What is dialectical behavior therapy?

Dialectical behavior therapy (DBT) is a type of cognitive-behavioral therapy developed by psychologist Marsha Linehan in the late 1980s.

It was specifically designed to treat people with borderline personality disorder (BPD), particularly those struggling with chronic suicidal thoughts.

Over time, though, DBT has been adapted to help with other mental health issues like depression, anxiety, PTSD, and eating disorders.

At its core, DBT is about finding a balance between acceptance and change, that’s the “dialectical” part.

It teaches people to accept themselves and their emotions as they are, while also working to change behaviors that are harmful or unhelpful.

It’s not about forcing positivity or ignoring pain; it’s about learning to manage intense emotions without self-destruction.

What’s the goal of dialectical behavior therapy?

DBT has one main goal: to help people build a life they feel is worth living, even in the face of intense emotional pain.

Those key goals can be broken down into a few pillars:

1. Mindfulness
   • Being fully present in the moment without judgment.
   • Helps people observe and experience their thoughts and feelings without getting flooded by them.
2. Distress tolerance
   • Building skills to tolerate pain and crises without making things worse (like self-harming, drinking, or lashing out).
   • It aims to establish coping strategies, such as distraction, self-soothing, and radical acceptance.
3. Emotion regulation
   • Learning to understand, name, and manage strong emotions.
   • Techniques include recognizing triggers, increasing positive emotions, and shrinking emotional vulnerability.
4. Interpersonal effectiveness
   • Teaching how to communicate needs, set boundaries, and maintain relationships while still respecting oneself and others.
   • It’s about assertiveness, negotiating, and saying “no” in a healthy way.

What makes DBT unique is the word “dialectical.” It’s about balancing two seemingly opposite ideas: acceptance and change.

Clients are persuaded to accept themselves as they are while also working hard to change behaviors that aren’t helping in DBT.

Why is dialectical behavior therapy effective in treating depression?

It helps treat depression because it tackles essential issues that often keep people stuck in depressive cycles, such as intense emotions, hopelessness, poor coping skills, and relationship struggles.

1. It builds emotional regulation skills

People with depression often experience overbearing negative emotions like sadness, guilt, shame, or anger.

DBT teaches how to recognize, label, and manage these feelings without being swept away by them.

Studies disclose that emotional dysregulation is a major predictor of depression severity, which DBT targets.

2. It improves distress tolerance

Depression can make even minor stressors feel insufferable.

DBT’s distress tolerance skills help individuals get through painful moments without making things worse.

This can prevent the spiral where one bad day triggers a much longer depressive episode.

3. It promotes active problem-solving instead of avoidance

DBT encourages a focus on “what can I do about this?” rather than sinking into helplessness.

People struggling with psychological difficulties often use avoidance as a coping strategy, which research shows worsens depressive symptoms over time.

DBT teaches action-based coping, like opposite action, to break that harmful pattern.

4. It cultivates mindfulness and self-awareness
   
   

Mindfulness is about noticing thoughts and emotions without judgment.

Depression often involves rumination, getting stuck replaying negative thoughts.

Mindfulness interrupts that loop by assisting people to observe their minds without getting trapped in it.

Studies like Hofmann et al. (2010) show that mindfulness-based techniques substantially lower depressive symptoms.

5. It helps repair relationships

Social isolation is both a cause and a consequence of depression.

DBT’s interpersonal effectiveness skills teach how to ask for support, set boundaries, and resolve conflicts, helping rebuild meaningful connections.

A solid social support system is a powerful protective factor against depression.

6. It balances acceptance and change

A lot of therapies concentrate on “fixing” symptoms, but DBT also emphasizes accepting where you are right now, even if it’s painful.

This balance prevents people from feeling like they’re constantly failing at getting better.

How effective is dialectical behavior therapy in treating depression?

It’s quite effective for treating depression, especially when depression is chronic, treatment-resistant, or combined with other issues like emotional dysregulation or suicidal ideation.

1. General effectiveness

Several studies show DBT extensively improves depressive symptoms:

• • Harley et al. (2008) discovered that adults with treatment-resistant depression who completed DBT reported substantial decreases in depression scores compared to those who didn’t.
  • In a meta-analysis by Kliem et al. (2010), DBT was associated with moderate to large reductions in depressive symptoms across multiple clinical groups, not just those with borderline personality disorder.

