Most people have heard of CBT – but have you come across its slightly younger, more emotions-focussed cousin, DBT?

DBT is a popular, highly practical form of therapy that teaches skills for coping with overwhelming emotions and building stronger relationships. 

It’s specifically designed for people dealing with very difficult mental health problems, like self-harming or feeling suicidal – people who often get left behind or deemed too risky by other therapy modalities. 

For those clients, DBT can be an essential lifeboat. But anyone can benefit from its teachings about mindfulness, tolerance, and acceptance. 

On this page, find out all about the history of DBT, core DBT skills, and what makes it LGBTQ-affirmative. 

What is DBT?

Dialectical Behavioural Therapy, or DBT, is a form of talking therapy designed for people who experience their feelings really intensely. 

It can be delivered as one-to-one therapy, but it’s also often offered as group therapy, and can be supported with self-guided tools like worksheets or workbooks. (You can also explore DBT-inspired exercises in the Voda app.)

DBT focuses on four key modules:

• Mindfulness: Using traditional meditation and grounding techniques to help you to feel present in your body. 
• Distress tolerance: Learning strategies to manage moments of crisis and acute stress.
• Emotion regulation: Building the ability to accept and soothe strong emotions – so they don’t overwhelm you. 
• Interpersonal effectiveness: Strengthening relational and communication skills, such as navigating conflict calmly, and setting clear boundaries. 

You can find out more about all of these modules further down this page. 

DBT was originally developed for people diagnosed with borderline personality disorder (BPD) and people who felt suicidal. 

It’s often now offered to a wider range of people, including neurodivergent people and others who experience emotions intensely, including those with complex trauma. 

It is also sometimes used to treat self-harm, disordered eating, and addiction. 

In general, it can be helpful for anyone who has trouble managing their strong emotions. 

What does DBT stand for?

DBT stands for Dialectical Behavioural Therapy. 

Dialectical means two opposing things that can be true at once. 

For example, you might really want to stop a bad habit, but also see how the bad habit helps you to cope. 

Or you might treat yourself with compassion, but also wish that you could change the way that you behave. 

All of these feelings can co-exist. DBT supports you to hold seemingly opposite truths and emotions at once. 

Behavioural relates to actions and behaviours. 

Like CBT, DBT is a form of behavioural therapy, because it supports you to look closely at, and change, your behaviours. 

What’s the difference between CBT and DBT?

CBT, or Cognitive Behavioural Therapy, is a type of talking therapy that supports people to identify and change unhelpful thoughts and habits. 

Like CBT, DBT is also a kind of behavioural therapy. That means that both approaches focus on changing behaviour. 

In fact, DBT was originally developed as an offshoot of CBT. 

But CBT has more of a focus on thoughts. A CBT therapist might encourage you to complete exercises where you list evidence for and against your thoughts, for example, to examine how likely it is that your worries could come true. 

DBT leans more towards emotions. In DBT, you learn practical coping skills for times when your feelings overwhelm you. 

DBT also teaches acceptance. You’re supported to accept your emotions and difficult circumstances, even though you also want them to change. 

Find out more about CBT and how it works.

History of DBT

DBT was first developed by the American psychologist Marsha Linehan in the 1980s. 

Linehan’s work is rooted in the empathy of lived experience. As a young woman, she spent two years in a psychiatric hospital as a patient. 

After becoming a psychologist herself, she set out to create an evidence-based way of working with suicidal people and people diagnosed with BPD. 

She did this through a trial-and-error process. Through observation, she discovered that many of these clients felt invalidated by CBT. 

She was influenced by Buddhist philosophy to bring mindfulness, meditation, and radical acceptance into her approach.

But she also found that focusing only on acceptance could leave clients feeling stuck, with no route to cope with their overwhelming feelings. 

So she also kept some of the behavioural elements of CBT, to support the clients to work towards change. 

DBT Skills

Unlike more open-ended forms of therapy, DBT focuses on teaching specific skills in four core modules: mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. 

Mindfulness

DBT mindfulness skills are all about rooting yourself in the here-and-now. 

This can support you to feel calmer, and develop your self-awareness and self-compassion. 

Heavily influenced by the principles of Buddhism and meditation, these skills include:

• Mindful breathing: By simply bringing attention to the breath, you can use one of your body’s most familiar, everyday actions to ground yourself. 
• Body scans: DBT makes use of meditation skills such as body scanning, in which you gently bring your attention to different parts of the body, one at a time. 
• Wise Mind: In DBT, the “Wise Mind” is the name for the part of yourself that combines logic with emotion. When you’re able to access this part, you’re getting in touch with your inner wisdom. 

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Distress tolerance

In DBT, distress tolerance skills are ways of helping yourself cope during the toughest moments. 

These skills can be particularly helpful for those who might lash out or turn to self-destructive behaviours when they feel overwhelmed. 

