Dialectical behavior therapy, or DBT, is a structured form of cognitive behavioral therapy developed by psychologist Marsha Linehan in the late 1980s for people with intense emotions, self-harm and suicidal behavior, most often in the context of borderline personality disorder. The word dialectical refers to its central balance: accepting yourself as you are while working to change. DBT has since been adapted for eating disorders, substance use, PTSD, and adolescents with emotional dysregulation, with solid evidence for reducing self-harm, hospitalizations and treatment dropout.
A full DBT program has four parts. Weekly individual therapy addresses your specific goals and reviews a diary card of emotions, urges and behaviors. A weekly skills group, usually running about six months, teaches four modules: mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. Phone coaching between sessions helps you apply skills in the moment. A consultation team supports the therapists. Many clinics offer DBT-informed therapy that uses the skills without the full program, which is helpful but not the same as comprehensive DBT. Medication can reduce specific symptoms such as depression or impulsivity alongside DBT, though no medication treats borderline personality disorder itself. Stedfast Psychiatry providers evaluate and manage co-occurring conditions and refer to DBT programs in Florida and South Carolina when a full program is indicated.