2. For treatment-resistant depression

DBT has been useful where other treatments failed.

• • Lynch et al. (2007) studied older adults with chronic depression and found that a modified version of DBT (DBT for depression) led to greater improvement compared to treatment-as-usual, including in hopelessness and self-harm risk.

This is important because around one-third of people with major depression don’t fully respond to traditional treatments like medication or standard CBT alone.

3. Impact on suicidality

DBT’s focus on suicidality makes it greatly relevant, since many people with depression experience suicidal thoughts.

It’s one of the few therapies proven to directly reduce suicide attempts.

4. Why it’s useful for depression

• • It directly addresses emotional suffering rather than just cognitive distortions.
  • It educates coping skills that people can apply immediately in daily life.
  • It combines acceptance strategies (like radical acceptance) with change strategies (like behavioral activation), which seems to work better for complex cases than pure “fix it” approaches.

Some additional numbers:

• • Depression scores often drop by about 30%–50% following a full DBT program, depending on the severity and specific group studied.

DBT isn’t the first-line treatment for mild to moderate depression (like CBT is usually recommended first).

But DBT can be a game-changer for those with chronic, severe, emotionally intense, or treatment-resistant depression.

What disorders and problems can dialectical behavior therapy help with?

Research has shown it helps with a wide range of mental health problems, notably those involving emotional dysregulation, self-destructive behaviors, and interpersonal difficulties.

1. Borderline personality disorder (BPD)

• • DBT is considered the gold standard for BPD treatment.
  • It lowers self-harm, suicidal behavior, emotional instability, and relationship chaos.

2. Depression

• • Very helpful for chronic, treatment-resistant, or emotionally intense
  • Assists with hopelessness, suicidal thoughts, and emotional numbness.

3. Anxiety disorders

• • Including generalized anxiety disorder (GAD), social anxiety, and panic disorder.
  • DBT teaches distress tolerance and emotion regulation, both crucial for managing anxiety.

4. Post-traumatic stress disorder (PTSD)
   
   

• • Especially for complex PTSD (C-PTSD) linked to ongoing emotional dysregulation.
  • DBT aids in regulating intense emotions and building coping skills before trauma processing.

5. Eating disorders
   

• • Mostly binge eating disorder and bulimia nervosa.
  • DBT eases bingeing and purging behaviors by targeting emotional eating patterns.

6. Substance use disorders

• • DBT for substance abuse (DBT-SUD) integrates addiction-specific strategies with standard DBT.
  • Makes it easier to stay sober by managing cravings, triggers, and emotional pain without using substances.

7. Self-harm and suicidal behavior
   
   

• • Even without a full BPD diagnosis, DBT is highly effective at reducing non-suicidal self-injury (NSSI) and suicide attempts.

8. Bipolar disorder

• • While DBT isn’t a primary treatment, it’s used as an adjunct to help people manage emotional swings, impulsiveness, and relationship issues.

9. Attention-deficit/hyperactivity disorder (ADHD) in adults

• • DBT has been adapted to help adults with ADHD improve emotional regulation, time management, and impulsivity.

10. Problems related to emotional dysregulation

Even outside formal diagnoses, DBT is useful for:

• • Anger issues.
  • Chronic feelings of emptiness.
  • Interpersonal chaos.
  • Difficulty tolerating distress.
  • Impulsivity and risky behavior.

The main structure (skills training, individual therapy, phone coaching, and therapist consultation) usually stays the same, but the attention and abilities emphasized might shift.

How does dialectical behavior therapy work?

Dialectical behavior therapy works by teaching people skills to manage extreme emotions, tolerate trouble, navigate relationships better, and become more mindful, all while balancing acceptance and change.

1. Structure of DBT

DBT typically includes four parts:

• • Individual therapy
    
    

Weekly one-on-one sessions focus on solving problems and applying DBT skills to real-life issues, such as self-harm, suicidal thoughts, or dangerous behaviors.

• • Group skills training

Clients attend weekly groups (like a class) to learn and practice the four core DBT skill sets:

• • • Mindfulness.
    • Emotion regulation.
    • Distress tolerance.
    • Interpersonal effectiveness.

• • Phone coaching

Clients can reach out to their therapist between sessions (within set boundaries) to get assistance using skills in real-time when a crisis happens.

