Insights from Dr. Micaela Thordarson, a licensed psychologist and manager of the mental health service line at Rady Children’s Health (Rady Children’s)
Key takeaways
- DBT blends acceptance with change: Unlike traditional CBT, DBT teaches individuals to balance accepting their current emotional experience with making meaningful behavioral changes through structured skills.
- Skills-focused approach builds emotional regulation: DBT breaks complex challenges into learnable skills—like mindfulness, distress tolerance, and interpersonal effectiveness—that help people manage intense emotions and improve relationships.
- Highly effective but requires access and practice: DBT works well for many ages and conditions, but success depends on consistent practice and access to properly trained clinicians who can deliver the full model.
Understanding how DBT works and who it can help
Dialectical behavior therapy (DBT) is a powerful, evidence-based form of cognitive-behavioral therapy (CBT) that was originally developed to help individuals with borderline personality disorder but has since been adapted to treat a wide range of mental health challenges. At its core, DBT focuses on helping people manage intense emotions, improve interpersonal relationships, and build skills for coping with distress in healthier ways.
By combining acceptance strategies with tools for change, DBT offers a structured, practical approach for those struggling with emotional dysregulation, self-harming behaviors, or chronic feelings of emptiness. Here, Dr. Micaela Thordarson, program supervisor in the adolescent intensive outpatient program at Rady Children’s, discusses what DBT is, how it works, and why it’s become a cornerstone of modern therapeutic practice.
DBT’s evolution since its creation
Dialectical behavior therapy was originally developed by Dr. Marsha Linehan to help adults who were considered untreatable, proving that meaningful change was possible even for those with severe mental health challenges. What makes DBT unique is its effectiveness across a wide range of populations—from adults with substance use disorders to children as young as seven with depression.
Its success lies in teaching people how to better regulate their emotions and respond more effectively to stress. DBT simplifies complex emotional and interpersonal challenges by breaking them down into practical, easy-to-learn skills for everyday life.
“It just makes sense. People really are able to use these skills and put them into practice and then feel successful, which of course feels amazing to everybody and which motivates them to keep going and keep trying with the skills they’ve learned,” states Dr. Thordarson.
How does DBT differ from CBT?
Dialectical behavior therapy builds on the foundation of cognitive behavioral therapy by incorporating a strong focus on balance and flexibility. While CBT emphasizes changing unhelpful thoughts and behaviors, DBT adds the crucial element of helping individuals determine what they need to accept in the moment versus what they can actively work to change.
DBT organizes its tools into distinct skill modules—like distress tolerance for managing intense emotions during crises, and interpersonal effectiveness for improving relationships and maintaining self-respect in social interactions. This makes it a structured and practical approach to emotional and behavioral challenges.
“We do have other skills. For example, mindfulness is not my favorite skill, personally, because I am a multitasker. I want to do a million things at once. Mindfulness is the opposite. But, it helps me slow down and pay attention to what’s going on right now in this moment,” notes Dr. Thordarson. “Even though those skills kind of annoy me, they’re the most important skills to be used across pretty much all settings.”
Why does DBT work so well?
What makes DBT especially effective is its ability to create a shared language for navigating emotional challenges. Instead of vague directions like “calm down,” individuals can name and apply specific skills, making communication clearer and more constructive.
DBT also teaches when and how to use these skills for maximum benefit—whether that’s taking a break, facing discomfort, or making tough decisions about relationships. This practical, easy-to-apply approach helps people know exactly what to do and when, making emotional regulation more accessible and effective in everyday life.
“I like to say that the things we learn in DBT are skills, not tools, because a tool is something that you can pick up, put into use, and it should work the same every single time. My hammer works the same, whether I picked it up today or six months ago,” explains Dr. Thordarson. “Skills are more like muscles. You have to learn them, practice them, and get good at them before they work. It does require investment and commitment to practice. Some people are able to do that right away, and others are struggling so intensely with their emotions it takes maybe two months to really start to notice some changes.”
Is there any downside to DBT?
Of course, every therapeutic approach can encounter obstacles. One challenge with DBT is that many patients face limited access to high-quality, properly trained clinicians. Because DBT is a specialized approach, not all providers who offer it have full training or the resources to deliver it as intended. They may only use bits and pieces rather than the comprehensive model.
Despite this, DBT is gaining recognition due to its strong track record of success. In fact, some middle and high schools, particularly on the East Coast, have started implementing full DBT programs for all students, reflecting its growing credibility and impact.
“At Rady Children’s, we have been doing some trainings for local school districts in Orange County,” shares Dr. Thordarson. “So, some of our school-based clinicians, where kids are able to access services more readily, are able to share that DBT with more students.”
She also encourages parents to check with their insurance company to see what kind of coverage they provide for a service such as DBT.
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