Dialectical Behavior Therapy: Managing Life’s Dialectic Experiences

Life with all it’s wondrous joys also brings sorrow. Our wellness is dependent on healthy processing of dialectic experiences. Life pulls in many direction, lifting with joys while challenging with disappointments and fears. We exist in a dialectical tension caused by opposing forces. Our managing of the complexity determines our experience of wellness. Dialectical behavior therapy operates with these factors in mind. “The ability to appreciate paradox and to think dialectically” is a helpful skill to manage the diversity of life experiences and a necessary ingredient to healing from trauma (Tedeschi et al., 2018).

Introduction: Strengthening Emotional Regulation and Building Resilience

Dialectical behavior therapy (DBT) is designed to improve emotional regulation and enhance resilience to help clients better tolerate stress. DBT achieves these objectives through teaching emotional regulation and interpersonal skills that navigate the opposing forces encountered in living. The underlying belief is that is people can manage their emotions they can effectively direct their own lives.

Dialectical behavior therapy has strong empirical support on its effectiveness for treating many conditions. Therapists have used DBT to treat clients suffering with depression, drug and alcohol abuse problems, post-traumatic stress disorder (PTSD), traumatic brain injuries (TBI), binge-eating disorder, and mood disorders. Research also suggests that DBT might help patients with symptoms and behaviors associated with spectrum mood disorders, including self-injury.

How Does Dialectical Behavior Therapy differ from Cognitive Behavioral Therapy?

Dialectical Behavior Therapy (DBT) shares its foundational principles with Cognitive Behavioral Therapy (CBT), yet it sets itself apart by incorporating additional techniques that specifically address emotional and interpersonal challenges. DBT is not merely an extension of CBT; rather, it provides a more nuanced framework for individuals to navigate their complex emotional landscapes.

A key feature of DBT is its emphasis on mindfulness, which encourages clients to focus on the present moment without judgment. This practice helps individuals become aware of their thoughts and feelings as they arise, allowing them to respond thoughtfully rather than react impulsively. By integrating mindfulness into therapy, clients learn how to observe their emotions without being overwhelmed by them—a critical skill in cultivating emotional regulation.

In addition to mindfulness, DBT also emphasizes skills development in areas such as distress tolerance and interpersonal effectiveness. Distress tolerance equips individuals with strategies to cope during moments of crisis without resorting to harmful behaviors or destructive patterns. This ability is crucial for navigating life’s inevitable stressors while maintaining a sense of stability and control. Furthermore, interpersonal effectiveness training empowers clients to communicate assertively and build healthier relationships.

By learning how to express their needs while respecting the needs of others, individuals can foster connections that are both fulfilling and respectful. Thus, DBT offers a comprehensive approach that not only targets cognitive distortions but also addresses the emotional complexities inherent in human experiences.

History of Dialectical Behavior Therapy

Marsha Linehan developed DBT as a modified form of cognitive behavioral therapy (CBT) in the late 1980s to treat people with borderline personality disorder (BPD) and chronically suicidal individuals. After Linehan’s techniques proved effective in treatment for BPD and self-harming clients, other therapists began integrating DBT into their practice to treat a variety of other mental health illnesses. 

Four Key Elements of Dialectical Behavior Therapy

A dialectical behavior therapists focuses on facilitating growth in four key areas: mindfulness, distress tolerance, emotional regulation and Interpersonal Effectiveness.

Mindfulness

​Mindfulness in DBT is paying attention in the present moment. In practice, mindfulness is that act of intentionally focusing attention on the present moment, allowing felt experience to exist in consciousness without a running commentary of words and judgements.

Mindfulness improves:

• Self-awareness
• Distress toleration
• Integration of multiple sources of data
• Inner peace

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Mindfulness halts automatic reaction to emotional arousal, creating a space where healthier choices can be made. Automatic learned responses often include destructive behaviors that push us off course, moving away from instead of toward life goals. Dijk warns that, “When you’re unaware of your inner experience—specifically, your thoughts, feelings, and urges—you’re much more likely to act on unhealthy urges and to automatically engage in behaviors that you will likely regret later” (Van Dijk, 2012). As we increase our self awareness and accept what we discover, we increase opportunities to heal the elements interfering with growth.

