Dialectical behaviour therapy

Explains what dialectical behaviour therapy is, what it is for, what happens during therapy and how to find a therapist.

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Dialectical behaviour therapy

Dialectical behaviour therapy (DBT) is a psychological therapy for people with borderline personality disorder (BPD), especially those with self-harming behaviour or suicidal thoughts. 

If you have been diagnosed with BPD, you might have experienced the following:

  • intense negative emotions (anger, shame, guilt, sadness, fear), which you find hard to control.
  • impulsive behaviour to control your emotions, including self-harming, using alcohol or drugs, binge eating, purging etc.
  • unstable relationships and fears of being abandoned by others
  • feelings of emptiness
  • mood swings, with your mood going up and down a lot
  • suicide attempts
  • self-harming.

DBT was specifically developed to address these problems.

Your present circumstances don't determine where you can go; they merely determine where you start.

(For more information about BPD, suicide and self-harm, see Borderline personality disorder, How to cope with suicidal feelings and Understanding self-harm.)

Why emotions are important in BPD

DBT suggests that if you have a diagnosis of BPD, your problems come mainly from difficulties in controlling your emotions.

You may have inherited genes that make you naturally more sensitive than others. Therefore, you may experience emotions more intensely than most people, and have more difficulty in letting go of intense emotions.

The environment you grew up in may also have played an important role; for example, you may have grown up with a family or school that did not help you learn how to experience and control your emotions. In such environments, you may have been expected to be ‘perfect’ and not to show any negative emotions; or your emotions may have been dismissed as incorrect, inappropriate or silly. For example, if you got upset because you lost a toy, your parents might have responded with “you can’t possibly be upset for just losing a toy!”, and to “stop over-reacting!”. You might also have experienced trauma (e.g. sexual or physical abuse, a loss) and have been told “not to be upset about it”.

Because in these environments a ‘normal’ display of emotions is not taken seriously or attended to, this may have resulted in you expressing your emotions more intensely to get a response, e.g. screaming and crying, instead of just saying that you are feeling sad. Because of this, you may not have learned when to trust your own feelings in a situation, how to recognise, accept and control intense emotions, or how to cope with distress.

As an adult, you might have adopted the features of the environment you grew up in – you feel that you shouldn’t be feeling the way you do, and that you should be able to deal with life’s problems. You might feel frustrated, ashamed and angry at yourself.

Before I started DBT, I believed that I did not really have a mental health problem; that I just needed to pull myself together, get a grip and stop wasting everyone’s time.

DBT suggests that in order to overcome these problems you need to learn how to control your emotions, and that the first step in doing so is to experience, recognise and accept your emotions. You can then start to reduce their intensity and let them go quicker.

In DBT, you are taught specific skills on how to do this.

What is dialectical behaviour therapy (DBT)?

Marsha Linehan developed DBT from cognitive behaviour therapy (CBT) and adapted it to meet the emotional needs of people diagnosed with BPD. CBT has traditionally focused on helping people change unhelpful ways of thinking and behaving. 

DBT also helps you to change, but it differs from CBT in that it focuses on accepting who you are at the same time. DBT therapists aim to balance ‘acceptance techniques’ with ‘change techniques’.

Acceptance techniques

Acceptance techniques focus on understanding and making sense of you as a person and the things you do. With these techniques, DBT therapists might point out that your behaviour (e.g. self-harming or using drugs) makes sense, even if it is not in your best interest in the long-term. It is often the only way you have learned to deal with intense emotions and has helped you to get through very difficult experiences. 

In DBT finally someone is saying 'yes, it makes sense' rather than 'no, that's wrong’.

Change techniques

DBT therapists use change techniques to encourage you to change your behaviour and learn more effective ways of dealing with your distress. They encourage you to replace behaviours that are harmful to you with behaviours that can help you move forward with your life.

Having a ‘pushy’ therapist in DBT kept me on track with making changes in my life.

The therapeutic relationship

If you have BPD, you may find that relationships are a key factor in keeping you alive and motivated. Therefore, DBT places particular importance on the relationship between you and your therapist, and this relationship is used to motivate you to change. 

I don't think I can say enough about how thankful I am to my therapist and the DBT team. I could never express how much their support meant to me and still means to me. My life changed in ways I never thought possible.

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