DBT Foundations: What Dialectical Behavior Therapy Is and How It Helps

If you're looking into DBT for the first time, you probably have a specific reason. Maybe your emotions feel unmanageable. Maybe a therapist or psychiatrist suggested it. Maybe you're a parent trying to figure out the right treatment for yourteenager orchild. Whatever brought you here, this guide covers what DBT actually is, what the skills look like in practice, and what to expect if you start a program at Metro NY DBT Center in New York, New Jersey, or Connecticut, with both in-person and virtual options available.

DBT (Dialectical Behavior Therapy) is a structured, skills-based therapy that balances acceptance and change to help people regulate intense emotions, reduce impulsive behaviors, and build healthier relationships. It was developed by Dr. Marsha Linehan and is considered the standard treatment for emotion dysregulation.

Key takeaways:

• DBT is built on four skills modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
• A full DBT program includes individual therapy, group skills training, phone coaching, and a therapist consultation team, all running at the same time.
• DBT was developed for borderline personality disorder but is now used to treat depression, anxiety, PTSD, eating disorders, substance use, and other conditions rooted in emotion dysregulation.
• Metro NY DBT Center offers fully adherent DBT for adults, adolescents, and children across NY, NJ, and CT.

Ready to learn more about whether DBT is right for you? Call 212-560-2437 orschedule a consultation.

What Is DBT?

Dialectical behavior therapy is a type of cognitive-behavioral treatment built around one core tension: the need to accept yourself as you are right now and the need to change behaviors that are causing harm. That tension, the "dialectic," is baked into every part of the therapy. The ultimate goal is to help you build what DBT calls "a life worth living," which means a life where you can manage your emotions, maintain relationships, and pursue what matters to you.

Dr. Marsha Linehan originally developed DBT in the late 1980s to treat people withborderline personality disorder and chronic suicidal behavior. Since then, research has supported its use for a much wider range of problems, including depression, anxiety, PTSD, eating disorders, and substance use. Multiple meta-analyses have found that DBT significantly improves emotional regulation and reduces symptoms across a range of psychiatric diagnoses.

DBT differs from standard CBT in a few concrete ways. Where CBT focuses primarily on identifying and restructuring distorted thoughts, DBT adds an equal emphasis on acceptance strategies drawn from mindfulness practice and on building specific behavioral skills. It also includes components you won't find in most CBT programs: a weekly skills group, between-session phone coaching, and a therapist consultation team.

The Foundations DBT Is Built On

Emotion Dysregulation and Biosocial Theory

DBT starts from a specific explanation of why some people struggle more than others with intense emotions. The "biosocial theory" says that emotion dysregulation develops from two interacting factors: a biological sensitivity to emotions (you feel things faster, more intensely, and take longer to return to baseline) and an environment that didn't adequately teach you how to manage those emotions, or that actively invalidated them.

This isn't about blame. It's a framework for understanding why willpower alone hasn't worked, and why you need concrete skills instead.

Dialectical Thinking

"Dialectical" means holding two things that seem contradictory at the same time. In DBT, the most basic dialectic is: "I am doing the best I can, and I need to do better." This both/and approach replaces the all-or-nothing thinking that tends to make emotional pain worse. You'll encounter dialectical thinking throughout the skills, in the way your therapist talks with you, and in how the group is run.

Mindfulness as the Base Skill

Mindfulness is the foundation of every other DBT skill. In this context, mindfulness doesn't mean meditation retreats or clearing your mind. It means learning to notice what you're feeling, thinking, and experiencing right now, without immediately reacting to it or judging it. Every DBT skills module cycles back to mindfulness because the other skills depend on your ability to pause and observe before you act.

The Four DBT Skills Modules

DBT skills training is organized into four modules. In a standard program, you cycle through all four over the course of treatment. Here's what each one covers and when it tends to matter most.

Mindfulness

Mindfulness skills teach you to observe your thoughts and emotions without getting swept up in them, to describe your internal experience in words, and to participate fully in what you're doing rather than operating on autopilot.

What you'll practice: observing without reacting, describing emotions accurately, staying present during conversations or tasks, and distinguishing between "emotion mind," "reasonable mind," and "wise mind."

When it helps most: when you feel overwhelmed and can't identify what you're actually feeling, when you tend to react impulsively before thinking, or when you feel disconnected or numb.

For example, you're in an argument with your partner and feel a surge of anger. Mindfulness skills help you notice the anger, name it, and pause long enough to choose a response rather than just react.

