Clinically reviewed by Bülent Ada, BSc.(Psychol.)(Hons.), MAPS · Updated December 2025

If you have ever searched for help with intense emotions, self-harm, or extreme mood shifts, you have probably encountered the term DBT. It gets mentioned often — sometimes in clinical contexts, sometimes in online communities, sometimes by people who have done it and describe it as something that genuinely changed their lives.

But what is DBT, exactly? And is it relevant to you?

Dialectical Behaviour Therapy is a structured, evidence-based form of psychotherapy that was originally developed in the 1990s for people with borderline personality disorder (BPD). Since then, its applications have expanded considerably. It is now used to support people with a wide range of presentations involving emotional intensity — including self-harm, eating disorders, PTSD, and difficulties regulating emotions that do not fit neatly into any single diagnostic category.

This article explains what DBT is, how it is structured, what the four skill modules involve, and what a DBT programme typically looks like in Australia.

Where DBT Came From

DBT was developed by psychologist Marsha Linehan at the University of Washington. Linehan’s initial work was with people who were experiencing chronic suicidal ideation and self-harm — a population for whom standard cognitive behavioural therapy was producing limited results.

What emerged from her research was a treatment built on a seemingly paradoxical premise: that effective therapy must hold two things simultaneously. It must communicate genuine acceptance of the person as they are, while also actively working toward change. Neither message alone was sufficient. Acceptance without a commitment to change could feel like abandonment. Change demands without acceptance felt invalidating and often caused people to disengage.

This tension — between acceptance and change — is the core of what “dialectical” means in DBT. A dialectic is a synthesis of two opposing ideas. In DBT, the primary dialectic is: I am doing the best I can, and I need to do better. Both are true at the same time.

Linehan’s clinical and personal investment in this work has been well-documented. Her contributions to the treatment of severe emotional dysregulation and suicide risk are considered among the most significant in modern clinical psychology, and the evidence base for DBT is now substantial.

What “Dialectical” Actually Means in Practice

The concept of dialectics can sound abstract, but in the therapy room it is quite concrete.

One of the most common dialectical tensions in DBT is between validation and problem-solving. A good DBT therapist will validate the emotional logic of your experience — help you see that your feelings make sense given your history and circumstances — while also collaborating with you on skills and strategies to respond differently. The two are not in conflict. They are both necessary.

Another dialectic that runs through the treatment is the balance between emotion mind and reasonable mind — two modes of processing that DBT holds in tension. Emotion mind is the state in which feelings drive behaviour. Reasonable mind is the analytical, logical state. DBT introduces a third concept: wise mind, the synthesis of both. Wise mind is not cold logic, nor is it being swept away by feeling. It is a grounded, integrated state in which you can acknowledge what you feel and respond thoughtfully.

Learning to access wise mind is one of the first skills taught in DBT, and it underpins everything else.

The Four DBT Skill Modules

DBT is built around four distinct skill modules. Each addresses a different dimension of emotional and interpersonal life. They are taught sequentially and revisited across the course of treatment.

1. Mindfulness

Mindfulness is the foundational module — the skills taught here are woven through the other three. In DBT, mindfulness is not primarily a relaxation technique. It is a set of what skills (what you do: observe, describe, participate) and how skills (how you do it: non-judgementally, one-mindfully, effectively).

The distinction matters. DBT mindfulness is about learning to notice your experience without being automatically controlled by it. You can observe that you are feeling intense anger without necessarily acting on it. You can describe what is happening internally without layering on harsh self-judgement. You can participate in your life rather than being held hostage by rumination about the past or worry about the future.

For people who have spent years in chronic emotional pain, this is not a trivial skill. It is often the first time they have been able to create any gap between what they feel and what they do.

2. Distress Tolerance

Distress tolerance skills are designed for moments of acute crisis — when emotions are at their peak and the risk of acting in harmful ways is highest. These are not skills for solving problems. They are skills for surviving a crisis moment without making it worse.

One widely taught framework is TIPP: Temperature (using cold water on the face or cold shower to activate the dive reflex and rapidly lower arousal), Intense exercise (to metabolise stress hormones), Paced breathing (slowing the exhale to activate the parasympathetic nervous system), and Progressive relaxation (systematically releasing muscle tension).

Other distress tolerance skills include ACCEPTS (distraction strategies — Activities, Contributing, Comparisons, Emotions, Pushing away, Thoughts, Sensations), self-soothe through the five senses, and radical acceptance — one of the most challenging and valuable concepts in the entire DBT framework.

