Dialectical Behavior Therapy (DBT)
If you are interested in counseling using DBT Skills, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.
What is Dialectical Behavioral TherapyDialectical Behavior Therapy (DBT) is an evidence-based treatment developed by Dr. Marsha Linehan in the late 1980s. Originally developed to treat individuals with chronic suicidality, self-injury, and borderline personality disorder, DBT has since been adapted and applied to a wide range of mental health concerns, including depression, anxiety, eating disorders, trauma, ADHD, substance use, anger and relationship difficulties, and emotion dysregulation more broadly.
DBT integrates principles from cognitive behavioral therapy, behavioral science, mindfulness practice, and dialectical philosophy. The central dialectic in DBT is the tension between acceptance (of yourself, your experiences, and your circumstances) and change (of behaviors, patterns, and responses). Effective treatment involves both, and the goal is to hold both at the same time rather than choosing one over the other. Scope: DBT-Informed Individual Therapy at OakHeartIt is important to understand what DBT is and is not at OakHeart, because there is significant variation across practices in what gets called "DBT."
Comprehensive, adherent DBT, as developed by Dr. Linehan, includes four required components delivered together: weekly individual therapy, a weekly skills training group (typically over 6 to 12 months), 24/7 phone coaching for between-session crisis support, and a consultation team for the treating clinicians. This level of care has the strongest evidence base for individuals with severe presentations, including borderline personality disorder, chronic suicidality, chronic self-injury, and significant emotion dysregulation that has not responded to other treatments. OakHeart provides DBT-informed individual therapy. Our clinicians integrate DBT skills, concepts, and dialectical principles into weekly individual therapy. We do not offer:
For many people, DBT-informed individual therapy is an excellent fit. The skills are powerful and broadly applicable, and many of the concerns that bring people to therapy can be effectively addressed through individual work that draws on DBT alongside other evidence-based approaches. For others, particularly individuals with severe emotion dysregulation, chronic suicidality, frequent self-injury, or a primary diagnosis of borderline personality disorder, comprehensive DBT is the more appropriate level of care, and we will help you identify a program that provides it. |
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When Comprehensive DBT May Be a Better Fit, and Where to Find It
Comprehensive DBT is generally indicated when:
There is chronic, severe, or escalating self-injury
For clients who would benefit from comprehensive DBT, the following programs in the Chicago area offer adherent or near-adherent DBT:
OakHeart can support continued individual therapy alongside a skills group at a separate practice. Your clinician can discuss whether this combined approach makes sense for your situation.
There is chronic, severe, or escalating self-injury
- There is chronic suicidality, recurrent suicidal behaviors, or recent suicide attempts
- Emotion dysregulation is severe and pervasive enough to significantly disrupt daily functioning
- There is a primary diagnosis of borderline personality disorder
- Previous outpatient individual therapy has not been sufficient
- Multiple psychiatric hospitalizations have occurred in connection with emotion dysregulation or self-harm
For clients who would benefit from comprehensive DBT, the following programs in the Chicago area offer adherent or near-adherent DBT:
- Chicago DBT Institute (Deerfield, IL): A Linehan Board-certified comprehensive DBT program for adolescents and adults
- DBT Center Chicago (Chicago, IL): A clinician-certified comprehensive DBT program for adults
- Family Counseling Service of Aurora (Aurora, IL): Adult DBT skills group; status of the program should be verified at the time of referral
OakHeart can support continued individual therapy alongside a skills group at a separate practice. Your clinician can discuss whether this combined approach makes sense for your situation.
The Core Skills of DBT
DBT teaches concrete skills organized into four modules. These skills are useful far beyond the populations DBT was originally developed for, and they can be integrated into individual therapy regardless of diagnosis.
Mindfulness. Mindfulness is the foundation of DBT. It involves paying attention to the present moment with awareness, openness, and non-judgment, rather than being lost in rumination about the past or worry about the future. DBT distinguishes between "wise mind" (the integration of emotional mind and reasonable mind), and teaches specific skills for accessing it. Mindfulness in DBT is not about achieving a particular state of calm; it is about being aware of what is happening in your mind and body so that you can respond effectively rather than react automatically.
