Treating Depression and Anxiety with Dialectical Behaviour Therapy (DBT)

What is Dialectical Behaviour Therapy (DBT)? 

I’ve been a Gold Coast psychologist for over 30 years, and in my practice at Integrated Health Specialists, I use DBT to help people develop practical skills for managing difficult emotions, improving relationships, and building a life worth living. While DBT was originally created for people with Borderline Personality Disorder (BPD), research now shows it’s highly effective for depression, anxiety, eating disorders, substance use issues, and other challenges where emotions feel unmanageable.

What you’ll learn about DBT for depression and anxiety

DBT offers structured, evidence-based techniques that create real change. In this article, I’ll explain:

• What Dialectical Behaviour Therapy is and how it works
• The four core skill modules DBT teaches
• How DBT helps specifically with depression and anxiety
• What to expect in DBT therapy sessions
• Whether DBT might be right for you
• How to access DBT on the Gold Coast

Understanding Dialectical Behaviour Therapy

Dialectical Behaviour Therapy was developed by psychologist Marsha Linehan in the 1980s. The word ‘dialectical’ refers to balancing opposites, in DBT’s case, acceptance and change. This means validating your experiences and emotions while also working toward positive changes.

DBT is a type of cognitive behavioural therapy that’s been adapted to address intense emotional experiences. What makes DBT unique is its focus on teaching specific, practical skills you can use in daily life, not just talking about problems. According to Healthdirect Australia, DBT has strong research support for helping people who experience emotional dysregulation — when emotions feel too intense, change too quickly, or last too long.

The four core skill modules of DBT

DBT teaches four sets of skills. Each module addresses different aspects of emotional and behavioural challenges, and research demonstrates that these skills significantly improve emotional regulation and reduce self-destructive behaviours.

Mindfulness

Mindfulness in DBT means paying attention to the present moment without judgment. It’s the foundation of all other DBT skills. Studies show that mindfulness practice can reduce symptoms of both anxiety and depression by helping you observe thoughts and feelings without getting overwhelmed by them.

Mindfulness skills include:

• Observing your thoughts, emotions, and physical sensations
• Describing your experiences using words without judging them
• Participating fully in activities in the present moment
• Taking a non-judgmental stance toward yourself and your experiences
• Focusing on one thing at a time
• Doing what works in each situation

Distress tolerance

When you’re in crisis or facing intense emotional pain, distress tolerance skills help you get through difficult moments without making things worse. Research indicates that these skills are particularly effective for reducing self-harm behaviours and managing suicidal thoughts.

Key distress tolerance skills:

• Self-soothing techniques using your five senses
• Distraction methods to shift your focus temporarily
• Improving the moment with imagery, meaning, prayer, or relaxation
• Weighing pros and cons before acting on urges
• Radical acceptance (accepting reality as it is, even when it’s painful)

In my practice, I’ve seen clients use distress tolerance skills to navigate panic attacks, resist urges to use substances, and cope with relationship conflicts without escalating the situation. One client described it as having a ‘toolkit’ for emotional emergencies — practical strategies she could turn to when therapy sessions weren’t immediately available.

Emotion regulation

This module helps you understand and manage emotions more effectively. Improved emotion regulation is one of the primary mechanisms through which DBT reduces symptoms of depression and anxiety.

Emotion regulation skills teach you to:

• Identify and label emotions accurately
• Understand what triggers specific emotions
• Reduce emotional vulnerability through self-care
• Increase positive emotional experiences
• Act opposite to unhelpful emotional urges
• Build emotional resilience over time

The emotion regulation module includes the concept of ‘opposite action’ — acting in ways that oppose the urge that comes with an emotion. For example, if depression makes you want to isolate, opposite action means reaching out to connect with others instead. 

Interpersonal effectiveness

Many people with anxiety or depression struggle in relationships, either being too passive and getting taken advantage of, or being too aggressive and damaging connections. Interpersonal effectiveness skills help you communicate your needs, set boundaries, and maintain relationships while respecting yourself and others. Studies demonstrate that improved interpersonal functioning significantly reduces symptoms of depression.

These skills include:

• Asking for what you need effectively
• Saying no while maintaining relationships
• Balancing priorities in relationships (objectives, relationship, self-respect)
• Validating others’ experiences
• Managing conflict constructively

How DBT helps with depression

Depression often involves intense negative emotions, hopelessness, and behaviours that reinforce the depressive cycle, like social isolation or inactivity. 

DBT addresses depression by:

• Teaching emotion regulation skills to manage the intense sadness, emptiness, or numbness that comes with depression
• Using opposite action to counter depression’s urges toward isolation and inactivity
• Building mastery and accomplishment through structured activities that create positive emotions
• Improving relationships through interpersonal effectiveness, reducing the loneliness that often accompanies depression
• Providing distress tolerance skills for managing suicidal thoughts or self-harm urges

In my experience, clients with depression particularly benefit from the behavioural activation components of DBT. Rather than waiting to ‘feel better’ before engaging in activities, DBT teaches you to engage in meaningful activities even when depressed, which then actually improves mood!

How DBT helps with anxiety

Anxiety involves overwhelming worry, physical symptoms like racing heart or tightness in chest, and often avoidance of anxiety-triggering situations. 

DBT helps with anxiety through:

• Mindfulness skills that help you observe anxious thoughts without getting caught in worry spirals
• Distress tolerance for managing panic attacks and acute anxiety
• Emotion regulation to reduce overall emotional vulnerability to anxiety
• Opposite action to gradually face feared situations instead of avoiding them
• Interpersonal effectiveness for managing social anxiety and assertiveness challenges

One particularly helpful aspect for anxiety is DBT’s emphasis on accepting uncertainty. Much anxiety stems from trying to control or predict everything. DBT’s mindfulness and radical acceptance skills help you tolerate uncertainty rather than fighting it, which paradoxically often reduces anxiety.

