The role of DBT in therapy is to help people understand their emotions, manage distress, improve relationships, and develop healthier ways to respond to challenging situations. Dialectical Behaviour Therapy (DBT) is a structured, skills-based approach that combines acceptance with positive change. It teaches people how to recognize emotional patterns, tolerate discomfort, communicate more effectively, and make thoughtful decisions even when feelings become overwhelming.
For children, teenagers, and adults, strong emotions can affect relationships, school, work, family life, and self-esteem. Some people experience intense emotional reactions, while others struggle to express their needs, manage conflict, or recover after stressful experiences. DBT offers practical strategies that can help individuals develop emotional awareness and coping skills over time.
At Tikvah Family Services, understanding different therapeutic approaches can help individuals and families make informed decisions about mental health support. DBT may be considered as part of a personalized treatment plan, depending on the person’s needs, goals, age, and circumstances.
This guide explains the role of DBT in therapy, the four core DBT skill areas, who may benefit, what sessions can involve, and how to decide whether this approach may be appropriate.
What Is DBT, and What Is Its Role in Therapy?
Dialectical Behaviour Therapy, commonly called DBT, is a form of psychotherapy originally developed by psychologist Marsha Linehan. It was initially developed to support people experiencing chronic suicidal thoughts and significant emotional difficulties, and it is now used for several mental health concerns when clinically appropriate.
The word dialectical refers to bringing together two ideas that may seem opposite: accepting yourself and your current experience while also working toward meaningful change.
For example, a teenager may recognize that their anger makes sense in the context of feeling rejected while also learning that shouting at family members is not helping them achieve what they need. DBT can help the teenager acknowledge the emotion without judging it and develop a more effective response.
The role of DBT in therapy is not to tell people to stop feeling angry, anxious, sad, or overwhelmed. Instead, it helps them understand what is happening, identify their choices, and practise skills that support healthier behaviour.
DBT may help individuals learn to:
- Recognize emotional triggers and early warning signs.
- Manage intense feelings without acting impulsively.
- Tolerate distress without making a difficult situation worse.
- Communicate needs and boundaries clearly.
- Develop healthier relationships.
- Reduce behaviours that interfere with daily functioning.
- Build confidence in handling future challenges.
DBT is not a universal solution, and it does not replace every other form of psychotherapy. A qualified mental health professional can help determine whether DBT, another approach, or a combination of treatments is most appropriate.
1. DBT Helps People Understand and Regulate Their Emotions
One of the most important roles of DBT in therapy is improving emotional regulation.
Emotional regulation means recognizing feelings, understanding their intensity, and choosing how to respond. It does not mean suppressing emotions or pretending everything is fine. Instead, it involves learning how to experience emotions without automatically allowing them to determine every action.
Some individuals experience emotions that rise quickly and feel difficult to control. A disagreement may lead to intense anger, a minor mistake may trigger overwhelming shame, or a change in plans may produce anxiety that lasts for hours.
Without effective coping strategies, these reactions can affect family relationships, friendships, school performance, and self-esteem.
How DBT supports emotional regulation
DBT encourages people to notice the relationship between events, thoughts, emotions, physical sensations, and actions.
Consider a fictional example of a teenager who receives a disappointing grade. The teenager thinks, “I’m a failure,” feels ashamed, becomes angry, and refuses to speak to their parents. The initial event is the grade, but the interpretation of that event also influences the emotional response.
A therapist using DBT-informed strategies might help the teenager:
- Identify the event that triggered the reaction.
- Name the emotions and physical sensations involved.
- Notice thoughts that may be making the situation feel worse.
- Consider alternative interpretations.
- Choose a response that supports their longer-term goals.
With practice, the teenager may learn to acknowledge disappointment without concluding that one grade defines their abilities.
Emotional regulation for children and teenagers
Children and adolescents are still developing the ability to recognize and manage complex emotions. Younger children may need adults to help them identify feelings, recognize bodily signals, and practise calming strategies.
