Therapeutic Aproaches - Dialectical Behavior Therapy (DBT)
When your emotions feel too intense to manage, DBT gives you actual tools
Dialectical Behavior Therapy (DBT) was originally developed by Dr. Marsha Linehan for people with borderline personality disorder, and has since been adapted and shown effective for a wide range of conditions involving emotional intensity, self-harm, relationship difficulties, and difficulty tolerating distress.
The “dialectical” in DBT refers to holding two seemingly opposite things as both true: that you are doing the best you can — and that you need to change. DBT is validating and challenging at the same time. It teaches practical, learnable skills that work.
What This Can Feel Like
Emotions are supposed to come and go, but for a lot of people, they hit harder, last longer, and feel nearly impossible to turn down. If any of this sounds familiar, you’re not alone.
- You send a text and then spend the next two hours reading into the silence, convinced something is wrong
- A small criticism at work stays with you for days, replaying on a loop no matter how hard you try to let it go
- You go from calm to completely overwhelmed in what feels like seconds, and you’re not sure what even triggered it
- You’ve pushed people away or said things you regret, not because you wanted to, but because the feeling was just too big to hold
- You use food, alcohol, shopping, or scrolling to take the edge off, even when you know it’s making things worse
- Conflict with someone you love sends you into a spiral of panic or shutdown
- You feel empty a lot of the time, then suddenly flooded with emotion, and neither state makes sense to you
- You’ve hurt yourself or thought about it as a way to get some relief from what’s going on inside
- You swing between desperately wanting closeness and feeling like the people closest to you are going to leave anyway
Why This Happens
For some people, the nervous system is just wired to feel things more intensely. Research suggests this heightened emotional sensitivity is often a combination of biology and environment, meaning some people are naturally more reactive, and that reactivity gets amplified when early experiences didn’t include much modeling of how to handle big feelings. DBT works from the understanding that you can absolutely learn new patterns, not by fighting your emotions, but by getting better at working with them.
How DBT Can Help
DBT is a structured, skills-based therapy that teaches you concrete ways to navigate intense emotions, improve your relationships, and get through a crisis without making things worse (American Psychological Association, 2023).
In sessions, you’ll work on four core skill areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. It’s practical by design, which means what you practice in sessions is meant to be used in your actual life, not just talked about in a room.
- Recognizing what’s actually happening emotionally before it reaches a tipping point
- Getting through a crisis moment without doing something you’ll regret
- Understanding the difference between a feeling and a fact, especially when your mind is moving fast
- Asking for what you need without it turning into a fight or a shutdown
- Setting limits with people in your life without blowing everything up or going silent
- Reducing the intensity and duration of emotional spirals over time
- Learning to tolerate discomfort without immediately needing it to stop
How Ellie Makes Support More Accessible
Starting therapy, especially for something as intense as emotional dysregulation, can feel like a big ask. Ellie tries to make the first steps as low-friction as possible.
- Therapists who specifically work with DBT are matched to you based on what you’re dealing with, so you’re not starting from scratch trying to find someone qualified
- Ellie works with many insurance plans, and the team helps you figure out what your benefits actually cover before your first session
- Scheduling is flexible, with evening and weekend options available so therapy doesn’t require rearranging your whole life
- You can meet with your therapist in person or by video, depending on what’s easier for you that week
- If your first therapist match doesn’t feel right, Ellie will help you find someone who fits better, because the relationship matters as much as the approach
- No one expects you to walk in with everything figured out. You can come as you are.
Frequently Asked Questions for Dialectical Behavior Therapy (DBT)
Not sure what to expect? These are the questions people ask us before they get started.
No. While DBT was originally developed for BPD, it’s now widely used for anyone dealing with intense emotions, self-harm, eating disorders, substance use, trauma, and relationship difficulties. The skills are broadly applicable.
Standard DBT includes both individual therapy and group skills training. Individual DBT without a group component is also practiced and can be effective, particularly when group isn’t available or doesn’t fit. Your therapist can discuss what makes sense.
Full DBT programs are typically structured as a one-year commitment. Shorter individual DBT-informed therapy is also common. Your therapist will help you set realistic expectations.
DBT is specifically designed for the type of emotional intensity and dysregulation that some people experience — and that other therapies weren’t built to address. If previous therapy felt inadequate for the depth of what you’re dealing with, DBT may provide the structure and skills that were missing.
Yes. DBT has an extensive research base and is recognized as an effective treatment by major clinical organizations for BPD, suicidal behavior, self-harm, and eating disorders, among others.