Dialectical Behavior Therapy, commonly called DBT, is a structured form of psychotherapy that teaches practical skills for managing intense emotions, responding to distress, improving relationships, and changing harmful behavioral patterns. The approach combines behavioral change strategies with mindfulness and acceptance-based principles, helping clients recognize that they can accept their current experience while still working toward meaningful change. DBT was originally developed for people with borderline personality disorder, but its principles have since been adapted for other mental health and substance use concerns involving emotional instability, impulsivity, or ineffective coping. At Rainbow Hill Recovery, we incorporate DBT into personalized outpatient care for adults addressing mental health symptoms, substance use, trauma, relationship difficulties, and challenges affecting daily functioning.
The word “dialectical” refers to bringing together ideas that may initially appear to conflict with one another. Within DBT, one of the most important dialectics is the balance between acceptance and change. A client can acknowledge that their reactions developed for understandable reasons while also recognizing that some of those reactions are no longer helping them. This balance can reduce shame and defensiveness while keeping therapy focused on specific behavioral changes.
DBT is based on the idea that problematic behaviors often develop as attempts to solve problems or escape overwhelming emotions. Substance use, self-isolation, angry outbursts, impulsive decisions, avoidance, or self-destructive behavior may provide temporary relief even when they create serious long-term consequences. Instead of simply telling someone to stop, DBT examines what the behavior accomplishes and teaches alternative skills that can serve the same need more safely. Clients then practice those skills repeatedly so they become more accessible during stressful situations.
Many people experience emotions that feel too intense, change rapidly, or remain present long after a stressful event ends. Others may become emotionally numb, disconnect from their surroundings, or react impulsively before they have time to consider the consequences. These patterns can affect work, relationships, treatment participation, substance use, physical safety, and confidence in one’s ability to manage everyday life. DBT provides a structured way to understand these reactions and build skills that can be applied before, during, and after emotionally difficult situations.
The need for effective mental health and substance use treatment is substantial. In 2024, approximately 61.5 million U.S. adults experienced a mental illness, while 46.3 million adults had a substance use disorder. About 21.2 million adults experienced both conditions during the same year, and 41.2% of adults with co-occurring mental illness and substance use disorder received neither type of treatment. These figures demonstrate why coordinated approaches that address emotional health and harmful coping behaviors together remain important.
Difficulty regulating emotions does not have one universal cause. A person’s emotional patterns may be influenced by temperament, genetics, brain development, trauma, chronic stress, family relationships, social experiences, learned coping habits, or co-occurring mental health conditions. Some people experience emotions more intensely from an early age, while others develop heightened reactions after repeated exposure to danger, instability, loss, neglect, or conflict. Experiencing one or more of these factors does not guarantee that someone will develop a particular disorder or need DBT.
A person may also grow up in an environment where emotions were dismissed, punished, ignored, or treated as signs of weakness. Without opportunities to identify feelings and learn healthy responses, avoidance, impulsivity, anger, substance use, or withdrawal may become the most familiar ways to cope. These behaviors can continue into adulthood even when they interfere with relationships, work, health, or personal goals. DBT helps clients understand how these patterns developed without suggesting that the patterns must remain permanent.
DBT may be considered when emotional reactions regularly feel overwhelming, unpredictable, or difficult to manage. A person may understand what they would like to do differently but struggle to access that knowledge during conflict, panic, cravings, shame, or anger. The presence of one sign does not mean someone has a specific diagnosis or that DBT is automatically the appropriate treatment. A licensed clinician can evaluate symptoms, safety, treatment history, functioning, and personal goals before recommending a therapeutic approach.
Possible signs that DBT skills may be helpful include:
These concerns may occur with anxiety, depression, trauma-related symptoms, borderline personality disorder, substance use disorders, eating disorders, or other behavioral health conditions. DBT should not be treated as a generic solution for every symptom or diagnosis. A treatment plan may use DBT alone, combine it with other therapies, or incorporate only selected DBT skills depending on the client’s needs. The goal is to match the intervention to the person rather than fitting every client into the same program.
DBT skills are commonly organized into four areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Each area addresses a different part of the process that occurs between an emotional trigger and a person’s response. The skills are intended to be practiced repeatedly rather than understood only as abstract concepts. Over time, clients can create a broader range of possible responses to situations that once seemed automatic or unmanageable.