Radical acceptance does not mean approving of pain or pretending difficult things are not difficult. It means ceasing to fight against reality as it is. Suffering, in DBT terms, is often understood as pain multiplied by non-acceptance. When you resist what cannot be immediately changed, you add a second layer of suffering to the original pain. Radical acceptance dissolves that second layer.

3. Emotion Regulation

Emotion regulation skills address what many people with intense emotional experiences most want: to feel less controlled by their emotions, to experience less volatility, and to move through emotional states without being overwhelmed by them.

The module begins with psychoeducation — understanding what emotions are, what functions they serve, and how they work physiologically. This alone can be meaningful for people who have spent years feeling bewildered or ashamed by the intensity of what they experience.

Key skills in this module include:

Opposite action — when an emotion is urging you toward a behaviour that is not in your long-term interest, deliberately doing the opposite. If shame urges withdrawal, opposite action might involve gently approaching a trusted person. If fear urges avoidance, opposite action involves approaching the feared situation. Research indicates that acting opposite to an emotion’s action urge can reduce the intensity of that emotion over time.

The PLEASE skills — addressing the biological foundations of emotional vulnerability. PLEASE stands for: treating Physical illness, reducing substance use that affects mood (Licit and illicit), balancing Eating, avoiding mood-Altering substances, getting adequate Sleep, and getting Exercise. The premise is straightforward: when your body is unwell, under-rested, or under-fuelled, your emotional vulnerability increases significantly.

Checking the facts — a bridge to cognitive work, involving examining whether an emotion fits the actual facts of a situation, rather than an interpretation of it.

4. Interpersonal Effectiveness

The interpersonal effectiveness module addresses a set of skills that many people with emotional dysregulation find genuinely difficult: asking for what you need, saying no, maintaining relationships, and preserving self-respect — all at the same time.

The best-known framework in this module is DEAR MAN, a structured approach to making requests or setting limits:

• D — Describe the situation factually
• E — Express how you feel about it
• A — Assert what you want clearly
• R — Reinforce the benefit of the other person responding positively
• M — stay Mindful of your goal
• A — Appear confident
• N — Negotiate if needed

Alongside DEAR MAN, the module teaches GIVE (skills for maintaining relationships: be Gentle, act Interested, Validate, use an Easy manner) and FAST (skills for maintaining self-respect: be Fair, no Apologies for existing, Stick to values, be Truthful).

For people who have historically either shut down in conflict or escalated quickly, these frameworks offer a middle path — a way to engage with difficult interpersonal situations without abandoning either the relationship or themselves.

Who DBT Can Help

DBT was originally developed for borderline personality disorder, and it remains one of the most robustly evidenced treatments for BPD, with research demonstrating reductions in self-harm, suicidal behaviour, and hospitalisation.

But the skill modules address processes — emotional intensity, impulsivity, relationship difficulties, distress intolerance — that appear across a much wider range of presentations. Evidence now supports DBT or DBT-informed approaches for:

• Self-harm and suicidal ideation (with or without a BPD diagnosis)
• Eating disorders, particularly binge eating disorder and bulimia nervosa
• PTSD, where emotional dysregulation makes trauma processing difficult
• Substance use disorders with high emotional reactivity
• ADHD-related emotional dysregulation — the intense emotional responses and rejection sensitivity that many people with ADHD experience
• Depression characterised by high emotional reactivity
• Generalised emotional dysregulation — people who do not meet criteria for any specific disorder but have longstanding difficulty managing the intensity or duration of their emotional experience

If you recognise yourself in any of these descriptions, a professional assessment can clarify whether DBT or a DBT-informed approach is appropriate for your situation.

What a DBT Programme Looks Like in Australia

Standard DBT, as developed by Linehan, has four components working together:

1. Individual therapy — weekly sessions with a DBT-trained therapist, focused on applying skills to the specific problems arising in your life that week
2. Skills training group — a structured group programme, typically run weekly for two to two-and-a-half hours, in which the four skill modules are taught systematically
3. Phone coaching — brief between-session contact with the individual therapist for crisis support and skills coaching in real-world situations
4. Therapist consultation team — regular peer supervision among DBT clinicians to maintain treatment fidelity and therapist wellbeing

A standard DBT programme typically runs for approximately six to twelve months, covering the full skill curriculum (which takes around six months to complete and is sometimes run twice).

Skills-only groups also exist — structured skills training without the individual therapy component. These can be valuable for people who are in stable individual therapy already and want to learn DBT skills, or for whom a full programme is not currently available. It is worth noting that skills-only groups are not equivalent to full DBT for complex presentations, but they can still provide meaningful benefit.