Distress Tolerance. Distress tolerance skills are designed to help you get through crisis moments without making the situation worse. These skills do not solve the problem causing the distress; they help you survive the moment without engaging in impulsive, harmful, or self-destructive behaviors. Skills in this module include distraction, self-soothing using the five senses, improving the moment, weighing pros and cons of acting versus not acting, and a set of skills for accepting reality (including radical acceptance, which is the practice of accepting what cannot be changed in order to free yourself from the additional suffering of fighting against it).
Emotion Regulation. Emotion regulation skills are designed to help you understand and influence your emotional life. This includes identifying and labeling emotions, understanding the function emotions serve, reducing vulnerability to intense emotional reactions (e.g., through sleep, nutrition, exercise, and reducing exposure to known triggers), increasing positive experiences, and learning specific skills for changing the intensity of an emotion when needed. A key concept in this module is "opposite action," which involves acting in a way that is opposite to what an unhelpful emotion is urging you to do, in order to change the emotion itself.
Interpersonal Effectiveness. Interpersonal effectiveness skills are designed to help you navigate relationships and interactions in a way that supports your goals, maintains your relationships, and preserves your self-respect. This module teaches structured frameworks for asking for what you need (DEAR MAN), maintaining relationships during conflict (GIVE), and protecting your self-respect in difficult interactions (FAST). These skills are particularly useful for clients who tend to default toward either submissiveness or aggressiveness in difficult conversations.
Mindfulness. Mindfulness is the foundation of DBT. It involves paying attention to the present moment with awareness, openness, and non-judgment, rather than being lost in rumination about the past or worry about the future. DBT distinguishes between "wise mind" (the integration of emotional mind and reasonable mind), and teaches specific skills for accessing it. Mindfulness in DBT is not about achieving a particular state of calm; it is about being aware of what is happening in your mind and body so that you can respond effectively rather than react automatically.
Distress Tolerance. Distress tolerance skills are designed to help you get through crisis moments without making the situation worse. These skills do not solve the problem causing the distress; they help you survive the moment without engaging in impulsive, harmful, or self-destructive behaviors. Skills in this module include distraction, self-soothing using the five senses, improving the moment, weighing pros and cons of acting versus not acting, and a set of skills for accepting reality (including radical acceptance, which is the practice of accepting what cannot be changed in order to free yourself from the additional suffering of fighting against it).
Emotion Regulation. Emotion regulation skills are designed to help you understand and influence your emotional life. This includes identifying and labeling emotions, understanding the function emotions serve, reducing vulnerability to intense emotional reactions (e.g., through sleep, nutrition, exercise, and reducing exposure to known triggers), increasing positive experiences, and learning specific skills for changing the intensity of an emotion when needed. A key concept in this module is "opposite action," which involves acting in a way that is opposite to what an unhelpful emotion is urging you to do, in order to change the emotion itself.
Interpersonal Effectiveness. Interpersonal effectiveness skills are designed to help you navigate relationships and interactions in a way that supports your goals, maintains your relationships, and preserves your self-respect. This module teaches structured frameworks for asking for what you need (DEAR MAN), maintaining relationships during conflict (GIVE), and protecting your self-respect in difficult interactions (FAST). These skills are particularly useful for clients who tend to default toward either submissiveness or aggressiveness in difficult conversations.
What Does DBT-Informed Therapy Look Like at OakHeart?
DBT-informed individual therapy at OakHeart is collaborative and skills-focused. Sessions typically include identifying patterns that are causing difficulty, learning and practicing relevant DBT skills, applying those skills to specific situations in your life, and reviewing how the application has gone. Between-session practice is an important part of the work, because skills are only useful to the extent that they become available in real moments rather than only during sessions.
Depending on your needs and goals, your clinician may integrate specific DBT tools into your individual sessions. These can include:
Your clinician will work with you to identify which skills modules are most relevant to your goals and may draw from DBT alongside other evidence-based approaches, including Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT). Because OakHeart is not a comprehensive DBT program, treatment will not include 24/7 phone coaching, and your therapist will be available between sessions only through the standard channels described in your treatment agreement.
