DBT is a type of counseling that helps us learn how to seize the moment, cope more easily with stress, improve relationships, and regulate emotions. So, it is helpful for many of us create more stability in our lives. It was at first intended for those with borderline personality disorder (BPD). It later received modification for others who exhibit self-destructive behavior such as eating disorders or substance abuse. On occasion, it is used in treating post-traumatic stress disorder (PTSD).

This treatment was developed in the late 1980s and spearheaded by Dr. Marsha Linehan and colleagues. They saw that cognitive behavioral therapy (CBT) was not working as well as counselors had hoped for patients with BPD. So, Dr. Linehan and her team developed techniques and added treatment to meet the singular needs of these patients.

Dialectics – What is it?

Dialectics is the idea that everything is composed of opposites. It holds that change occurs when one opposing force is stronger than another. These are the three assumptions that make up the core of dialectics:

  1. All things are interconnected.
  2. Change is inevitable and constant.
  3. Opposites integrate to allow for a closer approximation of the truth.

Cognitive Behavioral Therapy (CBT) vs. Dialectical Behavior Therapy (DBT)

CBT helps us understand how thoughts, feelings, and behaviors influence each other. It starts with learning about mental illness or challenges and how the issues affect us. A patient treated by CBT is taught practices and skills, such as problem-solving or realistic-thinking. As a result, we can change our behaviors, feelings, and thoughts, and feel better day to day.

DBT is focused on the emotional and social aspects of life. DBT helps individuals regulate emotions and harmful behaviors. It is the collaboration between the patient and his or her DBT therapist that is most important. Dialectical behavior therapy may include one-on-one sessions with the practitioner and group sessions, as well. DBT is a form of “talk therapy,” so potential patients need to know that it will take time and effort to benefit from DBT. So, with the support of a therapists, patients will, in many cases, find new strategies and skills that will support them continually.

DBT’s Four Major Skills

The core skills that are strengthened by Dialectical Behavior Therapy are:

  • Distress tolerance
  • Emotional regulation
  • Mindfulness
  • Interpersonal effectiveness

Dr. Linehan called these four skills the “active ingredients” of DBT. We discuss them in more detail below:

Distress Tolerance

These tools include:

  • Finding ways to improve the moment despite any pain or difficulty
  • Distracting yourself until you are calm enough to deal with whatever issue you are facing
  • Comparing coping strategies by listing the pros and cons of the situation
  • Self-soothing by relaxing and allowing your senses to feel at peace

Emotional Regulation

This skill helps patients deal with emotional reactions before they lead to feelings of shame, guilt, depression, and worthlessness. So, in learning to regulate our emotions better, we can feel less negative toward ourselves. These are the skills learned during DBT sessions.


Mindfulness is being aware of and accepting what is occurring in the present moment. In the world of DBT, mindfulness is “what” and “how” questions including:

What are you focusing on at this moment (the present, separating emotions, your emotions, thoughts, and sensations, and more)?

How can you be more mindful (balancing your emotions with your rational thoughts, taking effective action, and more)?

Interpersonal Effectiveness

The skills that you receive from this ingredient are:

  • Learning how to ask for what you want
  • How to get what you want
  • Learning how to work through conflict and relationship challenges
  • Learning self-respect


OptiMindHealth clinicians are skilled in a variety of therapeutic treatment approaches, including CBT, and DBT. If you feel that you could benefit from DBT or general counseling with an OMH provider, we invite you to reach out by requesting an appointment or contacting our office for more information.