Emotion Regulation and Beyond: Dialectical Behavioral Therapy

Developed in the 1970s by psychologist Marsha Linehan to treat her own Borderline Personality Disorder, Dialectical Behavioral Therapy (DBT) is a type of talk therapy specifically adapted for individuals who experience emotions very intensely. DBT is based on helping individuals accept the reality of their lives and behaviors, and also on guiding them to learn to change their lives, including unhelpful behaviors. A terminological way of explaining DBT may make it easier to understand. The term ‘’Dialectical’’ in the method implies that real life is complex and that health is not static but a continuous process, processed through a constant Socratic dialogue, a method of self-discovery, with the self and others. It is possible to say that DBT aims to continuously balance opposing forces and search for the truth about strong negative emotions. In the present therapy sketch, we will explore the realm of DBT, its application, method, and working areas.

What is Dialectical Behavioral Therapy?

Dialectical Behavioral Therapy (DBT), an evidence-based and multicomponent psychosocial intervention, is framed around a model that considers dysfunctional behavior as a maladaptive approach to emotion regulation (Elices et. al., 2017; Neacsiu et. al., 2014). DBT addresses a collection of skills translated from behavioral research and other evidence-based treatments in four different groups (Elices et. al., 2017).

Inspired by borderline personality disorder, Marsha Linehan gathered her practical knowledge and identified three bases to put DBT on a theoretical ground. These were that it should be compassionate, that it should be based on research data, and last but not least, that borderline personality disorder is an emotion dysregulation disorder in origin. If we give brief information about borderline personality disorder, borderline personality disorder is characterized by instabilities in the dimensions of emotion regulation, impulse control, interpersonal relationships, and self-perception, and these instabilities are in a pattern (Linehan, 2015).

Since emotional dysregulation is central the theoretical framework of DBT, it is crucial to begin by understanding emotion, emotion dysregulation, and regulation. APA defines emotions as “a complex reaction pattern, involving experiential, behavioral, and physiological elements, by which an individual attempts to deal with a personally significant matter or event” (APA, 2025). Emotional dysregulation, an essential aspect of DBT, is the inability to modify or regulate one’s emotional responses to experiences, actions, and verbal/non-verbal expressions. On the contrary, emotional regulation is related to regulating and soothing oneself after being triggered by strong emotions, suppressing impulsive and inappropriate behaviors associated with strong positive or negative emotions, and taking coordinated action to achieve goals. In DBT, Marsha Linehan’s Biosocial Theory explains emotional dysregulation as the result of the dynamic interplay between an individual’s biological vulnerabilities and environmental factors through development (Linehan, 2015).

Biosocial Theory

According to the biosocial model, emotional dysregulation is generally the result of a biological predisposition, environmental factors, and the interaction of the two over development. DBT suggests that the development of extreme emotional instability depends on the child’s defining characteristics (for example, emotional sensitivity, impulsivity) in interaction with the social context. The mutually reinforcing interaction between biological predispositions and environmental risk factors increases emotional dysregulation, contributing to negative cognitive and social outcomes. This environmental risk factor is described as an invalidating environment in biosocial theory, which consistently outlines ignoring, punishing, or trivializing the individual’s emotional needs and experiences. Over time, a constellation of identifiable traits and maladaptive coping strategies emerges, and these traits and behaviors increase the risk of generalized emotional dysregulation across the developmental horizon. This emotional dysregulation affects individuals recurrently, especially in interpersonal relationships, social functioning, and healthy emotional development (Linehan, 2015).

According to DBT, many mental health challenges can be conceptualized in terms of emotion dysregulation. When we consider that emotions lead to actions, emotional dysregulation often leads to behavioral dysregulation, such as impulsive or self-destructive behaviors, as individuals attempt to manage overwhelming emotional states. This can manifest itself directly in the emotional domain (such as the inability to identify and describe emotions), dysregulation in self-perception and interpersonal relationships, and self-destructive behaviors. To address these challenges, DBT developed four primary skills aimed at enhancing emotion regulation, distress tolerance, mindfulness, and interpersonal effectiveness (Linehan, 2015).