Teenagers may benefit from learning how sleep, stress, social relationships, academic pressure, and online interactions affect their emotional responses.
DBT skills can be adapted to developmental level. For some children, visual supports, role-play, games, and parent participation may make skills easier to understand. Comprehensive DBT is a specific treatment model, however, and using selected DBT-informed techniques does not necessarily mean a child is receiving a full DBT program.
2. DBT Teaches Mindfulness and Emotional Awareness
Mindfulness is one of the four central skill areas in DBT. It involves paying attention to the present moment with greater awareness and less automatic judgment.
People often react to situations before they have had an opportunity to understand what they are feeling. A person might assume a friend is ignoring them, interpret constructive feedback as rejection, or become overwhelmed by several worries at once.
Mindfulness can create a pause between an experience and a response.
What mindfulness looks like in therapy
A therapist may guide a client to observe their thoughts, emotions, and physical sensations without immediately trying to change them.
For example, someone experiencing anxiety before a social event might notice:
- Their heart is beating faster.
- Their shoulders feel tense.
- They are thinking, “Everyone will judge me.”
- They feel an urge to cancel their plans.
Rather than automatically cancelling, the person can practise noticing these experiences and deciding what to do next.
Mindfulness does not require someone to empty their mind or eliminate unwanted thoughts. The goal is to become more aware of what is happening and respond with greater intention.
Practical mindfulness exercises
Depending on the person’s needs, DBT mindfulness exercises may include:
- Taking a few slow, comfortable breaths while noticing bodily sensations.
- Describing an emotion using specific words.
- Observing a thought without treating it as an established fact.
- Paying attention to one activity at a time.
- Noticing the difference between an observable event and an interpretation of that event.
For a child, mindfulness might involve noticing five things they can see or describing how their body feels when they become frustrated. For an adult, it might involve observing anxious thoughts before responding to a difficult email.
These exercises can help people recognize emotional patterns earlier and create opportunities for more deliberate responses.
3. DBT Builds Distress Tolerance and Crisis Coping Skills
Another essential role of DBT in therapy is teaching distress tolerance. These skills help people get through difficult moments without making the situation more harmful.
Distress tolerance is especially relevant when a person cannot immediately change what is happening. Someone may have to wait for an important decision, cope with uncertainty, manage a painful disagreement, or tolerate disappointment.
When distress feels unbearable, people may respond impulsively. They might send angry messages, withdraw from supportive relationships, abandon responsibilities, or engage in other behaviours that create additional problems.
DBT teaches that a person can experience discomfort without having to act on every urge.
Understanding the difference between distress and danger
An important part of distress tolerance is distinguishing between an uncomfortable situation and an unsafe one.
Feeling anxious before an exam may be distressing but not necessarily dangerous. Being threatened or experiencing abuse requires attention to safety rather than simply learning to tolerate the situation.
DBT skills are not intended to teach people to accept mistreatment, ignore serious risks, or remain in unsafe environments. Safety concerns require appropriate support and action.
Examples of distress tolerance skills
A therapist may help a client identify safe coping strategies that fit their circumstances, such as:
- Taking a brief pause before responding during conflict.
- Moving to a quieter environment when overstimulated.
- Using grounding techniques to reconnect with the present moment.
- Listening to calming music or engaging in a familiar activity.
- Contacting a trusted person for support.
- Breaking a difficult task into smaller, manageable steps.
Suppose a university student receives a rejection email and immediately feels the urge to send an angry response. A distress tolerance strategy might involve stepping away from the computer, allowing the initial emotional intensity to settle, and reviewing the email later.
The goal is not to deny disappointment. It is to make room for disappointment without allowing a temporary emotional state to determine a potentially damaging action.
4. DBT Improves Communication and Interpersonal Relationships
Relationships can become difficult when people struggle to express their needs, manage disagreements, or cope with the possibility of rejection.
The role of DBT in therapy includes developing interpersonal effectiveness: the ability to communicate clearly, maintain appropriate boundaries, and navigate relationships while respecting both personal needs and the needs of others.
