What Are the Six Main Points of Dialectical Behavior Therapy?

Wondering about dialectic behavioral therapy (DBT) principles? While many therapists and clients are aware of dialectic behavioral therapy (DBT), they might not be able to definitively answer the question: “What are the six main points of dialectical behavior therapy?”

In this article, we’ll answer this question, explain core DBT principles, and provide a list of DBT worksheets to use in your therapy practice, in addition to assessing the pros and cons of DBT therapy.

Dialectical behavioral therapy is an effective psychotherapeutic treatment model used by mental health therapists. It can be used by DBT therapists or may be woven into regular talk therapy as an intervention to support emotional regulation and distress tolerance.

What are the six main points of dialectical behavior therapy?

DBT is similar to cognitive behavioral therapy (CBT) because it provides practical solutions to manage intense emotions, enhances communication skills, and improves relationships.

Therapists can use DBT to treat several conditions, such as depression, anxiety, and borderline personality disorder (BPD). It has also shown positive results with youth experiencing suicide and non-suicidal self-injury.

Before we answer the question, “What are the six main points of dialectical behavior therapy?”, it’s important to know the four modes of DBT treatment and what settings each may be used in.

The four modes of DBT treatment are:

Individual psychotherapy

DBT can enhance motivation in individual sessions by providing specific skills training to apply to situations in the client’s life. It can also be used as a case management strategy to empower the client to manage their own life in physical and social domains.

DBT skills training

Therapists use DBT concepts to teach new skills as a problem-solving strategy, and they may include the core principles of DBT. This mode of DBT is often conducted in a group therapy setting.

Immediate phone coaching

Also called in-the-moment training, or “invivo” training, this type of DBT is used in difficult situations or crises.

DBT consultation teams for therapists

Communicating with, or collaborating with, fellow therapists who practice DBT can enhance client care. DBT consultation teams support therapists in monitoring the fidelity of their treatment, enhancing their skills, and sustaining their motivation to work with higher-acuity clients.

Now that we’ve addressed the four modes of DBT, you may still be wondering: “What are the six main points of dialectical behavior therapy?”

Here are the six main points of DBT:

Distress tolerance

These dialectical behavior therapy techniques help individuals cope with difficult situations without trying to escape them.

Examples of distress tolerance skills include radical acceptance practices, self-soothing strategies, using distracting activities, and crisis skills like ACCEPTS, TIP, or IMPROVE.

Interpersonal effectiveness

This component of DBT focuses on improving relationships and communication skills.

Interpersonal effectiveness teaches individuals how to ask for what they need, set and maintain boundaries, and honor their values.

Key skills used in interpersonal effectiveness include assertive communication strategies, like “I statement” worksheets; DEAR MAN (a technique for assertiveness); GIVE (used to strengthen and maintain relationships); and FAST (used to enhance self-respect).

Emotional regulation

DBT emotional regulation worksheets use skills like STOP (to help people take a breath and proceed more mindfully), opposite action (to encourage taking a new approach), riding a wave or urge surfing (to manage overwhelming emotions and urges), and PLEASE (a skill to focus on healthy behaviors).

Mindfulness

This core DBT principle involves staying present and fully engaged in the moment without judgment.

Mindfulness is a skill, or practice, that helps individuals become more aware of their thoughts, feelings, and behaviors—which is crucial for emotional regulation and decision-making.

Key skills used in mindfulness include focusing on the present moment, practicing awareness of thoughts and feelings, and reducing distractions and judgments (of self, others, and situations).

Walking the middle path

This skill is about finding balance and avoiding extremes in thinking and behavior. By “walking the middle path,” clients are taught to emphasize the importance of dialectical thinking—holding two seemingly opposite truths simultaneously.

Key skills used in this component of DBT include balancing acceptance and change, avoiding all-or-nothing thinking, and finding the middle ground when making decisions and in behaviors.

Dialectical strategies

DBT emphasizes dialectics, the idea that two seemingly contradictory things can both be true.

Developing dialectic strategies can help individuals resolve conflict, navigate ambivalence, and see different perspectives in situations.

Key strategies include:

• Validation, by acknowledging and understanding both sides of an issue, including the client’s perspective
• Socratic questioning, which challenges assumptions to promote change
• Chain analysis, which identifies behavior patterns by breaking down events leading to emotional reactions

Pros and cons of DBT therapy

As with any therapeutic modality, DBT must be client-centered, collaborative, and assessed on a client-by-client basis. However, there are some general pros and cons of incorporating dialectical behavioral therapy into your therapy practice.

The pros and cons of DBT therapy include:

Pros of DBT

• Evidence-based treatment that is effective for several mental health conditions
• Structured, skills-based approach with practical strategies to apply to real-life situations
• DBT combines acceptance and change strategies that motivate clients to positively adapt their behavior and enhance their coping strategies
• Can be used in crisis management
• Creates long-term improvements in emotional regulation and distress tolerance
• Empowers clients to self-soothe, take control of their needs, and enhance their relationships and communication skills
• Helps clients to live in the moment, stay mindful, and build their resilience to distressing situations

Cons of DBT

• DBT skills training groups may be time-intensive and a long-term commitment for therapists and clients
• It may not be suitable for all mental health conditions
• Not all therapists have DBT training
• Group therapy may not suit everyone
• Individuals may not like the approach

DBT worksheets

We’ve created a catalog of worksheets and articles specifically focused on DBT, which are available in the SimplePractice Resource library.

These worksheets can be used for whiteboard exercises, as handouts for client homework, or to provide a visual during psychoeducation:

• Distress tolerance worksheets
• Emotional regulation worksheets
• DBT Wise Mind worksheet
• Assertive communication worksheets
• Assertive communication examples worksheet
• DBT ACCEPTS worksheet
• DEAR MAN worksheet
• DBT worksheets
• Boundary exploration worksheet

Sources

• Asarnow, J.R., Berk, M.S., Bedics, J., Adrian, M., Gallop, R., Cohen, J., Korslund, K., Hughes, J., Avina, C., Linehan, M.M., & McCauley, E. (2021). Dialectical Behavior Therapy for Suicidal Self-Harming Youth: Emotion Regulation, Mechanisms, and Mediators. Journal of the American Academy of Child and Adolescent Psychiatry.
• Chapman A. L. (2006). Dialectical behavior therapy: current indications and unique elements. 
• Linehan, M. (n.d.). Behavioral Tech Institute. What is DBT? 
• National Institute of Mental Health. (2021). Improved Emotion Regulation in Dialectical Behavior Therapy Reduces Suicide Risk in Youth. 

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