Mindfulness involves paying attention to the present moment with greater awareness and less automatic judgment. Clients may learn to observe thoughts, emotions, physical sensations, and external events without immediately reacting to them. This creates a pause between an experience and the action that follows, giving the person more time to choose a response. Mindfulness does not require clearing the mind or pretending that painful emotions are not present.
During treatment, mindfulness may be practiced through breathing, observing sensations, describing emotions, or focusing fully on one activity. A client might notice that anger is accompanied by a racing heart, tightened muscles, and an urge to leave or attack. Recognizing these signals earlier can make it easier to use another DBT skill before the situation escalates. Mindfulness becomes more useful when it is practiced during ordinary moments as well as during crises.
Distress tolerance focuses on surviving difficult moments without making the situation worse. These skills are particularly relevant when a problem cannot be solved immediately or when an emotional reaction is too intense for effective problem-solving. The goal is not to approve of painful circumstances or avoid change forever. Instead, clients learn how to remain safe and grounded until they can respond more thoughtfully.
Distress tolerance may include grounding, paced breathing, temporarily changing one’s environment, using sensory strategies, or delaying an impulsive action. Someone experiencing a substance craving might use these skills while contacting support, leaving a triggering setting, or waiting for the craving to decrease. A person in conflict might pause the conversation before saying something that could cause lasting damage. These strategies help protect recovery and relationships during moments when emotions are temporarily stronger than problem-solving abilities.
Emotion regulation involves understanding emotions, recognizing their purpose, and changing patterns that create unnecessary suffering. Clients may learn to identify emotions accurately, reduce physical vulnerabilities, examine whether interpretations fit the facts, and choose actions that support longer-term goals. The aim is not to eliminate sadness, anger, fear, or other normal emotions. Instead, therapy helps clients respond to emotions without allowing every feeling to determine their behavior.
Sleep disruption, poor nutrition, substance use, isolation, chronic stress, and untreated health concerns can increase emotional vulnerability. DBT encourages clients to notice these factors because emotional regulation becomes harder when the body and mind are already strained. Clients also practice changing behaviors that repeatedly intensify an unwanted emotional state. These skills can support greater stability while helping people understand that emotions provide information rather than commands.
Interpersonal effectiveness teaches clients how to communicate needs, establish boundaries, manage conflict, and protect self-respect within relationships. Someone may know what they need but fear rejection, anger, abandonment, or disapproval if they communicate directly. Another person may express needs aggressively because they do not believe they will otherwise be heard. DBT provides structured ways to balance personal goals, relationship goals, and self-respect during conversations.
Clients may practice asking for help, declining requests, negotiating solutions, or remaining focused during a difficult discussion. Role-playing can allow someone to rehearse a conversation before using the skill with a partner, relative, employer, or treatment provider. Feedback from a therapist or group can help the client adjust tone, wording, timing, and body language. The goal is not to control another person’s response but to communicate more clearly and consistently.
Comprehensive standard outpatient DBT contains four treatment modes: individual psychotherapy, group skills training, between-session coaching, and a consultation team for clinicians. Individual sessions focus on motivation and applying skills to specific problems, while skills groups teach and rehearse the four DBT skill areas. Between-session coaching is used in standard DBT to help clients apply skills in real-world situations, and clinician consultation supports consistent treatment delivery. Some outpatient programs instead offer DBT-informed therapy or selected skills as part of a broader treatment plan, so clients should ask which components are included.
Rainbow Hill Recovery incorporates DBT into a broader range of mental health and substance use services rather than presenting every client with one identical treatment schedule. Our therapy programming includes individual and group services, case management, psychiatry, mindfulness, distress tolerance, interpersonal skills, relapse prevention, and other clinically relevant topics. The specific combination of services depends on the client’s symptoms, level of care, treatment goals, safety, and progress. An assessment helps determine how DBT can fit within the overall plan.
Behavioral chain analysis is a DBT strategy used to examine what happened before, during, and after a concerning behavior. The therapist and client may identify vulnerabilities, triggering events, thoughts, emotions, physical sensations, decisions, and environmental factors that contributed to the outcome. This process avoids reducing the event to a simple statement such as “I lost control” or “I relapsed for no reason.” Understanding the sequence reveals points where a different skill or decision might interrupt the pattern next time.
For example, a return to substance use may begin several days before the substance is actually used. Sleep loss, isolation, an argument, missed appointments, shame, and contact with a triggering person may form part of the chain. The treatment plan can address each link through specific actions such as improving sleep, reaching out sooner, changing access to money, or leaving a high-risk environment. Chain analysis turns a painful event into information that can strengthen future relapse-prevention planning.
