Also part of the UPMC family:
Also part of the UPMC family:

​Dialectical Behavior Therapy

UPMC Content 3

What Are DBT Skills?

Dialectical behavior therapy (DBT) treatment is a type of psychotherapy — or talk therapy — that utilizes a cognitive-behavioral approach. DBT emphasizes the psychosocial aspects of treatment.

The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships. DBT theory suggests that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels.

Because few people understand such reactions — most of all their own family and a childhood that emphasized invalidation — they don’t have any methods for coping with these sudden, intense surges of emotion. DBT Skills are helpful in increasing the ability to see things clearly, and respond to stressors with skill.

Components of DBT Skills

  • Support-oriented: It helps a person identify their strengths and builds on them so that a person can feel better about him or herself and their life.
  • Cognitive-based: DBT helps identify thoughts, beliefs, and assumptions that make life harder: “I have to be perfect at everything.” “If I get angry, I’m a terrible person” and helps people to learn different ways of thinking that will make life more bearable.
  • Collaborative: It requires constant attention to relationships between clients and staff. In DBT people are encouraged to work out problems in their relationships, with their therapist and with others. DBT uses homework assignments, role-play of new ways to interacting with others, and the practice of skills such as soothing yourself when upset. The individual therapist helps the person to learn, apply and master the DBT skills.

The 4 Modules of Dialectical Behavior Therapy

​1. ​Mindfulness
​​​The essential part of all skills taught in skills group are the core mindfulness skills.

Observe, Describe, and Participate are the core mindfulness “what” skills. They answer the question, “What do I do to practice core mindfulness skills?”

Non-judgmentally, One-mindfully, and Effectively are the “how” skills and answer the question, “How do I practice core mindfulness skills?”

2. Interpersonal Effectiveness
The interpersonal response patterns –how you interact with the people around you and in your personal relationships — that are taught in DBT skills training share similarities to those taught in some assertiveness and interpersonal problem-solving classes. These skills include effective strategies for asking for what one needs, how to assertively say ‘no,’ and learning to cope with inevitable interpersonal conflict.

Some people experience problems in the application of these skills in specific contexts — especially emotionally vulnerable or volatile situations. An individual may be able to describe effective behavioral sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar set of behaviors when analyzing their own personal situation.

The interpersonal skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.

3. Distress Tolerance
Many approaches to mental health focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. Dialectical behavior therapy emphasizes learning to bear pain skillfully.

Distress tolerance skills are a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although the stance advocated here is a nonjudgmental one, this does not mean that it is one of approval: acceptance of reality is not approval of reality.

Distress tolerance behaviors are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus willfulness.

4. Emotion Regulation
Some people are emotionally intense — frequently angry, easily frustrated, sad, and anxious​. People grappling with these concerns might benefit from help in learning to regulate their emotions.

Dialectical behavior therapy skills for emotion regulation include:
  • ​Learning to properly identify and label emotions
  • Identifying obstacles to changing emotions
  • Reducing vulnerability to “emotion mind”
  • Increasing positive emotional events
  • Increasing mindfulness to current emotions
  • Taking opposite action
  • Applying distress tolerance techniques​
Find a Doctor

Browse UPMC doctors and medical professionals to find the care that's right for you. Customize your search by specialty, zip code, last name, and more.


Visit the UPMC Find a Doctor website.
Make an Appointment

Find important information on scheduling your appointment or finding a doctor or service that meets your needs.


Request an appointment now.
Find a Location

Browse addresses and contact information for our network of hospitals, specialty care practices, and community health locations.


Find a UPMC location near you.
Pay Your Bill

Learn more about how to pay your UPMC bill. Find resources including payment methods and contact information for assistance.


Pay your bill now.
Find a Career

Advance your career with UPMC. Discover our latest job listings and learn about our values and career pathways.


Find your ideal career at UPMC.