Psychology › Therapy & treatment › Cognitive behavioral therapy (CBT; Beck, Ellis)
Dialectical behavior therapy (DBT)
1993 (Linehan)· Therapy or method
Well replicatedStrong, repeated evidence.
A CBT-based treatment, created by Marsha Linehan, that pairs acceptance with change skills for people with intense emotions and suicidal behavior.
See it on the Psychology map →What it says
Psychologist Marsha Linehan at the University of Washington developed it for chronically suicidal women diagnosed with borderline personality disorder, publishing manuals in 1993. 'Dialectical' means holding opposites together: accepting yourself as you are while working to change. Standard DBT runs about a year, combining weekly individual therapy, a skills group, phone coaching and a team that supports the therapists. Its four skill areas are mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. In 2011 Linehan disclosed her own psychiatric hospitalization as a teenager.
Why it matters
It was the first therapy shown in trials to reduce suicide attempts and self-harm in borderline personality disorder, a group many clinicians once considered untreatable.
The evidence
Status: well replicated. Linehan's 1991 and 2006 randomized trials showed fewer suicide attempts and hospital stays; adolescent trials in Norway (2014) and the US (2018) found similar benefits.
Open questions
Which parts are essential: a 2015 study suggested the skills training carries much of the benefit. The full year-long program is costly and scarce.
Connections (4)
▸Dialectical behavior therapy (DBT) reduces self-harm, supporting Suicide prevention and the 988 lifelineWell replicated
The connection
DBT was built for people with repeated suicidal behavior. Patients track urges on daily diary cards, learn distress-tolerance skills to get through crises without harming themselves, and can phone their therapist for coaching. Trials show fewer suicide attempts and less self-harm, evidence few other therapies have.
Who showed it and when
Marsha Linehan's trials at the University of Washington in Seattle (1991, 2006), followed by adolescent trials in Norway (2014) and the US (2018).
The evidence
In Linehan's 2006 trial of 101 women, DBT roughly halved suicide attempts compared with expert community therapists; a 2018 US trial of teens found similar gains.
Open questions
Completed suicides are too rare to measure well in trials, so effects on them are unclear; long-term benefits and results outside specialist centers need more study.
▸Dialectical behavior therapy (DBT) was designed for borderline, one of the Personality disordersWell replicated
The connection
Linehan saw borderline personality disorder, marked by intense mood swings, unstable relationships and self-harm, as mainly a problem of regulating emotion. Standard CBT felt invalidating to these patients, who often quit. DBT added acceptance and validation to change strategies and taught concrete emotion skills.
Who showed it and when
Developed at the University of Washington in the 1980s and published in 1993; now used in clinics worldwide, including adaptations for adolescents.
The evidence
Randomized trials and a 2020 Cochrane review show DBT reduces self-harm and improves functioning in borderline personality disorder; it is the condition's most studied therapy.
Open questions
Other approaches, such as mentalization-based therapy and schema therapy, also work; it is unclear whether DBT is better or simply better studied.
▸Dialectical behavior therapy (DBT) adapts Cognitive behavioral therapy (CBT; Beck, Ellis)Well replicated
The connection
DBT kept CBT's structure, skills training, homework and step-by-step analysis of problem behaviors, but added acceptance, validation and Zen-derived mindfulness. Linehan had found that purely change-focused CBT made highly suicidal clients feel blamed, and many dropped out.
Who showed it and when
Marsha Linehan, a behavior therapist at the University of Washington in Seattle, developed it through the 1980s; manuals published in 1993.
The evidence
Linehan's own manuals describe DBT as a form of CBT, and treatment guidelines and reviews classify it as one.
Open questions
Whether its acceptance elements make DBT truly distinct from CBT, or mainly a well-packaged extension of it, is debated.
▸Dialectical behavior therapy (DBT) shares mindfulness skills with Mindfulness-based therapiesWell replicated
The connection
Mindfulness is DBT's first and core skill module: noticing thoughts and feelings without judging or acting on them. Linehan drew it from her own Zen practice, not from MBSR, so DBT and the mindfulness-based therapies share techniques and goals but grew from separate roots.
Who showed it and when
Linehan trained with Zen teachers, including Willigis Jäger in Germany, in the 1980s, building mindfulness into DBT before MBCT existed.
The evidence
Linehan's 1993 skills manual names mindfulness as the core skill; studies find DBT patients' gains in mindfulness track reductions in symptoms.
Open questions
How much mindfulness contributes to DBT's results, compared with its other skills, has not been isolated in trials.