• • Therapist consultation team

Counselors meet weekly with other DBT providers to support each other and stay on track, because DBT is intensive and emotionally heavy work.

2. Core concepts that make DBT work

• • Dialectics

The central idea is that two seemingly opposite things can both be true at the same time:

➔ “I am doing the best I can,” AND “I need to try harder.”

DBT aids in stopping seeing everything in black-and-white (all good/all bad) and finding the middle ground, a crucial step for emotional healing.

• • Validation
    
    

Psychotherapists validate that a client’s feelings make sense given their personal experiences.

Confirmation diminishes shame and defensiveness, making clients more open to changing harmful behaviors.

• • Behavioral change

DBT uses techniques from behavioral therapy (like reinforcement and exposure) to build healthier behaviors and reduce destructive ones.

3. The four core skill modules

Each skill module targets a different area of difficulty:

• • Mindfulness

Learning to be present, aware of thoughts and feelings without judgment.

Example: Noticing you’re feeling sad without getting swept away into despair.

• • Distress tolerance
    
    

Learning to survive crises without making things worse.

Example: Using cold water splashing, deep breathing, or grounding techniques instead of self-harming.

• • Emotion regulation

Understanding and managing emotional reactions more effectively.

Example: Recognizing when you’re vulnerable to emotional exhaustion and using skills to balance yourself.

• • Interpersonal effectiveness

Communicating needs, setting boundaries, and maintaining healthy relationships.

Example: Asking for help without guilt or saying “no” respectfully.

4. Stages of treatment

DBT moves through four stages depending on a client’s needs:

• • Stage 1: Stabilization

Aim to get dangerous behaviors (like self-harm, suicide attempts, substance abuse) under control.

• • Stage 2: Emotional processing
    

Deal with past trauma, emotional pain, and ongoing emotional suffering.

• • Stage 3: Building a life worth living

Concentrate on improving relationships, career, self-esteem, and goals.

• • Stage 4 (optional): Transcendence

For those who want to pursue deeper meaning and spiritual growth after becoming stable.

5. Scientific backing

DBT has been shown to radically decrease:

• • Suicide attempts.
  • Self-harming behaviors.
  • Depression and anxiety symptoms.
  • Hospitalizations.
  • Relationship problems.

Meta-analyses confirm that DBT is effective across many populations, not just people with BPD.

Who is a good candidate for dialectical behavior therapy?

A good candidate is typically someone who struggles with emotional intensity, self-destructive behaviors, or unstable relationships, and who needs practical skills to manage life better.

• You might be a good fit for DBT if:

• • You feel emotions intensely and quickly

DBT’s emotional regulation skills could be life-changing if you regularly feel like your emotions are consuming, come out of nowhere, and take forever to calm down.

• • You engage in self-harm, suicidal behaviors, or impulsive actions

DBT was specifically designed to shrink these high-risk behaviors by concentrating on keeping you safe first and then on long-term healing.

• • Your relationships are chaotic or painful

DBT’s interpersonal effectiveness skills can help a lot if you find yourself stuck in patterns of push-pull relationships, fear of abandonment, or frequent conflicts.

• • You experience chronic feelings of emptiness, anger, or self-hatred
    
    

DBT teaches acceptance skills to validate these feelings while working toward healthier emotional patterns.

• • You’ve tried other therapies (like CBT) and they didn’t fully work

DBT’s action-focused approach might be a better match if traditional talk therapy helped your thoughts a little but not your emotions or behaviors.

• • You struggle with black-and-white thinking

For example, (“I’m either a total failure or a complete success.”)

DBT’s emphasis on dialectics and finding the middle path directly addresses this.

• Signs DBT might be right for you:

• • You need concrete tools and skills

DBT isn’t just talking about your problems. It’s learning skills you practice every day.

• • You’re willing to work hard between sessions
    
    

DBT requires homework, like filling out diary cards or practicing mindfulness exercises.

• • You can commit to showing up regularly

DBT often asks for a serious time commitment: weekly individual sessions, weekly group sessions, and sometimes phone coaching.

• • You want a balance between acceptance and change

DBT offers a unique balance if you feel exhausted from constantly being told to “just change” or “just accept it”:

• • • You are valid as you are.
    • And you can work to change what’s hurting you.
    • Questions to ask yourself to know if it’s right:
    • Am I overwhelmed by my emotions and need better ways to cope?
    • Have other therapies helped my thinking, but not how I feel or act?
    • Am I ready to work hard, practice new abilities, and stick with it even when it’s uncomfortable?
    • Do I want a therapy that’s practical, structured, and aimed at real-life change?

