Dialectical behavioral therapy (DBT) grew out of cognitive behavioral therapy (CBT), but it adds a distinct emphasis on mindfulness and the ability to hold seemingly contradictory truths at the same time. “Dialectical” refers to that balancing act, the tension between working to change what’s within your control and accepting what isn’t.
Psychologist Marsha Linehan originally created DBT to treat borderline personality disorder, but its emphasis on mindfulness, distress tolerance, emotional regulation, and interpersonal skills has proven valuable for depression treatment as well.
Is DBT for Depression Effective?
Studies consistently show that DBT skills can reduce depressive symptoms. One study found DBT more effective than medication alone for people dealing with treatment-resistant depression.¹
A meta-analysis reports that DBT reduced depressive symptoms in teens, including self-harm behaviors.² Among older adults managing chronic depression, one study found that 71% of those combining DBT with medication reached remission within a year, compared to just 47% in the medication-only group.³
The Benefits of DBT for Depression
DBT builds distress tolerance and interpersonal skills, both of which can help manage depressive symptoms. The mindfulness component also helps pull attention back to the present, away from rumination about the past or anxiety about the future.
Here are some of the key benefits of DBT for depression:
- A proven ability to reduce suicidal thoughts and behaviors, which affect some people experiencing depression
- Greater self-acceptance and self-compassion, which push back against feelings of helplessness and worthlessness common in depression
- Improved mindfulness, helping reconnect you to your body and the present moment
- Stronger distress tolerance, building resilience against challenging situations
- Better interpersonal skills, supporting healthier relationships and stronger support systems during depressive episodes
If you are feeling suicidal or experiencing a mental health crisis, please reach out for immediate support by contacting your local emergency services, visiting your local emergency room, or calling/texting the National Crisis Hotline at 988.
Potential Drawbacks of DBT for Depression
DBT on its own centers heavily on skill-building for emotional regulation and interpersonal connection. You can still discuss day-to-day challenges as they arise, but a therapist utilizing DBT might spend less time processing past events and more time building tools to handle them moving forward.
That being said, therapists typically include DBT techniques in a more “eclectic” format, pulling from multiple modalities depending on the needs of the client. So, if you see “DBT” listed on a therapist’s profile alongside other therapy models, it’s highly unlikely that they’re offering a highly structured “DBT program.” However, when this is the case, a more rigid DBT format could feel a bit overwhelming for someone who is used to a more free-flowing version of therapy sessions.
Commonly Used DBT Skills for Depression
DBT skills fall into four core categories: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. A DBT therapist may draw from dozens of specific techniques, but each one ties back to one of these four areas.
Mindfulness
Depression often pulls attention toward the past, fueling feelings of guilt and regret, or the future, through worry and hopelessness. Mindfulness redirects that energy toward the present, anchoring you in what’s actually happening rather than in ruminative cycles.
Here are a few mindfulness exercises commonly used in DBT:
- Pairing an activity with mindfulness: Pick one task, such as eating, walking, or washing dishes, and do it with full attention. Notice the physical sensations, sounds, and surroundings as you go.
- Thought labeling: When a negative thought surfaces, like “I’m not good enough,” reframe it as “I’m having the thought that I’m not good enough.” This small shift creates distance from the thought instead of getting pulled into it.
- Loving kindness meditation: Repeat compassionate phrases first toward yourself, then a loved one, then out into the world. This helps shift focus away from worry and toward genuine warmth for yourself and others.
Distress Tolerance
Distress tolerance is about learning to move through difficult emotions and situations rather than being overwhelmed by them.
A few distress tolerance techniques used in DBT:
- The STOP method:
- Stop whatever you’re doing
- Take a deep breath in and out
- Observe your thoughts and feelings without judging them
- Proceed with intention, choosing your response rather than reacting automatically
- The TIPP acronym:
- Temperature: Splash cold water on your face or hold something cold against your skin for 10-30 seconds
- Intense exercise: Get your heart rate up with a run, brisk walk, or anything physically demanding
- Paced breathing: Slow your breath down, making exhales longer than inhales
- Progressive muscle relaxation: Tense and release muscle groups one at a time, moving from your feet up to your head
- Urge surfing: Teaches you to sit with a difficult urge rather than act on it, trusting that the intensity will eventually pass on its own.
Interpersonal Effectiveness
Relationships can take work under the best circumstances, and depression can make communication even harder. Learning specific interpersonal skills helps you express your needs clearly and build more satisfying connections.
