Dialectical behavior therapy

Mindfulness training helps people notice thoughts, emotions, physical sensations, and cravings in the present moment without reacting immediately. During addiction recovery, this awareness can create space between an urge and a behavioral response, giving someone time to practice other coping skills.

Distress tolerance skills help people move through painful emotions or stressful situations without making the situation worse. Strategies may include grounding, paced breathing, self-soothing, distraction, or radical acceptance.

In recovery, these tools may provide alternatives to using substances when cravings, conflict, or emotional distress become intense.

Emotion regulation focuses on recognizing emotions, understanding what influences them, and responding in ways that support longer-term goals. DBT may use strategies such as checking the facts or opposite action when strong emotions are pushing someone toward harmful or impulsive behavior.

The goal is not to suppress emotion, but to respond to it more intentionally.

Interpersonal effectiveness helps people communicate needs, set boundaries, manage conflict, and maintain self-respect in relationships. These skills can be especially useful when substance use has affected trust or when social pressure creates challenges during recovery.

DBT teaches people to balance relationship needs with their own values, safety, and recovery goals.

DBT was originally developed to treat borderline personality disorder, a condition that may involve difficulty regulating emotions, unstable relationships, impulsivity, self-harm, or suicidal behavior.

The National Institute of Mental Health identifies DBT as one psychotherapy used for borderline personality disorder and notes its focus on mindfulness, controlling intense emotions, reducing self-destructive behaviors, and improving relationships.

DBT skills may help someone develop greater awareness of emotional patterns while practicing distress tolerance, emotion regulation, and interpersonal effectiveness.

People experiencing post-traumatic stress disorder may struggle with painful emotions, avoidance, relationship difficulties, or attempts to manage emotional distress through harmful behaviors.

DBT may sometimes be incorporated into treatment when emotional regulation or safety skills need attention. However, DBT is not automatically a replacement for trauma-focused treatment. The appropriate approach depends on symptoms, treatment goals, safety considerations, and a licensed mental health professional’s recommendations.

DBT skills such as mindfulness, distress tolerance, and emotion regulation may also be useful when depression or anxiety contributes to difficulty coping with everyday life.

For someone with major depressive disorder, for example, treatment may involve addressing withdrawal, intense negative emotions, or self-destructive behaviors. For anxiety, mindfulness and distress tolerance may help someone remain present during uncomfortable emotional or physical sensations.

DBT may be one component of care rather than the only psychological treatment used.

DBT and DBT-informed approaches have also been adapted for concerns such as eating disorders and other mental health conditions. When substance use occurs alongside complex psychiatric needs, DBT may be one part of a broader plan that also includes individual therapy, psychiatric care, medication management, group therapy, or other clinically appropriate approaches.

When considering a DBT therapist or therapy program, useful questions may include the following.

• Training and licensure. Ask whether the clinician is a licensed mental health professional and what DBT-specific training they have completed.
• Treatment format. Find out whether the clinician provides comprehensive DBT, individual DBT-informed therapy, or skills training only.
• Experience with substance use. Ask how they adapt the approach when addiction or recovery concerns are part of the treatment plan.
• Experience with co-occurring conditions. Many mental health conditions can occur alongside substance use, so relevant clinical experience may matter.
• Skills practice. Ask how you practice mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness between appointments.
• Progress and goals. Discuss how treatment priorities are established and how progress will be reviewed.

A good therapeutic fit involves more than credentials alone. Someone should also feel able to ask questions, understand the treatment plan, and work collaboratively with the clinician.

DBT teaches practical ways to manage intense emotions, tolerate distress, communicate more effectively, and respond to urges without automatically acting on them. DBT focuses on balancing acceptance with change, helping people acknowledge difficult experiences while practicing healthier behavioral responses. Over time, these skills may support self-compassion, stronger relationships, and a more fulfilling life during recovery.

The word dialectical refers to holding two ideas that may appear opposite at the same time. In dialectical behavior therapy, someone can accept their current emotions and circumstances while also working toward positive change. This approach can help reduce rigid, all-or-nothing thinking and create a greater sense of flexibility when dealing with setbacks, cravings, or emotional distress.

Suitability depends on the individual. It may be considered when substance use occurs alongside emotional dysregulation, impulsivity, relationship difficulties, self-harming behaviors, or certain mental health conditions. A licensed mental health professional can help determine whether DBT is a suitable part of a broader treatment plan based on symptoms, safety needs, and recovery goals.

Comprehensive DBT generally follows a treatment hierarchy. Life-threatening behaviors, including serious self-harm or suicidal ideation, are addressed before behaviors that interfere with therapy or quality of life. Once immediate safety concerns are addressed, treatment can focus more heavily on emotional regulation, relationships, coping skills, and building a life that feels meaningful and sustainable.

Behavior research has found meaningful benefits for DBT in certain populations, particularly people with borderline personality disorder and self-harming behaviors. One Australian controlled trial found reductions in self-injury, emergency service use, psychiatric admissions, and hospital days among participants receiving DBT compared with treatment as usual. Research supports DBT as an effective treatment for some people, but outcomes vary based on diagnosis, program structure, engagement, and individual needs.