Dialectical Behavior Therapy (DBT)
Practical, evidence-based skills for steadying strong emotions, riding out crises, and protecting the relationships that matter.
Navigating Dialectical Behavior Therapy
What Is Dialectical Behavior Therapy?
Dialectical Behavior Therapy, usually shortened to DBT, is an evidence-based treatment that teaches concrete skills for handling emotions that arrive fast, hit hard, and take a long time to settle. Psychologist Marsha Linehan developed it in the late 1980s, building on cognitive behavioral therapy and adding the piece that tradition was missing: acceptance. A dialectic means two things that are true at the same time. DBT rests on one such pair: you’re doing the best you can, and you can learn skills that make this easier.
Many people come to DBT after years of well-meant advice to calm down. When a feeling moves faster than thought, DBT’s answer is skills. It breaks emotion regulation into small skills you can practice, so a wave of emotion becomes something you can ride out instead of something that decides what you do next.
Our psychologists teach DBT skills within individual therapy, matched to what sets you off and what it costs you. The work is structured and practical, and you use it between sessions as much as in them.
How Effective Is DBT?
DBT measurably reduces self-harm and psychiatric crisis visits. In research on borderline personality disorder, where DBT is one of the most-studied treatments, therapy also reduces symptom severity and can improve daily functioning. It was first developed and tested with people whose emotions were causing them the most harm, and it has since been used much more widely. Behavior usually changes first. People have fewer crises and fewer moments they need to repair afterward, and more of their life runs on their own terms.
The two findings below are pooled reviews rather than single studies. Each one links to its source so you can read it yourself.
Controlled Trials of DBT
A meta-analysis of 18 controlled trials found DBT reduced self-harm and other self-directed behavior, and lowered how often people needed psychiatric crisis services. Source: DeCou et al., 2019, Behavior Therapy.
Trials in the Cochrane Review
In a Cochrane review of 75 randomized trials of therapy for borderline personality disorder, DBT and mentalization-based treatment were the most-studied approaches. Compared with usual care, the therapies in the review reduced symptom severity and were linked to less self-harm and better daily functioning. Source: Storebø et al., 2020, Cochrane Review.
What Conditions Can DBT Treat?
DBT treats conditions that share a common pattern: emotion that rises past the point where clear thinking helps, and ways of coping that get you through the moment but cost you later. The same skills help with irritable low moods, panic, strained relationships, and the emotional toll of injury and illness.
These are the areas where we use it most, on its own or woven into individual therapy that draws on more than one approach.
Emotions That Escalate Fast
Feelings can go from calm to unbearable in minutes, and it can take a long time to repair what happened in between.
Depression and Irritability
Some depression shows up as irritability, and the low mood and short temper keep feeding each other.
Panic and Overwhelm
When anxiety builds into panic, distress tolerance skills give you something to do besides wait for it to pass.
Relationships Under Strain
These skills help you ask clearly, say no, and repair arguments without giving up your self-respect or the relationship.
Trauma, Steadied First
DBT skills build the stability that makes trauma therapy possible, so working through the past doesn’t overwhelm your present.
Life After Brain Injury
Irritability and mood swings are common after a brain injury. We adapt the skills for changed attention and energy.
Chronic Illness and Pain
A long-term illness brings flares, setbacks, and anxious waits for test results, which are the moments these skills are built for.
Adjusting to Disability
Grief and anger often arrive when your body changes. Our disability counseling addresses the whole adjustment, including your sense of identity.
If what you’re carrying isn’t on this list, it’s still worth asking. DBT skills often help wherever strong emotions and hard circumstances keep running into each other.
How Does DBT Work?
DBT works by holding two truths at once: your reactions make sense given what you’ve lived through, and some of what you do with them has to change. The whole treatment is built on that balance of acceptance and change.
The skills come in four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. They’re taught in session and practiced between sessions until they hold up in the moments you need them most, and your psychologist starts with the module that fits what’s hardest for you right now.
Mindfulness: Noticing Before Reacting
Every other skill depends on this one. Mindfulness in DBT means catching a feeling early and naming it, which gives you a few seconds to choose how to respond. It’s closely related to mindfulness-based therapy, adapted for moments of intense emotion.
Distress Tolerance: Getting Through the Wave
These are crisis skills for when a feeling has already peaked. They help you calm your body quickly, get through the next hour without making things worse, and come out the other side with nothing new to repair.
Progress often shows up first as things that stop happening: the blowup that doesn’t come, the urge that passes, the argument that ends a day sooner than it used to.
Emotion Regulation: Turning Down the Volume
These skills make hard emotions less frequent and less consuming. You learn to read what a feeling is trying to do for you, lower your vulnerability to it, and act against its pull, a skill DBT calls opposite action.