DBT could be a great fit if you said yes to most of those.

Who might not be a good candidate for dialectical behavior therapy?

1. People unwilling or unable to commit to the structure

DBT is highly structured and skill-based.

It typically involves weekly individual therapy, weekly group skills classes, daily homework, and sometimes phone coaching.

If someone can’t consistently attend sessions, refuses to do homework, or isn’t open to practicing skills outside therapy, DBT might not work well.

2. People seeking only insight-based therapy

Some people want therapy to direct their attention mainly on processing emotions, talking through issues, or gaining insight (like in psychodynamic therapy).

DBT is action-focused because it emphasizes behavior change, skill acquisition, and active coping.

DBT might feel frustrating or “too much” if someone doesn’t want structured tools and prefers purely exploratory conversations.

3. People with active psychosis or severe cognitive impairment

If someone is experiencing active hallucinations, severe delusions, or significant cognitive impairments, such as dementia or severe intellectual disability, they might struggle with the cognitive demands of DBT (like mindfulness practice, behavioral analysis, or skill memorization).

Other therapies focused on stabilization and reality orientation would likely be more appropriate first.

4. People in acute mania

DBT might not be effective right away if someone is in a current manic or hypomanic episode.

Mania often needs stabilization medication first because it impairs the attention, impulse control, and emotional regulation needed to participate in DBT sessions.

5. People with no immediate motivation for change
   
   

DBT relies heavily on a client’s willingness to change actions, even small ones.

That’s why it doesn’t work for someone who:

• • Doesn’t see any problems in their behavior.
  • Feels 100% forced into therapy by others (court, parents, partner).
  • Isn’t open to the idea of working toward goals, because DBT is collaborative and requires active participation.

That said, motivation can change once therapy begins, so sometimes initial reluctance isn’t a hard no.

6. People who need crisis stabilization first

If someone is so acutely unsafe that immediate hospitalization or crisis stabilization is needed, DBT may be introduced later.

It’s great for reducing suicidal behaviors long-term, but it’s not designed for emergency psychiatric crisis management on its own.

How to get started with dialectical behavior therapy?

Getting started can feel like a big step, but if you’re ready to commit to it, it can also be life-changing.

1. Find a qualified DBT therapist or program

• • Look for someone trained specifically in DBT

Not every therapist who says they offer DBT provides it in its full, evidence-based format.

Ideally, they should have formal DBT training.

• • Search through reliable directories:

• • • • Behavioral Tech’s Provider Directory.
      • Psychology Today (filter by “DBT”).
      • Local hospital outpatient programs or mental health clinics.

• • • Ask questions when contacting therapists

• • • • Do you offer comprehensive DBT (individual therapy + skills group + phone coaching)?
      • Are you part of a DBT consultation team?
      • Have you been trained by a DBT-recognized organization?

True DBT programs usually have all four components: individual therapy, group skills training, phone coaching, and therapist consultation.

2. Consider full DBT vs. DBT-informed therapy
   
   

• • Full DBT is the entire structured program (best for serious emotional or behavioral problems).
  • DBT-Informed Therapy uses DBT skills and principles but may not include all parts (better if you want to focus just on skill-building or if full DBT isn’t available near you).

Full DBT is strongly recommended if you’re dealing with life-threatening behaviors (like self-harm or suicidal thoughts).

3. Assessment and commitment

• • Most DBT programs start with an assessment phase.

Therapists will evaluate your needs, emotional issues, and treatment goals.

• • You’ll usually be asked to sign a commitment agreement.

This says you agree to:

• • • Attend sessions regularly.
    • Practice skills between sessions.
    • Work on dropping life-threatening behaviors.

Commitment is a key DBT principle. That’s not because they want to trap you, but because showing up for yourself is part of the rehab.

4. Start learning the skills

Once you’re enrolled, you’ll likely begin with:

• • Mindfulness (foundational skill to stay present).
    
  • Distress tolerance (managing disasters without making things worse).
  • Emotion regulation (understanding and balancing emotions).
  • Interpersonal effectiveness (handling relationships and communication better).