Depending on your needs and goals, your clinician may integrate specific DBT tools into your individual sessions. These can include:
- Diary cards, which are structured logs you complete between sessions to track emotions, urges, target behaviors, skills use, and other relevant information. Diary cards help bring patterns into focus, support accurate tracking of progress over time, and direct the focus of each session toward what is most clinically relevant.
- Behavioral chain analyses, which involve walking through a specific situation step-by-step to understand the chain of vulnerabilities, prompting events, thoughts, emotions, sensations, and behaviors that led to a particular outcome. Chain analyses are useful for understanding patterns of behavior that have been difficult to interrupt, identifying intervention points, and planning skillful responses for future situations.
- Solution analysis, which involves identifying specific skills and alternative responses that could be applied at each link of the chain to produce a different outcome going forward.
- Behavioral targets and hierarchies, which help organize treatment around the most clinically important behaviors first (e.g., life-threatening behaviors, therapy-interfering behaviors, quality-of-life-interfering behaviors), so that limited session time is focused on what matters most.
- Skills coaching within session, which involves identifying specific situations where a DBT skill could have been applied, practicing the skill in session, and developing a plan for using it between sessions.
Your clinician will work with you to identify which skills modules are most relevant to your goals and may draw from DBT alongside other evidence-based approaches, including Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT). Because OakHeart is not a comprehensive DBT program, treatment will not include 24/7 phone coaching, and your therapist will be available between sessions only through the standard channels described in your treatment agreement.
What Can DBT Skills Help With?
DBT skills are useful across a wide range of concerns. At OakHeart, clinicians integrate DBT skills into the treatment of depression, anxiety disorders, PTSD and trauma, non-suicidal self-injury (when at a severity appropriate for outpatient individual treatment), substance use disorders, eating disorders, ADHD with prominent emotion dysregulation, anger management, and relationship and interpersonal difficulties.
DBT skills are also useful for individuals who do not meet criteria for any specific diagnosis but who struggle with intense emotions, impulsive behavior, difficult interpersonal patterns, or distress tolerance.
DBT skills are also useful for individuals who do not meet criteria for any specific diagnosis but who struggle with intense emotions, impulsive behavior, difficult interpersonal patterns, or distress tolerance.
How is DBT Different from CBT and ACT?
DBT, CBT, and ACT share important common ground. All three are structured, skills-based, evidence-based approaches, and all three emphasize the role of thoughts and behaviors in psychological wellbeing. They differ in emphasis.
Traditional CBT tends to focus on identifying and modifying the thoughts and behaviors that maintain a specific clinical concern (e.g., depression, anxiety, OCD). It is often diagnosis-specific and protocol-driven.
ACT focuses on changing your relationship with difficult thoughts and feelings, building psychological flexibility, and aligning behavior with values, rather than on changing the content of thoughts directly.
DBT focuses on building specific behavioral skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, and on holding the dialectic between accepting yourself as you are and working to change. DBT is particularly well suited for individuals whose emotions are intense, whose patterns of behavior have been hard to change through cognitive approaches alone, or who benefit from concrete, named skills they can apply in specific situations.
Many of our clinicians are trained in more than one of these approaches and will draw from whichever framework, or combination of frameworks, best fits your needs and goals.
Traditional CBT tends to focus on identifying and modifying the thoughts and behaviors that maintain a specific clinical concern (e.g., depression, anxiety, OCD). It is often diagnosis-specific and protocol-driven.
ACT focuses on changing your relationship with difficult thoughts and feelings, building psychological flexibility, and aligning behavior with values, rather than on changing the content of thoughts directly.
DBT focuses on building specific behavioral skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, and on holding the dialectic between accepting yourself as you are and working to change. DBT is particularly well suited for individuals whose emotions are intense, whose patterns of behavior have been hard to change through cognitive approaches alone, or who benefit from concrete, named skills they can apply in specific situations.
Many of our clinicians are trained in more than one of these approaches and will draw from whichever framework, or combination of frameworks, best fits your needs and goals.
