Dialectical behavior therapy is a therapeutic approach designed for people with intense emotions. Participants learn mindfulness skills to help them become more aware and accepting of their emotions. A DBT program may be helpful for adolescents or adults with anxiety, depression, eating disorders, post-traumatic stress disorder (PTSD), and other mental health conditions. This guide to finding a DBT therapist contains more information about dialectical behavior therapy, along with tips on finding a qualified therapist.
Dialectical behavior therapy is a type of psychotherapy, or talk therapy, used to help people manage intense emotions.(1) Talk therapy is one of the most common tools used in psychology, as it helps participants identify troubling thoughts, emotions, and behaviors.(2) Individuals involved in this type of therapy work to change how they feel about themselves and interact with others, making talk therapy a valuable tool for improving self-esteem and relationships. DBT is based on the practice of cognitive-behavioral therapy, which helps people recognize faulty ways of thinking and learn appropriate coping skills.
DBT may consist of the following elements:
The first step to succeeding with dialectical behavior therapy is to find an experienced DBT therapy provider. Forming a good relationship with a DBT therapist makes it easier to agree on treatment goals.(4) Because choosing a therapist is an important decision, adolescents and adults in need of mental health treatment should research each provider carefully before committing to a consultation. Following these steps makes it easier to find the best therapist.
DBT isn’t appropriate for every person, but it may help individuals with depression, anxiety, PTSD, and other conditions that interfere with the ability to regulate emotions. Before scheduling an appointment, it’s important to narrow down the type of mental health support needed, as some therapists have more experience treating certain conditions than other therapists do.
DBT has been shown to help individuals with treatment-resistant major depressive disorder, commonly known as depression.(5) Researchers believe this type of therapy is effective because it helps participants become more skilled at expressing their emotions, managing intense emotions appropriately, and accepting intense emotions. DBT treatment for depression may also help reduce depression symptoms. These symptoms include persistent sadness, appetite changes, sleep problems, difficulty concentrating, and feelings of worthlessness.
Individuals with anxiety often feel tense, nervous, or “on edge.”(6) These emotions are difficult to manage, especially for people who struggle to identify their feelings or accept them as a natural part of life. DBT treatment for anxiety may be helpful if it includes mindfulness training, as mindfulness skills have been shown to help individuals with generalized anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), and PTSD.(7) With lower levels of anxiety, an individual finds it easier to function at work, at school, and at home, leaving them feeling more confident in their ability to cope with stressful circumstances.
DBT was designed specifically to help people with borderline personality disorder (BPD). The reason it’s such an effective form of BPD treatment is that people with BPD often experience intense emotions that are difficult to manage. For example, people with this mental health condition often worry that their family members or friends are going to abandon them, causing them to feel intense anxiety.(8) DBT for borderline personality disorder helps individuals learn how to replace negative behaviors with more appropriate coping skills.
Some people develop PTSD after witnessing or experiencing a traumatic event. This type of event is usually dangerous or shocking, as is the case with witnessing a homicide or experiencing a sexual assault. DBT isn’t suitable for every individual with PTSD, but it may help individuals with complex PTSD learn to better regulate their emotions.(9) As a result, DBT for post-traumatic stress disorder has the potential to improve daily functioning for people who’ve experienced significant trauma.
The reason DBT is appropriate for some people with PTSD is that PTSD often causes intense emotions, especially during flashbacks. Because DBT helps people learn to manage intense emotions, it can help prevent PTSD from damaging personal relationships.
Individuals with eating disorders tend to develop strong emotions around food, weight, and eating. Many of them suppress their emotions or aren’t even aware of those emotions, making it more difficult to function.(10) DBT may be effective in helping individuals with eating disorders improve their emotional awareness and develop the skills necessary to accept their emotions instead of suppressing them.(11) This type of therapy also helps people with eating disorders increase their interpersonal effectiveness and improve their distress tolerance.
Substance abuse often goes hand in hand with other mental health conditions, as some people use drugs or alcohol to cope with their symptoms. DBT may be helpful for individuals with co-occurring disorders or for people who haven’t responded to other treatment options for substance abuse. The term “co-occurring disorder” refers to the presence of a substance use disorder with at least one other mental health condition. For example, an individual may have alcohol use disorder paired with PTSD or generalized anxiety disorder paired with marijuana use.
When used with people who have substance use disorders, DBT promotes abstinence by helping each client set attainable goals. Instead of asking the client to commit to a lifetime of sobriety, for example, the therapist may ask them to commit to just 5 days without using substances.(12) These intermediate goals are a lot more manageable for people who are recovering from substance abuse and other mental health disorders.