See Psychology of Mindfulness for more on this topic

Distress Tolerance

Dialectical experience of oppositional forces creates stress. Navigating the complexity requires managing arousal without crumbling into self destructive patterns. Distress tolerance skills enhance our ability to cope with stressful situations, allowing constructive responses to intervene rather than defensive learned reactions. Defensive learned reactions such as intoxication, overspending, unhealthy indulgence, or lashing out have long-term negative consequences.

Our ability to tolerate and mitigate heighten arousal is correlated with many life successes and failures. Skills such as mindfulness, distraction, and relaxed breathing assist in bringing stress back to manageable levels. “The major emphasis of DBT is to learn to bear emotional pain skillfully”(Van Dijk, 2012).

See Affect Tolerance for more on this topic

​Emotional Regulation

​Dijk explains, “People who have difficulty regulating or managing their emotions usually find it difficult to tolerate their emotions and often have trouble identifying, understanding, and expressing how they feel” (Van Dijk, 2012). Research supports this concept. Our skills of identifying and differentiating emotion strongly supports regulation. Differentiating emotion is a labelling process rather than a judgment process. We regulate with granular descriptions of felt experience.

DBT teaches that we can act from three different minds:

• emotional mind
• reasonable mind
• wise mind

See Emotional Regulation for more on this topic

Passion and logic has historically been pitted against each other in philosophy. Marsha Linehan wrote that, “Acting from your wise self is about finding a balance between your emotional and reasoning self and following your intuition about what’s in your best interest in the long run” (Van Dijk, 2012). The wise mind is accessible only when we employ mindful self-awareness and tolerate distressing emotion states. The wise mind is akin to Daniel Goleman’s emotional intelligence.

Interpersonal Effectiveness

We need others. We are biologically driven to belong. While we may want connection, we aren’t always skilled at connecting. When our need to belong is frustrated, we suffer. The dialectic involved in relationships is the oppositional demands for respect of self while honoring the individuality of others.

This dialectical factor of relationships weighs on every interaction. When too much weight is put on either side (self or other), relationships struggle. We either divorce our self respect in efforts to  please others or selfishly ignore others in personal pursuits of pleasure. A dialectic involvement in healthy relationships requires balancing the needs of others with the needs of the self, while maintaining one’s self-respect.

DBT focuses on developing balanced interpersonal effectiveness to honor balance in three ways: acting with self respect, treating others well, and communicating with assertiveness.

See Autonomy in Romantic Relationships for more on this topic

Self-Respect:

Retaining a healthy sense of autonomy is fundamental to cultivating and maintaining fulfilling relationships (Murphy, 2024). Autonomy allows individuals to express their unique identities, pursue personal interests, and engage in activities that bring them joy outside of the partnership. When people prioritize their own passions and hobbies, they not only enrich their lives but also contribute positively to the relationship dynamic.

By engaging in self-discovery and nurturing personal growth, individuals develop a stronger sense of self-worth that enhances their ability to connect with others authentically. This balance between individuality and togetherness fosters an environment where both partners can thrive without losing themselves in the relationship.

Moreover, living a life rooted in self-respect is essential for establishing boundaries that honor one’s values and integrity. Individuals who practice self-respect are more likely to communicate openly about their needs while being considerate of their partner’s feelings. Compassionately honoring one’s values means making choices aligned with personal beliefs, which ultimately strengthens the foundation of trust within the relationship.

When both partners uphold integrity—acting consistently with their core principles—they foster an atmosphere of mutual respect and understanding. In this way, prioritizing autonomy does not equate to selfishness; instead, it cultivates healthier connections where both individuals feel valued for who they truly are, leading to deeper emotional intimacy and satisfaction within the relationship context.

Treating Others Well:

Kindness does, in fact, matter. Kindness connects us with reality. Science has sadly found that as we become more self sufficient, connection to others begins to erode. We must work to remain connected and kind. 

We remain connected to others by: 

• Caring
• Remaining interested
• Validating others emotions and experiences
• Respecting differences

Assertiveness:

DBT teaches that communication usually takes one of four possible styles. These styles are passive, aggressive, passive-aggressive, and assertive.

