Medically reviewed by Kevin Wandler, MD, Chief Medical Advisor
Some people feel emotions faster and more intensely than others, and it can take longer for those feelings to settle. When emotions run that high, alcohol or drugs may seem like the quickest way to get relief, and relationships can start to feel like a constant source of conflict. Dialectical behavior therapy, or DBT, teaches concrete skills for riding out intense emotions without making the situation worse.
At Promises Dallas-Fort Worth in Lewisville, DBT skills are part of treatment for adults across the Dallas-Fort Worth area who are living with substance use disorders, mental health conditions or both.
What Is Dialectical Behavior Therapy?
DBT is a form of cognitive behavioral therapy. It was originally developed to help people who struggle with overwhelming emotions and suicidal or self-harming behavior, and it has since been adapted to help with substance use and a range of other conditions.
The word dialectical refers to holding two ideas that seem to conflict at the same time. In DBT, the central balance is between acceptance and change: accepting yourself and your situation as they are right now, while also working to build a life that feels worth living. That balance can ease the shame many people carry into treatment, which often gets in the way of change.
The Four Core DBT Skill Areas
Mindfulness
Mindfulness is the foundation of DBT. It means paying attention to the present moment on purpose, without judging it. Mindfulness helps you notice an emotion or craving as it rises, observe it, and create a pause before you react.
Distress Tolerance
Distress tolerance skills help you get through a crisis without making it worse. They are designed for moments when a problem cannot be solved right away. Examples include turning to a planned distracting activity, calming your body by changing its temperature or slowing your breathing, and weighing the pros and cons of acting on an urge before you do.
Emotion Regulation
Emotion regulation skills help you understand what you are feeling, why, and what to do about it. You learn to name emotions accurately, lower your vulnerability to painful moods by caring for sleep, eating and physical health, and build more positive experiences into your life over time.
Interpersonal Effectiveness
Interpersonal effectiveness skills help you ask for what you need, say no, and handle conflict while protecting both the relationship and your self-respect. For many people in recovery, these skills make it easier to set boundaries with people who still drink or use.
Why DBT Helps With Co-Occurring Disorders
When a person has both a substance use disorder and a mental health condition, the two often share a common thread: difficulty tolerating painful emotions. Someone living with depression, bipolar disorder or trauma may use substances to numb symptoms, and substance use can in turn make those symptoms more intense.
DBT speaks directly to that cycle. Instead of trying to avoid or escape distress, you learn skills to face it safely. That makes DBT a natural fit for dual diagnosis treatment, where both conditions are treated together. DBT skills may be especially useful for people who:
- Experience intense mood swings or emotional reactions
- Act impulsively when upset
- Have a history of trauma, including people receiving PTSD treatment
- Struggle with repeated conflict in close relationships
- Have returned to use during emotional crises in the past
To learn more about integrated care, read how co-occurring disorders are treated.
How DBT Is Used at Promises DFW
At Promises DFW, DBT skills are taught and practiced as part of an individualized treatment plan. You may learn a skill in group therapy, try it out during the day, and then talk through what worked and what did not in individual therapy. This learn, practice and review rhythm helps skills become habits.
DBT skills appear across our levels of care, including residential addiction and mental health treatment, our in-person partial hospitalization program in Lewisville and our virtual intensive outpatient program for adults throughout Texas. DBT is often combined with cognitive behavioral therapy, trauma-informed care, psychiatric care and family therapy, depending on your needs.
What a DBT Skills Session Can Look Like
A DBT skills group often feels more like a class than a traditional therapy group. A therapist introduces a skill, explains when to use it and walks the group through practice. Members might try a short mindfulness exercise, role-play asking for something they need, or build a personal list of distress tolerance strategies for high-risk moments. Between sessions, you may track emotions, urges and the skills you used, then review that record with your therapist.
Frequently Asked Questions
Do I need a mental health diagnosis to benefit from DBT skills?
No. DBT skills can help anyone who struggles with strong emotions, impulsive decisions or conflict in relationships, including people whose main concern is substance use.
Are DBT skills a substitute for crisis care?
No. DBT skills are designed to help with distress, but they do not replace emergency help. If you are thinking about suicide or harming yourself, call or text 988. If you are in immediate danger, call 911.
Can family members learn about DBT skills?
It can help when loved ones understand the skills you are learning. Family therapy at Promises DFW can help families communicate more effectively and support new coping habits at home.
Will I keep using DBT skills after treatment?
That is the goal. DBT skills are meant to be practiced for life, and they can become part of your aftercare plan and relapse prevention strategy.
Build Skills for Hard Moments
You do not have to keep reaching for substances to manage overwhelming emotions. Call (469) 546-9303 to speak with our admissions team, learn about insurance coverage, or contact Promises DFW to ask about DBT and our programs.