Some individuals avoid conflict because they fear upsetting someone. Others become defensive, raise their voices, or withdraw when they feel misunderstood. Some find it difficult to say no, ask for help, or explain what they need.
DBT provides structured ways to approach these challenges.
Learning to express needs clearly
A person can practise describing a problem without attacking the other person, making a specific request, and remaining focused on the issue.
For example, instead of saying, “You never listen to me,” a teenager might learn to say, “I feel frustrated when I am interrupted. Can I finish explaining before we discuss it?”
The second statement identifies the problem and makes a clear request without making a sweeping accusation.
Building boundaries and self-respect
Interpersonal effectiveness also involves learning to say no, negotiate disagreements, and recognize personal limits.
For instance, an adult who regularly agrees to extra responsibilities despite feeling overwhelmed may practise saying, “I cannot take that on this week, but I can help next Monday.”
This approach can support healthier relationships because it encourages honest communication rather than resentment or avoidance.
DBT and family relationships
Family members can sometimes become caught in recurring cycles of conflict. One person raises their voice, another withdraws, and the original concern remains unresolved.
A DBT-informed approach may help family members identify their emotional triggers, recognize escalation patterns, and practise more effective communication.
Parent involvement can be particularly useful when children and teenagers are learning new skills. Caregivers may need guidance on validating feelings while maintaining reasonable limits and expectations.
Validation does not mean agreeing with every interpretation or allowing every behaviour. It means communicating that a person’s emotional experience has been heard and taken seriously.
5. DBT Can Support People Experiencing Anxiety, Depression, and Emotional Instability
DBT is used in several mental health contexts, although the strength of evidence differs by condition and treatment format. Its best-established use is in treating borderline personality disorder and associated high-risk behaviours. It may also be helpful for some people experiencing difficulties with emotion regulation, self-harm, and other complex mental health concerns.
The appropriateness of DBT depends on the person’s symptoms, goals, history, and access to a suitably trained provider.
DBT and anxiety
People with anxiety may experience intense worry, physical tension, avoidance, or difficulty tolerating uncertainty.
DBT skills can help them observe anxious thoughts, manage distress, and respond more thoughtfully when anxiety rises. However, DBT is not always the first-line or only treatment for anxiety disorders. Cognitive Behavioural Therapy (CBT), exposure-based interventions, and other evidence-based approaches may be more directly suited to particular anxiety presentations.
A therapist can help determine which approach is appropriate.
DBT and depression
Depression may involve low motivation, persistent sadness, hopelessness, withdrawal, or difficulty managing daily responsibilities.
DBT skills may help some individuals recognize emotional patterns, tolerate difficult feelings, and communicate their needs. Depending on the presentation, treatment may also involve CBT, behavioural activation, interpersonal psychotherapy, medication assessment, or other interventions.
DBT should not be presented as a guaranteed treatment for depression or a substitute for individualized assessment.
DBT and self-harm or suicidal behaviour
Comprehensive DBT has a significant role in treatment for people who experience recurrent self-harm, suicidal behaviours, and severe emotion dysregulation, particularly in the context of borderline personality disorder.
Treatment may include structured skills training, individual therapy, strategies for managing crises, and a clear treatment framework. The exact format depends on the program.
When someone is at immediate risk of suicide or serious self-harm, routine therapy exercises are not enough. Urgent professional assessment and emergency support may be necessary.
DBT and neurodivergent individuals
Some autistic people and individuals with ADHD experience challenges involving emotional regulation, impulsivity, sensory overload, or transitions. Selected DBT-informed skills may be helpful when adapted to the person’s communication style, sensory needs, developmental level, and goals.
However, autism and ADHD are not themselves indications that every person needs DBT. Support should be individualized and respectful of neurodiversity. It should not aim to suppress harmless autistic traits or force someone to behave in a way that hides their needs.
