Dialectical Behavior Therapy Services: Evidence-Based Treatment for Emotion Regulation

Dialectical behavior therapy (DBT) is a structured treatment that Marsha Linehan developed for chronically suicidal people with borderline personality disorder (BPD), aimed at what she and a colleague call “pervasive emotional dysregulation”. Comprehensive DBT has four modes: weekly individual therapy, a skills training group, phone coaching between sessions, and a consultation team for the therapists. In randomized trials it has reduced suicide attempts in adults with BPD and, by the end of six months of treatment, suicide attempts and self-harm in high-risk teens. A skills group on its own is a different service, so ask any program exactly which of the four modes it provides. In metro Atlanta, the options covered below run from a four-mode outpatient program and residential care for teens and adults to stand-alone skills groups, and one program posts its DBT fees.

If you are thinking about suicide or self-harm right now

Crisis help does not depend on a DBT intake, and a waitlist is not a safety plan.

• Call, text or chat 988 to reach the 988 Suicide & Crisis Lifeline, free and confidential at any hour; for Spanish, dial 988 and press 2. Veterans can dial 988 and press 1 or text 838255.
• Text HOME to 741741 to reach Crisis Text Line, free and available 24/7 (message and data rates may apply).
• In Georgia, the Georgia Crisis and Access Line (GCAL) at 1-800-715-4225 operates 24/7 and is also how to reach Georgia’s mobile crisis response.
• Call 911 if someone is in immediate danger.

What a comprehensive DBT program includes

DBT keeps the change strategies of cognitive behavioral therapy and adds acceptance strategies delivered through validation; Behavioral Tech’s overview defines a dialectic as “a synthesis or integration of opposites.” Dimeff and Linehan describe five functions the treatment has to serve: improving motivation to change, building capabilities, carrying new behavior into daily life, structuring the person’s environment, and keeping the therapists capable and motivated. In standard outpatient DBT, four modes carry those functions.

Mode	What it is for	How often
Individual therapy	Building motivation and applying skills to specific challenges and events in the person's life	Once a week, "for as long as the client is in therapy"
Skills training group	Teaching a set curriculum of skills	Weekly, for about 2.5 hours; the full curriculum runs 24 weeks
Phone coaching	Coaching the person on how to use DBT skills to cope with a difficult situation	Between sessions
Consultation team	Helping therapists monitor their fidelity to the treatment	Regular meetings for therapists only; the client does not attend

Sources for this table: Behavioral Tech overview of DBT; University of Washington Behavioral Research and Therapy Clinics on DBT; Peachtree Comprehensive Health’s DBT program overview.

The skills curriculum has four modules. Behavioral Tech’s overview describes mindfulness as being fully aware and present in the moment, distress tolerance as tolerating pain in difficult situations rather than changing it, emotion regulation as changing emotions you want to change, and interpersonal effectiveness as asking for what you want and saying no while keeping self-respect. Because the skills group follows a set curriculum, it works differently from the open-ended process groups in the Atlanta group therapy guide’s comparison of group types.

Emotion regulation is one of those four modules, but the whole package, not just that module, is aimed at the emotional dysregulation DBT was built for. A program that teaches only that module, or only the skills, is offering part of the treatment, not all of it.

How DBT decides what to work on first

The University of Washington’s Behavioral Research and Therapy Clinics describe DBT in four stages. Stage 1 aims to move the person “from being out of control to achieving behavioral control.” Stage 2 moves from “quiet desperation” to full emotional experiencing. Stage 3 is about learning to live: setting life goals, building self-respect, and finding peace and happiness. The same page says only some people need Stage 4, which is about finding a deeper meaning.

Treatment targets are ranked, and in any session the individual therapist puts the greatest emphasis on the highest-ranked problem behavior from the past week:

1. Behaviors that are imminently life-threatening or could lead to the person’s death.
2. Behaviors that interfere with therapy.
3. Behaviors whose consequences seriously degrade quality of life.
4. Building behavioral skills.

So after a week with suicidal behavior, that behavior takes priority over other topics in the next session. People who expect to talk mainly about relationships or work early on should know this order in advance.

What the research shows, and for whom

The trials below enrolled people with BPD, suicidal behavior or self-harm. They mostly measure behavior (suicide attempts, self-harm, hospital use) rather than emotion regulation as a separate outcome, so they say little about how DBT works for someone whose main problem is emotional intensity without those behaviors.

