DBT Skills

Dialectical Behavior Therapy (DBT) is a structured, skills-based form of cognitive behavioral therapy developed by psychologist Marsha Linehan in the 1980s. It was created for people who experience emotions very intensely and have struggled to find relief in standard therapy — originally those with borderline personality disorder and chronic suicidal thoughts.

What makes DBT distinctive is its balance. Earlier change-focused therapies could leave people feeling criticized — as if their suffering were their own fault. DBT weaves in radical acceptance: the stance that you can fully accept yourself and your reality as it is andcommit to building a life worth living. That tension — acceptance and change held together — is the "dialectic."

DBT has the strongest evidence for borderline personality disorder and for reducing self-harm and suicide attempts. But because its skills target emotion dysregulation — the common thread beneath many struggles — they have been adapted and studied for a wide range of concerns:

• Chronic suicidal thoughts and self-harm
• Borderline personality disorder
• Post-traumatic stress disorder, especially with dysregulation
• Eating disorders, particularly binge eating and bulimia
• Substance use disorders
• Treatment-resistant depression and mood instability

You do not need a diagnosis to benefit from DBT skills. Many people learn them simply because their emotions feel bigger and harder to steer than they'd like.

A dialectic is the idea that two seemingly opposite things can both be true. The central one in DBT is:

Holding both at once dissolves a trap many people fall into: either blaming themselves entirely ("I'm broken") or refusing any responsibility for change ("this is just how I am"). DBT insists on both compassion and accountability. This same both/and stance shows up throughout the skills — for example, validating a feeling while still choosing not to act on it.

DBT skills are organized into four groups. The first, mindfulness, is the foundation the others rest on; it's revisited between each of the other modules.

1. Mindfulness

The foundation. Mindfulness in DBT means observing your experience — thoughts, feelings, sensations — as it is, without judging it or immediately reacting. It builds the pause between an urge and an action, which is where every other skill becomes possible. DBT frames this as accessing "wise mind": the overlap between the emotional mind and the reasonable mind, where you can act from both feeling and reason at once.

2. Distress tolerance

Skills for surviving a crisis without making it worse— for the moments when a painful situation can't be fixed right now and the urge is to do something impulsive. A well-known example is TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation), which uses the body to bring down extreme arousal fast. Others include distraction, self-soothing through the senses, and radical acceptance of what cannot be changed.

3. Emotion regulation

Skills for understanding emotions and turning down their intensity over time. This includes naming emotions accurately, reducing vulnerability with the PLEASE skills (treat PhysicaL illness, balance Eating, avoid mood-Altering substances, balance Sleep, get Exercise), building positive experiences, and opposite action— acting against an emotion's urge when the emotion doesn't fit the facts (for example, approaching rather than avoiding when fear is unwarranted).

4. Interpersonal effectiveness

Skills for asking for what you need, setting boundaries, and saying no while protecting the relationship and your self-respect. The best-known is DEAR MAN (Describe, Express, Assert, Reinforce, stay Mindful, Appear confident, Negotiate) for making a request, paired with GIVE (for the relationship) and FAST (for self-respect).

"Comprehensive" DBT — the version tested in research — is more than a class. It has four components that work together:

• Individual therapy — weekly sessions to apply skills to your specific life and targets.
• Skills training group — a class-like format, usually weekly for several months, that teaches the four modules.
• Phone coaching — brief between-session contact to help use skills in real-life moments.
• Therapist consultation team — the clinicians meet to support each other and keep treatment on track.

Many people encounter DBT skills in a group or a "DBT-informed" therapy that borrows the skills without all four components. That can help — but it's worth knowing the difference when a specific, research-tested outcome matters.

DBT is one of the most rigorously studied psychotherapies. Randomized controlled trials show it reduces suicide attempts, self-harm, hospitalization, and treatment dropout in people with borderline personality disorder, and it is recommended in clinical guidelines as a first-line treatment. Adapted versions have shown benefit for eating disorders, substance use, and adolescents.

Like any therapy, DBT works best when it fits the person and is delivered well. It asks for real practice between sessions — the skills are a set of tools that get stronger with use.

Meridian maintains a verified directory of New Hampshire providers, including clinicians and programs offering DBT and DBT-informed care.