What is DBT?

Dialectical Behavior Therapy (DBT) is a specialized form of cognitive behavioral therapy (CBT) developed to help people manage overwhelming emotions, cope with distress, reduce emotionally reactive behavior, and improve interpersonal relationships. DBT was initially designed to treat borderline personality disorder (BPD), a condition marked by emotional instability and intense interpersonal conflicts. Since then, DBT has been successfully adapted to treat a wide range of mental health conditions, including depression, anxiety, PTSD, eating disorders, and substance use disorders.

The "dialectical" in DBT refers to the integration of two seemingly opposite concepts: acceptance and change. In DBT, clients are taught to accept themselves and their experiences as they are while also learning strategies to make positive changes. This balance lies at the heart of DBT and is a key reason for its effectiveness with individuals who experience strong emotional reactions and struggle with behavioral control.

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How Does DBT Work?

DBT is a structured, skills-based therapy grounded in behavioral science, mindfulness practice, and the principle of dialectics—the balance between acceptance and change. Rather than offering open-ended talk therapy, DBT is highly practical and theory-driven. It teaches clients specific tools over four core areas—mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness—to navigate emotional intensity, improve relationships, and build a more stable, values-aligned life.

Treatment follows a clear framework: clients identify target behaviors, build insight into emotional and cognitive patterns, and practice new responses through weekly assignments and real-life application. The emphasis is on building mastery over time, with each skill set intentionally sequenced to support the next.

Clients work collaboratively with their therapist to identify patterns that are causing distress and develop strategies to respond more effectively. DBT sessions emphasize active learning—whether that’s through practicing mindfulness, applying skills in high-stress situations, or reflecting on what worked (and what didn’t) between sessions.

At its core, DBT rests on the belief that people are doing the best they can and can learn to do better with the right tools and support. This ethos—compassionate, nonjudgmental, and change-oriented—runs through every part of the therapy process.

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What to Expect in DBT Treatment

Starting DBT involves an initial phase where you and your therapist establish treatment goals and identify specific problem behaviors to target. From there, you'll begin learning DBT skills and how to effectively apply them. Treatment typically starts with mindfulness skills, which helps you slow down, become more aware and focused, and build greater acceptance, setting the foundation to learn and apply other DBT skills.

Sessions are structured and goal-oriented, often involving worksheets, exercises, and homework. You might keep a daily diary card to track emotions, urges, behaviors, and skill use. Over time, these patterns help guide therapy and illuminate areas where progress is being made, or where additional support is needed.

DBT treatment is collaborative, meaning your therapist will work with you, not just tell you what to do. You’ll be encouraged to explore what’s meaningful to you and how to apply DBT tools in a way that fits your life.

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Comprehensive DBT vs. DBT-Informed Therapy

Not all DBT is delivered in the same format, and understanding the difference between Comprehensive DBT and DBT-Informed Therapy can help you choose the right path for your needs.

At CBTAA, we currently provide DBT-Informed Therapy, which integrates the most effective components of DBT into individual sessions. Many clients find that DBT-informed care gives them the skills, structure, and support they need.

Comprehensive DBT

Comprehensive DBT offers a highly structured and coordinated approach to treatment, combining multiple components of care into an integrated system. Each element is designed to reinforce the others, providing clients with consistent support, skill development, and opportunities to apply what they’re learning in real time. This framework helps ensure that therapy is not only effective in-session, but also translates into meaningful change outside of it. This model includes:

• Weekly individual DBT therapy sessions where clients work one-on-one with a trained therapist to address personal goals, apply DBT skills to daily life, target problematic behaviors using a treatment hierarchy, and build a strong therapeutic alliance.
  
  
• Weekly skills group where clients learn and practice DBT skills across four key modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. These groups follow a structured curriculum that helps clients learn, practice, and build a solid foundation of coping skills—with the added benefit of a supportive peer environment.
  
  
• Phone coaching, which allows clients to contact their therapist between sessions for in-the-moment support when they may feel overwhelmed or uncertain about how to respond. This aspect of DBT helps bridge the gap between learning skills in therapy and applying them during emotionally charged moments.
  