Here are a couple common DBT skills related to interpersonal effectiveness:
- The DEARMAN acronym:
- Describe the situation objectively
- Express how you feel about it
- Assert what you need or want
- Reinforce the benefits of getting that need met
- Mindfully stay focused on your goal, repeating your point if needed
- Appear confident through tone and eye contact
- Negotiate by staying open to alternative solutions
- The GIVE skill:
- Gentle: Stay respectful and avoid hostility or blame
- Interested: Show genuine attention through eye contact and body language
- Validate: Acknowledge the other person’s perspective, even if you disagree
- Easy manner: Keep things light where possible, using humor or a warm tone
Emotional Regulation
Emotions carry valuable information, but they can feel unmanageable without the right tools. This area of DBT focuses on recognizing what you’re feeling and developing strategies to effectively manage intense emotions.
A few emotional regulation techniques:
- Opposite action: Depression tends to push you toward isolation or self-doubt. Opposite action means doing the reverse. For instance, if your depressive instinct is to withdraw, the opposite action would be reaching out to a friend instead.
- Cope ahead: Picture a challenging situation in vivid detail, then mentally rehearse the coping strategies you’d want to use. Walk through it as specifically as possible, then practice a relaxation technique afterward to keep your body calm.
- Positive self-talk: Depression amplifies automatic negative thinking. Recognizing these thoughts and actively countering them with more compassionate, realistic ones takes practice but builds real change over time.
What to Expect During DBT for Depression
At New Directions Mental Health, many of our therapists take a flexible approach, using techniques from multiple standpoints depending on the needs of the client. Our therapists typically aren’t running fully structured DBT programs. Most blend DBT techniques and skills with other modalities like cognitive behavioral therapy (CBT), interpersonal therapy (IPT), acceptance and commitment therapy (ACT), or trauma-based modalities as necessary.
More formal DBT follows a structured, intensive format. It typically begins with an assessment to confirm that DBT is the right fit for your needs, followed by a combination of individual and group sessions. Some therapists also offer crisis planning and phone coaching when necessary.
Individual DBT Sessions
In individual sessions, your therapist helps you work through thoughts and behaviors getting in the way of your progress. You may explore specific depression symptoms or relationship challenges that are holding you back, but the emphasis stays on building new skills rather than dwelling on the past.
You might be asked to track emotions and behaviors in a journal to bring into sessions, helping identify patterns to address together.
Group Skill Building
DBT frequently incorporates group sessions where you can practice skills alongside others working toward related goals. Group settings offer a low-stakes way to rehearse interpersonal techniques before applying them “in real life,” and connecting with others facing similar struggles can be a powerful reminder that you’re not alone.
Crisis Planning
If needed, your therapist can help you build a clear plan for navigating a mental health crisis. This might include hotline numbers or identifying the nearest emergency room. Some therapists offer crisis phone support during specific hours, and they’ll be upfront with you about their availability and boundaries.
How Long Can I Expect DBT for Depression to Last?
You and your therapist will determine together when you should conclude your sessions, but most DBT programs run somewhere between six months and a year. Over that time, you’ll build skills across all four core areas, and once those skills feel solid, you’ll typically transition out of regular one-on-one sessions. Some people continue with occasional group or individual check-ins for ongoing support.
Find Depression Treatment in Pittsburgh with New Directions Mental Health
New Directions Mental Health provides comprehensive depression care across Pittsburgh and Western Pennsylvania, including individual therapy, psychiatric services, and alternative treatments like TMS and Spravato®. Several of our locations also offer group therapy, and many of our therapists are trained in DBT techniques.
Ready to learn more about depression treatment near you? Call 724.374.7414 or schedule your first appointment today.
Sources:
- Harley, R., Sprich, S., Safren, S., Jacobo, M., & Fava, M. (2008). Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. The Journal of nervous and mental disease, 196(2), 136–143. https://doi.org/10.1097/NMD.0b013e318162aa3f
- Cook, N. E., & Gorraiz, M. (2016). Dialectical behavior therapy for nonsuicidal self-injury and depression among adolescents: preliminary meta-analytic evidence. Child and adolescent mental health, 21(2), 81–89. https://doi.org/10.1111/camh.12112
- Lynch, T. R., Morse, J. Q., Mendelson, T., & Robins, C. J. (2003). Dialectical behavior therapy for depressed older adults: a randomized pilot study. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 11(1), 33–45.
- DBT: Dialectical Behavior Therapy. (2026). https://dialecticalbehaviortherapy.com/