Distress Tolerance

Distress tolerance skills are for moments of crisis, when the pain is high and you can't solve the problem right now. The goal isn't to feel better. It's to get through the moment without making things worse: no self-harm, no substance use, no blowing up a relationship.

What you'll practice: the skills for self-soothing with your five senses, radical acceptance of situations you can't change, and weighing the pros and cons of acting on urges versus tolerating them.

When it helps most: during a panic attack or emotional crisis, when you have strong urges to self-harm or use substances, or when you're facing a situation that feels unbearable but can't be fixed immediately.

For example, you get a text that triggers intense shame and your first impulse is to hurt yourself. Distress tolerance skills give you a concrete sequence so the crisis passes without creating a new problem.

Emotion Regulation

Where distress tolerance is about surviving a crisis, emotion regulation is about the longer game: understanding your emotional patterns, reducing how often you get hit by intense negative emotions, and learning to shift emotions when you want to.

What you'll practice: identifying and labeling emotions accurately, understanding what triggers them, reducing vulnerability to negative emotions through basic self-care like sleep, eating, exercise, and treating illness, building positive experiences, and acting opposite to unhelpful emotional urges through a technique called "opposite action."

When it helps most: when mood swings dominate your day, when you feel controlled by shame, anger, or sadness, or when you want to understand why you keep ending up in the same emotional place.

For example, every Sunday night you spiral into dread about the week ahead. Emotion regulation skills help you map the trigger, check whether the emotion fits the facts, and use opposite action like preparing something small for Monday and doing one enjoyable activity Sunday evening instead of withdrawing.

Interpersonal Effectiveness

These skills address how you interact with other people: how to ask for what you need, say no, handle conflict, and maintain your self-respect in relationships. If you're a parent or caregiver, these same principles apply to navigating family dynamics with your teen or child.

What you'll practice: structured frameworks for making clear requests and setting boundaries, techniques for navigating disagreements without damaging the relationship, strategies for maintaining your self-respect during difficult conversations, and learning to identify what matters most in a given interaction: the outcome you want, the relationship, or your own values.

When it helps most: when you avoid conflict and then resent people, when you say yes to everything and burn out, when arguments escalate quickly, or when you feel like you lose yourself in relationships.

For example, your boss keeps assigning extra work without adjusting your deadlines. Interpersonal effectiveness skills help you prepare a clear, specific request, deliver it in a way that preserves the working relationship, and hold your ground without apologizing for having limits.

What Does a Full DBT Program Include?

A fully adherent DBT program has four components that work together. This isn't a menu where you pick one or two; the research supporting DBT is based on all four running simultaneously.

Individual therapy runs weekly for 45 minutes. You meet one-on-one with your DBT therapist to apply skills to your specific life problems, track your progress using diary cards, and work on the behaviors that are most interfering with your life and your treatment.

Group skills training also runs weekly, for 75 minutes. This is structured like a class, not group therapy. A skills trainer teaches the four modules, and you practice them with other group members. You're not expected to share personal details about your life; the focus is on learning and rehearsing the skills.

Phone coaching happens as needed between sessions. These are brief calls with your individual therapist when you need help applying a skill in a real-life moment. The point is to get support before you fall back on old patterns, not after.

Our DBT clinicians meet on a schedule as a team to ensure we are providing the most effective and compassionate treatment possible.

Research on DBT has shown reductions in suicidal behavior, self-harm, and psychiatric hospitalizations among adults who complete the program. For people who need a more accelerated structure, Metro NY DBT Center also offers anintensive DBT program for adults that covers the same modules on a compressed timeline.

What to Expect at Metro NY DBT Center in NYC, NJ & CT

Metro NY DBT Center runs fully adherent DBT programs foradults,adolescents, and children aged 8–12. The center serves New York, New Jersey, and Connecticut through both in-person and virtual sessions.

Locations: The New York office is at 1776 Broadway, Suite 2210, in Midtown Manhattan. The New Jersey offices are in Florham Park at 205 Ridgedale Ave, Suite 101 and in Cranford at 214 Walnut Ave, Suite A. Virtual sessions are available for clients across NY, NJ, and CT.

How the program is structured for adults: Theadult program includes all four DBT components: weekly individual therapy for 45 minutes, weekly group skills training for 75 minutes, phone coaching, and a clinician consultation team. Stage 1 treatment, which covers the foundational skills, runs approximately 29 weeks.