  
• A consultation team for DBT therapists, providing ongoing peer support and accountability to ensure therapists stay grounded and effective, and maintain fidelity to the treatment model.

Comprehensive DBT is especially helpful for individuals struggling with chronic emotional dysregulation, anger, impulsivity, or unstable relationships. It is also well suited for those with borderline personality disorder, chronic suicidal ideation, self-harming behaviors, or those who have found other treatments ineffective. Although Comprehensive DBT requires a significant commitment of both time and effort, it offers an extensive and supportive framework for building lasting, meaningful change.

DBT-Informed Therapy

DBT-Informed Therapy draws on the core principles and skills of DBT, without requiring participation in the full program. At CBTAA, we incorporate DBT skills and strategies into individual therapy in a way that’s tailored to your specific goals and needs.

This may look like:

• Focusing individual sessions on one or more of the DBT skill modules (such as mindfulness or emotion regulation).
• Drawing from the broader DBT framework—including key principles like acceptance and change, and core skills for managing emotions, relationships, and distress—even when sessions don’t follow a structured skills module.
  
  
• Integrating DBT tools as an adjunct to other therapy modalities, like Cognitive Behavioral Therapy (CBT) or Acceptance and Commitment Therapy (ACT).
  
  
• Applying DBT concepts to help manage emotional intensity, tolerate distress, or navigate difficult relationships, even if those aren’t the primary concerns bringing someone to therapy.

DBT-Informed Therapy can be a great fit for clients who want to build specific skills or who may benefit from DBT’s skills, structure, or concepts, but don’t need (or aren’t ready for) the full comprehensive model. It’s also well-suited for individuals who are already engaged in other types of therapy but want to incorporate DBT techniques into their care.

While it’s not a replacement for Comprehensive DBT in high-risk cases, DBT-informed therapy can be incredibly effective for managing intense emotions, improving self-awareness, and fostering growth.

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Key DBT Skill Areas

DBT includes four core skill areas, which are taught in a structured sequence, allowing clients to gradually build on each set of skills as they progress through the program.

Mindfulness

Mindfulness is the foundation of DBT. It involves learning to observe your thoughts, feelings, and environment without judgment. With mindfulness, you become more aware of what’s happening in the present moment, making it easier to respond thoughtfully rather than react impulsively. This increased awareness can help reduce emotional reactivity, clarify thinking, and improve decision-making. Mindfulness is a practice that is developed over time and is essential to the effectiveness of the other DBT skills.

Distress Tolerance

Distress tolerance focuses on helping you get through difficult moments without making things worse. These skills teach you how to tolerate emotional pain or discomfort using strategies such as healthy distraction, self-soothing, and radical acceptance. Radical acceptance means recognizing that some things are outside of your control and choosing to accept reality as it is rather than fighting against it. Developing distress tolerance allows you to ride out emotional waves more safely and with less disruption to your life.

Emotion Regulation

Emotion regulation involves understanding your emotional experiences and learning how to influence them in healthy ways. These skills help reduce emotional vulnerability and intensity while increasing the likelihood of experiencing positive emotions. Emotion regulation skills teach you how to identify what you’re feeling, where those feelings come from, and how to manage them effectively. This leads to better emotional stability, resilience, and confidence in your ability to handle life’s ups and downs.

Interpersonal Effectiveness

Interpersonal effectiveness helps you navigate relationships and increase interpersonal skills. Whether you're asking for what you need, setting boundaries, or managing conflict, these skills are essential for maintaining healthy, respectful, and reciprocal connections with others. You’ll learn how to be assertive without being aggressive, how to preserve your self-respect, and how to strengthen your communication so that your needs are more likely to be met. These skills are especially useful in personal and professional relationships where clarity and confidence are key.

Each skill area contains a variety of specific techniques, and clients are encouraged to repeat the lessons that are most helpful to them. Over time, consistent practice leads to greater self-control, resilience, and emotional balance.

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When Should I Seek DBT Therapy?

You might consider DBT if you frequently feel overwhelmed by your emotions, struggle with impulse control, or find yourself caught in destructive relationship patterns. DBT is often recommended for individuals who experience intense mood swings, chronic feelings of emptiness, or difficulty managing anger. If you’ve been diagnosed with borderline personality disorder—or are dealing with symptoms of anxiety, depression, PTSD, or self-harming behavior—DBT may offer meaningful relief.

