Approaches / Acceptance and mindfulness
Dialectical behaviour therapy (DBT)
A skills-based programme that balances acceptance with change, developed first for people with intense emotions and self-harm.
Overview
Dialectical behaviour therapy was developed by Marsha Linehan for people with strong emotions and repeated self-harm. It combines individual therapy, skills training and support for the therapist.
Core ideas
DBT balances acceptance of a person as they are with work towards change. It teaches skills in four areas: mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness.
It draws on a biosocial account in which emotional sensitivity and an invalidating environment interact.
What a session can involve
A standard programme includes weekly individual sessions and a skills group, and often phone coaching between sessions. Individual sessions usually track recent difficulties and the use of skills, with safety given priority.
Formats and settings
Comprehensive programmes run for about a year in many services. Adaptations exist for adolescents, families and other groups, and skills-only versions are used in some settings.
How it relates to other approaches
DBT sits within cognitive and behavioural traditions and shares mindfulness with mindfulness-based cognitive therapy and acceptance with acceptance and commitment therapy. Its emphasis on validation connects with ideas from humanistic work.
Limits and open questions
A full programme asks for a large time commitment and trained teams, which limits access. Questions remain about which components matter most and how to adapt it across cultures and age groups.
The diagnosis of borderline personality disorder, for which DBT was first developed, is debated and carries stigma. NICE guidance for England and Wales says to consider a comprehensive DBT programme for women with this diagnosis when reducing recurrent self-harm is a priority. This recommendation describes a particular context; it does not mean that only women may benefit or that DBT is the only option.
History
Linehan began developing DBT in the 1980s while working with chronically suicidal women. The foundational manual was published in 1993.
Key people
Marsha Linehan developed DBT.
Sources and inspection notes
NHS, Treatment for borderline personality disorder
Supports: That DBT is described as a therapy designed to treat borderline personality disorder in NHS information (UK).
NICE, Borderline personality disorder: recognition and management (CG78)
Supports: Recommendation 1.3.4.5 describes considering a comprehensive DBT programme for women with borderline personality disorder when reducing recurrent self-harm is a priority (England and Wales). It does not establish that DBT is appropriate only for women.
Supports: National Library of Medicine catalogue record confirms author, title, publisher and 1993 publication. The catalogue record is not a review of the book’s clinical claims.