Thoughtful Thursday. Strong emotions can feel like a flood. Anger, shame, panic, and grief can hit fast and fill the whole day. For many people, substances became a way to turn the volume down.
Dialectical behavior therapy, known as DBT, gives people other tools. It teaches practical skills for handling intense feelings, getting through stress, and building steadier relationships.
What DBT Is
DBT is a type of cognitive behavioral therapy built for people who struggle to regulate emotions. The HHS Prevention Services Clearinghouse describes its aim as helping people “build a life worth living.” The name comes from a central idea: two things can be true at once. You can accept yourself as you are and work to change.
DBT began as a treatment for borderline personality disorder and chronic suicidality. Today clinicians also use it with depression, PTSD, and substance use disorders, in adults and teens.
The Four Skill Areas
DBT teaches skills in four areas. The Prevention Services Clearinghouse describes them this way.
Mindfulness means staying present and accepting what is happening right now without judgment.
Distress tolerance means getting through painful moments without turning to harmful behaviors, such as substance use. It is the skill people often reach for in the middle of a craving or a crisis.
Emotion regulation means becoming less vulnerable to painful emotions and learning to understand and shift them.
Interpersonal effectiveness means asking for what you need, saying no when you must, and keeping relationships respectful.
Two of these skill areas focus on acceptance. Two focus on change. That balance is the “dialectic” in the name.
How DBT Works
Standard DBT has several parts. The clearinghouse lists individual therapy, phone coaching between sessions, a consultation team for therapists, and group skills training. Group sessions run weekly with small groups led by two skills trainers. Programs can last from about 24 to 52 weeks, depending on need.
WisHope’s DBT program offers group settings and individual therapy, along with a telehealth support line that clients can call between sessions. Visit that page for current details about the program.
What the Research Says
The clearinghouse rates DBT as “supported,” meaning at least one study in a usual care setting showed a favorable effect lasting six months or more on at least one target outcome. That rating covers DBT broadly, not substance use alone.
For substance use specifically, the evidence is promising but small. A 2019 systematic review and meta-analysis found three randomized trials with 75 adult women in total. DBT lowered self reported substance use compared with usual treatment in the short and long term, and fewer people dropped out. It did not differ meaningfully from 12 step programs. The authors called the evidence limited and asked for larger trials.
A separate study of an adapted DBT skills group in an Irish addiction service followed 64 adults with co occurring emotional and substance problems. Participants reported less emotional dysregulation, less dysfunctional coping, and more skill use after the program. The study had no comparison group, so it cannot prove DBT caused the changes.
In short, DBT is a reasonable, evidence informed option, especially for people whose substance use is tied to overwhelming emotions. It is not a guaranteed fix, and the research base is still growing.
Who Might Benefit
DBT may fit people who feel swamped by emotions, who act impulsively when stress rises, who have a history of trauma, or who struggle in relationships. It also pairs well with other care, including medication and therapies like acceptance and commitment therapy or prolonged exposure. Many people use more than one approach.
Questions to Ask
If DBT interests you, ask a program how it delivers DBT, how its clinicians are trained, how often the group meets, and what support exists between sessions. Our post on questions to ask a treatment program can help you prepare.
The Bottom Line
DBT does not tell you to stop feeling. It teaches you to feel without being run by your feelings. Skills like these take practice, and they build over time.
If you are exploring treatment options, learn about our treatment programs or complete our online pre-assessment form. Our admissions team can help you find the right fit.