What to expect in DBT therapy

Standard DBT involves four components: individual therapy sessions, skills training group, phone coaching, and a consultation team for therapists. However, many therapists (including myself) also offer DBT-informed therapy, which incorporates DBT principles and skills into individual treatment without the full program structure.

Individual therapy sessions

In individual DBT therapy, we work together to:

• Identify your treatment goals
• Apply DBT skills to specific situations in your life
• Analyse behaviours that interfere with your quality of life
• Problem-solve obstacles to using skills effectively
• Work through past traumas or current crises

Sessions typically occur weekly, lasting 60 minutes. With a Mental Healthcare Treatment Plan from your GP, you can access Medicare rebates for psychology sessions in Australia.

Skills training

In comprehensive DBT programs, skills training occurs in a group format — similar to a class where you learn and practice the four skill modules. In DBT-informed individual therapy, I teach these skills during our sessions and provide worksheets for practice between appointments.

Homework and practice

DBT requires active participation between sessions. You’ll practice skills in daily life and complete diary cards tracking your emotions, urges, and skill use. This might sound like a lot of work, and honestly, it is. But in my experience, people who engage with homework and practice make significantly more progress.

In my experience at Integrated Health Specialists here on the Gold Coast, clients who commit to practising skills — even imperfectly — see real improvements in their ability to manage emotions, navigate relationships, and reduce suffering.

Is DBT right for you?

DBT might be particularly helpful if you:

• Experience intense emotions that feel overwhelming or out of control
• Have difficulty managing relationships or swing between being too passive and too aggressive
• Engage in self-destructive behaviours (self-harm, substance use, binge eating, reckless driving)
• Struggle with suicidal thoughts
• Find that standard talk therapy hasn’t been enough
• Want practical, skills-based tools rather than just discussing problems
• Are willing to practice skills between sessions

That said, DBT isn’t the only effective treatment for depression or anxiety. Other evidence-based approaches like Cognitive Behavioural Therapy (CBT) or Acceptance and Commitment Therapy (ACT) might be better suited to your specific needs. As a Gold Coast Psychologist with over three decades of experience in treating depression, anxiety, and a range of other concerns, I can help you determine which approach makes most sense for your situation.

My approach to DBT at Integrated Health Specialists

I’ve been practising as a Gold Coast psychologist for over 30 years, and my approach is holistic. That means recognising that mental health, physical health, relationships, and lifestyle all interconnect. I integrate DBT skills with other evidence-based approaches to create treatment tailored to your unique needs.

I believe in balancing acceptance and change, validating your experiences and emotions while also helping you develop skills to manage them more effectively. DBT’s emphasis on both acceptance and change aligns perfectly with this philosophy.

Whether you’re struggling with depression, anxiety, relationship challenges, or intense emotions that feel unmanageable, DBT skills can help you build a life that feels worth living. At Integrated Health Specialists here in Mudgeeraba, we offer a warm, non-judgmental space where you can learn practical tools for managing emotions, improving relationships, and reducing suffering. I also offer online telehealth sessions for those who can’t (or prefer not to) make it to my practice in person. 

If you’d like to explore whether DBT might be right for you, book an appointment with me at Integrated Health Specialists. I’m here to support your journey toward greater emotional balance and wellbeing.

FAQs about DBT for depression and anxiety

How long does DBT treatment take?

Standard comprehensive DBT programs typically run for 6-12 months, although some people benefit from longer treatment. Research suggests that improvements often begin within the first few months, but developing mastery of the skills takes time and practice. DBT-informed individual therapy may be shorter or longer depending on your specific needs and goals.

Is DBT better than CBT for depression and anxiety?

It’s not about one being universally ‘better’. Different approaches work better for different people. Research shows both CBT and DBT are effective for depression and anxiety. DBT may be particularly helpful if you struggle with intense emotions, relationship difficulties, or self-destructive behaviours. Standard CBT might be more suitable if your primary concerns are negative thought patterns or specific anxiety triggers. As your psychologist, I can help determine which approach fits your needs or utilise a combination of therapies.

Will I need to talk about traumatic experiences?

DBT focuses primarily on building skills and managing current challenges. Processing past trauma typically comes later in treatment, once you’ve developed emotion regulation and distress tolerance skills. You’re always in control of what you discuss, and we work at a pace that feels safe for you. Trauma-informed care principles guide my approach.

What if I can’t do the homework?

Life happens, and sometimes homework gets difficult. In DBT, we approach this with curiosity rather than judgment — what got in the way? What skills might help? The goal is progress, not perfection. That said, research indicates that regular practice significantly improves outcomes. I’ll work with you to find realistic ways to integrate skills practice into your life.

Can DBT help with other issues beyond depression and anxiety?

Yes. While originally developed for borderline personality disorder, DBT has proven effective for eating disorders, substance use issues, PTSD, bipolar disorder, and other conditions involving emotional dysregulation. The skills are broadly applicable to many mental health challenges.

Disclaimer

This article provides general information about Dialectical Behaviour Therapy for depression and anxiety and doesn’t constitute professional mental health advice. DBT may not be appropriate for everyone, and individual treatment should be determined through consultation with a qualified mental health professional. If you’re experiencing severe depression, suicidal thoughts, or a mental health crisis, please contact Lifeline (13 11 14), Beyond Blue (1300 22 4636), or emergency services (000).

Client examples mentioned have been anonymised to protect privacy.

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• How Exposure Therapy Helps with PTSD Recovery
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