Adults with BPD and repeated suicidal behavior

In a 2006 trial in Archives of General Psychiatry, Linehan and colleagues randomized 101 women with recent suicidal and self-injurious behavior who met diagnostic criteria for BPD to one year of DBT or one year of community treatment by experts, a non-behavioral therapy designed to control for therapist expertise, allegiance and training. Women receiving DBT were half as likely to make a suicide attempt, were hospitalized less often for suicidal ideation, had fewer psychiatric emergency visits and hospitalizations, and were less likely to drop out of treatment. The study followed participants for a year after treatment ended.

A 2020 Cochrane review pooled 75 randomized trials with 4,507 participants. Compared with treatment as usual, DBT reduced BPD severity and self-harm and improved psychosocial functioning; for self-harm the pooled estimate came from 7 trials with 376 participants. The reviewers rated all of these findings as low-quality evidence and wrote that they were “unsure whether these effects would alter with the addition of more data.” Across all psychotherapies compared with usual care, only the improvement in BPD severity reached their threshold for a clinically relevant difference.

Teens who have attempted suicide or self-harmed

A 2018 trial in JAMA Psychiatry (McCauley and colleagues) randomized 173 adolescents aged 12 to 18 at four academic medical centers. All had made at least one suicide attempt and met the trial’s other high-risk entry criteria. They received six months of DBT or of individual and group supportive therapy. Both groups had weekly individual and group sessions, therapist consultation meetings and parent contact as needed, so DBT was tested against an active treatment on a similar weekly schedule.

At the end of treatment, DBT had significant advantages on all three primary outcomes. In the DBT group, 90.3% had no suicide attempts, compared with 78.9% in the comparison group; 54.2% had no self-harm of any kind, compared with 36.9%. More teens completed DBT (75.6% versus 55.2%). From 6 to 12 months, the advantage of DBT decreased and there were no statistically significant differences between the groups. The authors wrote that the results “support DBT as the first well-established, empirically supported treatment” for reducing repeated suicide attempts and self-harm in young people.

For a family, that means DBT outperformed a credible alternative for suicidal teens during treatment, but its edge was not shown to last past the treatment period. Ask what care continues after the core months end.

In the UK, the National Institute for Health and Care Excellence’s self-harm guideline recommends that clinicians consider DBT adapted for adolescents (DBT-A) for children and young people with significant emotional dysregulation difficulties who have frequent episodes of self-harm (recommendation 1.11.4). That is UK guidance, not a US rule, but it is consistent with the trial above.

Do you need comprehensive DBT, a skills group, or something else?

Is a skills group enough?

A 2015 trial in JAMA Psychiatry took DBT apart. It randomized 99 women with BPD and recent, repeated suicidal or self-injuring behavior, including a suicide attempt in the past year, to one of three treatments for a year: DBT skills training plus case management (no DBT individual therapy), DBT individual therapy plus an activities group (no skills training), or standard DBT with both. All three groups had similar improvements in the frequency and severity of suicide attempts. The two treatments that included skills training led to greater improvements in nonsuicidal self-injury and depression during treatment. Standard DBT had lower dropout than individual therapy without skills (24% versus 48%), and fewer emergency department visits and psychiatric hospitalizations during follow-up (3% versus 13% for each). The authors concluded that “interventions that include DBT skills training are more effective than DBT without skills training, and standard DBT may be superior in some areas.”

Two details matter before reading this as “a skills class is enough.” The skills-only arm came with case management, and clinicians in all three arms used DBT’s suicide risk assessment and management protocol. A stand-alone skills class with no clinician tracking suicide risk is not what was tested.

DBT is not the only evidence-based option for BPD

The Society of Clinical Psychology (Division 12 of the American Psychological Association) lists four psychological treatments for BPD: DBT with strong research support, mentalization-based treatment (MBT) and schema-focused therapy with modest research support, and transference-focused therapy with “strong/controversial research support.” The page adds that other treatments may also be effective but have not been studied as rigorously. In the Cochrane review, MBT reduced self-harm and suicidality compared with usual care, also on low-quality evidence. If no DBT program is available or the wait is long, these are legitimate alternatives to raise with a clinician.

When substance use or another disorder is the main problem

Dimeff and Linehan summarize two small trials in people with BPD and drug dependence. In a 1999 trial comparing DBT with community treatment as usual in 28 polysubstance-dependent women with BPD, those receiving DBT were more likely to stay in treatment (64% versus 27%) and had greater reductions in drug use, measured by interviews and urine tests. In a 2002 trial of 23 opiate-dependent people with BPD, DBT was compared with comprehensive validation therapy plus a 12-step program: both reduced opiate use, only DBT kept the reduction through the last four months of treatment, and the comparison treatment kept more participants (100% versus 64%). Both trials were small and enrolled only people with BPD, so they support DBT when the two problems occur together; they did not test DBT as a replacement for standard addiction treatment in someone without BPD.