Skills are usually taught one module at a time in group sessions, while your therapy centers itself on applying them to your challenges.

5. Practice

• • Homework is a big part of DBT

You might be asked to fill out diary cards, track emotions, practice mindfulness exercises, or apply a new skill in your daily life.

• • Real change comes from using the skills outside therapy when life gets messy, rather than just talking about them.

6. Stay patient and persistent
   
   

• • DBT isn’t a quick fix.

It usually takes 6 months to a year (sometimes longer) to work through a full DBT program.

• • Getting better happens slowly, through consistent small changes over time.
  • Many people report noticeable improvements in emotional stability, relationships, and self-respect after completing the program.

If you can’t access in-person DBT right now, there are some good online options too:

• • Online DBT skills groups.
  • Telehealth DBT therapy.
  • Self-help books like “The DBT Skills Training Handouts and Worksheets” by Marsha Linehan. (Good if you’re supplementing, not as a therapy replacement.)

How to find a therapist specialized in dialectical behavior therapy?

1. Search through specialized directories
   
   

Some trusted places to find qualified DBT providers include:

• • Behavioral Tech’s Find a Therapist tool

• • • Behavioral Tech Directory
      (Behavioral Tech was founded by Marsha Linehan, the creator of DBT.)

• • DBT-Linehan Board of Certification Directory

• • • DBT-LBC Directory (Lists therapists certified in DBT, meaning they passed a tough evaluation.)

• • Psychology Today

• • • Go to Psychology Today → Search for Therapists → Use the filter for “Dialectical Behavior Therapy” under “Treatment Orientation.”

• • Local hospitals and mental health clinics

• • • Many psychiatric hospitals and community mental health centers have full DBT programs, especially for more intensive needs.

2. Check their credentials
   
   

Not every therapist who says they “use DBT skills” is trained in comprehensive DBT.

To make sure they’re legit, ask:

• • Where did you receive your DBT training?

Ideally, from Behavioral Tech, DBT-LBC, or a university program known for DBT.

• • Do you offer full-model DBT (individual therapy, skills group, phone coaching, consultation team)?

If not, they might be DBT-informed, which is helpful but different.

• • Are you part of a DBT consultation team?

In true DBT, therapists meet regularly with a team to maintain quality.

3. Consider what format you want

• • Full DBT program

Good if you struggle with high-risk behaviors like self-harm, suicidal thoughts, or intense emotional instability.

• • DBT-informed therapy

Excellent if you want to learn DBT skills but don’t necessarily need the full structure (common for depression, anxiety, or emotional sensitivity).

You can also choose between:

• • • In-person therapy.
    • Telehealth (online DBT programs and therapists).
      

Online DBT programs have exploded recently, and many offer legit, structured care if you don’t have access nearby.

4. Ask about cost and insurance

• • DBT can sometimes be more expensive because of its intensive format.
  • Some therapists take insurance while others don’t.
  • Some clinics offer sliding scale fees based on income.

You can also look into university-affiliated clinics, non-profits, or group skills classes, which tend to be cheaper if cost is a concern.

5. Trust the fit

Once you find a potential DBT therapist:

• • Book an initial consultation (many offer a free 15–20 min call).
  • Pay attention to how you feel since DBT therapists should be warm, validating, non-judgmental, and practical.
  • Remember that feeling safe and respected is crucial for the work ahead.

What are the benefits of dialectical behavior therapy?

1. Emotional regulation

One of DBT’s main strengths is teaching people how to manage intense emotions.

People struggling with depression often experience strong sadness, anger, or numbness.

DBT offers specific techniques, like opposite action and checking the facts, to help regulate these emotions before they spiral out of control.

Studies exhibit that DBT pointedly reduces emotional dysregulation.

2. Improved relationships
   
   

DBT pays a lot of attention to interpersonal effectiveness, which is essentially learning how to ask for what you need, set healthy boundaries, and cope with conflicts without exploding or withdrawing.

Relationships can feel tremendous or disappointing for many people with depression. DBT builds practical skills to navigate them better, which improves self-esteem and emotional security over time.

3. Improved coping with stress

DBT introduces distress tolerance skills, which are ways to survive emotional pain without making things worse (e.g., self-harm, substance use, impulsive behavior).

It emphasizes short-term strategies like distraction, self-soothing, and improving the moment.