Substance use may function as an attempt to escape emotional pain, reduce anxiety, numb traumatic memories, tolerate loneliness, or create temporary relief. DBT helps clients recognize the connection between emotions and substance-related decisions while developing alternative coping responses. Skills may be applied to cravings, high-risk relationships, shame following a lapse, or situations where drugs and alcohol are available. This makes DBT particularly relevant when emotional dysregulation and substance use repeatedly reinforce one another.
Clinical research has examined DBT adaptations for people with substance use disorders, particularly when substance use occurs alongside borderline personality disorder or other significant emotional difficulties. Earlier research found that DBT could be adapted for drug-dependent clients, while more recent trials have continued exploring DBT-based interventions for different substance-use populations. The evidence does not establish DBT as the only effective addiction treatment, and some clients may need medication, contingency management, cognitive behavioral therapy, or other services. DBT can be one part of a coordinated plan that addresses both substance use and the emotional triggers contributing to it.
DBT has one of its strongest research foundations in the treatment of borderline personality disorder, especially when self-harm, emotional instability, or suicidal behavior is present. A 2024 systematic review examined 18 randomized controlled trials involving a combined 1,755 participants, with most studies supporting DBT’s effectiveness for borderline personality disorder. NIMH identifies DBT as a treatment developed specifically for this condition and notes that it teaches emotional control, reduces self-destructive behaviors, and improves relationships. Research should still be interpreted according to the population studied, the treatment format, and the outcomes being measured.
A 2021 meta-analysis concluded that DBT reduced self-harming behavior and improved depression among people with borderline personality disorder. The same analysis found negligible effects on suicidal ideation and anger, and its authors called for additional high-quality randomized trials. These findings show why DBT should be described accurately rather than presented as a guaranteed solution for every symptom. Results depend on clinical needs, treatment engagement, program quality, duration, and whether the approach is delivered as comprehensive DBT or skills training alone.
Rainbow Hill Recovery offers DBT as part of its outpatient mental health and substance use treatment services in Los Angeles. Our available levels of care include a Partial Hospitalization Program, Intensive Outpatient Program, and Outpatient Program. PHP provides the greatest degree of outpatient structure, while IOP offers regular treatment with more independence outside program hours. OP may be appropriate for clients who need flexible continuing services or are transitioning from a more structured level of care.
Depending on the individualized plan, clients may participate in individual therapy, group therapy, psychiatric services, case management, addiction education, relapse-prevention work, and practical skill development. DBT can be integrated with experiential therapy, trauma-informed care, mindfulness, and other therapeutic approaches when appropriate. Program placement considers symptoms, safety, daily functioning, substance use, treatment history, responsibilities, living conditions, and available support. Care is adjusted as the client develops skills and moves toward greater stability.
DBT requires active practice because understanding a skill is different from using it during an emotionally intense moment. Clients may complete exercises, track emotions, review behavioral patterns, or practice specific responses between sessions. A person might use mindfulness before answering an upsetting message, distress tolerance during a craving, emotion regulation after a difficult day, or interpersonal effectiveness during a conflict. Repeated practice helps make the skills more accessible when they are needed most.
Progress does not mean that difficult emotions, relationship problems, or cravings disappear completely. It may mean recognizing a warning sign earlier, pausing before acting, asking for support, or recovering more quickly after a setback. Therapists can review what worked, identify barriers, and modify the plan when a skill was not effective. DBT treats mistakes as opportunities to gather information and continue building capabilities.
Skills learned in structured treatment must eventually be applied within work, relationships, independent living, and other everyday settings. Changes in routine, renewed stress, conflict, grief, or substance-related triggers may test a client’s ability to use DBT consistently. Continuing care provides opportunities to review these experiences and strengthen skills before problems become larger. Aftercare can also help clients maintain accountability while gradually relying less on intensive program structure.
Rainbow Hill Recovery’s aftercare services may include ongoing therapy, support groups, regular check-ins, relapse-prevention education, practical resources, and assistance with maintaining stable routines. These services help clients continue working on mindfulness, emotional regulation, distress tolerance, communication, and recovery planning. The aftercare plan is personalized according to progress, ongoing needs, support systems, and long-term goals. Continued participation can help clients carry what they learned in treatment into a more independent stage of recovery.