Even if you don’t have a formal diagnosis, DBT can help if you want to improve emotional balance, reduce reactivity, or gain better control over how you respond to stress. This therapy is especially useful when other approaches haven’t led to the changes you’re seeking. Many people find that DBT’s structured skills and emphasis on validation create a sense of empowerment and direction that has been missing in past therapeutic experiences.

DBT is appropriate for both adolescents and adults, and can be adapted to fit individual, group, or family therapy formats. Whether you're working through long-standing emotional challenges or simply want new strategies to manage life more effectively, DBT provides a toolkit for change rooted in compassion, practice, and self-awareness.

How Long Does DBT Therapy Take?

The length of DBT treatment depends on your individual needs and goals. In a Comprehensive DBT program, group skills training typically takes place once a week for about six months, covering the four core modules, and is then usually repeated for another six months to support deeper learning. Individual therapy runs alongside groups and may extend beyond a year, especially when addressing chronic or high-risk concerns. While some clients begin to notice positive shifts within a few months, particularly when they practice skills regularly, DBT is most effective when approached as a long-term commitment.

In DBT-informed therapy, the timeline is more flexible. Some clients focus on a specific issue or skill set and can begin noticing initial benefits after a few weeks, with meaningful progress in just a few months. Others continue therapy over a longer period, integrating DBT tools into broader work on relationships, mood regulation, or life transitions. Your therapist will collaborate with you to create a treatment plan that aligns with your goals, capacity, and pace—whether you're building foundational skills or working toward deeper emotional growth.

DBT vs. CBT: What’s the Difference?

While both DBT and CBT are evidence-based therapies, they differ in several key ways. CBT focuses primarily on identifying and changing negative thought and behavior patterns. It’s highly effective for treating anxiety, depression, ADHD, and most other common mental health issues. The goal in CBT is to recognize distortions in thinking and reframe them in a more balanced way, while also developing healthier behaviors by reducing avoidance and reinforcing effective, goal-directed activities.

DBT builds on these ideas by integrating the concepts of acceptance and mindfulness. DBT encourages clients to acknowledge their experiences as valid and understandable, even if change is still needed. This can be especially powerful for people who have felt dismissed or misunderstood in other therapeutic settings. Additionally, DBT places greater emphasis on helping clients navigate intense emotions, strengthen distress tolerance, and improve how they relate to others—particularly in high-stress or high-conflict situations.

In addition to individual sessions, Comprehensive DBT includes group skills training and access to phone coaching, which makes it more intensive and holistic than traditional CBT. It’s particularly well-suited for people dealing with emotional dysregulation, relationship challenges, or impulsive behaviors.

How Do I Find a Dialectical Behavior Therapist Near Me?

Finding a qualified DBT therapist starts with identifying professionals who are trained in the full DBT model, not just elements of it. For comprehensive DBT, look for licensed clinicians who offer individual therapy, skills group sessions, phone coaching, and who follow a structured DBT protocol.

At CBTAA, we offer in-person DBT therapy in New York City, New York, New Jersey, and Connecticut, along with HIPAA-compliant virtual sessions for clients seeking flexibility. Our therapists are highly trained and experienced in helping clients navigate complex emotional and behavioral challenges using the DBT framework.

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Get Started with CBTAA

At CBTAA, we don’t just practice CBT—we set the standard. Every clinician on our team is committed to evidence-based care and trained in CBT or CBT-based therapies like DBT and ACT. With regular tape reviews, supervision by master clinicians, and collaborative consultation groups, our therapists continuously refine their expertise—so you receive the most effective, research-backed care available.

We believe therapy should lead to real, lasting change. That’s why we focus on outcomes, not just sessions. You’ll work with a highly relatable therapist who’s dedicated to helping you get better, and who never stops learning. From the moment you reach out, you’ll benefit from the strength of our entire clinical team and our shared commitment to helping you grow.

Let us help you build the life you want with clarity, connection, and the tools that actually work. To get started, schedule a free 15-minute consultation with one of our Clinician Coordinators.