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

Published: February 17, 2022 Updated: November 24, 2022
Published: 02/17/2022 Updated: 11/24/2022
Stephanie Capecchi, LCSW
Written by:

Stephanie Capecchi

LCSW
Headshot of Naveed Saleh, MD, MS
Reviewed by:

Naveed Saleh

MD, MS
  • What Is Dialectical Behavior Therapy?Definition
  • What Can DBT Help With?What It Helps
  • How Does Online DBT Therapy Work?How Online Works
  • What Skills Are Taught In Online Dialectical Behavior Therapy?Skills
  • Is Online DBT Effective?Effectiveness
  • Potential Challenges of Online DBT TherapyPotential Challenges
  • How to Find DBT Therapy OnlineFind DBT Online
  • Final ThoughtsConclusion
  • Additional ResourcesResources
  • DBT Therapy Online InfographicsInfographics
Stephanie Capecchi, LCSW
Written by:

Stephanie Capecchi

LCSW
Headshot of Naveed Saleh, MD, MS
Reviewed by:

Naveed Saleh

MD, MS

Dialectical behavior therapy (DBT) is offered in-person or online. Individuals may want to take advantage of online DBT therapy due to health/safety concerns, geographic distance from an in-person provider, or simply preference. DBT therapy online should follow the same structure of in-person DBT, with some minor adjustments to accommodate the virtual setting.

Find a therapist that provides online DBT. BetterHelp has over 20,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp starts at $60 per week. Complete a brief questionnaire and get matched with the right therapist for you.

Choosing Therapy partners with leading mental health companies and is compensated for marketing by BetterHelp

Visit BetterHelp

What Is Dialectical Behavior Therapy?

is a type of mental health therapy that includes individual therapy, 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.

What Can DBT Help With?

DBT was designed to treat BPD, a mental health diagnosis 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.

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 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.8

The DBT skills group also presents 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 rather than completed on paper and handed in.8

What Skills Are Taught In Online Dialectical Behavior 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 are:

  • 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.

Popular Choices For Online Therapy 

BetterHelp  – Best For Those “On A Budget”


Online-Therapy.com – Best For Multiple Sessions Per Week

According to 14 Best Therapy Services (updated on 1/16/2023), Choosing Therapy partners with leading mental health companies and is compensated for marketing by BetterHelp and Online-Therapy.

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 research.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

COVID-19 pushed many service providers to quickly adapt to the need for telehealth. As mental health professionals have adopted the ne 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/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 an online 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

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.

Additional Resources

Education is just the first step on our path to improved mental health and emotional wellness. To help our readers take the next step in their journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy may be compensated for marketing by the companies mentioned below.

DBT Skills Course

Jones Mindful Living – Dialectical Behavior Therapy (DBT) is a popular treatment for BPD. Learn DBT skills with live weekly classes and online video courses for only $19 per month. Free One Week Trial

Online Therapy

BetterHelp – Get support and guidance from a licensed therapist. BetterHelp has over 20,000 therapists who provide convenient and affordable online therapy.  Complete a brief questionnaire and get matched with the right therapist for you. Get Started

Online-Therapy – Online-Therapy.com provides a weekly live video session, unlimited text messaging, and self-guided activities like journaling. Starting at $64 per week, this is one of the most affordable options for CBT therapy. Try Online-Therapy

Starting Therapy Newsletter

A free newsletter for those interested in learning about therapy and how to get the most benefits out of therapy. Get helpful tips and the latest information. Sign Up

Choosing Therapy Directory 

You can search for therapists by specialty, experience, insurance or price, and location. Find a therapist today.

Choosing Therapy partners with leading mental health companies and is compensated for marketing by BetterHelp, Online-Therapy.com, and Jones Mindful Living.

For Further Reading

  • Mental Health America
  • National Alliance on Mental Health
  • MentalHealth.gov

DBT Therapy Online Infographics

How Does Online DBT Therapy Work? What Skills Are Taught in Online DBT? Is Online DBT Effective?

11 sources

Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.

