How Dialectical Behavior Therapy (DBT) Helps with Depression and Mood Disorders

By Dr. Bliss Lewis, MD

If you’ve ever struggled with depression or know someone who has, you know how overwhelming it can be. The heavy sadness, low energy, and hopelessness can feel like they’re here to stay. But here’s some good news: there are evidence-based tools that can help—and Dialectical Behavior Therapy (DBT) is one of them.

Originally created to treat Borderline Personality Disorder (BPD), DBT has evolved into a therapy that helps many people with a range of mental health challenges—including depression and mood disorders.

In this article, we’ll break down what DBT is, how it works, and how it can help ease symptoms of depression in a real, lasting way.

What is Dialectical Behavior Therapy (DBT)?

DBT was developed by psychologist Dr. Marsha Linehan in the late 1980s. She designed it to help people who struggled with intense emotions, self-harm, and chronic suicidal thoughts—especially those with BPD. But over time, research has shown that DBT works for other conditions too, including anxiety, eating disorders, PTSD, and yes—depression.

DBT is a type of cognitive behavioral therapy (CBT), which means it focuses on how your thoughts, feelings, and behaviors are connected. But what makes DBT unique is its focus on two big ideas: acceptance and change.

That means learning to accept yourself as you are, while also working to make positive changes in your life.

How DBT Helps People with Depression

People with depression often feel stuck. You might replay painful memories, struggle to connect with others, or have trouble managing strong emotions. DBT teaches skills to help with all of that through four core modules:

1. Mindfulness

Mindfulness is the foundation of DBT. It’s about paying attention to the present moment, without judgment.

When you’re depressed, your mind may spend a lot of time in the past (regret, guilt) or the future (worry, hopelessness). Mindfulness helps you bring your attention back to what’s happening right now—what you see, hear, and feel in this moment.

DBT teaches simple mindfulness practices like:

• Observing your breath or sounds around you
• Describing what you feel without labeling it as “good” or “bad”
• Participating fully in the present activity

This helps calm the mind and creates space between your thoughts and reactions.

Why it helps: Mindfulness reduces rumination, which is the habit of replaying the same negative thoughts over and over. Less rumination = fewer depressive symptoms (Kuyken et al., 2010).

2. Distress Tolerance

This module is all about surviving emotional pain without making things worse. Depression often brings overwhelming emotions, like sadness, shame, or even numbness. When those feelings hit hard, some people may shut down, isolate, or even consider self-harm.

Distress tolerance skills help you get through the moment safely. These are crisis tools—not long-term solutions, but things to help you cope without acting impulsively.

Examples include:

• Using cold water or holding ice cubes to “shock” your system back to the present
• Distracting yourself with safe activities (like going for a walk or watching a favorite show)
• Self-soothing with your senses—smelling essential oils, drinking tea, listening to calming music

💡 Why it helps: Distress tolerance builds emotional resilience. Instead of reacting to pain with panic or escape, you learn to ride the wave until it passes.

3. Emotion Regulation

This module teaches you how to understand and manage your emotions—something many people with depression struggle with.

Often, depression brings a sense of numbness or feeling “stuck” in sadness. Emotion regulation skills help you tune into your feelings and shift your emotional state in healthy ways.

Some core DBT emotion regulation tools:

• Naming your emotions accurately (e.g., “I feel discouraged” instead of just “bad”)
• Building habits that support emotional health: sleep, nutrition, movement, and routine
• Increasing positive emotions through enjoyable activities, even when you don’t “feel” like it

One key strategy here is called “ABC PLEASE”—a DBT acronym that stands for daily habits to reduce emotional vulnerability. It includes:

• Accumulating positive experiences
• Building mastery (doing things you’re good at)
• Coping ahead for hard situations
• PLEASE: Treating Physical Illness, Eating balanced meals, Avoiding mood-altering drugs, Sleeping well, and Exercising

Why it helps: Healthy habits directly influence your mood. By taking care of your body and brain, you become more emotionally balanced and less reactive (Neacsiu et al., 2014).

4. Interpersonal Effectiveness

When you’re depressed, it’s easy to feel disconnected from others. You might avoid social situations or feel like a burden. This only deepens the sense of loneliness and isolation.

DBT teaches interpersonal skills to help you:

• Ask for what you need in relationships
• Set healthy boundaries
• Say no without guilt
• Handle conflict in a respectful way

The goal is to help you build stronger, more supportive connections—and reduce the isolation that often fuels depression.

Why it helps: Strong relationships are one of the best predictors of emotional well-being. People who feel supported recover faster and stay healthier longer (Teo, 2013).

What the Research Says About DBT and Depression

So, does DBT really work for depression? The short answer: yes—especially when it’s used as part of a broader treatment plan.

Several studies have shown that DBT can significantly reduce symptoms of depression, particularly in people who also have mood instability, self-harm behavior, or difficulty regulating emotions.

For example:

• A 2014 study found that adults with treatment-resistant depression who used DBT showed significant improvement in emotional regulation and depressive symptoms (Neacsiu et al., 2014).
• Another study showed DBT was more effective than medication alone in reducing suicidal thoughts and improving mood in people with depression and borderline traits (Harley et al., 2007).
• DBT skills training alone—without the full therapy—has also been found to help reduce depressive symptoms (Linehan, 2014).

Should You Try DBT for Depression?

If you’re living with depression—especially if it comes with strong emotions, impulsive behaviors, or difficulty in relationships—DBT might be a great fit for you.

DBT is usually offered in group settings (for skills training) along with one-on-one therapy. Many therapists are trained in DBT, and some clinics offer full DBT programs.

It can also be combined with:

• Medication
• Exercise and movement
• Nutritional support
• Mind-body practices like yoga or meditation
• Regular check-ins with your doctor

Final Thoughts

Depression is tough—but with the right tools, healing is possible. DBT offers a powerful, practical path forward by teaching real-life skills to manage emotions, reduce suffering, and build a more meaningful life.

Whether you’re just beginning your mental health journey or have tried therapy before, DBT is worth exploring. It’s not a quick fix, but with time and practice, it can help you feel more grounded, connected, and in control.

Other resources: 

https://my.clevelandclinic.org/health/treatments/22838-dialectical-behavior-therapy-dbt

DBT Cheat Skills sheet – https://acrobat.adobe.com/id/urn:aaid:sc:AP:609c2e15-b2bd-4f05-bfc7-b2ad1c66179a