For neurodivergent children and teenagers, a therapist may consider visual instructions, concrete examples, predictable routines, additional processing time, and collaboration with caregivers.
6. DBT Provides Practical Skills That Can Be Used Outside Therapy
DBT is designed to help people apply what they learn in everyday life. The aim is not simply to understand emotional challenges during a session, but to develop skills that can be practised in real situations.
The four core DBT skill areas are mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
| DBT skill area | Main purpose | Everyday example |
|---|---|---|
| Mindfulness | Increase awareness of thoughts, feelings, and sensations | Notice frustration before responding |
| Distress tolerance | Cope with difficult situations without worsening them | Pause before sending an angry message |
| Emotion regulation | Understand emotions and respond more effectively | Identify what contributes to anxiety or anger |
| Interpersonal effectiveness | Communicate needs and maintain boundaries | Ask for help or say no respectfully |
Practising skills between sessions
A therapist may invite a client to keep a diary of emotional experiences or practise one specific skill during the week.
For example, someone might record what happened before an argument, identify the emotion they experienced, describe their response, and consider what they could try differently next time.
The purpose is not to judge every reaction as a success or failure. It is to recognize patterns and identify opportunities for learning.
Children may benefit from practising skills with a caregiver during calm moments rather than waiting until they are already overwhelmed. Teenagers and adults may prefer written reminders, phone notes, or brief reflection exercises.
Progress can be gradual. A person may recognize an emotional trigger before they can consistently respond differently. Over time, repeated practice may help make more effective responses easier to access.
7. DBT Can Be Part of an Individualized Therapy Plan
DBT is a structured treatment, but it is not the only therapeutic approach that can help with emotional and relationship difficulties. A qualified therapist should consider the person’s needs, preferences, safety, developmental stage, and treatment goals before recommending a particular approach.
Depending on the situation, DBT may be used as a comprehensive treatment program or as a source of selected skills within a broader treatment plan. These are not identical forms of care, so it is useful to ask a provider exactly what they offer.
What happens during DBT therapy?
The process varies by provider and program. A comprehensive DBT program commonly includes several coordinated components:
- Individual therapy: The client and therapist work on treatment goals, emotional patterns, and behaviours that affect quality of life and safety.
- Skills training: Clients learn and practise mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Skills training may take place in a group or another structured format.
- Between-session practice: Clients apply skills in everyday situations and review what they learn.
- Treatment planning: The provider monitors progress, addresses barriers, and adjusts treatment as needed.
Some comprehensive programs include additional coaching and consultation arrangements for clinicians. Not every therapist offering DBT-informed individual therapy provides all the components of comprehensive DBT.
How long does DBT take?
There is no single timeline that applies to everyone. Comprehensive DBT programs commonly run over several months, and some continue longer depending on the treatment model and clinical needs.
Progress depends on factors such as the person’s goals, the severity and complexity of their difficulties, the consistency of attendance, opportunities to practise skills, and the suitability of the treatment.
Rather than promising a particular outcome within a set number of sessions, a therapist should explain the treatment plan, how progress will be reviewed, and what additional support might be needed.
How to choose a DBT therapist
When considering DBT, ask prospective providers:
- What training and experience do you have in DBT?
- Do you offer comprehensive DBT or DBT-informed individual therapy?
- What age groups do you work with?
- How do you adapt treatment to a person’s communication and developmental needs?
- How will we identify goals and measure progress?
- What support is available if symptoms worsen between sessions?
- What are the fees, session format, and cancellation policies?
If a child or teenager is involved, ask how caregivers may participate and how the therapist balances privacy, family collaboration, and safety.
It is also important to confirm whether the provider is qualified and authorized to deliver the type of service being offered in the relevant jurisdiction.
DBT Compared With CBT and Other Therapy Approaches
DBT and Cognitive Behavioural Therapy share some features, including structured sessions, practical exercises, and an emphasis on developing skills. However, they differ in their treatment frameworks and areas of emphasis.