The Biosocial Model: How DBT Understands Emotion Dysregulation
DBT is grounded in what is called the biosocial model, which describes how chronic emotion dysregulation develops over time. The model proposes that emotion dysregulation arises from the transaction between two factors:
Biological vulnerability. Some individuals are born with a temperament characterized by heightened emotional sensitivity, heightened emotional reactivity (emotions are felt more intensely), and a slower return to emotional baseline after an emotion is activated. This biological predisposition is not a flaw or a choice; it reflects real differences in how the nervous system processes emotional information.
Invalidating environment. An invalidating environment is one in which a person's internal experiences (emotions, thoughts, sensations) are consistently dismissed, criticized, punished, ignored, or treated as wrong, inappropriate, or excessive. Invalidating environments can range from severe (abuse, neglect, ongoing emotional dismissal) to subtle (a well-meaning family that consistently misreads a child's emotional needs, or a poor fit between a child's temperament and the family or cultural context). Invalidating environments are not always abusive, and parents and caregivers often do their best with what they understand at the time.
The transaction between these two factors over time is what produces chronic emotion dysregulation. A biologically sensitive child in a chronically invalidating environment learns that their emotional experiences are not trusted or understood, may oscillate between suppressing emotions and expressing them with escalated intensity to be heard, and often does not develop effective skills for understanding, tolerating, or regulating their emotions. Over time, this can lead to the patterns of intense emotion, impulsive behavior, identity confusion, and relationship difficulties that DBT was originally developed to treat.
The biosocial model is important clinically for several reasons. It locates the origin of emotion dysregulation in an understandable developmental process rather than in personal weakness or character flaw. It identifies validation as a core therapeutic intervention, alongside skills training. And it explains why the dialectic of acceptance and change is central to treatment: clients need to be accepted as they are (validating the biological reality of their experience and the impact of past environments) while also developing the skills to function differently going forward.
Biological vulnerability. Some individuals are born with a temperament characterized by heightened emotional sensitivity, heightened emotional reactivity (emotions are felt more intensely), and a slower return to emotional baseline after an emotion is activated. This biological predisposition is not a flaw or a choice; it reflects real differences in how the nervous system processes emotional information.
Invalidating environment. An invalidating environment is one in which a person's internal experiences (emotions, thoughts, sensations) are consistently dismissed, criticized, punished, ignored, or treated as wrong, inappropriate, or excessive. Invalidating environments can range from severe (abuse, neglect, ongoing emotional dismissal) to subtle (a well-meaning family that consistently misreads a child's emotional needs, or a poor fit between a child's temperament and the family or cultural context). Invalidating environments are not always abusive, and parents and caregivers often do their best with what they understand at the time.
The transaction between these two factors over time is what produces chronic emotion dysregulation. A biologically sensitive child in a chronically invalidating environment learns that their emotional experiences are not trusted or understood, may oscillate between suppressing emotions and expressing them with escalated intensity to be heard, and often does not develop effective skills for understanding, tolerating, or regulating their emotions. Over time, this can lead to the patterns of intense emotion, impulsive behavior, identity confusion, and relationship difficulties that DBT was originally developed to treat.
The biosocial model is important clinically for several reasons. It locates the origin of emotion dysregulation in an understandable developmental process rather than in personal weakness or character flaw. It identifies validation as a core therapeutic intervention, alongside skills training. And it explains why the dialectic of acceptance and change is central to treatment: clients need to be accepted as they are (validating the biological reality of their experience and the impact of past environments) while also developing the skills to function differently going forward.
Frequently Asked Questions
Does OakHeart provide a comprehensive DBT program? No. OakHeart provides DBT-informed individual therapy, which integrates DBT skills, concepts, and dialectical principles into individual sessions. We do not offer the skills group or 24/7 phone coaching components that are part of comprehensive adherent DBT. For clients who need comprehensive DBT, we can assist with referrals to appropriate programs in the Chicago area.
How will I know if DBT-informed individual therapy is enough or if I need comprehensive DBT? Your clinician will discuss this with you during the assessment phase of treatment. In general, if you have chronic or escalating self-injury, current or recent suicidal behavior, severe emotion dysregulation, multiple recent psychiatric hospitalizations, or a primary diagnosis of borderline personality disorder, comprehensive DBT is often the more appropriate level of care. If your concerns are more moderate and can be addressed effectively in weekly individual sessions, DBT-informed individual therapy may be a good fit.