  • Linehan, M.M. (2015). DBT Skills Training Manual (2nd ed.). New York, NY: Guildford Press.

  • Harley, R., Sprich, S., Safren, S., Jacobo, M., & Fava, M. (2008). Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. The Journal of nervous and mental disease, 196(2), 136-143.doi: 10.1097/NMD.0b013e318162aa3f https://pubmed.ncbi.nlm.nih.gov/18277222/

  • Lynch, T. R. (2018). Radically Open Dialectical Behavior Therapy: Theory and Practice for Treating Disorders of Overcontrol. Reno, Nevada: Context Press, an imprint of New Harbinger Publications.

  • Ahovan, M., Balali, S., Shargh, N. A., & Doostian, Y. (2016). Efficacy of dialectical behavior therapy on clinical signs and emotion regulation in patients with obsessive-compulsive disorder. Mediterranean Journal of Social Sciences, 7(4), 412-412. Doi: 10.36941/mjss https://www.mcser.org/journal/index.php/mjss/article/view/9336

  • Safer, D. L., Telch, C. F., & Agras, W. S. (2001). Dialectical behavior therapy for bulimia nervosa. American Journal of Psychiatry, 158, 632-634. doi: 10.1176/appi.ajp.158.4.632. https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.158.4.632

  • Ritschel, L. A., Lim, N. E., & Stewart, L. M. (2015). Transdiagnostic applications of DBT for adolescents and adults. American journal of psychotherapy, 69(2), 111-128. https://doi.org/10.1176/appi.psychotherapy.2015.69.2.111

  • Goldstein, T. R., Axelson, D. A., Birmaher, B., & Brent, D. A. (2007). Dialectical behavior therapy for adolescents with bipolar disorder: a 1-year open trial. Journal of the American Academy of Child & Adolescent Psychiatry,46(7), 820-830. https://doi.org/10.1097/chi.0b013e31805c1613

  • Zalewski, M., Walton, C. J., Rizvi, S. L., White, A. W., Martin, C. G., O’Brien, J. R., & Dimeff, L. (2021). Lessons Learned Conducting Dialectical Behavior Therapy via Telehealth in the Age of COVID-19. Cognitive and Behavioral Practice. https://doi.org/10.1016/j.cbpra.2021.02.005

  • Landes, S. J., Pitcock, J. A., Harned, M. S., Connolly, S. L., Meyers, L. L., & Oliver, C. M. (2021). Provider perspectives on delivering dialectical behavior therapy via telehealth during COVID-19 in the Department of Veterans Affairs. Psychological services. https://doi.org/10.1037/ser0000571

  • O’Hayer, C. V. (2021). Building a Life Worth Living During a Pandemic and Beyond: Adaptations of Comprehensive DBT to COVID-19. Cognitive and Behavioral Practice. https://doi.org/10.1016/j.cbpra.2020.12.005

  • Hyland, K. A., McDonald, J. B., Verzijl, C. L., Faraci, D. C., Calixte-Civil, P. F., Gorey, C. M., & Verona, E. (2021). Telehealth for Dialectical Behavioral Therapy: A Commentary on the Experience of a Rapid Transition to Virtual Delivery of DBT. Cognitive and Behavioral Practice. https://doi.org/10.1016/j.cbpra.2021.02.006

     

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Stephanie Capecchi, LCSW
Written by:

Stephanie Capecchi

LCSW
Headshot of Naveed Saleh, MD, MS
Reviewed by:

Naveed Saleh

MD, MS
  • What Is Dialectical Behavior Therapy?Definition
  • What Can DBT Help With?What It Helps
  • How Does Online DBT Therapy Work?How Online Works
  • What Skills Are Taught In Online Dialectical Behavior Therapy?Skills
  • Is Online DBT Effective?Effectiveness
  • Potential Challenges of Online DBT TherapyPotential Challenges
  • How to Find DBT Therapy OnlineFind DBT Online
  • Final ThoughtsConclusion
  • Additional ResourcesResources
  • DBT Therapy Online InfographicsInfographics
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