CBT often focuses on the relationship between thoughts, emotions, and behaviours, helping people identify unhelpful thinking patterns and develop more effective responses.
DBT places particular emphasis on balancing acceptance and change, tolerating distress, regulating emotions, and navigating relationships. It can be especially relevant when intense emotions and impulsive responses create repeated difficulties.
Other approaches may be suitable depending on the concern. For example, trauma-focused therapies may be indicated for trauma-related symptoms, while family therapy may be useful when relationship patterns are central to the difficulty.
| Approach | Common focus |
|---|---|
| DBT | Emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness |
| CBT | Connections between thoughts, emotions, and behaviours |
| Family therapy | Family relationships, communication, and interaction patterns |
| Trauma-focused therapy | Processing trauma-related symptoms and experiences using an appropriate evidence-based model |
| Play therapy | Supporting children’s expression and exploration through developmentally appropriate play |
These approaches are not necessarily mutually exclusive. A qualified clinician can help identify the most appropriate treatment or combination of approaches.
Frequently Asked Questions About the Role of DBT in Therapy
What is the main purpose of DBT?
The main purpose of DBT is to help people manage intense emotions, tolerate distress, improve relationships, and develop more effective behavioural responses. It combines acceptance of current experiences with practical strategies for change.
Who can benefit from DBT therapy?
DBT may benefit people who experience significant emotion dysregulation, recurrent self-harm, suicidal behaviours, or certain complex mental health difficulties. Selected DBT skills may also help some people manage anxiety, interpersonal conflict, impulsivity, and stress. Suitability depends on individual circumstances.
Is DBT suitable for children and teenagers?
DBT-based approaches can be adapted for adolescents, and specialized programs exist for young people with significant emotional and behavioural difficulties. Work with younger children may require developmentally adapted methods and caregiver involvement. Ask whether the provider has specific training and experience with the child’s age group.
Is DBT better than CBT?
Neither approach is universally better. DBT may be especially appropriate when severe emotional dysregulation, self-harm, or recurrent crises are central concerns. CBT may be particularly suitable for many anxiety and depression presentations. Treatment selection should be based on the individual’s needs and the available evidence.
How long does DBT take to work?
The timeline varies. People may begin learning practical skills early in treatment, but using them consistently in challenging situations can take time. Comprehensive DBT often involves a structured program lasting several months or longer.
Can DBT be delivered online?
Some DBT services and skills-training programs are offered virtually, depending on the provider and treatment model. Online treatment should include appropriate privacy protections, a plan for managing clinical risk, and access to emergency support when needed. Not every situation is suitable for virtual care.
Does DBT teach people to control their emotions?
DBT does not require people to eliminate or suppress emotions. It teaches them to recognize emotions, understand their effects, tolerate distress, and choose responses that better support their goals.
What should I do if someone is at immediate risk of self-harm?
If someone is in immediate danger, call 911 in Canada or go to the nearest emergency department. In Canada, call or text 988 for suicide crisis support. For a child or teenager, involve a responsible adult and seek urgent professional assistance when safety is a concern.
Understanding the Role of DBT in Therapy
The role of DBT in therapy is to help people develop practical skills for managing emotions, coping with distress, communicating effectively, and responding to challenges with greater awareness. By combining acceptance with change, DBT encourages people to recognize their experiences without allowing difficult emotions to dictate every decision.
DBT is not the right treatment for every person or every mental health concern. Its usefulness depends on the individual’s needs, treatment goals, clinical circumstances, and access to an appropriately trained provider. For some people, comprehensive DBT may be appropriate; for others, DBT-informed skills may complement another therapeutic approach.
At Tikvah Family Services, families and individuals can explore their support options and ask questions about which approaches may suit their circumstances. The first step is understanding the concern, identifying meaningful goals, and discussing an individualized plan with a qualified professional.
Contact Tikvah Family Services
Website: https://tikvahfamilyservices.ca/
Email: info@tikvahfamilyservices.ca
Phone: (289) 807-4231
