Dialectical Behavior Therapy (DBT): A Guide to Emotion Regulation

Does it sometimes feel like your emotions are too big to manage? That you react more intensely than others, and it takes a long time for your feelings to settle? Dialectical behavior therapy, or DBT, was developed specifically to help in these situations. It is a therapy form that teaches concrete skills for emotion regulation, relationships, and life management.

What Is Dialectical Behavior Therapy?

DBT was developed by American psychologist Marsha Linehan in the 1980s. She worked with people who had borderline personality disorder and self-harming behavior: a group for whom traditional therapy forms had not worked well enough. Linehan discovered that merely pushing for change did not help; people first needed to feel accepted exactly as they are.

This gave rise to DBT's core principle: dialectics, or combining two opposing truths. You do not need to change to be accepted, and at the same time you can learn new skills that make life easier. Acceptance and change do not exclude each other. They are both true simultaneously.

The Four DBT Skill Groups

The backbone of DBT consists of four skill groups practiced in both individual therapy and group settings:

1. Mindfulness

Mindfulness is the foundation of everything in DBT. You learn to observe your thoughts and feelings without judgment. This is especially important because many people who struggle with intense emotions tend to judge themselves harshly: which only makes things worse. Mindfulness teaches you to be kind to yourself.

2. Distress Tolerance

Life brings moments when we cannot change the situation. We can only endure it. Distress tolerance skills help you survive crisis moments without harming yourself. These include the TIPP technique: Temperature change (cold water on the face), Intense exercise, Paced breathing, and Progressive muscle relaxation. These techniques, especially the cold-water and intense-exercise methods, are best learned with a professional and are not suitable for people with a heart condition or an eating disorder.

3. Emotion Regulation

Emotion regulation does not mean suppressing feelings. It means the ability to identify your emotions, understand them, and influence them flexibly. You learn, for example, to recognize vulnerability factors (sleep, nutrition, exercise) and practice opposite action: approaching a situation you fear instead of withdrawing.

4. Interpersonal Effectiveness

Many problems treated in DBT relate to relationships. You learn to ask for what you need, say no, and maintain self-respect in interactions. The DEAR MAN technique is one of the best-known DBT tools: Describe, Express, Assert, Reinforce, Mindful, Appear confident, Negotiate.

The Structure of DBT

Comprehensive DBT treatment includes four components:

• Individual therapy once a week (45–60 min)
• Skills group once a week (2–2.5 hours)
• Phone coaching with the therapist during crises
• Consultation team for therapists (ensures treatment quality)

The skills group typically runs for about one year, during which all four skill groups are covered twice. In individual therapy, you work on personal challenges and practice applying skills to your own life.

Who Is DBT Suitable For?

DBT was originally developed for treating borderline personality disorder, and it remains the most effective known treatment for this condition. Today, however, it is used much more broadly:

• Intense emotional fluctuations
• Self-harming behavior and suicidal thoughts
• Eating disorders, especially binge eating
• Substance use problems
• Depression with emotion regulation difficulties
• Impulsive behavior
• Chronic relationship problems

DBT is also suitable for adolescents: DBT-A (Adolescents) is a version developed specifically for young people.

What Does DBT Cost and How Do I Access Treatment?

DBT individual therapy typically costs 80–120 euros per session in Finland. Skills group prices vary, often 30–60 euros per session. In public healthcare, DBT treatment is available in some psychiatric units.

Kela and rehabilitative psychotherapy

Kela's rehabilitative psychotherapy is available to people aged 16 to 67 whose ability to work or study is threatened by a mental health disorder. You must have been in appropriate care for at least 3 months, and a psychiatrist must have written you a B statement (B-lausunto). Kela covers up to 80 sessions per year and up to 200 sessions over three years. The reimbursement for individual therapy is 57.60 euros per session, and you pay the rest yourself. The therapist must be a Kela-approved provider, so check the therapist's eligibility in advance. Current conditions and reimbursement amounts are at kela.fi.

NOTE: Comprehensive DBT treatment (individual + group + phone coaching) is offered by fewer therapists. However, many therapists utilize DBT skills as part of other therapy approaches.

Where to find a therapist

You can look for a therapist in several places:

• Search services run by the Finnish Psychological Association (Psykologiliitto) and professional bodies.
• Kela's service provider search, if you are applying for rehabilitative psychotherapy (only Kela-approved therapists qualify for reimbursement).
• The Valitse Terapia service and other directories.
• Your own health centre, occupational health service or student health service (YTHS), which can refer you onward.

You can contact several therapists and see with whom the collaboration feels natural.

When looking for a therapist, you can ask during an introductory session whether they offer comprehensive DBT treatment or DBT-informed individual therapy.

Why Does DBT Work?

The power of DBT lies in its practicality. It does not just help understand problems. It provides concrete tools you can use immediately. Many people in DBT report that for the first time in their lives, they have ways to cope with intense emotions without harming themselves.

Research shows that DBT significantly reduces self-harming behavior, hospital stays, and therapy dropouts. It improves emotion regulation, relationships, and quality of life. The changes are lasting: the skills you learn stay with you for life.

Get help in a crisis now

If you are having thoughts of self-harm or are otherwise in an acute crisis, you do not have to face it alone.

• In an emergency, call 112.
• MIELI Mental Health Finland crisis line: 09 2525 0113 (English and Arabic), 09 2525 0111 (Finnish), 09 2525 0112 (Swedish).
• For under-29s: Sekasin chat (sekasin.fi).

Help is available anonymously, and you do not need to be sure your situation is serious enough.

If you recognize yourself in this article, know that you do not have to manage alone. DBT can help you learn new ways of being with yourself and with others: ways that make life more bearable and, ultimately, richer.

Sources

• Kela: Rehabilitative psychotherapy
• Mielenterveystalo (Mental Health Hub)
• Valvira: JulkiTerhikki register of licensed professionals