Dialectical behavioral therapy (DBT) is an outgrowth of cognitive behavioral therapy (CBT) with a specific focus on mindfulness and holding multiple truths at once. The word “dialectical” refers to holding two opposing ideas at the same time, and DBT involves a conversation around working toward changing what we can control and accepting what we can’t.

DBT was originally developed by American psychologist Marsha Linehan to treat borderline personality disorder, but its focus on building skills related to mindfulness, distress tolerance, emotional regulation, and interpersonal relationships can be successful in treating depression as well.

Is DBT for Depression Effective?

Research shows that DBT skills can significantly reduce the symptoms of depression. One research study noted the increased efficacy of DBT for people with difficult-to-treat depression compared to those who were only on medication.¹

In one meta-analysis, DBT was found to lower symptoms of depression in teens, including self-injury.² In a study of older adults with chronic depression symptoms, of those who completed DBT treatment along with taking medication, 71% were in remission after a year, versus the 47% from the “medication only” group.³

Benefits of DBT for Depression

DBT has been proven to help people learn more distress tolerance and interpersonal skills, both factors that can influence depression symptoms. Additionally, mindfulness practices can connect people back to the present moment instead of focusing too heavily on the past or future.

Here are some of the benefits of DBT for depression:⁴

• DBT is proven to reduce suicidal thoughts and behaviors, which can be a factor for some people with depression
• DBT helps people gain more self-acceptance and self-compassion, which directly combat the common depressive feelings of helplessness and worthlessness
• Enhanced mindfulness can help connect you back to your body and the present moment
• Increased distress tolerance can help you become more resilient to life’s challenges
• Improved interpersonal skills can lead to better relationships and support during depressive episodes

Potential Drawbacks of DBT for Depression

DBT can be a good fit for many people with depression, but it does require a lot of dedication. For some, it may feel a bit too intense if you’re not ready to stick to a strict regimen.

Additionally, DBT is innately focused on building specific skills to help with emotional regulation and interpersonal connections. You’ll still talk to your therapist about the problems you’re facing, but expect less time “unpacking” what happened to you and more time developing skills to face the problems.

Commonly Used DBT Skills for Depression

DBT skills focus on four key areas: Mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. There are dozens of skills that a DBT therapist might introduce, but each one will focus on one of these four areas in some way.

Mindfulness

Depression can often cause people to focus on the past, with feelings of guilt or regret, or pull them into the future with worry and hopelessness. The point of mindfulness is to focus your energy on the present moment instead, grounding in reality and not your ruminative thoughts or worries.

Some mindfulness skills and exercises you might encounter in DBT include:

• Choosing one activity to do mindfully: This could be eating, taking a walk, or doing the dishes without any distractions, giving the task your full attention. Notice how your body feels and what sights and sounds you encounter.
• Thought labeling: If you notice yourself having a negative depressive thought, like “I’m not good enough,” stop and label the thought instead, saying, “I’m having the thought that I’m not good enough.” This creates more distance and helps you notice the thoughts you’re having instead of just ruminating on them.
• Loving kindness meditation: This exercise involves repeating loving, compassionate mantras, first for yourself, then for a loved one, then zooming out to the world. This shifts your focus from whatever worries or hopeless thoughts you experience to positive emotions for yourself and others.

Distress Tolerance

Distress tolerance involves learning how to navigate and move through negative emotions and situations instead of letting them overtake you.

Here are just a few distress tolerance skills a DBT therapist might have you practice whenever you’re feeling dysregulated:

• The STOP method:
  • Stop, pause what you’re doing
  • Take a breath, a mindful and deliberate inhale and exhale
  • Observe your thoughts and feelings without judgment
  • Proceed mindfully, choosing your response consciously instead of simply reacting
• The TIPP acronym:
  • Temperature: Dip your fact in a bowl of ice water or hold an ice pack up to your face for 10-30 seconds
  • Intense exercise: Run, walk fast, play basketball, lift weights, anything that gets your heart rate up
  • Paced breathing: Slow your breathing down, exhaling longer than you inhale
  • Progressive muscle relaxation: Tense and relax each set of muscle groups, starting with your toes and working you way up to your head
• Urge surfing: Instead of acting on an urge, whether it’s self-harming, lashing out at a loved one, or drinking, this distress tolerance skill teaches you how to sit with that urge, knowing that it will pass.

Interpersonal Effectiveness

Strengthening relationships can be difficult and nuanced even when you’re not depressed, so learning helpful skills for effective communication can help you get your needs met and feel more fulfilled.