This is huge for people with depression who often feel stuck in cycles of rumination and hopelessness.

4. Mindfulness skills
   
   

Mindfulness is the foundation of DBT.

It assists in staying present instead of getting trapped in regrets about the past or fears about the future, something particularly helpful for depressive thinking patterns.

Mindfulness-based practices have been shown to lower depressive symptoms and prevent relapse.

5. Reduction in suicidal and self-harm behaviors

DBT was created because other therapies weren’t working for chronically suicidal individuals.

In clinical trials, DBT consistently decreases suicidal ideation and self-harming behaviors better than standard treatments.

6. Structured, yet flexible approach

DBT programs typically have a clear structure, such as weekly individual therapy, skills groups, and phone coaching, but they’re adaptable to individual needs.

This balance between structure and personalization makes it more engaging and sustainable, which can be very helpful for those who find traditional therapy too rigid or vague.

7. Empowerment and self-efficacy

Unlike therapies that mainly focus on why someone feels bad, DBT also teaches how to feel better by offering concrete, actionable tools.

This builds competence and hope over time, which is critical for recovering from depression.

What are dialectical behavior therapy’s limitations, downsides, and potential risks?

Even though DBT has a lot going for it, it’s not perfect or ideal for everyone.

It can fall short in some areas:

1. High time commitment

DBT is intense.

A standard DBT program usually includes:

• • Weekly individual therapy.
  • Weekly group skills training (around 2 hours).
  • Homework assignments.
  • Optional phone coaching.

This heavy schedule can feel crushing for those already battling depression, low energy, or executive dysfunction.

Treatment dropout rates for DBT can be high, sometimes around 24%–34%, depending on the population.

2. It requires active participation
   
   

DBT is very skill-based.

You’re expected to practice mindfulness exercises, emotion regulation strategies, and interpersonal skills outside of therapy sessions.

It can be extremely hard to engage with the program if someone is not ready, too emotionally devastated, or lacks stability (serious substance abuse, homelessness).

3. Limited availability of fully trained therapists

True, evidence-based DBT requires a therapist trained specifically in DBT methods, ideally in a full DBT team.

However, fully trained DBT providers are rare in many places. Some therapists might offer “DBT-informed” therapy instead, which may not deliver the same results.

4. Expensive and not always covered

It can be pricey.

Because it often involves both individual and group therapy, costs can add up fast, and insurance companies don’t always fully cover comprehensive DBT programs.

It could lead to starting therapy and then having to drop out halfway if people can’t afford it, which can feel demoralizing.

5. Emotionally challenging
   
   

DBT pushes you to face painful emotions head-on through mindfulness and distress tolerance.

For people early in their healing process or with very complex trauma histories, diving into this kind of work without proper emotional preparation can backfire, causing even more emotional flooding, dissociation, or worse, depression in the short term.

It’s not that DBT causes harm, but without the right pace and support, it can feel destabilizing at first.

6. Not the best fit for every diagnosis

While DBT is great for:

• • Borderline personality disorder (BPD).
  • Chronic suicidal ideation.
  • Depression with emotional dysregulation.
  • PTSD.

It’s less effective for:

• • Primary psychotic disorders such as schizophrenia.
  • Severe cognitive impairments.
  • Individuals who are not emotionally dysregulated.

Some adaptations of DBT (like DBT-PE for PTSD) exist, but still, it’s not the best match for every mental health issue.

7. Therapist burnout
   
   

Interestingly, DBT can be hard on therapists, too.
Since it’s designed for high-risk clients (e.g., chronic suicidality), therapists face emotional exhaustion, secondary trauma, and professional burnout.
If a therapist isn’t properly supported within a DBT consultation team, it can impact the quality of therapy you get.

A study in 2015 (Harned et al.) highlighted that DBT providers without good team support show higher rates of burnout, which risks therapy effectiveness.

Potential risks in specific situations

• • Suicidal clients: DBT could leave serious gaps in safety nets if not delivered properly (without thorough risk management planning).
  • Complex PTSD clients: Mindfulness exercises can trigger flashbacks or dissociation if introduced too quickly.
  • Substance use clients: DBT alone may not be enough; integrated substance abuse treatment might be necessary.

How long will I need dialectical behavior therapy to treat my depression?

Most standard DBT programs are designed to last around 6 months to 1 year.