For adolescents and families:  DBT-A includes multi-family skills groups where teens and parents learn together, plus a fifth skills module called "Walking the Middle Path" that focuses on reducing family conflict. There's also a 7-week Parent and Caregiver DBT Intensive for parents who want to build DBT skills on an accelerated timeline.

Pretreatment: Before starting the full program, you'll go through a pretreatment phase. For adults, this typically includes a 60-minute intake assessment followed by four individual pretreatment sessions. These sessions orient you to how DBT works, help you and your therapist agree on treatment goals, and build the commitment needed to get the most out of the program.

Insurance and payment: Metro NY DBT Center is an out-of-network provider. You pay at the time of service and receive detailed invoices to submit to your insurance company for potential out-of-network reimbursement. The center encourages you to check your out-of-network mental health benefits before starting. Program components and fees are clarified during your consultation.

Ready to take the next step? Start the admissions process or call 212-560-2437 to schedule a consultation.

How to Get Started

1. Schedule a consultation. Call 212-560-2437 or email info@metronydbt.com. You can alsovisit the contact page orstart the admissions processon the website.
   
   
2. Complete an intake assessment. This is a 60-minute session where a clinician evaluates your needs and determines whether DBT is the right fit. For adolescents, there's a separate 45-minute parent intake as well.
   
   
3. Begin pretreatment. You'll have several individual sessions to learn how the program works, set your treatment targets, and commit to the structure: attending group, doing skills practice between sessions, and using phone coaching.
   
   
4. Start Stage 1 DBT. Once pretreatment is complete, you begin weekly individual therapy and group skills training simultaneously. For adults, this phase runs approximately 29 weeks.
   
   

DBT Foundations FAQ

What are DBT foundations? The core concepts and skills DBT is built on: the biosocial theory of emotion dysregulation, dialectical thinking, mindfulness as a base skill, and the four skills modules of mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. You learn these during pretreatment and the early weeks of Stage 1.

Is DBT only for borderline personality disorder?

No. DBT was originally developed for BPD, but it's now used to treat depression, anxiety, PTSD, eating disorders, substance use, and otherconditions involving emotion dysregulation. The common thread is difficulty managing intense emotions and the behaviors that follow.

Can DBT help with anxiety or depression?

Yes. DBT skills like mindfulness, emotion regulation, and distress tolerance directly address patterns that maintain anxiety and depression such as avoidance, rumination, and emotional withdrawal. Research supports DBT's effectiveness across multiple diagnoses beyond BPD.

What are the four DBT modules?

Mindfulness builds present-moment awareness. Distress tolerance helps you survive crises without making them worse. Emotion regulation teaches you to understand and shift emotional patterns. Interpersonal effectiveness covers communicating needs, setting boundaries, and managing conflict.

What's the difference between CBT and DBT?

CBT focuses on identifying and changing distorted thoughts. DBT includes cognitive-behavioral techniques but adds acceptance-based strategies, especially mindfulness, along with a structured skills group, phone coaching between sessions, and a therapist consultation team. DBT places more emphasis on managing intense emotions and relationships.

Do you offer virtual DBT in NY, NJ, and CT?

Yes. Metro NY DBT Center offers virtual sessions for clients in New York, New Jersey, and Connecticut. Individual sessions can be held virtually or in-person, and many group skills training sessions are available virtually.

How do I start DBT at Metro NY DBT Center?

Call 212-560-2437, email info@metronydbt.com, orsubmit a consultation request online. You'll complete an intake assessment, go through pretreatment sessions, and then begin the full program.

Where are your offices?

 New York: 1776 Broadway, Suite 2210, Midtown Manhattan. New Jersey: 205 Ridgedale Ave, Suite 101, Florham Park and 214 Walnut Ave, Suite A, Cranford.

Will there be homework in DBT?

 Yes. Between sessions you'll track emotions and behaviors on a diary card and practice the skills from group. Skills practice outside sessions is a core part of how DBT works… the therapy room is where you learn, but daily life is where you apply them.

How does out-of-network payment work?

 Metro NY DBT Center is an out-of-network provider. You pay at the time of service and receive detailed invoices to submit to your insurance company for potential reimbursement. The center recommends checking your out-of-network mental health benefits before starting. Fees are discussed during your consultation.

Ready to get started?

Contact Metro NY DBT Center to schedule a consultation.

Phone: 212-560-2437 Email: info@metronydbt.com

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New York: 1776 Broadway, Suite 2210, New York, NY 10019 New Jersey: 205 Ridgedale Ave, Suite 101, Florham Park, NJ 07032 | 214 Walnut Ave, Suite A, Cranford, NJ 07016