Dialectical Behavioral Therapy Skills

DBT offers a structured approach that focuses on teaching individuals these four core skills, based on the idea that individuals will lead a better life if their skills in these areas improve (DBT, 2025). Let’s take a closer look at the skills DBT focuses on!

Mindfulness: Mindfulness emphasizes observing, identifying, and participating in the present moment effectively and without judgmental framing. According to DBT, the benefits of developing mindfulness skills can be explained as follows:

Focusing on what is happening in the present moment comforts the individual, allowing them to enjoy the moment without fearing the future or worrying about the mistakes of the past.
Individuals who practice mindfulness exercises regularly enhance their concentration and ability to focus.
Mindfulness exercises help the mind relax and reduce stressful thoughts, leading to better sleep quality.
Mindfulness is known to lower blood pressure and promote a state of relaxation by increasing attention control and emotion regulation.
Many studies have shown that mindfulness exercises alleviate stress, anxiety, and depression.

Distress Tolerance: Situations in life that are beyond our control and cause us distress are an inevitable part of life. Based on this aspect of life, DBT suggests that distress tolerance needs to be developed in order to control impulsive actions and radically accept challenging life events. Distress tolerance relates to the ability to manage real or perceived distress. Through distress tolerance, individuals acquire the ability to tolerate negative emotions rather than avoid them or behave in challenging situations in a way that makes them feel worse. The benefits of developing distress tolerance skills can be explained as follows:

Distress tolerance skills help individuals decrease the frequency of impulsive actions.
It equips individuals to handle moments of extreme anxiety, fear, anger, frustration, or discomfort.
Individuals who practice distress tolerance skills have a more balanced emotional state and better overall mental health.
It helps control rising stress levels in difficult situations.
Individuals who practice distress tolerance skills solve problems more healthily and easily.

Emotion Regulation: Emotion regulation includes strategies to change emotions and the tendency to respond with appropriate emotions. In this way, individuals have the power to manage intense emotions that cause problems in their lives. According to DBT, the benefits of developing emotional regulation skills can be explained as follows:

Emotional regulation skills allow for managing emotional storms in healthy and constructive ways.
Emotional regulation skills enable individuals to recognize and understand their emotions and learn how to cope.
It reduces an individual’s vulnerability to emotional fluctuations and alleviates emotional pain.
It increases emotional awareness and empowers the individual to change unwanted emotions.
It increases emotional resilience, leading to better mental health and stronger relationships.

Interpersonal Effectiveness: Interpersonal effectiveness refers to the skills and strategies we use to interact effectively with others around us. Through interpersonal effectiveness, individuals learn to communicate assertively with others, maintain self-esteem, and strengthen relationships. According to DBT, the benefits of interpersonal effectiveness can be explained as follows:

By practicing interpersonal effectiveness, individuals gain the ability to communicate their thoughts, feelings, and needs clearly and assertively.
Individuals become experts in understanding both their own feelings and other people’s feelings.
Individuals’ ability to resolve conflicts that arise in relationships in a healthy and appropriate manner is strengthened.
Individuals gain the ability to express themselves confidently without aggressive behavior.
Interpersonal effectiveness develops empathy and helps to set personal boundaries and expectations in relationships.
It strengthens the ability to build and maintain healthy, supportive, and strong relationships.

It is clearly known that these four core skill principles, on which DBT focuses, offer a profound and comprehensive improvement to the lives of individuals. However, the multifaceted function of Dialectical Behavioral Therapy extends its benefits beyond the four dimensions. Here are the other areas of benefit that Dialectical Behavioral Therapy touches in the lives of individuals (Vijayapriya and Tamarana, 2023):

Reduces self-destructive thoughts and behaviors.
Strengthens self-confidence and self-esteem.
Improves cognitive functioning.
Promotes personal development.
Enhances feelings of self-acceptance and self-compassion.
Increases life satisfaction.