Interpersonal Effectiveness: Holding Your Ground
People often underestimate this module. It teaches scripts and skills, DEAR MAN being the best known, for asking for what you need, saying no without lingering guilt, and getting through a hard conversation with your self-respect and the relationship both intact.
Between Sessions: Where the Skills Become Yours
DBT is learned the way any skill is learned, by practicing in calm moments so it’s there in hard ones. Each week you and your psychologist review what you tried, what worked, and what needs adjusting.
Is DBT Right for You?
DBT therapy fits when emotions regularly hit harder and faster than you can think, and what happens afterward keeps costing you. You don’t need to be in crisis to learn these skills, and you don’t need a diagnosis to start. A free 15-minute consultation is a conversation, not a commitment. We offer both in-person and telehealth sessions.
What Is DBT Like at Rowan Center?
DBT sessions are structured and active. Each one follows a plan you build together. You review what happened since last time, choose the skill that applies, and plan how to handle the moment differently when it comes back. Sessions are close to an hour, usually weekly to start.
The first sessions are mostly about mapping. Your psychologist wants to know what sets off your strongest emotions, what you currently do to get through them, and what each of those responses costs you. That map decides which skills module you start with.
You practice a skill between sessions and bring back what happened. The skill gets fitted to your life, not the other way around.
We teach the skills through one-on-one individual therapy, and we blend them with CBT or acceptance and commitment therapy where that serves you better. Sessions are available in person and online.
How Do You Get Started With Therapy at Rowan?
Getting started at Rowan takes four steps: you reach out, have a one-on-one intake conversation, get matched with a psychologist trained in DBT, and begin your first session, in person or online. The steps are the same whichever approach you work in. Here’s exactly what happens.
Start by Reaching Out
Call us directly, fill out the interest form, or schedule a free consultation, whichever is easiest for you.
One-on-One Intake Conversation
Our intake team reviews your information and reaches out for a one-on-one call to talk through what’s been going on, what you’ve already tried, and what you want help carrying. If you would rather skip the phone, this step can happen over email.
Expert Therapist Match
Based on your needs and preferences, we match you with a psychologist trained in DBT, factoring in what you’re working on and whether in-person or online care fits your week.
Start Your First Session
Once matched, you begin sessions at our office or through our secure online platform, whichever fits the week you have.
Why Choose Rowan Center for DBT?
At Rowan, doctoral-level psychologists teach DBT skill by skill, with a direction set in the first sessions and a way of checking whether it’s working. Many practices list DBT among their services. Here, behavioral medicine is the core of the practice, not one service among many.
The first sessions map what sets off your strongest emotions, what you do to get through them, and what that’s been costing you. It feels like a conversation, not a test, and it ends with a clear next step: the skills module you’ll start with, and why.
What we work on comes from the moments that are hardest for you, not a fixed curriculum. Two people with the same diagnosis often start in different modules here, because different moments are costing them the most.
You leave early sessions with something to use that week: a way to calm your body, a script for the conversation you’ve been avoiding, and one concrete plan for the next hard hour. We start with small skills and build insight as you go.
With your permission we work directly with your physician, psychiatrist, or rehab team. Everyone works from one shared plan, so the skills you’re building and your medical care stay connected.
We track the moments that used to go badly: how often they happen, how intense they are, and how long it takes to recover. If the numbers haven’t moved after a reasonable stretch, we change the approach rather than keep going out of habit.
Sessions run in person and by telehealth. DBT asks you to practice between sessions, so the schedule has to fit your week, and we plan around it with you.
Frequently Asked Questions About DBT
How is DBT different from CBT?
DBT is a form of cognitive behavioral therapy, so they’re relatives rather than rivals. Classic CBT focuses on change, such as testing thoughts and shifting behavior. DBT keeps those tools and adds acceptance, mindfulness, and crisis skills, because when emotions are intense and fast, working on change alone often isn’t enough. In practice our psychologists draw on both, and they use DBT skills when strong emotions are what’s holding progress back.
How long does DBT usually take?
A full course of DBT traditionally runs six months to a year, because four skills modules take time to learn and practice. Skills-focused individual work is often shorter, and the first skills often start helping within weeks. You’ll set a direction in the first sessions and review progress against it, so the timeline stays honest rather than open-ended.
Is DBT at Rowan a full program with a skills group?
We teach DBT skills through individual therapy rather than running a separate weekly skills group. Your psychologist works through the modules with you one-on-one, matched to your situation, in person or by video. If your circumstances call for a full DBT program with group skills training, we’ll say so at the consultation and help you find the right fit.
Does insurance cover therapy at Rowan Center?
Rowan is in-network with Medicare, Aetna, and Cigna, and is credentialed with Tricare East and West as a non-network provider. For most other PPO plans we can provide a superbill you submit for out-of-network reimbursement, and we can process claims directly with your insurer. If you’re not sure what your plan covers, call us and we’ll help you work it out before you book.