Most people have heard of Cognitive Behavioral Therapy (CBT) not everyone has heard of, or are as clear about, Dialectical Behavior Therapy, or DBT.
Originally developed to treat people with Borderline Personality Disorder (BPD), DBT has grown into a robust, evidence-based therapy used for a range of mental health challenges — including depression, anxiety, PTSD, eating disorders, and substance use. So what exactly is DBT, and how does it work?
Let’s break it down.
First Things First: What Does “Dialectical” Even Mean?
The word dialectical refers to the idea that two seemingly opposite things can both be true at the same time. In DBT, the core dialectic is:
Acceptance AND Change
In other words, DBT for anxiety helps people accept themselves and their current reality while also working toward meaningful change. This balance is at the heart of the therapy, and it’s what sets DBT apart from CBT which focuses solely on changing thoughts and behaviors.
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The Four Core Skills of DBT
DBT is mainly skills-based. Clients are taught practical tools to manage intense emotions, navigate relationships, and build a life worth living. These skills can be taught in group settings, (kind of like a class) or with support from a therapist in individual sessions.
I personally weave DBT skills and concepts throughout the work I do with clients, and utilize at home practice work sheets if clients feel that would be supportive.
Here are the four main skill areas:
1. Mindfulness
This is the foundation of DBT. Mindfulness teaches you how to be fully present in the moment — not stuck in the past or freaking out about the future. It’s about observing your thoughts, feelings, and surroundings without judgment.
Think of it as the “pause button” for your emotional reactions.
2. Distress Tolerance
Life is full of painful moments. Distress tolerance skills help you survive a crisis without making things worse. Instead of reacting impulsively (say, sending that angry text or engaging in self-harm), you learn how to ride the wave until it passes.
These are the “emergency coping” tools in your DBT toolbox.
3. Emotion Regulation
Ever feel like your emotions go from 0 to 100 in seconds? Emotion regulation skills teach you how to better understand, name, and manage those intense feelings so they aren’t in the driver seat.
The goal isn’t to suppress emotions — it’s to work with them more effectively.
4. Interpersonal Effectiveness
This is all about relationships — asking for what you need, setting boundaries, and saying no (without guilt). These skills help you build healthier, more balanced connections with others.
Think of this as learning how to speak your truth and maintain your relationships.
If you have any more questions about DBT for anxiety or how I personally use it in the work I do with clients, feel free to reach out to me at hello@julianabruyn.com