DBT does not drop the goal of abstinence. Its stance, which Dimeff and Linehan call dialectical abstinence, joins “unrelenting insistence on total abstinence” with nonjudgmental problem solving after a relapse, including steps to reduce risks such as overdose and infection. If alcohol, benzodiazepines or other sedatives are involved, do not stop suddenly on your own: alcohol withdrawal may quickly become life-threatening, and stopping a benzodiazepine abruptly or too fast can cause withdrawal reactions, including seizures. Ask how the program arranges medical oversight before any plan to stop; GCAL can also help people find an open crisis or detox bed in Georgia.

The University of Washington clinics state that research has shown DBT effective for a wider range of problems, including substance dependence, depression, post-traumatic stress disorder and eating disorders. If a program offers DBT for one of those, ask which studies support DBT for that problem and how it compares with the standard first-line treatment for it.

Matching your situation to a service

Use this table to prepare for an assessment, not as a diagnosis.

Situation	What to ask about	Question to put to the program
Adult with a recent suicide attempt or repeated self-harm, with BPD features	Comprehensive DBT with all four modes; MBT is another option with trial support	"Do you have a consultation team, and is phone coaching available?"
Teen with a suicide attempt or frequent self-harm	DBT adapted for adolescents, with caregivers involved	"How are parents involved, and what happens after the core months?"
Risk is too high to stay safe between weekly sessions, or outpatient care has not been enough	An intensive outpatient, day or residential program that uses DBT	"What is the step-down plan when I leave?"
Intense emotions or relationship conflict without suicidal behavior or self-harm	A skills group alongside an individual therapist may be a reasonable place to start, though the trials above did not study this group	"Do you require individual therapy, and who do I contact between sessions?"
A specific disorder, such as PTSD, an eating disorder or substance use, is the main problem	The first-line treatment for that disorder, with DBT added only for a stated reason	"Why DBT for this problem, and what is the evidence?"

The trials above delivered six to twelve months of treatment. Intensive and residential formats are built differently from those trials, so their link to ongoing outpatient care matters. When family conflict is the main driver of a teen’s distress, family systems therapy and other family-based approaches are a different route worth comparing.

How much time DBT takes, and what it costs

Comprehensive DBT is a large weekly commitment. Standard outpatient DBT means an individual session every week plus a weekly skills group of about 2.5 hours. The adult trials above ran for a year, and one Atlanta program, Peachtree DBT, recommends completing the skills modules twice, which it equates to a full year of treatment. The adolescent trial ran for six months. Between sessions, people practice skills in daily life, which is the point of the generalization function and of phone coaching.

Intensive formats compress that time. Hillside’s virtual intensive outpatient program runs Monday through Friday from 3:00 to 6:00 p.m. for at least six consecutive weeks, extendable to 8 or 10. Skyland Trail offers a 90-day residential DBT program for adults.

One program here posts its DBT fees. Peachtree Comprehensive Health’s fees and insurance page lists $250 for the DBT program intake assessment and $235 for a 45-minute session with a certified DBT clinician, and says it is a private pay facility that does not accept any insurance; it provides statements, or superbills, and asks patients to contact their insurer about benefits and reimbursement. That page does not list a price for the skills group. The other program pages cited here do not post a price, so cost depends on the program and the plan. The Affordable Care Act (ACA) lists mental health and substance use disorder services among ten essential health benefit categories that non-grandfathered individual and small-group plans must cover. The Atlanta CBT guide explains how federal and Georgia parity rules apply to therapy coverage. Skyland Trail says it is in-network with most major insurance plans, that Medicare and Medicaid do not cover its services at any level of care, and that financial aid is available to eligible families. The DBT-Linehan Board of Certification’s listing for Hillside Residential names insurers including Georgia Medicaid; confirm current coverage with Hillside. Also ask whether phone coaching is included in the session fee or billed separately.

How to vet a DBT program before you start

Ask these on the first call, in this order.