• Passive: A passive communicator stuffs personal emotions and desires rather than communicate them. They communicate protectively rather than openly to avoid risk of negative or confrontational reactions.
• Aggressive: An aggressive communicator uses domination and control. They utilize techniques of shame, fear, and confusion. They use these techniques to avoid open dialogue and compromise.
• Passive-Aggressive: Passive-aggressive communicators don’t openly communicate emotions but express emotions in more subtle ways. They may use sarcasm, silent treatments, or indirect comments to convey their message. They say “I’m not angry,” but then slam a door and sulk.
• Assertive: Assertive communicators express thoughts feelings and opinions in a clear, honest, and respectful way. The assertive communicator meets the dialectic aspect of relationships head on, concerned with meeting autonomous needs while meeting the needs of others as much as possible. Assertive communicators utilize skills of emotional attunement, listening, and negotiating.

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​Assertive communication is not about always getting one’s way. Forcing others to comply is not assertive communication. Listening with non-judgmental intent to understand is the most powerful way to connect. The other feels respected and their sense of worth is validated during these interactions. Assertive communication on the part of the speaker doesn’t always work because the other may respond with attempts to manipulate, or passive acceptance never openly expressing of their own feelings. Unfortunately, not all relationships are salvageable.

See Assertiveness for more on this topic

Associated Concepts

• Lazarus’ Cognitive Processing Theory: This theory posits that emotions arise not directly from external stimuli, but from our interpretations and evaluations of those stimuli. This “appraisal” process involves two key stages: primary appraisal (assessing the significance of the event—is it irrelevant, positive, or stressful?) and secondary appraisal (evaluating our ability to cope with the event).
• Process Model of Emotional Regulation: This model describes distinct stages where individuals can regulate emotional experience and expression. These stages involve situation selection, modification, attention deployment, cognitive change, and response modulation for effective emotion management.
• Borderline Personality Disorder: A mental health disorder characterized by a pattern of varying moods, self-image, and behavior. Individuals with BPD often experience intense mood swings, unstable relationships, impulsiveness, and difficulty regulating their emotions.
• Dyadic Regulation: This regulation involves mutual influence on each other’s emotions and support in close relationships. It begins in mother-infant bonds and continues throughout life. Emotional attunement, validation, partner buffering, and limiting negative affect are key techniques in dyadic regulation.
• Stress and Coping Theory: This theory developed by Richard Lazarus and Susan Folkman suggests that individuals experience stress when they perceive a discrepancy between the demands of a situation and their perceived ability to cope with those demands.
• Emotional Flooding: This concept, also known as emotional overwhelm, occurs when intense emotions overwhelm a person, hindering clear thinking and rational action. It can impair decision-making, disrupt relationships, and lead to maladaptive behaviors.
• Interpersonal Effectiveness: This refers to techniques that enable individuals to communicate with others in a way that is assertive, maintains self-respect, and strengthens relationships. It helps individuals ask for what they want, say no, and cope with interpersonal conflict.

A Few Words by Psychology Fanatic

Recognizing and managing life’s conflicts is a primary skill for flourishing. Life, as far as I can predict, will always struggle against opposing forces. DBT recognizes this primary function of life and attends to fundamental skills to assist clients with this task.

David Richo wrote in his wonderful book Five Things We Cannot Change that a spiritual practice is to hold both our hands out, cupped, palms upward, and imagine them holding the opposites. He explains, “We feel the light and equal weight of both, since our hands are empty. We then say for example, ‘I can serenely hold both my need for a relationship and not having one right now’” (Richo, 2006). Perhaps, DBT teaches exactly how to do just that, hold our hands out, examining opposites, and managing to integrate them into a healthy, flourishing life.

Last Update: May 21, 2025

References:

Murphy, T. Franklin (2024). The Role of Autonomy in Emotional and Cognitive Development. Psychology Fanatic. Published: 4-13-2024; Accessed: 5-21-2025. Website: https://psychologyfanatic.com/autonomy/
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Richo, David (2006). The Five Things We Cannot Change: And the Happiness We Find by Embracing Them. ‎ Shambhala; Reprint edition. ISBN-10: 1590303083
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Tedeschi, Richard G.; Shakespeare-Finch, Jane; Taku, Kanako; Calhoun, Lawrence G. (2018). Posttraumatic Growth: Theory, Research, and Applications. Routledge; 1st edition. ISBN: 9781032913247; DOI: 10.4324/9781315527451
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Van Dijk, Sheri (2012). Calming the Emotional Storm: Using Dialectical Behavior Therapy Skills to Manage Your Emotions and Balance Your Life. New Harbinger Publications. ISBN-10: 1608820874
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