Frequently asked Dialectical Behavior Therapy Questions

A few weeks ago we spent some time asking commonly asked questions about DBT, to round out this segment, here is Part 2 of those frequently asked Questions.

Can Dialectical Behavior Therapy help with Relationship Issues?

Yes, Dialectical Behavioral Therapy (DBT) can be extremely helpful for improving relationships both with ourselves and with others. One of the core skills taught in DBT is Interpersonal Effectiveness, which focuses on:

• Validation: Recognizing other people’s emotional experience and responses is fundamental for a relationship to be able to withstand requests and conflict.  

• Assertiveness: Learning how to express needs and feelings clearly and directly, without being passive or aggressive.

• Conflict resolution: Navigating difficult conversations or conflicts in a way that maintains respect and balance in relationships.

  
  

The module of skills dedicated to relationship effectiveness is all about how to cultivate, maintain and repaire relationships all the while upholding your self respect. The ability to focus on both your needs and others highlights a dialectical strategy and allows people to practice accepting those in their life while also creating the change they wish to see in their relationships.

For people who struggle with relationships, DBT’s emphasis on mindfulness, emotional regulation, and communication can further help them build stronger, healthier connections with others. Whether in romantic relationships, friendships, family, or work dynamics, DBT teaches individuals to manage their emotions more effectively and respond to others in a way that is aligned with their values. 

Can DBT be used for conditions other than Borderline Personality Disorder?

DBT is a third wave of Cognitive Behavioral Therapy (CBT) meaning, the core of its interventions evolved from established, evidence based practices from CBT for things like depression, anxiety, ptsd, substance use. AND it adds in the addition of acceptance work, validation, mindfulness and building a life worth living (values work) which makes it a more comprehensive and robust treatment that sees the whole person versus just treating the diagnostic symptoms.

While DBT was originally designed for people with Borderline Personality Disorder (BPD), it has been shown to be effective for a range of other mental health conditions. Some of the conditions that DBT has been adapted to treat include:

• Depression: Especially in cases where individuals experience intense mood swings or emotional numbness.

• Anxiety disorders: Including generalized anxiety disorder and panic disorder, where emotional dysregulation contributes to the anxiety.

• Post-traumatic stress disorder (PTSD): DBT can help individuals manage trauma-related emotions and improve coping skills.

• Shame: It uses acceptance and change strategies to help individuals move from feeling paralyzed by shame to experiencing self-compassion and resilience. 

• Substance use disorders: DBT can be combined with other approaches to help individuals manage cravings, triggers, and urges.

  
  

Because DBT focuses on emotional regulation, distress tolerance, and mindfulness, it’s versatile enough to be helpful for anyone who struggles with intense emotions or problematic behaviors, regardless of the specific diagnosis. Additionally, in our practice we have seen DBT be effective for working with grief, life transitions and helping people find more balance in their lives.

How do DBT Therapists structure sessions?

In comprehensive DBT programs, there are two key formats: individual therapy and group skills training. Both are important and work together to help individuals achieve more skillfulness and fulfillment in their lives.

• Individual Therapy: In these one-on-one sessions, the focus is on the specific challenges and goals of the individual. The therapist helps the client find workability in current life problems and will help the client to learn and apply DBT skills to what is not working. Sessions are both structured and flexible. One unique aspect of DBT is the use of diary cards, which are tools clients use to track their emotions and behaviors outside of therapy, allowing the therapist to gain better insight into clients overall functioning and to help with targeted interventions.

• Group Skills Training: In addition to individual therapy, sometimes clients will attend weekly group sessions where they learn DBT skills in a structured format. This includes four modules: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness. These sessions offer a community environment where clients can practice these skills with others, receive feedback, and learn from shared experiences.

  
  

What is this "Role of Hierarchy in DBT" mean?

DBT is unique in that it uses a hierarchy of care approach. This hierarchy is used to ensure that treatment prioritizes the most urgent needs first. In a typical DBT program, the priority is as follows:

1. Reducing life-threatening behaviors (e.g., suicide attempts, self-harm, high risk behaviors)

2. Reducing therapy-interfering behaviors (e.g., missing sessions, therapist behaviors, lack of commitment to the process)

3. Reducing quality-of-life interfering behaviors (e.g., difficulties in managing emotions, interpersonal conflicts)

4. Addressing past trauma or deeper issues

   
   

This structure ensures that the most pressing concerns are addressed first and are not lost in other life happenings that can be discussed during session time. This hierarchical approach provides clients with a sense of stability and clarity about what to work on, which can help reduce overwhelming feelings about their treatment.

What does it look like to emphasize both Acceptance and Change?

Taking a dialectical approach is one of the key principles of DBT. A dialectic stance is the idea that two seemingly opposite things can be true at the same time. DBT therapists emphasize the importance of accepting client’s as they are while simultaneously encouraging them change the behaviors they wish to change. This dual approach creates a balanced treatment strategy that both validates someone where they are at and empowers them to grow.

For example, a DBT therapist might help a client recognize and accept that their intense emotions are real and valid, while also teaching them ways to manage those same emotions and avoid acting on urges that might harm themselves or others.

Ready to be more dialectical in your own life? -Let's get started.

~On Point Practice

References

1. Marsha Linehan’s Original Work:

   • Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.

     • This book is the primary source where Marsha Linehan, the creator of DBT, outlines the principles, structure, and techniques of DBT therapy.

2. Research Articles on DBT: 

   • Behavioral Tech Institute. (n.d.). Training and education in dialectical behavior therapy (DBT). BehavioralTech.org. Retrieved July 23, 2025, from https://behavioraltech.org/

     • This source provides foundational evidence regarding the core components and effectiveness of Dialectical Behavior Therapy (DBT). We reference research from Behavioral Tech that demonstrates DBT implemented with full fidelity—including essential elements such as the consultation team, skills group, phone coaching, and individual therapy—unlike other studies that may omit critical components.

3. Research Articles on DBT:

   • Linehan, M. M., et al. (2006). Dialectical behavior therapy for patients with borderline personality disorder and drug dependence: A randomized controlled trial. Archives of General Psychiatry, 63(7), 757–766.

     • This study is one of many clinical trials that tested the effectiveness of DBT for treating individuals with BPD and co-occurring conditions, establishing DBT as an evidence-based treatment.