Dialectical Behavior Therapy (DBT)

Dialectical behavior therapy teaches four concrete skill sets for people whose emotions move faster than their coping does. It was developed specifically for chronic suicidal behavior and borderline personality disorder, and it has since proven useful well beyond that.

The dialectic in the name is the tension it holds deliberately: you are doing the best you can, and you need to do things differently. Most approaches pick one of those. DBT insists on both, and that combination is why it lands with people who have found other therapy either too soft or too blaming.

The four skill sets

Mindfulness

Noticing what is happening internally without immediately acting on it. Not meditation for its own sake — the practical capacity to observe an emotion arriving before it has already made a decision for you.

Distress tolerance

What to do in the moment when the feeling is unbearable and the usual options are self-harm, using, or a decision you will regret. These are specific, physical, and deliberately unglamorous techniques for surviving a crisis without making it worse.

Emotion regulation

Reducing how often the crises happen — naming emotions accurately, understanding what set them off, and changing the conditions that leave you vulnerable, including sleep, food, and illness.

Interpersonal effectiveness

Asking for what you need, saying no, and handling conflict without either capitulating or torching the relationship. For many people this is the hardest set and the one that changes daily life most.

What we use it for

• Borderline personality disorder, the condition it was built for
• Self-harm and suicidal behavior as explicit treatment targets
• Trauma, where emotional flooding gets in the way of processing
• Substance use, where distress tolerance addresses the moment the craving peaks
• Bipolar disorder and depression, for the regulation skills

Where this fits in our programs

Therapy at Golden Coast Rehab is delivered inside a program rather than as a standalone service. That means our specialty mental health partial hospitalization and intensive outpatient programs, provided under our County of San Diego contract, and our substance use intensive outpatient and outpatient programs under DHCS certification 370254AP.

Which modalities you work with is decided with your clinician based on what you are dealing with, not assigned by a template.

Coverage and cost

If you have Medi-Cal in San Diego County — any of the four managed care plans — treatment here can be covered at no cost to you. See how Medi-Cal works here.

Call (858) 925-8589, answered 24 hours a day. The San Diego County Access and Crisis Line is available around the clock at 1-888-724-7240.