They’re designed to support you as you ride the wave of intensity, like an umbrella in a storm. 

Distress tolerance skills include:

• TIPP: An acronym standing for Temperature, Intense Exercise, Paced breathing, and Progressive muscle relaxation. This is all about adjusting your body state, to change your emotional state. 
• Distracting: DBT practitioners might encourage you to make a list of activities that you find distracting. When you’re very distressed, it might help to distract yourself until your nervous system calms a little. 
• Radical acceptance: Acceptance is not about being happy with what’s happening, but simply accepting that it is, rather than fighting it. DBT teaches us to radically accept our emotions as part of being human. 

Emotional regulation

Emotion regulation is an important part of DBT: it’s all about recognising big emotions, and finding strategies to calm them, so that you can think and act from a more stable place. 

“Regulation” means control – so you could think of it as bringing your emotions under your control, rather than being controlled by them. 

Emotional regulation skills include:

• STOP: Another acronym, this one stands for: Stop, Take a breath, Observe, Proceed mindfully. This reminds you to pause and reflect before you react.
• Opposite Action: This famous DBT skill is about trying to shift your mood or mindset by acting in the opposite way to how you feel. For example, projecting confidence when you feel ashamed or nervous. 
• Check the Facts: This more cognitive skill encourages you to check your emotions against the objective facts of a situation, so you can see more clearly what is the truth, and what is shaped by how you feel. 

Interpersonal effectiveness

DBT’s interpersonal effectiveness module teaches you to strengthen your relationships by communicating clearly and respectfully. 

Interpersonal effectiveness skills include:

• Boundaries: DBT teaches healthy boundaries: how to communicate your own, and how to respect them from others. 
• DEAR MAN: This acronym stands for Describe, Express, Assert, Reinforce, Mindful, Appear confident, and Negotiate. It’s all about communicating needs clearly. 
• FAST: FAST is an acronym designed to help you maintain self-respect during conflict and hard conversations. It stands for Fair, no Apologies, Stick to your values, and Truthful. 
• GIVE: The third important acronym in interpersonal effectiveness skills stands for Gentle, act Interested, Validate, and Easy Manner. This supports you to keep relationships intact and healthy. 

DBT for LGBTQ+ people

DBT is not a LGBTQ+ specific form of therapy, but it can be really helpful for boosting self-acceptance and self-worth in queer and trans people. 

LGBTQ+ people have a higher risk of suicide and self-harm. This is not because being LGBTQ+ itself causes mental health problems, but because we face minority stress.

Studies have suggested that neurodivergent people also may be more likely to be LGBTQ+.

As a result, many LGBTQ+ have experienced DBT in some form. Some may have found it helpful, and others less so – just like any other group, there’s a huge variation in what works for LGBTQ+ people. 

These are some of the pros of DBT for LGBTQ+ people:

• It teaches self-acceptance. In a society that encourages us to feel shame, this emphasis on acceptance can have big benefits for LGBTQ+ people. 
• It recognises systemic context. Marsha Linehan was a great believer that our environment shapes how we feel. This means that DBT recognises how stigma and discrimination in society might shape your experiences. 
• It roots you in your values. DBT teaches you to get in touch with your own values, and build a life that works for you, not a life that follows the “norm”.
• DBT skills don’t discriminate. Skills in emotional regulation and distress tolerance, for example, could be useful for anyone, no matter your sexuality or gender.

But some of the cons of DBT for LGBTQ+ people may include:

• Mindfulness could feel difficult for some. People experiencing gender dysphoria, for example, might struggle with body-centred mindfulness skills, like body scanning. 
• Interpersonal skills might not always be appropriate. When you’re facing homophobia or transphobia, you might need to prioritise safety instead of using interpersonal effectiveness skills. 

Just like any other therapy, if you’re looking for a DBT therapist, it can help to check if they are LGBTQ-affirmative. 

Find out more about LGBTQ-affirmative therapy.

Does DBT work for everyone?

There’s no magic bullet style of therapy that works for everyone. DBT might resonate with you, and it might not – there’s nothing wrong with you if not. 

DBT demands a lot of time and effort. It might not be right for those who:

• Want to spend more time processing events from the past, rather than focusing on their emotions and behaviour in the present.
• Might need additional support alongside DBT, people navigating psychosis, significant cognitive impairments, or substance use. 
• Don’t like structured, skills-focussed therapy, and would prefer to talk in an open-ended way. 

Try LGBTQ-affirmative DBT skills with Voda

Voda is the LGBTQ-affirming mental wellbeing app that's built by us, for us. 

If you’re interested in trying out queer-affirming self-care practices informed by DBT, our app has plenty to choose from. 

Discover self-led techniques for riding the waves of strong emotions and grounding yourself in the present moment – all written by queer therapists. 

Download Voda via Google Play and on the App Store. 

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