Four Sanare clinicians on a staircase

Dialectical Behavioral Therapy (DBT)

What is DBT?

Dialectical behavior therapy, or DBT, was created by psychologist Marsha Linehan in the late 1980s for people with intense, fast-moving emotions and a history of self-harm or suicidal behavior. It was first used for borderline personality disorder. Today it's used much more widely, for mood disorders, trauma, eating disorders and anyone who feels ruled by their emotions.

The "dialectical" part means holding two things at once: accepting yourself as you are right now, and working to change. Both are true, and DBT treats both as necessary.

The four skill sets

  • Mindfulness. Noticing what's happening inside and around you without immediately reacting.

  • Distress tolerance. Getting through a crisis without making it worse, using things like cold water, paced breathing and distraction.

  • Emotion regulation. Understanding emotions, lowering vulnerability to them, and changing ones that don't fit the facts.

  • Interpersonal effectiveness. Asking for what you need and saying no while keeping relationships and self-respect intact.

Using skills where they're needed

DBT skills are easy to learn on a worksheet and hard to use when you're furious at your landlord or panicking in a crowded store. Linehan built phone coaching into standard DBT for exactly this reason: skills have to be practiced in real moments.

Sanare takes that further. Our clinicians are with clients at home, at work, and out in the community, so we can coach skills as situations happen. A client might practice an interpersonal effectiveness script before calling their benefits office, with their clinician sitting beside them. Over weeks, they need less coaching.

Who it helps

We use DBT skills with clients living with personality disorders, mood disorders, bipolar disorder, complex trauma and schizoaffective disorder. Many clients also attend a DBT skills group elsewhere, and we work alongside it.

DBT in Denver

Sanare serves adults 18 and older across the Denver and Boulder metro. Get in touch or call 303.476.1974. For more on DBT research, see the Association for Behavioral and Cognitive Therapies.