DBT

What is DBT?

Dialectical Behaviour Therapy (DBT) is a structured therapy that combines cognitive-behavioural techniques with acceptance-based strategies. It was originally developed by Marsha Linehan in the 1980s for people with borderline personality disorder (BPD), but has since been adapted for a wide range of conditions involving emotional dysregulation.

The word “dialectical” refers to the idea of holding two seemingly opposite truths at the same time - in DBT, this means balancing acceptance (accepting yourself and your emotions as they are) with change (developing skills to manage emotions and behaviours more effectively).

How DBT works

The four skills modules

DBT teaches four sets of skills, usually delivered in a group setting alongside individual therapy:

Mindfulness - learning to pay attention to the present moment without judgement. In DBT, mindfulness is the foundation that supports all other skills. It helps you notice what you are feeling and thinking without being overwhelmed by it.

Distress tolerance - learning to get through moments of crisis without making things worse. These are practical strategies for surviving intense distress - not eliminating it, but enduring it without self-harm, substance use, or other harmful behaviours.

Emotion regulation - learning to identify, understand, and manage your emotions. This includes recognising what triggers intense emotional responses, understanding the function of different emotions, and developing strategies for reducing emotional vulnerability.

Interpersonal effectiveness - learning to communicate your needs, set boundaries, and maintain relationships. These skills help you balance your own needs with the needs of others while maintaining self-respect.

The structure

A full DBT programme typically includes:

• Individual therapy (weekly, 50-60 minutes) - working one-to-one with a DBT therapist on applying skills to your specific difficulties
• Skills training group (weekly, around 2 hours) - learning and practising the four skills modules with other participants
• Phone coaching (as needed) - brief contact with your therapist between sessions for support in applying skills to real-life situations
• Therapist consultation team - therapists meet regularly to support each other in delivering effective treatment

A standard DBT programme lasts around 12 months, though shorter adaptations exist.

DBT and neurodivergence

Why emotional dysregulation matters

Emotional dysregulation is a core feature of both ADHD and autism, though it is not always recognised in diagnostic criteria.

For people with ADHD, emotional dysregulation can include intense frustration, rapid mood shifts, difficulty recovering from emotional setbacks, and impulsive reactions driven by strong feelings. Research suggests that around 75% of children with ADHD experience some form of emotional dysregulation, and for many this continues into adulthood.¹

For autistic people, emotional dysregulation often takes the form of meltdowns, shutdowns, overwhelming anxiety, or difficulty processing and expressing emotions. Many autistic people also experience alexithymia - difficulty identifying and describing their emotions - which can make emotional experiences feel confusing and uncontrollable.

Evidence for autistic people

Recent research provides strong evidence for DBT with autistic adults. A randomised controlled trial with 63 autistic adults found that DBT significantly reduced emotional dysregulation, depression, and improved quality of life, with improvements sustained at six-month follow-up.²

Importantly, the study found that improvements in emotional dysregulation were linked to a decrease in alexithymia - suggesting that DBT can help autistic people develop better emotional awareness, not just better emotional control.²

A qualitative study of autistic adults who completed DBT found that participants reported meaningful changes in their relationship with their emotions, with one participant describing the experience as learning to “live with my emotions much better.”³

Evidence for ADHD

A 2025 meta-analysis of randomised controlled trials found that DBT produces moderate effect sizes in reducing ADHD symptoms compared to control treatments. The effect was particularly strong for emotional dysregulation and quality of life, making DBT a viable alternative or complement to medication for adults with ADHD.¹

Adaptations for neurodivergent people

Standard DBT was designed for neurotypical people and needs adapting for neurodivergent clients. Key adaptations include:

Mindfulness modifications

Standard mindfulness practices - sitting still, closing your eyes, focusing on your breath - can be overwhelming or dissociating for some neurodivergent people. Adapted approaches include:

• Externally-focused mindfulness (noticing sounds, textures, or objects rather than internal sensations)
• Shorter practice periods
• Movement-based mindfulness (walking, gentle stretching)
• Flexibility about posture and environment
• Using stim toys or fidget tools during practice

Sensory awareness

Group skills training sessions need to accommodate sensory sensitivities:

• Adjusting lighting, reducing background noise
• Allowing movement breaks
• Providing written materials alongside verbal instruction
• Offering online or hybrid options for people who find group settings overwhelming

Communication clarity

• Using concrete, explicit language rather than assuming participants will infer meaning
• Providing written agendas and session summaries
• Allowing extra processing time
• Being direct about expectations and group norms

Pace and structure

• Allowing more time to learn and practise each skill
• Maintaining consistent, predictable session structure
• Building in repetition and review
• Offering individual support alongside group work for people who need additional help applying skills

What to expect

Before you start

Most DBT programmes begin with an assessment to determine whether DBT is the right fit. You may be asked about your emotional difficulties, self-harm or suicidal thoughts (if relevant), and what you hope to get from the programme.

During the programme

The skills group typically runs weekly for around two hours. You will learn about each of the four skills modules in turn, practise techniques in the group, and be asked to practise between sessions. Individual therapy runs alongside the group and focuses on applying skills to your specific situation.

After the programme

Many people find that the skills they learn in DBT continue to be useful long after the programme ends. Some people return for “refresher” groups or continue with individual therapy to maintain and build on what they have learned.

Accessing DBT in the UK

DBT is available through:

• NHS mental health services - some areas offer full DBT programmes, particularly through specialist personality disorder or emotional dysregulation services. Availability varies significantly by region.
• Private therapists - look for therapists trained in DBT who are registered with a recognised professional body (BABCP, BACP, or UKCP)
• Charity and third-sector services - some mental health charities offer DBT skills groups

When seeking DBT, ask whether the therapist or service has experience working with neurodivergent clients and what adaptations they offer.

Further reading on neurobetter

• Counselling and therapy - overview
• CBT
• ACT
• Emotional dysregulation
• Personality disorders
• Self-harm

neurobetter services

• Local services directory - find therapists near you
• Ask a Counsellor - get a confidential response from a registered counsellor