Suicidal ideation is a broad term that relates to thoughts of suicide and death.(13) When used with adolescents, DBT has been shown to reduce incidents of self-harm, including repeat suicide attempts.(13) Having the opportunity to meet with a therapist may also help individuals with suicidal thoughts learn how to cope with depression, anxiety, and other mental health issues.
Many other types of therapy focus on reducing suicidal thoughts by treating underlying mental health conditions. For example, therapists often focus on treating the feelings of hopelessness and sadness associated with depression. Treating these symptoms may reduce suicidal thoughts and other concerning behaviors. DBT is different. Instead of focusing on the underlying condition, a DBT therapist addresses suicidal thoughts directly. DBT therapists also receive specialized training to help them assess the risk of suicide in each patient and respond appropriately.
Individuals with attention-deficit hyperactivity disorder (ADHD) may have symptoms of hyperactivity, inattention, or both. These symptoms can interfere with an individual’s ability to succeed in school, at work, or in personal relationships, making it important to seek treatment. DBT treatment for ADHD is effective for some people, as it helps participants develop mindfulness skills and other self-soothing mechanisms.(15) These mechanisms can be helpful for managing ADHD symptoms.
Many DBT programs take place in person, which means the client needs to come to an office and meet with the provider. Since the COVID-19 pandemic began, however, many providers have started offering online therapy for DBT. When compared to in-person therapy for DBT, online treatment has about the same level of effectiveness. Participants are also more likely to attend online sessions, which may improve treatment outcomes.(16)
Office therapy for DBT is highly effective, as it gives the therapist the opportunity to observe each client’s hand gestures, facial expressions, and other forms of body language. This may provide insight into how a client is feeling, providing a strong foundation for individual DBT therapy. Going to an office has the added benefit of allowing the individual to get out of their usual environment, which may help them gain more insight into their emotions. Some people also feel more comfortable opening up to a DBT-trained therapist if they don’t have to worry about family members or neighbors hearing what they say.
As noted previously, some individuals are more likely to attend online sessions than in-person sessions, which may improve their treatment outcomes. Another advantage of online therapy is that it’s easy to schedule an appointment and connect with a provider. Some popular online therapy providers include BetterHelp, Talkspace, Calmerry, Amwell, and Cerebral. Participants don’t have to worry about driving to an office or looking for a place to park every time they want to discuss their emotions. If an individual needs more intensive care, they’re also more likely to seek in-person therapy once they’ve tried online therapy, making online DBT a good introduction to working with a mental health professional.(17)
The next step is to use online therapy directories and databases to find a local DBT provider. Many people start with general search engines, but it’s better to use a directory of DBT programs in a specific country or city.
Directory listings typically contain provider names, physical addresses, telephone numbers, website addresses, and professional credentials. Many directories also have a short blurb explaining how each therapist approaches their relationships with clients.
Now, it’s time to schedule an appointment with a DBT therapist. During the first session, a provider usually asks questions to determine if DBT is a good fit for the client’s needs. A therapist also uses this initial consultation to gather information about the individual’s medical and mental health history. If the client decides to continue with DBT therapy, they’ll have additional opportunities to discuss their concerns, work on becoming more assertive, and change how they manage intense emotions.
DBT therapy usually lasts for 6 to 12 months, but the exact length of time depends on how well the individual responds. Mental health conditions are complex, and some conditions require more intensive treatment than others. Adolescents may also respond differently than adults, so the length of a DBT program also depends on the individual’s age. Therapists usually meet with each client once per week for 40 to 60 minutes.
DBT programs have many benefits for participants, including improved relationships. In fact, researchers have found that participating in DBT therapy is a good way to reduce marital distress when a spouse has trouble regulating their emotions.(18) Emotional dysregulation is stressful, as it increases conflict and makes it difficult for couples to work through their problems. Working with a DBT provider makes it easier to manage intense emotions, relieving some of this stress.
DBT also helps participants increase their self-respect, as they learn to identify and respect their own values. Mindfulness training and other aspects of DBT allow individuals to live on their own terms, making it easier to manage strong emotions and interact with other people appropriately.
Finally, DBT helps improve some of the symptoms of depression, anxiety, and other mental health conditions. For example, people who receive DBT as part of an inpatient treatment program need fewer days of hospitalization. This type of therapy also improves depressive symptoms, reduces self-harm behaviors, and leads to lower levels of drug and alcohol use.