Accessing DBT in Australia

DBT is available through:

• Private clinical psychologists trained in DBT — individual sessions attract Medicare rebates under a Mental Health Treatment Plan (referral from GP required)
• Some public hospital and community mental health services — these typically offer group programmes but often have significant waiting lists
• Headspace centres for young people aged 12–25, some of which offer DBT-informed programmes

Medicare rebates apply to individual DBT sessions when delivered by a registered psychologist under a Mental Health Treatment Plan. Group skills training sessions may or may not attract Medicare rebates depending on how they are structured and billed — it is worth confirming this with your provider before commencing.

If you are considering a DBT programme, ask the clinician or service about their training and whether they follow Linehan’s adherent model or a DBT-informed approach. Both can be helpful, but knowing what you are accessing allows you to make an informed decision.

What to Expect When You Begin

DBT makes demands of its participants. It involves homework — practising skills between sessions, completing diary cards (structured daily records of emotions, urges, and skill use), and bringing that data into sessions and groups. This is not busywork. The diary card is the primary tool for tracking what is actually happening in your emotional life and for identifying where skills are and are not being applied.

Many people find the initial weeks of DBT confronting. Learning to observe and describe your emotional experience with precision — rather than being swept away by it — is a skill that takes time to build. Some of the concepts, particularly radical acceptance, can feel difficult or even counterintuitive at first.

What the research and clinical experience consistently suggest, however, is that people who engage with the treatment — including the homework — tend to see meaningful change. DBT is not a passive experience. It is an active, skills-based programme that asks you to practise, review, and practise again.

Questions to Ask a Potential DBT Therapist

If you are considering DBT, some useful questions to ask include:

• Have you completed formal training in DBT, and do you participate in a consultation team?
• Do you offer individual sessions alongside group skills training, or skills training only?
• How long is the programme, and what does a typical week look like?
• How does the treatment approach self-harm or crisis situations?
• What are the costs, and what Medicare rebates apply?

A clinician who is genuinely trained in DBT will welcome these questions. They reflect exactly the kind of informed, engaged approach the treatment asks of its participants.

For further information about the psychological services available at Mind Health Associates, including therapeutic approaches offered in Parramatta and via telehealth, visit our services page.

Frequently Asked Questions

What is Dialectical Behaviour Therapy?

DBT is a structured, evidence-based therapy developed by Marsha Linehan, originally for borderline personality disorder. It holds two ideas together: genuine acceptance of you as you are, and active work toward change. DBT teaches practical skills across four modules to help people manage intense emotions, reduce harmful behaviours, and build more effective relationships, supported by strong research evidence.

What are the four modules of DBT?

The four skill modules are mindfulness (noticing experience without being controlled by it), distress tolerance (surviving crises without making them worse), emotion regulation (reducing volatility and acting opposite to unhelpful urges), and interpersonal effectiveness (asking for needs, saying no, and keeping self-respect). Mindfulness is foundational and woven through the other three, and skills are taught with practice between sessions.

Is DBT only for borderline personality disorder?

No. DBT was developed for BPD and remains strongly evidenced for it, but its skills target processes such as emotional intensity, impulsivity and distress intolerance that appear across many presentations. Evidence now supports DBT or DBT-informed approaches for self-harm, eating disorders, PTSD, substance use, ADHD-related emotional dysregulation, and general difficulty managing the intensity of emotions.

How long does a DBT program take?

A standard DBT program typically runs for about six to twelve months and covers the full skill curriculum, which takes around six months and is sometimes repeated. Standard DBT combines weekly individual therapy, a weekly skills group, between-session phone coaching, and a therapist consultation team. Skills-only groups also exist and can help, though they are not equivalent to full DBT.

Does Medicare cover DBT in Australia?

Medicare rebates apply to individual DBT sessions delivered by a registered psychologist under a Mental Health Treatment Plan from your GP. Group skills training may or may not attract rebates depending on how it is structured and billed, so it is worth confirming with your provider first. Some public and Headspace services also offer DBT-informed programs.

Related reading

• DBT services
• How ACT works
• Emotion regulation and the window of tolerance

About the author: Bülent Ada is the Principal Psychologist and Founding Director of Mind Health Associates in Parramatta, Sydney. With over 20 years of clinical experience, Bülent specialises in complex trauma, personality disorders, emotional dysregulation, and evidence-based psychological treatment. Learn more about Bülent

This article is for informational purposes only and is not a substitute for professional mental health advice. If you are experiencing mental health concerns, please consult a qualified health professional.

Ready to take the next step? Mind Health Associates offers evidence-based psychological support in Parramatta and via telehealth across Australia. Contact us to enquire about appointments.