Do I have to have BPD or be self-injuring to benefit from DBT skills? No. While DBT was originally developed for borderline personality disorder, the skills themselves are useful for a wide range of concerns, including depression, anxiety, trauma, eating disorders, ADHD, anger, and relationship difficulties. Many clients who would never meet criteria for BPD find DBT skills genuinely useful.
Can I do DBT skills group at another practice and individual therapy at OakHeart? Yes, in some cases. Some DBT skills groups are designed to be open to clients whose individual therapy is provided elsewhere. If you are participating in a skills group at another practice, your OakHeart clinician can coordinate with that program and integrate the skills you are learning into your individual work. Your clinician can discuss whether this is a good fit for your situation.
How long does DBT-informed therapy take? This varies widely depending on the concerns you are working on, the depth of skills practice needed, and the presence of co-occurring conditions. Some clients work on a specific set of skills over a few months and feel ready to wrap up. Others use DBT-informed individual therapy over longer periods, particularly when working on layered concerns. There is no fixed timeline.
Will I have to do homework? Skills practice between sessions is a significant part of DBT and DBT-informed work. Skills only become useful in real moments to the extent that they have been practiced enough to be available when you need them. Your clinician will work with you to make practice manageable rather than overwhelming.
Our team of licensed psychologists, counselors, and social workers in North Aurora and Sycamore, Illinois provides evidence-based DBT-Informed treatment to clients throughout Kane County, DeKalb County, DuPage County, and the surrounding Chicago suburbs, including in-person and telehealth options throughout Illinois.
How will I know if DBT-informed individual therapy is enough or if I need comprehensive DBT? Your clinician will discuss this with you during the assessment phase of treatment. In general, if you have chronic or escalating self-injury, current or recent suicidal behavior, severe emotion dysregulation, multiple recent psychiatric hospitalizations, or a primary diagnosis of borderline personality disorder, comprehensive DBT is often the more appropriate level of care. If your concerns are more moderate and can be addressed effectively in weekly individual sessions, DBT-informed individual therapy may be a good fit.
Do I have to have BPD or be self-injuring to benefit from DBT skills? No. While DBT was originally developed for borderline personality disorder, the skills themselves are useful for a wide range of concerns, including depression, anxiety, trauma, eating disorders, ADHD, anger, and relationship difficulties. Many clients who would never meet criteria for BPD find DBT skills genuinely useful.
Can I do DBT skills group at another practice and individual therapy at OakHeart? Yes, in some cases. Some DBT skills groups are designed to be open to clients whose individual therapy is provided elsewhere. If you are participating in a skills group at another practice, your OakHeart clinician can coordinate with that program and integrate the skills you are learning into your individual work. Your clinician can discuss whether this is a good fit for your situation.
How long does DBT-informed therapy take? This varies widely depending on the concerns you are working on, the depth of skills practice needed, and the presence of co-occurring conditions. Some clients work on a specific set of skills over a few months and feel ready to wrap up. Others use DBT-informed individual therapy over longer periods, particularly when working on layered concerns. There is no fixed timeline.
Will I have to do homework? Skills practice between sessions is a significant part of DBT and DBT-informed work. Skills only become useful in real moments to the extent that they have been practiced enough to be available when you need them. Your clinician will work with you to make practice manageable rather than overwhelming.
Our team of licensed psychologists, counselors, and social workers in North Aurora and Sycamore, Illinois provides evidence-based DBT-Informed treatment to clients throughout Kane County, DeKalb County, DuPage County, and the surrounding Chicago suburbs, including in-person and telehealth options throughout Illinois.
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References
Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.
Linehan, M. M. (2015). DBT skills training handouts and worksheets (2nd ed.). Guilford Press.
Rizvi, S. L. (2019). Chain analysis in dialectical behavior therapy. Guilford Press.
Linehan, M. M. (2015). DBT skills training manual (2nd ed.). Guilford Press.
Linehan, M. M. (2015). DBT skills training handouts and worksheets (2nd ed.). Guilford Press.
Rizvi, S. L. (2019). Chain analysis in dialectical behavior therapy. Guilford Press.
