Dialectical Behaviour Therapy (DBT) - Darlinghurst Psychologists

Dialectical Behavioural Therapy (DBT)

Dialectical Behaviour Therapy (DBT) is an evidence-based therapy developed to help individuals who experience intense emotions, impulsivity, or difficulty in relationships. Originally designed for people with borderline personality disorder, DBT is now widely used to support those struggling with emotion regulation, self-harm, chronic suicidality, and other complex mental health challenges.

DBT combines cognitive-behavioural strategies with mindfulness and acceptance-based practices, promoting a balance between change and acceptance. The therapy focuses on building skills in four core areas: mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. DBT takes a skills approach to therapy and looks at helping people use effective and evidence-based psychological that matches their current mood and emotive states (i.e. whether highly dysregulated or at baseline to move towards their personal ‘life worth living’

DBT can be delivered in different formats to suit individual needs. The full DBT model typically involves a combination of weekly individual therapy and a structured skills training group. However, DBT principles and techniques can also be effectively integrated into standalone individual therapy, offering flexibility for clients who may not need or prefer the full program. Whether in a group setting or one-on-one, DBT supports clients in developing greater emotional resilience and a more balanced, values-driven life. At Darlinghurst Psychologists we provide individual DBT, however, have relationships with group skills programs that we can recommend and work alongside if you are interested in attending a structured skills training group.

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Dialectical Behaviour Therapy (DBT) – Frequently Asked Questions

1. What is Dialectical Behaviour Therapy (DBT)?

DBT is a structured psychotherapy that integrates cognitive-behavioural techniques with mindfulness, emotional regulation, and interpersonal skills. It focuses on balancing acceptance and change—called “dialectics.” Originally developed by Marsha Linehan, DBT helps individuals tolerate distress, manage emotions, and build more effective relationships.

Reference: Linehan, M. M. (2015). DBT skills training manual (2nd ed.).

2. What conditions does DBT treat effectively?

DBT was originally developed for Borderline Personality Disorder (BPD) but has been adapted and supported by evidence for a variety of clinical presentations, including:

- Borderline Personality Disorder (BPD)
- Chronic suicidality and self-harm
- Post-Traumatic Stress Disorder (PTSD)
- Complex trauma and emotion dysregulation
- Eating disorders (e.g., bulimia nervosa, binge eating disorder)
- Substance use disorders
- Depression and anxiety with emotion regulation difficulties
- Adolescents with behavioural dysregulation

DBT is listed as an empirically supported treatment by the APA Division 12 (Society of Clinical Psychology):
https://div12.org/treatment/dialectical-behavior-therapy-for-borderline-personality-disorder/

3. What are the core components of DBT?

DBT consists of four key skill modules:

1. Mindfulness – Being present and observing thoughts without judgment
2. Distress Tolerance – Surviving emotional crises without making them worse
3. Emotion Regulation – Understanding and managing intense emotional responses
4. Interpersonal Effectiveness – Navigating relationships while respecting self and others

Therapy involves:

- Skills training (usually in a group format)
- Individual DBT therapy (weekly sessions)
- Between-session coaching (e.g., phone support)
- Therapist consultation teams to support clinical fidelity

Source: Linehan, 2015; Swales & Heard, 2009

4. How is DBT delivered?

There are multiple delivery formats:

Comprehensive DBT

- Weekly individual therapy (45–60 minutes)
- Weekly skills training group (2–2.5 hours)
- Phone coaching for in-the-moment support
- Consultation team meetings for therapists

This full model—individual therapy plus group skills—has been shown to yield superior outcomes compared to individual therapy alone, especially for emotion regulation, suicidality, and treatment retention.

Adapted DBT Programs

- Skills-only DBT groups (without individual therapy)
- Short-term DBT skills groups (as brief as 8–20 weeks)
  These programs have shown effectiveness for moderate emotion dysregulation and as early interventions in stepped-care or community settings.

Source: Linehan et al., 2006; Neacsiu et al., 2010; Valentine et al., 2020

5. How long does DBT take?

Standard DBT programs typically last:

- 6–12 months (full protocol)
- 24 weeks for a complete cycle of skills training
- Programs often repeat the 24-week cycle once for consolidation

Evidence also supports shorter DBT group programs (≤ 20 weeks), especially for individuals with less complex presentations or those accessing DBT through private services, partial hospital programs, or outpatient groups.

Reference: Valentine et al., 2020

6. Is DBT effective?

Yes—DBT is one of the most rigorously studied psychotherapies. Research shows it:

- Reduces suicide attempts and self-injurious behaviours
- Improves emotion regulation, distress tolerance, and interpersonal functioning
- Decreases psychiatric hospitalisation
- Increases treatment adherence and engagement

Reference: Linehan et al., 2006; APA Division 12

7. How does DBT differ from CBT?

While DBT shares some foundations with Cognitive Behavioural Therapy (CBT), it has unique elements:

CBT	DBT
Focus on thoughts/behaviours	Focus on acceptance and change
Highly structured	Structured + emphasis on flexibility and validation
Targets symptoms	Targets life-threatening behaviours first
Homework-focused	Skill-focused, includes coaching and mindfulness

DBT also prioritizes therapeutic relationship validation and real-time emotional processing.

8. Is DBT suitable for everyone?

DBT is best suited for individuals who:

- Experience intense, rapidly shifting emotions
- Struggle with unstable relationships or severe interpersonal distress
- Would benefit from a structured program that builds emotional regulation over time
- Engage in self-harm, suicidal thoughts, or impulsive behaviours

This includes individuals suffering from intensive anxiety, depression, relationship issues, emotion dysregulation or with complex histories of trauma.

Reference: Lynch et al., 2007

References

Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.

Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., … & Lindenboim, N. (2006). Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of General Psychiatry, 63(7), 757–766. https://doi.org/10.1001/archpsyc.63.7.757

Neacsiu, A. D., Rizvi, S. L., & Linehan, M. M. (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy, 48(9), 832–839. https://doi.org/10.1016/j.brat.2010.05.017

Valentine, S. E., Bankoff, S. M., Poulin, R. M., Reidler, E. B., & Pantalone, D. W. (2020). The use of dialectical behavior therapy skills groups in a partial hospital program. Journal of Psychotherapy Integration, 30(3), 371–383. https://doi.org/10.1037/int0000200

Swales, M. A., & Heard, H. L. (2009). Dialectical behaviour therapy: Distinctive features. Routledge.

Lynch, T. R., Trost, W. T., Salsman, N., & Linehan, M. M. (2007). Dialectical behavior therapy for borderline personality disorder. Clinical Psychology Review, 27(2), 153–162. https://doi.org/10.1016/j.cpr.2006.09.006

Society of Clinical Psychology, APA Division 12. (n.d.). Dialectical Behavior Therapy for Borderline Personality Disorder. Retrieved from https://div12.org/treatment/dialectical-behavior-therapy-for-borderline-personality-disorder