That’s based on the original model by Marsha Linehan and how most DBT clinics and therapists structure treatment today.

Here’s a rough breakdown:

Phase:	Duration:	Focus:
Stage 1.	6–12 months.	Stabilize life-threatening behaviors, reduce emotional chaos.
Stage 2 (if needed).	Additional 6–12 months.	Process underlying trauma and emotional pain.
Stage 3 (optional).	Varies.	Build self-esteem, pursue life goals, and maintain emotional stability.

For depression specifically:

If you are dealing primarily with major depressive disorder (MDD) (and not borderline personality disorder or complex trauma), you might need a shorter DBT program, often around 6 months.

Some people start seeing improvements by 3 months in emotional regulation and coping skills.

A study by Harley et al. (2008) noted that DBT for treatment-resistant depression led to major improvement after just 6 months of weekly sessions + group skills training.

However, full symptom remission often took closer to 9–12 months.

It depends on several factors:

• Severity of your depression

Mild to moderate depression might respond faster (3–6 months). Severe, chronic depression often takes longer.

• Other mental health conditions
  
  

Therapy might take closer to a year or longer if you also have anxiety disorders, PTSD, or emotional dysregulation (common in complex depression).

• Commitment to skills practice

DBT isn’t just talking in therapy, since it’s practicing mindfulness, emotional regulation, and distress tolerance daily.

The more consistent the practice, the faster the progress.

• Therapist’s approach

Some therapists offer “DBT-informed” therapy (a shorter, more flexible model) versus full, comprehensive DBT (which is longer and more structured).

• Support systems

Having strong outside support networks (friends, family, work flexibility) tends to speed up recovery.

Many people keep practicing the skills for life even after “finishing” DBT, just like someone with diabetes keeps managing their health even after getting stable.

You might graduate from formal therapy but still use mindfulness, opposite action, and distress tolerance when depression symptoms flare up again.

When to quit dialectical behavior therapy?

You should consider stopping DBT when you’ve achieved the goals you set at the beginning of therapy, and when you can consistently use the skills without heavy therapist support.

Signs you might be ready to stop DBT:

1. You’re managing emotions effectively

If you can handle intense emotions like sadness, anger, anxiety, or shame without falling into harmful behaviors (self-harm, isolation, explosive reactions), that’s a strong sign you’ve mastered key DBT skills.

2. You rarely engage in crisis behaviors

DBT’s priority is making life more stable by reducing suicidal thoughts, self-harm, reckless behaviors, and emotional meltdowns.

If crises have become rare and manageable, you might have graduated from the need for DBT.

3. You use DBT skills automatically

Skills like mindfulness, opposite action, self-soothing, and wise mind decision-making feel natural, and you don’t have to think hard about them.

When coping strategies become your default instead of a forced effort, that’s major progress.

4. You’ve met your personal therapy goals
   
   

At the start of DBT, people usually set specific goals, such as stopping self-harming, managing depressive episodes, and building healthy relationships.

It’s often time to move toward ending therapy when you’ve met those consistently, not just during “good weeks”.

5. You feel confident handling relapses

Depression and emotional struggles can return.

A key part of ending DBT is feeling confident that even if symptoms pop up, you know what to do without needing emergency therapy sessions.

Gradual tapering is ideal

Stopping therapy is not usually an abrupt “one day you’re in, next day you’re out” situation.

It’s more common (and healthier) to taper down slowly:

• Move from weekly sessions to biweekly.
• Then monthly “check-in” sessions.
• You’ll eventually end formal therapy, but stay connected in case you need a “booster” session later.

This tapering helps you test your skills in real life without losing all support at once.

Situations when stopping DBT might not be ideal:

• If you’re still actively suicidal or engaging in dangerous behaviors.
  
• If emotional regulation is inconsistent (you manage for a month but crash hard afterward).
• If you haven’t fully addressed the underlying trauma that fuels your depression or emotional difficulties.

It might make sense to continue therapy longer or shift into a different phase, like trauma-focused DBT, or individual therapy in these cases.

Stopping Therapy ≠ Ending Self-Work

Even when you finish DBT, life will still throw curveballs.

You’ll likely keep practicing mindfulness, emotional regulation, and interpersonal skills long after formal therapy ends.

It’s more like graduating since you’ve learned the tools, and now you use them to live your life, even if it’s messy sometimes.