Rainbow Hill Recovery provides DBT within coordinated outpatient care for adults who need support managing emotions, improving relationships, changing harmful behaviors, or strengthening substance use recovery. Our team can combine DBT skills with individual therapy, group programming, psychiatric support, case management, trauma-informed treatment, and relapse-prevention education. Each treatment plan is shaped around the client’s symptoms, stability, strengths, responsibilities, and personal goals. This approach allows DBT to serve a clear clinical purpose rather than being offered as a generic set of worksheets.
Someone does not need to wait until emotional distress has caused a crisis, damaged an important relationship, or contributed to a return to substance use before asking for support. An assessment can clarify which symptoms require attention, whether DBT is appropriate, and which outpatient level of care may provide the right degree of structure. Rainbow Hill Recovery offers multiple treatment levels, coordinated clinical services, practical skills training, and continuing support in one Los Angeles outpatient setting. Call (310) 341-4887 to speak with our team about Dialectical Behavior Therapy and the next appropriate step.
Joie Gyondla serves as Rainbow Hill Recovery’s Clinical Support Coordinator, bringing compassion, empathy, and a genuine commitment to supporting every client who walks through our doors. With a background in recovery support, Joie understands the importance of creating a welcoming, organized, and affirming environment where individuals feel seen, valued, and supported throughout their treatment journey.
Working closely with both clients and the clinical team, Joie helps ensure that each person’s experience is as seamless as possible, providing encouragement, guidance, and practical support every step of the way. Her calm presence and dedication to helping others foster a sense of safety and connection that allows clients to focus on what matters most: their recovery.
Joie believes that healing begins with compassion and that even the smallest acts of kindness can make a lasting difference. She is proud to be part of the Rainbow Hill Recovery team, helping create a community where every individual is empowered to build a healthier, more authentic future.
Co-Founder of the LGBTQ+ Association for Addiction and Mental Health Professionals Clinical Outreach Specialist for Rainbow Hill Recovery LGBTQ Sensitivity Training Consultant
Steven Buffin-Stewart is the Case Manager at Rainbow Hill Recovery, with over five years of experience in substance use and mental health treatment. A CADC ll professional in recovery themselves, Steven combines clinical knowledge with lived experience to provide compassionate, coordinated care and foster inclusive, affirming spaces where clients feel supported, empowered, and hopeful in their healing journey.
Steven Buffin-Stewart is the Program and Case Manager at Rainbow Hill Recovery, with over five years of experience in substance use and mental health treatment. A CADC ll professional in recovery themselves, Steven combines clinical knowledge with lived experience to provide compassionate, coordinated care and foster inclusive, affirming spaces where clients feel supported, empowered, and hopeful in their healing journey.
Janae Borrego serves as Rainbow Hill Recovery’s Cross-Cultural Relations Officer and Outpatient Therapist, where she combines her clinical expertise with a deep commitment to fostering an inclusive, culturally responsive environment for every client. Her ability to understand, appreciate, and navigate diverse cultural perspectives has made her an invaluable leader as Rainbow Hill continues to grow and evolve.
In her role, Janae works to strengthen cultural understanding throughout the organization, ensuring that clients, families, and staff feel respected, heard, and represented. She provides ongoing guidance on cultural sensitivity and inclusive practices while helping shape programs that honor the unique identities, backgrounds, and lived experiences of those we serve.
As an Outpatient Therapist, Janae is dedicated to helping clients navigate recovery, mental health, and life’s challenges with compassion, authenticity, and evidence-based care. She believes that meaningful healing begins when individuals feel safe to show up as their authentic selves and receive support that acknowledges the whole person.
Janae is passionate about creating spaces where diversity is celebrated, connection is strengthened, and every individual has the opportunity to heal and thrive. Her leadership continues to advance Rainbow Hill Recovery’s mission of providing affirming, trauma-informed care that meets the evolving needs of the communities we serve.
With over a decade of experience in addiction recovery, Andrew is passionate about helping individuals reclaim their lives and find lasting healing. As Co-founder and Director of Rainbow Hill Recovery, he is dedicated to creating a supportive environment that fosters hope, resilience, and transformation.
Joey Bachrach is the Co-Founder and CEO of Rainbow Hill Recovery, an LGBTQ-affirming mental health and substance use treatment center in Los Angeles. Drawing from both professional leadership and lived recovery experience, Joey is dedicated to creating safe, inclusive spaces where individuals are fully seen, affirmed, and supported on their healing journey.