Dialectical behavior therapy (DBT) was originally developed for people with borderline personality disorder (BPD), but it has since proven effective for a wider range of mental health conditions. The common thread among people who benefit most is difficulty regulating emotions, whether that shows up as self-harm, binge eating, substance use, or chronic suicidal thoughts. Here’s a closer look at who gets the most out of this approach and what the evidence actually shows.
People With Borderline Personality Disorder
BPD remains the condition with the strongest evidence base for DBT. The American Psychiatric Association recommends structured psychotherapy as the core treatment for BPD in both adolescents and adults, and DBT is one of the best-supported options. It directly targets the symptoms that make BPD so disruptive: emotional instability, impulsivity, distorted self-image, fear of abandonment, and self-injurious behavior.
Across randomized controlled trials, DBT consistently reduces self-harm and suicidal behavior in people with BPD, with improvements lasting up to 24 months after treatment ends. Studies report moderate to large improvements in depression, hopelessness, anger, and dissociation. Beyond symptom relief, DBT also reduces how often people with BPD end up in emergency rooms or psychiatric hospitals, which makes it valuable from a practical standpoint as well.
People Struggling With Self-Harm and Suicidal Thoughts
You don’t need a BPD diagnosis to benefit from DBT’s focus on self-harm and suicidality. The APA notes that DBT “may also be useful in treating patients with other diagnoses who are at significant risk for suicide.” A meta-analysis of DBT adapted for adolescents found large reductions in both self-harm and suicidal ideation by the end of treatment. The improvements in suicidal thinking were especially notable, with effect sizes exceeding those for self-harm.
This makes DBT a strong fit for anyone caught in a cycle of chronic suicidal thoughts or repetitive self-injury, regardless of the underlying diagnosis. The therapy teaches concrete skills for tolerating distress and riding out intense urges without acting on them.
Adolescents With Emotional Instability
DBT has been adapted specifically for teenagers (called DBT-A), and the results go beyond just reducing harmful behaviors. In a large study of adolescents, DBT-A significantly improved emotion regulation, reduced general psychological symptoms, and strengthened identity development. That last finding matters because identity confusion is a core challenge of adolescence, and it tends to be more pronounced in teens with emotional instability.
One feature that sets DBT-A apart is its inclusion of parents or caregivers. A module called “Walking the Middle Path” teaches dialectical thinking skills to both teenagers and the adults in their lives, helping families navigate conflict and communication breakdowns together. Parents typically attend about eight skills training sessions. This family component makes DBT-A particularly well suited for teens whose emotional struggles create friction at home.
People With Binge Eating Disorder
DBT adapted for binge eating disorder (DBT-BED) focuses on the emotional triggers behind binge episodes. In a randomized trial, 64% of participants in the DBT group stopped binge eating entirely by the end of treatment, compared to 36% in an active comparison therapy. That 64% abstinence rate held at the 12-month follow-up, suggesting durable results.
There’s an important caveat, though. Despite the strong reduction in binge eating itself, the study found no measurable long-term advantage for DBT over comparison therapy on broader emotion regulation measures. In other words, people stopped binge eating, but the researchers couldn’t confirm this was because they’d become better at managing emotions overall. The practical takeaway: DBT-BED works well for breaking the binge cycle, but the exact mechanism may be more complex than simply learning to regulate feelings.
People With Substance Use Disorders
DBT has been adapted for people who struggle with both substance use and emotional dysregulation, a combination that makes treatment especially difficult because these patients frequently drop out. In an early trial comparing DBT to standard community treatment among women with both substance dependence and BPD, 64% of DBT participants stayed in treatment versus just 27% in the comparison group. DBT participants also showed greater reductions in drug use, confirmed by both interviews and urine testing.
A second trial found that DBT participants maintained their reductions in opiate use through the final four months of treatment, while participants in the comparison group did not sustain their gains. DBT specifically targets substance-related behaviors like reducing cravings, managing withdrawal discomfort, and building alternatives to substance use as a coping strategy. The improved treatment retention alone is significant, since staying in therapy long enough is one of the biggest predictors of recovery.
People With PTSD, Especially Alongside BPD
Standard DBT on its own produces only modest improvements in PTSD symptoms. But when combined with a trauma-processing component called prolonged exposure (DBT PE), the results are substantially better. In research settings, 71 to 80% of people who completed the combined protocol no longer met criteria for PTSD, compared to 40% of those who received DBT alone.
In real-world community clinics, the numbers were lower but still meaningful. About 44% of people who completed DBT PE lost their PTSD diagnosis, compared to roughly 24% of those in standard DBT. Patients who started or completed the trauma-focused addition showed large improvements in PTSD severity, while those who received only standard DBT showed moderate improvement. This combined approach is particularly relevant for people with both BPD and PTSD, a pairing that’s common and notoriously difficult to treat.
People With Treatment-Resistant Depression
The evidence here is more preliminary. For people whose depression hasn’t responded to medication, a 16-session DBT skills training protocol showed significantly greater improvement in depressive symptoms compared to continuing medication alone. A separate study found that skills training focused on processing emotions helped reduce depressive symptoms in treatment-resistant patients.
However, the gains may not last. One study found that a DBT-based approach produced meaningful reductions in depression at seven months, but by 12 and 18 months, the advantage over standard treatment had faded. A Cochrane review looking at psychotherapy for treatment-resistant depression, including DBT, concluded that combining therapy with medication was about as effective as medication alone, though the studies reviewed were mostly small. DBT may offer short-term relief for stubborn depression, but it’s not yet established as a reliable long-term solution for this group.
Who May Not Be a Good Fit
DBT requires active participation: attending weekly individual and group sessions, practicing skills between sessions, and committing to a program that typically runs about a year in outpatient settings (or around 8 to 12 weeks in inpatient programs). That structure means certain conditions can make standard DBT impractical or inappropriate.
Across clinical trials, the most consistent exclusion criteria include active psychosis or schizophrenia, intellectual disability, and ongoing violent or aggressive behavior that could endanger other group members. Some programs also exclude people in an active manic episode, those with very low body weight (BMI under 16.5), or those unable to attend sessions consistently. These aren’t permanent disqualifications. They reflect the reality that someone in acute psychosis or severe medical crisis needs stabilization before they can engage with a skills-based therapy that demands significant cognitive effort and homework.
People who have already completed multiple rounds of DBT without benefit, or those whose primary issue doesn’t involve emotion dysregulation, may find other therapeutic approaches more helpful. DBT’s core strength is teaching people to manage overwhelming emotions and the destructive behaviors that follow. If that’s not the central problem, the fit may not be right.