. Emotion regulation
Emotion regulation helps you understand, accept and effectively respond to your emotions. It’s about recognizing why you feel a certain way and taking steps to keep those feelings from disrupting your day or your goals.
Key DBT emotion regulation skills include:
- Recognizing emotions: Naming primary and secondary emotions helps you understand what you’re feeling and where those feelings might be coming from.
- Building emotional resilience: Taking care of basic needs like sleep, nutrition and stress management reduces the intensity of tough emotions and makes them easier to handle.
- Practicing self-validation: Accepting your emotions without judgment allows you to experience them fully without feeling overwhelmed, so you can choose how to respond.
- Balancing emotional urges: Channeling emotions like anger or anxiety in a way that is more productive than reactive leads to more consistent regulation.
- Learning how to STOP: The stop skill in DBT encourages you to stop what you’re doing, take a step back, observe the situation and proceed more mindfully.
When you’re able to identify and understand your emotions, it’s easier to feel steady and less reactive to sudden mood changes. These DBT coping skills help you stay mindful of what you’re feeling and offer practical ways to shift out of emotions that might be holding you back.
Find more practical eating disorder coping skills here.
4. Interpersonal effectiveness
Interpersonal effectiveness helps you build and maintain relationships while staying true to yourself. This set of skills helps you communicate confidently, set boundaries that feel right and handle conflicts in a way that respects both your needs and those of others.
Interpersonal effectiveness skills that are emphasized in DBT include:
- Assertive communication: Learning how to share what you need or feel in a direct, respectful way that doesn’t come off as aggressive or passive.
- Mindful listening and validation: Learning to fully hear someone and acknowledge their feelings to build trust and mutual respect.
- Boundary setting: Understanding and communicating your expectations and limits within relationships.
- Conflict navigation: Handling disagreements in ways that reduce tension and encourage understanding.
These skills aren’t just about what to say or do — they’re about handling challenging interactions in ways that build stronger connections and deeper self-respect.
Challenges in learning DBT skills
Mastering DBT skills takes time and practice. “Early on, individuals may struggle to understand the concepts, and it can take reviewing the material in groups and with their therapist more than once to fully grasp them,” explains Dr. Marcom.
“The process of engaging in DBT can bring up strong, uncomfortable emotions, and patients are asked to manage those emotions in new ways through skill practice,” Dr. Marcom adds. “For DBT to be effective, individuals need to practice the skills outside of group and individual therapy sessions, which can be difficult to do at first.”
The most effective way to help people work through challenges in DBT is with a consistent, validating approach. “It is imperative that therapists understand each individual’s perspective and validate their struggles. Their emotion dysregulation, thoughts and feelings are all valid,” says Dr. Marcom. This ensures individuals feel seen and understood, making it easier for them to make meaningful changes and create the life they want.
DBT for eating disorders
With its focus on helping people manage emotions and reduce harmful behaviors, DBT has proven effective for those facing many different challenges.
“There is often ambivalence when someone with an eating disorder decides to seek treatment,” explains Dr. Marcom. “The challenge they often face is that they will need to learn skills and strategies to work toward acceptance and acknowledgement of that ambivalence, while simultaneously implementing change. They can have ambivalence about getting better while still working toward recovery.”
And that’s not all. “The focus on skill development is especially helpful for those with eating disorders in higher levels of care, where there’s less opportunity to rely on old coping strategies, making it essential to build more effective ones,” Dr. Marcom adds.
See how DBT supports eating disorder recovery.
DBT for depression and anxiety
DBT is equally beneficial for mood and anxiety disorders, teaching practical skills for handling emotional highs and lows. This empowers individuals to develop the tools they need to navigate their everyday experiences with greater confidence.
See how DBT supports mood and anxiety recovery.
Creating meaningful change with DBT
Whether you or a loved one is navigating an eating disorder, a mood disorder or anxiety, DBT can help you build valuable skills that make everyday life feel more manageable. With programs for adults and adolescents of all genders, ERC Pathlight offers support that meets you exactly where you are.
“Therapists help individuals understand the ‘why’ behind what they are doing, saying, thinking and feeling to identify what is contributing to behaviors and how to do things differently next time,” explains Dr. Marcom.
If you have noticed that intense emotions are impacting your daily life and are curious if DBT can help, call us at (866) 622-5914 or reach out for a free assessment today. We’ll listen to what you’re going through and guide you to the care you need to heal. It just takes one call to get started.
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