Here are a couple of DBT interpersonal effectiveness skills:

• The DEARMAN acronym:
  • Describe the current situation
  • Express your feelings about the situation
  • Assert yourself by asking for what you want or need
  • Reinforce the positive things that will happen if you get what you need
  • Mindfully focus on your goals, even speaking like a “broken record” if you feel like you’re not being heard or if the subject gets changed
  • Appear confident and effective; use a confident speaking voice and make eye contact
  • Negotiate, offering alternatives to the solution if necessary
• The GIVE skill:
  • Gentle: Be nice and respectful, avoiding any sorts of attacks or threats
  • Interested: Listen and make sure your body language shows you’re interested by making eye contact and leaning toward the person you’re talking to
  • Validate: Show that you understand the other person’s thoughts about the situation you’re discussing
  • Easy manner: Use some humor, smile, and try to stay “light” during the conversation

Emotional Regulation

Emotions give us important information, but they can be overwhelming if we don’t have the tools to process them. Boosting skills in this area can help people understand how they’re feeling, then manage and reduce the intense negative emotions.

Here are some emotion regulation skills you might encounter in DBT:

• Opposite action: Depression often makes us feel stuck, or convinces us that we’re not worthy. Opposite action involves acting in opposition to these thoughts. For example, depression may have you withdraw from loved ones, so the opposite action would be calling a friend.
• Cope ahead: Imagine a situation that is likely to make you feel uncomfortable or dysregulated, being as specific as possible, then decide ahead of time what coping or problem-solving skills you think you should apply. Be as thorough and vivid as possible when thinking through the situation, rehearsing in your mind applying the effective coping skills, then practice relaxation techniques after.
• Positive self-talk: Depression can increase the automatic negative thoughts we have, and it takes effort to counteract these thoughts. Notice the negative thoughts and then dispute them with positive thoughts that promote self-compassion.

What to Expect During DBT for Depression

Formal DBT is an intensive, structured program. You’ll start with a pre-assessment so the therapist can ensure that DBT is the appropriate treatment for your needs. Then, you’ll likely attend individual sessions and group therapy. Sometimes, a therapist may also help you develop a crisis plan and provide crisis coaching over the phone as needed.

Note that, while DBT can be provided as a very structured, regimented approach to therapy, many therapists will use a more “eclectic” approach, pulling in DBT exercises and ideas while also utilizing other modalities, such as cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) depending on the unique needs of the client.

Individual DBT Sessions

During individual DBT sessions, your therapist will help you learn to modify the thoughts and behaviors getting in the way of productive therapy and skill-building. You may spend some time investigating the things that are blocking your progress, like specific depression symptoms or relationship issues, but remember that DBT is less focused on “unpacking” negatives and instead centers around building skills to replace unhelpful behaviors.

Your therapist might ask you to track your emotions and behaviors in a journal that you’ll bring into sessions so you can look for patterns and determine what to work on during sessions.

Group Skill Building

DBT often involves group sessions in which you can practice DBT skills with others. It can be helpful to rehearse interpersonal effectiveness skills with neutral people in the group before applying them to your life, and seeing other people going through similar challenges can remind you that you’re not alone.

Crisis Planning

When necessary, your therapist could help you create a structured process to utilize during a mental health crisis. This could include having a list of hotlines to call and identifying the local ER in case things ever escalate. Certain therapists may be available for crisis phone calls during certain hours, but they’ll let you know their boundaries and schedule.

How Long Can I Expect DBT for Depression to Last?

A therapist will work with you to determine when you’re ready to conclude therapy sessions, but a typical DBT program lasts between six months and a year. You and your therapist will work on skill-building in each of the four main areas of DBT, then once you feel like you’ve acquired and practiced the necessary skills you’ll likely be phased out of individual therapy. Or, you may continue going to either group or individual sessions for “maintenance” if necessary.

How Northeast Health Services Treats Depression in Massachusetts

Northeast Health Services offers comprehensive depression treatment across Massachusetts, providing individual therapy, psychiatric care, and alternative treatments like TMS and Spravato®. Some of our clinics also offer group therapy, and many of our therapists have training in DBT.

If you’re ready to learn more about getting depression treatment in Massachusetts, you can call 508.794.8711 or schedule your first appointment.

 

Footnotes:

1. Harley, R., Sprich, S., Safren, S., Jacobo, M., & Fava, M. (2008). Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. The Journal of nervous and mental disease, 196(2), 136–143. https://doi.org/10.1097/NMD.0b013e318162aa3f
2. Cook, N. E., & Gorraiz, M. (2016). Dialectical behavior therapy for nonsuicidal self-injury and depression among adolescents: preliminary meta-analytic evidence. Child and adolescent mental health, 21(2), 81–89. https://doi.org/10.1111/camh.12112
3. Lynch, T. R., Morse, J. Q., Mendelson, T., & Robins, C. J. (2003). Dialectical behavior therapy for depressed older adults: a randomized pilot study. The American journal of geriatric psychiatry, 11(1), 33–45. https://pubmed.ncbi.nlm.nih.gov/12527538/
4. Dialectical Behavioral Therapy. (2026). https://dialecticalbehaviortherapy.com/