When people hear about Dialectical Behaviour Therapy (DBT), it’s often immediately associated with Borderline Personality Disorder (BPD). This connection is so strong that some may assume DBT is only appropriate for individuals with a BPD diagnosis, or those who are suicidal or self-harming. These assumptions aren’t just held by recipients of therapy, as clinicians and referring professionals sometimes carry the same beliefs. As a result, people who might greatly benefit from DBT are often overlooked, simply because they don’t “fit the profile.”
But here’s the truth: DBT has come a long way since its early days as a treatment specifically designed for BPD. Today, it’s recognized as a powerful therapeutic approach for a wide range of emotional and behavioral challenges. While it’s still incredibly effective for treating suicidal ideation, self-harm, and other challenges associated with BPD, DBT is also helpful for issues such as:
- Emotion dysregulation (intense, hard-to-control emotional reactions)
- Depression and anxiety
- Rumination
- Interpersonal difficulties
- Dissociation
In fact, for some people, DBT is sometimes recommended before certain trauma treatments can begin, especially if risky or self-harming behaviours are part of their coping responses. The goal is to build the emotional and behavioral foundation needed for deeper trauma work to be safe and effective, by learning and solidifying skills.
So what makes DBT different from other forms of therapy like CBT (Cognitive Behavioral Therapy)? While CBT focuses primarily on changing thoughts, DBT zeroes in on emotional experiences and, importantly, behavioral skills. These skills are taught over a 24-week course and include structured modules on:
- Mindfulness (being present)
- Distress tolerance (crisis survival and reality acceptance)
- Emotion regulation (emotion literacy, reducing vulnerabilities, and changing emotions)
- Interpersonal effectiveness (improving relationships, self-respect, and meeting needs)
Clients don’t just learn these skills—they practice them via assigned activities, in-session role-plays, and phone coaching between appointments to help with generalizing skills to real-life situations. This can be very effective, especially for people who find that their emotions regularly overpower their ability to think or act clearly.
Ultimately, DBT is about helping people build a life worth living. And that doesn’t require a specific diagnosis. If someone struggles with overwhelming emotions, intense reactions, or rocky relationships, DBT may offer the tools they need, whether or not BPD is part of the picture.