DBT Therapy Online: How It Works & Who It’s Right For

What Is Dialectical Behavior Therapy?

Dialectical behavioral therapy (DBT) is a type therapy that includes individual sessions, a group format for learning mental health skills, and phone coaching to help people use those skills while in high distress. DBT is the gold-standard treatment for borderline personality disorder (BPD), although it is also useful for other mental health concerns, like other personality disorders and mood disorders.

What Can DBT Help With?

DBT was designed to treat BPD, a personality disorder where people struggle with emotional regulation, feelings of emptiness, identity difficulties, urges to hurt oneself, mood disturbance, and other symptoms. DBT focuses on teaching and implementing skills to help with regulating emotions and improving one’s life, which also lead to using DBT for anxiety and other health concerns.

DBT can also be an effective treatment for the following:^{1,2,3,4,5,6,7}

• BPD
• Avoidant personality disorder (AVPD)
• Depression
• Obsessive compulsive disorder (OCD)
• Eating disorders or disorders of “over control,” such as anorexia, using a specialized type of DBT called radically open-DBT (RO-DBT)
• Post-traumatic stress disorder (PTSD)
• Substance use disorder
• Bipolar disorder

How Does Online DBT Therapy Work?

Whether therapy is done online or in-person, DBT follows the same basic format and structure, typically including weekly individual therapy and a group where individuals learn and practice DBT skills. The content of individual therapy is similar in-person vs. online, including a review of emotions, urges, and skills used from the previous week using a tracking tool called a diary card that can be shown via video, in-person, or scanned in to the therapist.⁸

Online DBT Skills Groups

The DBT skills group also functions similarly whether it’s online or in-person. Online, the members would gather on a platform such as Zoom. The presenting therapist would teach one or more skills, encouraging participation from members in activities, discussions, and skill practice. One difference via telehealth is that any assigned homework would need to be completed online or scanned in rather than completed on paper and handed in.⁸

What Skills Are Taught in DBT Online Therapy?

A central part of DBT is skills training, which is typically taught in a group format with a mental health professional presenting new skills each week. There’s also homework for the participants to complete using those same skills that are applicable for many situations in daily life.¹

Skills taught in online DBT therapy include:

• Mindfulness: Mindfulness is a foundational set of skills in DBT. It refers to paying full attention to what is happening in the present moment without judgment. This module of skills teaches what mindfulness is and how to use it in daily life.
• Distress tolerance: This set of skills gives participants tools to manage uncomfortable and difficult emotions without making the situation worse. For example, participants may learn ways to distract and soothe themselves instead of turning to behaviors such as arguing or self-harming.
• Interpersonal effectiveness: Learning to be effective with other people is another of the skills sets in DBT. In this module, participants learn how to be appropriately assertive, build relationships, and uphold boundaries.
• Emotional regulation: Emotional regulation presents opportunities for participants to find ways to manage emotions proactively so they are less prone to ineffective emotional reactions. This includes caring for physical health, generating positive emotions, and setting oneself up for success in difficult situations.

Is Online DBT Effective?

Early studies of online DBT suggest that it’s effective, which aligns with the evidence suggesting that, in general, online therapy does work.^8,9,10 Accounts note that certain tweaks were needed to accommodate the approach, such as determining how to turn in homework electronically vs. in-person. Also, since administering DBT via telehealth is still relatively new, some researchers call for additional studies to be done.¹¹

When done online, both the individual therapy component and the skills group would be done via an online platform such as Zoom. Both components would look similar to how they would be completed in person with some adjustments to accommodate the physical distance.

With any type of therapy, efficacy is partially driven by the participants readiness and willingness to fully engage. DBT will be more effective if you come to it with an open mind and a willingness to try the skills in your own environment.

Potential Challenges of Online DBT Therapy

As mental health professionals have adopted the new approach to online DBT therapy, potential challenges have been identified, including technological difficulties, poor internet connection, and patients’ lack of access to certain equipment.⁹

An additional challenge of DBT online therapy is any safety concerns. A common symptom with BPD is self-injurious behavior and/or suicidal thoughts or actions. For this reason, thorough safety planning is needed to ensure that all parties know how to handle unsafe urges.⁸ If someone is unable to keep themselves safe in the home environment, an in-person setting may be more appropriate.

Confidentiality must also be attended to when using online therapy. One researcher noted that members must ensure they are in a room alone to ensure that other members have privacy.⁸

How to Find DBT Therapy Online

When working to find a DBT therapist, first ensure that the provider has training and/or experience in DBT. You can use an online therapist directory to check that a provider offers both the individual therapy and the skills component. If they do not offer dialectical behavior therapy online, they may still be able to refer you to a colleague who can assist.

Once you have identified that they have the appropriate training and/or experience, make sure that they are the right fit for you in terms of personality and approach. It is acceptable—even encouraged—to come with a list of questions about their training and/or approach in order to have a consultation prior to entering treatment.

Final Thoughts on Online DBT Therapy

Online dialectical behavior therapy may be a good choice for you based on your geographical location and proximity to treatment options and healthcare needs. With special considerations, online DBT therapy can be done effectively with good results.