Dialectical Behavior Therapy (DBT for short) isn’t just a bunch of therapy buzzwords. It’s a real, structured approach that helps people manage intense emotions, navigation of relationships, and creates a life that feels worth living.
This was first developed to support people living with borderline personality disorder (BPD), but it’s since been shown to be a powerful tool for many other challenges like anxiety, depression, healing from trauma, managing impulsive behaviors, and even overcoming substance use.
At the heart of DBT, it teaches you how to balance two things at the same time: logic and emotions. Most of us lean heavily on one side or the other, depending on the situation. Maybe you’re great at thinking things through logically… until you get upset, and then logic goes right out the window. Or maybe you’re someone who feels everything deeply, but sometimes wishes you could take a step back and not get swept away.
DBT helps you operate from your “wise mind”. The place where logic and emotion work together. And it does that by teaching four main skill areas.
1. Distress Tolerance
Life can throw curveballs faster than you can blink. A breakup, a fight with a friend, bad news from work, or even just an overwhelming day can make emotions feel unbearable.
When we’re in that heightened emotional state, our brains want to do something—anything, to get rid of the discomfort. That “anything” can sometimes be destructive: saying hurtful things, making impulsive decisions, self-harming, or numbing out with substances.
Distress tolerance skills are about hitting pause before you do something you can’t take back. It’s like giving yourself a life jacket in emotional rough waters. You might still be in the storm, but you’re not going to drown.
For example, maybe you just had an intense argument. Instead of firing off a text you’ll regret, you might take a cold shower, go for a brisk walk, watch an episode of a comfort show, or do a quick grounding exercise. The goal isn’t to avoid the problem forever; it’s to let the intense emotion settle so you can respond instead of react.
2. Mindfulness
If your brain had a favorite pastime, it might be time traveling to the past (replaying mistakes, cringing at awkward moments) or to the future (worrying about what could go wrong). The problem? We usually skip right past the present moment, which is where life actually happens.
Mindfulness in DBT teaches you how to notice and experience what’s happening right now, without judgment. It’s about being in the current moment instead of living in “what if” or “if only.”
Picture this: you’re eating dinner, but instead of tasting your food, you’re thinking about an email you forgot to send. Mindfulness would be slowing down enough to actually taste that bite, notice the texture, and enjoy it. Sounds simple, but it can be surprisingly powerful.
This isn’t just “being calm” or “thinking positive.” It’s learning how to observe your thoughts without letting them boss you around. And yes, mindfulness can be practiced anywhere, whether you’re on a quiet mountain trail here in Colorado or standing in line at the grocery store.
3. Emotion Regulation
Emotions aren’t the enemy, but they can feel that way when they’re intense or unpredictable. Emotion regulation is about understanding your feelings, knowing what triggers them, and having strategies to keep them from taking over.
It’s not about shutting emotions down, it’s about managing them so you can still make choices you’ll feel good about later.
For example, maybe you know that skipping meals makes you way more irritable and likely to snap at people. Or you notice that certain conversations always leave you feeling anxious. Emotion regulation skills help you spot those patterns, prepare for them, and keep your reactions in check.
Over time, you build up what DBT calls “emotional resilience”—the ability to experience strong emotions without feeling like you’re being knocked over by a wave.
4. Interpersonal Effectiveness
Relationships are complicated, whether it’s with friends, family, coworkers, or partners. Sometimes we have trouble saying no. Sometimes we avoid asking for what we need because we don’t want to cause conflict. Other times, we go all-in on winning an argument but lose sight of the relationship itself.
Interpersonal effectiveness skills teach you how to be clear, assertive, and respectful—all at the same time. You learn how to set boundaries without guilt, ask for what you need without demanding it, and handle conflict without blowing up or shutting down.
It’s not about being perfect in relationships, but it’s about building trust, respect, and balance so the people in your life know where you stand and you feel heard.
Does DBT Really Work?
DBT is not just “feel-good” advice. There’s a mountain of research showing it works.
In one University of Washington study, people in DBT had half as many suicide attempts as those in other expert-led therapies. They also had less severe self-harm, fewer ER visits, and fewer hospital stays for suicidal thoughts. On top of that, they were more likely to stick with treatment—something that’s not always easy when you’re going through intense struggles.
And it’s not just in research clinics. In the real world, DBT has been shown to lower depression, hopelessness, anger, impulsivity, and even reduce substance use for people who struggle with both emotional pain and addiction.
That’s the thing about DBT, it’s not a quick fix. It’s more like learning a new language: the language of your own thoughts, feelings, and choices. Once you know it, you can use it for the rest of your life.
What DBT Looks Like in Practice
If you’ve never done DBT before, it can help to know what to expect. A full DBT program usually has four parts:
Skills Training Group
Think of this like a class where you learn DBT skills step-by-step. The group leader teaches the skill, explains how to use it in daily life, and gives homework so you can actually practice it. These groups usually meet once a week for around 2–2.5 hours, and it takes about 24 weeks to cover the whole curriculum. Some programs repeat the cycle, so you get a full year of skills practice.
Individual Therapy
This is your one-on-one time to talk through personal challenges and figure out how to use DBT skills in your specific situations. Sessions are usually once a week for about an hour, and they happen alongside the skills group.
Phone Coaching
Life doesn’t wait until your next therapy session to throw a crisis at you. DBT includes phone coaching so you can reach out to your therapist between sessions for quick guidance, especially when you’re in the heat of the moment and need help applying a skill right away. Evolve Counseling understands this and offers Teletherapy for this very reason.
Therapist Consultation Team
This part happens behind the scenes. Your therapist is part of a team that meets regularly to support each other, share strategies, and make sure they’re giving you the best care possible.
The Four Stages of DBT Treatment
One of the most unique things about DBT is that it’s organized into stages based on where you are in your healing journey.
- Stage 1 – Out of control
- Life feels like constant chaos. You might be in crisis mode—self-harming, feeling suicidal, using substances, or acting impulsively. The goal here is to get to a place where your behavior is under control and you’re safe.
- Stage 2 – Quiet desperation
- You’re no longer in crisis, but you still feel stuck. There might be past trauma, emotional numbness, or a deep sense of emptiness. The goal is to start feeling emotions fully and begin processing the pain that’s been numbed or buried.
- Stage 3 – Building a life worth living
- Now it’s about creating goals, finding meaning, and building relationships and routines that support your well-being. You’re learning how to navigate life’s ups and downs without losing your footing.
- Stage 4 – Deeper meaning (optional)
- For some, the journey continues into exploring purpose, fulfillment, and connection to something bigger than yourself. This stage isn’t for everyone, but for those who seek it, it’s about moving from “life is okay” to “life is deeply meaningful.”
Is DBT Right for You?
At Evolve Counseling Services here in Fort Collins, we see DBT change lives. Lindsey Phillips, LPC, and Ben Smith, LPC use principles of DBT (Dialectical Behavioral Therapy) and CBT (Cognitive Behavioral Therapy) to provide an overall package for what you need to become the master of your mind. Whether you’re dealing with intense emotions, past trauma, self-destructive patterns, or just want better tools for handling stress and relationships, DBT can help. And with Evolve Counseling also offering teletherapy, they have all the tools necessary to help.
It’s not about becoming a different person; it’s about becoming more in control of your choices, more in tune with your emotions, and more connected to the life you want to live.
