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DBT Pros and Cons

5 min.

DBT offers useful skills to support mental health healing and a more balanced life. However, it does require commitment and may not be the right fit for all mental health diagnoses.

By: Alex Bachert, MPH

Clinically Reviewed By: Don Gasparini Ph.D., M.A., CASAC

July 9, 2023


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Table of Contents

Dialectical behavior therapy, or DBT, is a type of talk therapy designed to help people learn how to understand and regulate their emotions. DBT was originally developed in the 1980s to treat people with borderline personality disorder (BPD) who were suffering from suicidal thoughts but it is now used to manage a wide range of conditions, including major depressive disorder, anxiety disorders, and substance use disorders.

Although this evidence-based treatment is an effective tool for helping people with various mental health conditions build meaningful lives, DBT is not the right fit for everyone, since people have different needs and preferences. Below, we review the main pros and cons of DBT, as well as how it differs from cognitive behavioral therapy (CBT).

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Pros: Reasons to consider DBT

1. Increased mindfulness

The goal of DBT is to provide people with skills to cope with difficult emotions and situations. One DBT skill is mindfulness: the idea of being fully present in the current moment. Practicing mindfulness can reduce stress and anxiety, improve focus and concentration, enhance emotional intelligence, and make it easier to cope with difficult emotions. DBT strives to make mindfulness a manageable process, so you’ll begin with something simple like sitting with your eyes closed or coloring.

2. Enhanced interpersonal effectiveness

If you have trouble setting boundaries or asking for what you need, DBT might be an effective form of therapy for you. DBT combines listening skills, social skills, and assertiveness training to help people better understand their needs and how to communicate that information to others. This is a powerful skill for anyone but is especially beneficial for people with mental health conditions who may need to advocate on their own behalf. For example, DBT can help people with social anxiety to feel more comfortable in social settings by empowering them to set boundaries and tell others what they need.

3. Better emotional regulation 

DBT was designed to provide clear advice on how to understand, manage, and accept emotions. This form of therapy teaches people how to identify their emotions in order to improve emotional intelligence and more effectively cope with difficult situations. DBT offers specific resources, such as DEAR MAN, to improve communication skills and emotional regulation in relationships.

4. Ability to tolerate distress

Another important DBT skill is distress tolerance. This means learning how to manage distressing emotions without resorting to unhealthy coping mechanisms. Distress tolerance is also about developing the tools to foster resilience and improve overall mental health. Resilience is a valuable skill for anyone who’s looking to develop better coping habits but it is especially useful for people who are struggling with intense emotions, impulsive behaviors, or self-harm. For example, if someone with OCD has a tough day where they struggle with repeated thoughts and urges, resilience can remind them that tomorrow is a new day to manage obsessions and reduce anxiety.

5. Ability to handle crises 

DBT teaches people four skills to help them work through crises: distracting, self-soothing, improving the moment, and considering the pros and cons. These crisis skills are designed to support people during tough moments and motivate them to remain calm throughout a crisis. These concrete skills can be comforting and particularly useful for people who struggle to handle stress, such as individuals with anxiety disorders or trauma. 

Cons: Reasons DBT might not be right for your needs

1. It’s a time commitment

A full course of DBT typically takes 6-12 months to complete but can be even longer for people with certain mental health conditions. DBT requires one-on-one sessions with a therapist, group therapy sessions, and even take-home assignments to help you implement your new skills outside of a therapeutic setting. With DBT, therapists also offer telephone crisis coaching when people need support between sessions. If you’re not ready or willing to commit this much time to treatment or practicing your skills, then DBT might not be the best fit for you. 

2. Requires group work

Group sessions are an important component of the DBT curriculum. Group DBT is a chance to learn and practice new skills before trying them outside of a therapy setting. While many people enjoy this social learning, others might prefer a more traditional therapy experience. 

3. Calls for active participation

DBT is a comprehensive treatment program that requires people to be fully invested in individual and group therapy, homework assignments, and sometimes even phone calls between therapy sessions. Changing your mindset and behaviors requires time and patience, so you should be prepared to show up every day that you’re participating in DBT. If you’re not ready to commit to making positive changes in your life, then DBT might not be right for you.

4. Not appropriate for all mental health conditions 

If you think you might benefit from mental health support, it’s best to speak with your therapist about which treatment is right for you. While DBT is an effective, evidence-based treatment for BPD, it may not work as well for certain mental health conditions and preferences. For example, there’s conflicting research about DBT’s effectiveness for obsessive-compulsive disorder (OCD), panic disorder, and post-traumatic stress disorder.

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What is the difference between DBT and CBT? 

Dialectical behavioral therapy (DBT) and cognitive behavioral therapy (CBT) are types of talk therapy designed to help people better understand their thoughts, feelings, and behaviors. However, DBT takes it a step further by encouraging people to accept and validate those thoughts and feelings. Instead of changing your behaviors entirely, DBT can help you improve your quality of life by prioritizing mindfulness and emotional regulation.

Here are a few of the key differences between DBT and CBT:

  • Therapy goals: Both forms of psychotherapy examine how people’s thoughts influence their behaviors. However, CBT is more goal-oriented and provides people with tools to manage their behaviors. DBT focuses more on helping people to cope with emotions and accept themselves.
  • Treatment philosophy: CBT tends to be more logic-focused, while DBT focuses on how a person reacts to others and themselves. DBT teaches mindfulness techniques to help people identify and accept emotions and triggers instead of trying to change them.
  • Therapy structure: While CBT typically involves 5-20 sessions, DBT is a long-term treatment that includes both individual and group therapy.

DBT with Charlie Health

Deciding to start therapy is a big decision. Whether you’re interested in DBT or any other type of therapy, Charlie Health is here to listen to your needs, answer your questions, and match you with an appropriate treatment plan. 

Our virtual Intensive Outpatient Program (IOP) offers personalized mental health treatment for teens, young adults, and families who are dealing with a variety of mental health struggles. Learn how to get started on your healing journey today.

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