How much does dialectical behavior therapy cost?

​The cost varies based on several factors, including the therapist’s qualifications, session format, and available insurance reimbursements.

These are the potential expenses:​

• Typical DBT session costs in Belgium
• Individual sessions: Generally range from €50 to €100 per 45–60-minute session.
• Group sessions: DBT often includes group skills training, which can be more cost-effective.

Prices vary, so it’s advisable to consult specific providers for rates.​

• Insurance reimbursement

• • Belgium’s public health insurance (mutualités) may partially reimburse psychotherapy sessions:

• • • Reimbursement rates: Typically, €10 to €20 per session, with some plans covering up to 80% of the session cost.​
    • Eligibility: Reimbursement depends on factors like age, diagnosis, and the therapist’s affiliation with recognized health insurance agreements.​
    • Documentation: You’ll need to submit specific forms provided by your mutualité, completed by your therapist, to claim reimbursements.​

• • Overall program costs

A standard DBT program typically includes weekly individual sessions and group skills training over several months:​

• • • Duration: Programs often span 6 months to 1 year, depending on individual needs.​
    • Total cost estimate: Considering weekly sessions at €70, the total cost over 6 months could be around €1,680.

Insurance reimbursements can substantially cut this amount.​

Tips to manage costs

• Discuss fees upfront: Talk to your therapist about session costs and any available sliding scale options based on income.​
• Check insurance coverage: Contact your insurance to understand what portion of therapy costs they cover and any requirements for reimbursement.​
• Consider group therapy: Group sessions can be more affordable and are a core component of DBT.​
• Explore online options: Some online DBT programs offer flexible pricing and may be more cost-effective.​

Dialectical behavior therapy exercises and worksheets for depression

1. DBT PLEASE Skill worksheet

This worksheet concentrates on the PLEASE skill, which emphasizes maintaining physical health to stabilize mood.

It guides you through assessing and improving aspects like sleep, nutrition, and exercise.

• • Worksheet.

2. Emotion regulation skills

These worksheets help identify emotional triggers, challenge negative thoughts, and apply strategies like opposite action to manage depressive symptoms.​

• • Worksheet.

3. Distress Tolerance skills

Designed for moments of acute emotional pain, this resource offers crisis survival strategies to help you navigate intense depressive episodes without resorting to harmful behaviors.​

• • Worksheet.

4. Overcoming Depression workbook
   
   

A comprehensive workbook featuring 44 exercises across various sections, including understanding depression, increasing positive feelings, and coping with stress. It’s structured to support long-term recovery.​

• • Worksheet.

5. DBT Skills Training Handouts and Worksheets by Marsha M. Linehan

This comprehensive collection includes over 200 pages of handouts and worksheets covering all four DBT modules.

It’s a valuable resource for both therapists and individuals seeking to deepen their understanding of DBT skills.

• • Worksheet.

6. The Dialectical Behavior Therapy Skills Workbook

This workbook offers practical exercises and examples to help individuals apply DBT skills in daily life, particularly useful for those dealing with intense emotions associated with depression.

• • Worksheet.

7. Anxiety & Depression Reduction Workbook

A resource that provides tools and exercises to manage anxiety and depression, focusing on building lifelong coping mechanisms.

• • Worksheet.

Online platforms offering DBT worksheets

• Therapist Aid: Extends a variety of free DBT worksheets, including those focused on depression.
• Mental Health Center Kids: Provides printable DBT worksheets suitable for all ages, covering skills like mindfulness and emotion regulation.
• Positive Psychology: Features a collection of DBT worksheets and handouts to improve coping mechanisms.

Tips for using these worksheets:

• Start small: Begin with one or two worksheets that resonate with your current challenges.​
• Consistency: Allocate regular time each week to work through the exercises.​
• Reflect and journal: Keep a journal to note insights, progress, and areas needing more attention.​
• Seek support: Consider discussing your experiences with a counselor or support group to enhance understanding and application of the skills.​

Conclusion

DBT is a powerful, evidence-based approach that helps people manage strong emotions, build healthier coping skills, and create a life worth living.

Although it was originally developed for borderline personality disorder, DBT has proven effective for depression, anxiety, PTSD, and more.

Its blend of acceptance and change strategies offers a structured yet flexible path toward increasing emotional resilience.