Insights from Dr. Mikaela ThordarsonA licensed psychologist and mental health service line manager At Ready Children’s Health (Ready Children)
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 down complex challenges into learnable skills – such as 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 appropriately trained therapists who can provide the complete 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 The focus is on helping people manage intense emotions, improve interpersonal relationships, and build skills to deal with distress in healthy ways.
By combining acceptance strategies with tools for change, DBT offers a structured, practical approach for people struggling with emotional dysregulation, self injurious behaviorOr chronic feelings of emptiness. Here, Dr. Mikaela Thordarson, program supervisor in the Adolescent Intensive Outpatient Program at Rady Children’s, discusses what DBT is, how it works, and why it has become a cornerstone of modern therapeutic practice.
Development of DBT 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 people 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 seven-year-old children suffering from depression.
Its success lies in teaching people how to better regulate their emotions and respond to stress more effectively. DBT simplifies complex emotional and interpersonal challenges by breaking them down into practical, easy-to-learn skills for everyday life.
“It makes perfect sense. People are actually able to use these skills and put them into practice and then feel successful, which certainly feels amazing to everyone and which motivates them to move forward and keep trying with the skills they’ve learned,” says Dr. Thordarson.
How is DBT different 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 important element of helping individuals determine what they need to accept in the moment versus what they can actively work on changing.
DBT organizes its tools into distinct skill modules – such as distress tolerance for managing intense emotions during crisis, and interpersonal effectiveness for improving relationships and maintaining self-esteem in social interactions. This makes it a structured and practical approach to emotional and behavioral challenges.
“We have other skills too. For example, personally mindfulness is not my favorite skill, because I’m 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 in the moment,” says Dr. Thordarson. “Even though those skills make me nervous, they are the most important skills used in almost all settings.”
Why does DBT work so well?
What makes DBT particularly effective is its ability to create a shared language for dealing with 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 to maximum benefit – whether it’s taking a break, facing discomfort, or making difficult decisions about relationships. This practical, easy-to-implement approach helps people know exactly what to do and when to do it, 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 you can pick up, put to use, and it should work the same way every time. My hammer works the same way whether I picked it up today or six months ago,” explains Dr. Thordarson. “Skills are like muscles. You have to learn them, practice them, and get good at them before they work. It requires investment and commitment to practice. Some people are able to do it right away, and other people are struggling so intensely with their emotions that it takes maybe two months to really start to notice some changes.”
Are there any downsides to DBT?
Of course, each therapeutic approach may encounter obstacles. One challenge with DBT is that many patients face limited access to high-quality, appropriately trained therapists. Because DBT is a specialized approach, not all providers who offer it have the full training or resources to deliver it as intended. They may only use bits and pieces rather than comprehensive models.
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 begun to implement the full DBT program for all students, indicating its growing credibility and effectiveness.
“At Ready Children, we’re doing some training for local school districts in Orange County,” shares Dr. Thordarson. “So, some of our school-based therapists, where kids are able to access services more easily, are able to share that DBT with more students.”
She also encourages parents to check with their insurance company to see what type of coverage they provide for a service like DBT.
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Get mental health resources from CHOC pediatricians
CHOC’s mental health team created the following resources on common mental health topics in children and teens, like depression, anxiety, suicide prevention and more.
