DBT Therapy: What It Is and How to Get Started

DBT therapy is a structured, skills-based treatment that helps people manage intense emotions, improve relationships, and get through hard moments without making things worse. By the end of this post you will know what to expect and how to find a therapist who offers it. This post explains what DBT actually involves and how to decide if it might be right for you.

If you are in crisis, call or text 988 to reach the Suicide & Crisis Lifeline.

What does DBT stand for, and where did it come from?

DBT stands for dialectical behavior therapy. The word "dialectical" means holding two things as true at once. You are doing the best you can. You can also do better. That tension is at the center of how DBT works.

DBT was developed by psychologist Marsha Linehan to treat people who experienced severe emotional pain and found standard talk therapy hard to stay in. It draws on cognitive behavioral techniques and adds skills training, which is what makes it different from most other therapy formats.

Who does DBT therapy help?

DBT was first developed to treat borderline personality disorder (BPD). It is now used for depression, eating disorders, post-traumatic stress, and intense emotional reactivity. You do not need a BPD diagnosis to benefit from it.

DBT is commonly used for people who experience:

• Intense or rapidly shifting emotions that feel hard to control
• Urges to self-harm or thoughts of suicide
• Eating disorders, particularly binge eating and bulimia
• Depression that has not responded to other treatments
• Post-traumatic stress
• Anxiety that shows up as emotional reactivity
• Difficulty in close relationships

If you recognize yourself in that list, it is worth asking a therapist whether DBT might be a good fit. You do not need a formal diagnosis before your first appointment.

What happens in a DBT session?

Full DBT, sometimes called standard DBT, has two parts that run at the same time.

The first is individual therapy. You meet one-on-one with your therapist, usually once a week. You talk through what happened since your last session, look at moments where things went wrong, and practice applying skills to those situations.

The second is a skills training group. This is a small group, led by a therapist, that meets weekly. It is not a support group where people share feelings. It is closer to a class. You learn specific skills, do homework between sessions, and practice with other group members.

Some therapists also offer phone coaching between sessions. These are short calls for moments when you are in a hard spot and need help using a skill in real time.

Not every provider offers all three components. Some offer individual therapy only, or teach DBT skills without the full group format. This is sometimes called DBT-informed therapy. Ask any therapist you contact which format they use.

What are the four DBT skills?

DBT organizes its skills into four modules. You work through all four, usually in a set order.

Mindfulness. This is the foundation. It means paying attention to what is happening right now, without judging it. Most other DBT skills build on this one.

Distress tolerance. These skills help you get through a crisis without making it worse. They are for moments when you cannot change what is happening and need to survive it intact.

Emotion regulation. These skills help you understand your emotions, reduce how often painful ones show up, and change their intensity once they start.

Interpersonal effectiveness. These skills help you ask for what you need, say no, and keep relationships healthy. The goal is to hold your own without losing the relationship.

You practice each module over several weeks, then cycle back through them. Repetition is part of how the skills stick.

How long does DBT therapy take?

Standard DBT runs for about six months to a year. Some people do a second cycle to keep practicing. The length depends on what you are working on and how quickly the skills become habits.

DBT-informed therapy uses individual sessions with a DBT-trained therapist, without the group format. The timeline is more flexible and closer to regular therapy.

DBT asks more of you than some other therapy formats. There is homework between sessions and skills to practice in daily life. That is useful to know going in so you can plan for it.

How much does DBT therapy cost, and does insurance cover it?

Without insurance, a therapy session often costs $100 to $200, depending on where you live. Therapists with extra training, such as in DBT, may charge more. Group skills sessions are usually less expensive than individual sessions.

Whether your plan covers outpatient mental health therapy, including DBT, depends on your specific plan. Not all plans are required to cover mental health benefits.

Call the number on your insurance card. Ask whether your plan covers outpatient mental health visits, what limits apply to session type or format, and what your copay or coinsurance would be.

If cost is a concern, ask therapists whether they offer a sliding scale fee. Some do. You can read more about how sliding scale therapy works at /blog/sliding-scale-therapy.

For a broader look at what therapy costs, see /blog/how-much-does-therapy-cost.

How do I find a DBT therapist?

Look for a therapist who lists DBT as a specialty and can describe their training. Training in DBT varies. Some therapists have completed an intensive training program. Others have attended a workshop. It is fine to ask.

Questions worth asking a potential DBT therapist:

• Are you trained in DBT, and what did that training involve?
• Do you offer standard DBT with a skills group, or individual DBT-informed therapy?
• Do you offer phone coaching between sessions?
• Do you take my insurance, and what would I pay per session?
• How long do most of your DBT clients stay in treatment?

You can also do DBT therapy online. Many therapists offer video sessions, and some skills groups run online as well. Online DBT follows the same structure as in-person. If you are more comfortable at home, or your area has few DBT providers, online is a real option.

If you are not sure whether you need a therapist or a psychiatrist, /blog/psychiatrist-vs-therapist explains the difference. DBT is delivered by therapists. If you also want to talk about medication, you would see a psychiatrist or psychiatric nurse practitioner separately.

Common questions

Do I need a diagnosis to start DBT therapy?

No. You do not need a formal diagnosis before your first appointment. Many people start DBT because they recognize the problems it addresses. A therapist will talk with you about what you are experiencing and help you decide whether DBT is a good fit.

Is DBT only for people with borderline personality disorder?

No. DBT was first developed for BPD. It is now used for depression, eating disorders, post-traumatic stress, and intense emotional reactivity. If you do not have a BPD diagnosis, that does not mean DBT is not for you.

Can I do DBT therapy online?

Yes. Many therapists offer DBT via video sessions, and some skills groups meet online. The format and skills are the same as in-person DBT. Online therapy can be a good option if you live somewhere with few DBT providers or prefer to be at home.

What is the difference between DBT and CBT?

Cognitive behavioral therapy (CBT) focuses mainly on identifying and changing unhelpful thought patterns. DBT grew out of CBT but adds a strong focus on emotional intensity, acceptance, and skills training in a group format. DBT also puts more emphasis on the relationship between you and your therapist as part of the treatment.

How do I know if DBT is working?

Most people notice changes gradually. You might find that a skill you practiced in group actually helped during a hard week. Or that a relationship conflict went differently than it used to. Your therapist will track your progress with you. If things are not improving after several months, that is worth raising directly in your sessions.

Not sure whether DBT or another type of therapy might fit what you are going through? Tell saycalm what's going on, and we'll explain your options and help you find a provider who fits. Start a conversation