1. Which of the four modes do you provide, and who delivers each one? If a mode is missing, ask what replaces it.
2. Is there a DBT consultation team, and is my individual therapist on it? Behavioral Tech calls the team essential to fidelity.
3. When can I use phone coaching, and what happens after hours?
4. How do you assess and respond to suicide risk? In the 2015 trial, every clinician used DBT’s structured risk protocol.
5. How long is the program, and how many times will I go through the skills curriculum?
6. Is any clinician, or the program itself, certified by the DBT-Linehan Board of Certification? For clinician certification, the board requires certain prerequisites, a DBT knowledge exam and three consecutive recorded therapy sessions; you can search certified clinicians and the board’s list of certified programs. Treat certification as one data point alongside the answers above.
7. For teens: how are parents or caregivers involved?
8. For intensive or residential care: what is the plan after discharge?

Separately, confirm any clinician’s Georgia license on the Secretary of State’s free license lookup.

DBT services in metro Atlanta

Each program below describes its DBT services on its own web pages, as checked in November 2026. The table reports what each page states and what it does not mention. It is not a ranking, an endorsement or a complete list, and services change, so confirm details directly.

Program	Format and ages, per its page	What the page says about the four modes	Worth confirming
Peachtree DBT, part of Peachtree Comprehensive Health, 3520 Piedmont Rd. NE	Weekly individual and group format; children, adolescents and adults	Describes a comprehensive program with all four: weekly individual therapy, weekly skills group, phone coaching as needed, and a consultation team	Private pay with no insurance accepted; fees are in the cost section above. The page makes no DBT-Linehan Board certification claim
Hillside, 690 Courtenay Drive NE	Residential treatment for ages 11 to 17	The DBT-Linehan Board's certified programs list includes "Hillside Residential," certified in 2018 according to the board's listing for the program	The board notes that listed programs may have expanded services since certification and that some listed offerings may not have been reviewed
Hillside virtual intensive outpatient program	Virtual IOP for ages 11 to 17 in Georgia and Florida	Lists DBT groups for teens, individual therapy, DBT coaching calls outside program hours, family therapy and a caregiver DBT skills group	Ages: the program's own page says 11 to 17, but Hillside's homepage describes it as for teens 12 to 17, so confirm eligibility for an 11-year-old before applying. The board's listing names the residential program, not this one, and the page does not mention a consultation team
Hillside DBT Day Treatment	In-person, six-week partial hospitalization program for teens 13 to 17 in Atlanta who live at home; 35 or more hours of programming a week	Hillside's homepage says the curriculum is grounded in DBT and in SEE Learning (Social Emotional Ethical Learning); it does not list the four modes	Not the program named in the board's certification listing; ask which modes are included
Skyland Trail, Atlanta nonprofit	Residential DBT for adults 18 and older and adolescents 14 to 17; adults can step down to day treatment (PHP) and IOP	For adults: weekly individual DBT, daily skills groups and 24/7 coaching; the adolescent program includes family therapy and education	No consultation team mentioned
MARR Treatment Centers, 53 Perimeter Center E	DBT integrated across its programs, which include addiction treatment	Individual sessions, a skills group and brief phone coaching between sessions	The page does not mention a consultation team or say which levels of care include DBT
Intown Counseling & Wellness, 2921 Piedmont Rd. NE	Weekly DBT skills group, generally 2 hours, in person or virtual	Skills group only; individual therapy is required for enrollment, with any therapist, who does not need DBT training; the practice consults with members' therapists	Phone coaching is not mentioned

Sources for this table: Peachtree Comprehensive Health’s DBT program overview; Hillside; DBT-Linehan Board of Certification certified programs list; DBT-Linehan Board of Certification announcement on Hillside; Hillside virtual intensive outpatient program; Skyland Trail residential DBT program; MARR Treatment Centers DBT page; Intown Counseling & Wellness DBT skills group.

The last row is an example of the skills-group format discussed above: useful for some people, but not the four-mode package tested in the adult trials. Two more skills-only options exist. Peachtree Comprehensive Health runs DBT skills groups in 8-week modules, describes them as “psycho-educational and not process-oriented,” and requires every participant to be in weekly individual therapy, with any therapist. Georgia State University’s Psychology Clinic, a training clinic open to the community, lists DBT skills groups among its services; its contact details are in the guide to where to find therapy and skills groups in Atlanta. Before joining any skills group, ask whether it requires an individual therapist and who tracks suicide risk between sessions.

Comparing programs, and what to do while you wait

Pick two or three programs whose format fits your situation and ask each the vetting questions on the same day, writing the answers side by side. Compare four answers in particular: whether all four modes are in place, how suicide risk is handled, how long the program runs, and what you will pay after insurance. If every option has a long wait, ask the intake staff what they would offer in the meantime, whether MBT or another listed therapy is available sooner, and keep the crisis lines above within reach.

This article is general information and does not replace an assessment by a licensed clinician.

Last updated: November 2026.