Who this approach usually helps
- Intense emotions and mood swings
- Borderline personality disorder
- Self-harm
- Explosive anger and impulsive behaviour
- Turbulent relationships and fear of abandonment
- Emotional eating
What DBT is and where it comes from
DBT was developed by the American psychologist Marsha Linehan in the 1980s and 1990s. She worked with people who repeatedly had suicidal thoughts or harmed themselves, and saw that standard CBT, focused mainly on change, often left them feeling blamed and misunderstood. Her answer was to add acceptance alongside change.
"Dialectical" refers to holding two seemingly opposite truths together: "I am acceptable as I am right now" and "I want to change, and I can". Both are true at once. DBT was originally designed for borderline personality disorder, but today it is used for a wider range of problems whose core is difficulty regulating emotions.
The four DBT skill areas
A large part of DBT is skills training, almost like a practical class. The skills fall into four groups:
Mindfulness: paying attention to the present moment without judgement, so you can notice an emotion before it sweeps you away. Distress tolerance: ways to get through crisis moments without making things worse, such as cold water, slow breathing or distraction. Emotion regulation: recognising and naming emotions, reducing vulnerability (for example through regular sleep and meals) and changing emotions that don't fit the facts. Interpersonal effectiveness: saying no, asking for what you need and keeping your self-respect in relationships without damaging them.
What DBT sessions look like
Full or "standard" DBT usually has several parts: a weekly individual session, a group skills class, brief contact with the therapist in difficult moments for help applying skills, and a consultation team for the therapists. Many therapists also offer adapted DBT in individual sessions, teaching the skills within the session itself.
An individual session often starts with a "diary card" logging the emotions, urges and skills you used during the week. If, say, a phone argument with family left you in intense anger, your therapist goes through the chain of events with you step by step: what happened, what you thought, what your body felt, what you did, and where a skill could have helped. This "chain analysis" is not about blame but about finding points where change is possible.
Who it helps and what the evidence says
DBT is one of the most researched treatments for borderline personality disorder and has good evidence for reducing self-harm and high-risk behaviour. DBT and its skills are also used for explosive anger, emotional eating, impulsive behaviour and teenagers struggling with intense emotions, although the evidence in these areas is more varied.
If your emotions seem to surge like a sudden wave, your relationships are full of conflict, or you calm yourself in ways you later regret, DBT may help. You don't need a specific diagnosis to benefit from learning these skills.
How long it takes
A standard DBT programme typically lasts about six months to a year, because learning and practising four skill areas takes time and old emotional patterns don't change overnight. Shorter, skills-focused versions, for example a few months on emotion regulation and distress tolerance, are also common. You and your therapist set the length based on your goals and progress.
DBT online and in Farsi
Skills teaching, diary cards and chain analysis work well by video, and online DBT has been widely used in recent years. One advantage is that you practise skills right where most emotions arise: at home, in relationships and in daily life.
In many Iranian families, expressing emotion or being "too sensitive" has been met with labels and blame. A therapist familiar with this culture understands why saying no to parents is hard, or why the loneliness of migration can intensify emotions. Naming emotions in your mother tongue, the way you actually feel them, also makes the work easier.
Safety, limits and alternatives
An important note: online therapy is not an emergency service. If you are at risk of harming yourself or cannot keep yourself safe, please contact local emergency services or the nearest hospital now. In the first sessions your therapist will also make a safety plan with you.
Full DBT with a skills group and between-session contact is not always available, and in some situations, such as high and ongoing risk, in-person or team-based care may be needed. If your main difficulty is deep, long-standing patterns in relationships, schema therapy is a good option. Mentalization-based treatment (MBT) is another well-researched treatment for borderline difficulties, and for anxiety or depression without intense emotional swings, cognitive behavioural therapy (CBT) is often enough.