Working Areas

Going beyond emotion regulation, DBT showed effectiveness not just for borderline disorder but also for a wide range of mental health disorders and challenges. DBT has been shown to reduce depressive symptoms significantly (Feldman et al., 2009). It has been demonstrated that DBT skills are an effective treatment in eating disorders (Telch et al., 2001) as well as alcohol-related problems (Linehan et al., 1999) and attention-deficit/hyperactivity disorder (ADHD) (Hirvikoski et al., 2011). Additionally, research showed that DBT skills reduce PTSD symptoms (Bohus et al., 2013), aggression, and impulsivity. DBT skills have also reduced the potential for violence and anger expression in those with a history of intimate partner violence (Linehan et al., 2009). In vocational rehabilitation centers for individuals with severe mental disorders, DBT skills have reduced depression, hopelessness, and anger and increased job satisfaction (Comtois et al., 2010).

Takeaways

DBT is a type of talk therapy specifically adapted for individuals who experience emotions very intensely.
In DBT, Marsha Linehan’s Biosocial Theory explains emotional dysregulation as the result of the dynamic interplay between an individual’s biological vulnerabilities and environmental factors through development.
DBT offers a structured approach that focuses on teaching individuals these four core skills: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
DBT showed effectiveness for a wide range of mental health disorders and challenges.

References

Elices, M., Pascual, J. C., Carmona, C., Martin-Blanco, A., Soler, J., & Fernandez-Navarro, L. (2017). Exploring the relation between childhood trauma and emotion dysregulation in borderline personality disorder: The role of different types of trauma. Journal of Personality Disorders, 31(4), 499–512.
Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.
American Psychological Association. (2025). APA dictionary of psychology (updated edition). American Psychological Association.
Vijayapriya, K., & Tamarana, S. (2023). The effectiveness of dialectical behavior therapy in enhancing emotional regulation and psychological well-being: A meta-review. Asian Journal of Psychiatry, 84, 103584.
Feldman, G., Harley, R., Kerrigan, M., Jacobo, M., & Fava, M. (2009). Change in emotional processing during a dialectical behavior therapy–based skills group for major depressive disorder. Behaviour Research and Therapy, 47(4), 316–321.
Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69(6), 1061–1065.
Linehan, M. M., Schmidt, H., Dimeff, L. A., Craft, J. C., Kanter, J., & Comtois, K. A. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. American Journal on Addictions, 8(4), 279–292.
Hirvikoski, T., Waaler, E., Alfredsson, J., Pihlgren, C., Holmström, A., & Johnson, A., et al. (2011). Reduced ADHD symptoms in adults with ADHD after structured skills training group. Behaviour Research and Therapy, 49(3), 175–185.
Bohus, M., Dyer, A. S., Priebe, K., Krüger, A., Kleindienst, N., Schmahl, C., et al. (2013). Dialectical behaviour therapy for post-traumatic stress disorder after childhood sexual abuse in patients with and without borderline personality disorder: A randomized controlled trial. Psychotherapy and Psychosomatics, 82(4), 221–233.
Linehan, M. M., Lynch, T. R., Harned, M. S., Korslund, K. E., & Rosenthal, Z. M. (2009). Preliminary outcomes of a randomized controlled trial of DBT vs. drug counseling for opiate-dependent BPD women. Paper presented at the 43rd Annual Convention of the Association for Behavioral and Cognitive Therapies, New York.
Comtois, K. A., Kerbrat, A. H., Atkins, D. C., & Harned, M. S. (2010). Weekly therapist ratings of therapeutic alliance in dialectical behavior therapy for individuals with severe and persistent mental illness. Psychotherapy Research, 20(3), 315–326.
Dialectical Behavior Therapy. (2025, March 26). Dialectical Behavior therapy: DBT skills, worksheets, videos. https://dialecticalbehaviortherapy.com/

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This page is also part of the Roamers Therapy Glossary; a collection of mental-health related definitions that are written by our therapists.

While our offices are currently located at the South Loop neighborhood of Downtown Chicago, Illinois, we also welcome and serve clients for online therapy from anywhere in Illinois and Washington, D.C. Clients from the Chicagoland area may choose in-office or online therapy and usually commute from surrounding areas such as River North, West Loop, Gold Coast, Old Town, Lincoln Park, Lake View, Rogers Park, Logan Square, Pilsen, Bridgeport, Little Village, Bronzeville, South Shore, Hyde Park, Back of the Yards, Wicker Park, Bucktown and many more. You can visit our contact page to access detailed information on our office location.