DBT helped me with my illness because it taught me other ways to express myself. Now, I can express my emotions in different words and I've really expanded my vocabulary so other people know what I am feeling and how they can help me.

– Skyland Trail alumni

Dialectical Behavior Therapy (DBT)

DBT for borderline personality disorder, self-harm, frequent suicide attempts, and emotion regulation

We offer specialized, intensive dialectical behavior therapy (DBT) treatment programs for adults for whom DBT is indicated, including those with a borderline personality disorder diagnosis.

Clients who participate in our intensive DBT treatment community often have symptoms that include impulsivity, self-injurious behaviors or frequent suicide attempts. They also often have extreme emotional reactions to what others perceive as "day-to-day" frustrations or mildly stressful situations. Many of our DBT clients have tried other models of therapy unsuccessfully.

Our most intensive level of care is our DBT residential treatment program. Clients who admit to our residential DBT program may step-down to our nonresidential day treatment and intensive outpatient programs as their skills improve. We do not admit clients directly to our DBT day treatment or intensive outpatient programs.

Skyland Trail also offers a DBT outpatient program, which is open to graduates of our 90-day intensive program as well as adults with no prior relationship with Skyland Trail.

Watch Video: Andrea's Journey

"After several hospitalizations, Skyland Trail was my last hope. If I was going to survive, this was going to be the place that did it, because I felt like I had done everything else." Hear Andrea's story of discovering skills, hope, and a better future.
Watch Video >

About our residential dialectical behavior therapy program

As one of the best dialectical behavior therapy treatment centers, Skyland Trail applies a system-wide DBT approach to a continuum of care from our DBT residential treatment program to day treatment to intensive outpatient programs. Our around-the-clock, certified DBT treatment team is trained in coaching DBT skills and understands how to support recovery for our DBT clients.

Clients who admit to our dialectical behavior therapy residential treatment program complete a 90-day DBT curriculum.

Our DBT recovery community provides a validating and safe environment for clients to learn coping skills to manage the stress that they encounter in life. Through one-on-one and group therapy sessions, DBT clients learn to be aware of what they are thinking and feeling in the moment. 

Instead of becoming overwhelmed and reacting with intense or desperate behavior, clients learn to recognize their specific emotions and respond with healthy strategies to maintain control and feel better. Mindfulness of the moment, effectively managing personal relationships and learning to tolerate unexpected events are just a few ways DBT is helpful for clients struggling with BPD or emotional dysregulation.

Practice is key. Clients practice using their new skills in our expressive therapy groups and in "real world" situations as they gradually take on greater daily responsibilities and move toward independent living.

Recovery is Possible: Aina's Story

"Early in life, I decided I would give the people what they want. I would smile, dance and keep them laughing. That approach to life and relationships led me to the very thing I was trying to avoid."
Read Aina's Story >

Building a foundation of DBT skills for independent living and continued therapeutic work

The 90-day residential DBT treatment program at Skyland Trail addresses stage 1 of DBT therapy, which focuses on attaining foundational skills and capacity to manage suicidal behaviors, therapy-interfering behaviors, major quality-of-life-interfering behaviors, and deficits in behavioral skills. Dr. Marsha Linehan, creator of DBT, describes the goal of stage 1 as, "moving from being out of control of one's behavior to being in control."

Although many clients in our DBT program are learning to cope with trauma, the focus of stage 1 of DBT therapy does not involve working directly on post-traumatic stress. Instead, the goal of DBT treatment at Skyland Trail is to help clients develop practical strategies to cope with intense emotions so that they can prevent repeat hospitalizations, practice healthy coping skills, and build trusting relationships with therapists. 

Once they have learned the shared language and framework of DBT, and can use DBT skills to effectively participate in therapy and supportive social relationships, clients are prepared to continue therapeutic work on an outpatient basis in the community while living independently.

Listen: About Our DBT Program

DBT Program with Catherine Moon

DBT Primary Counselor Catherine Moon, LMSW, explains the DBT Program at Skyland Trail.
Listen >

What is dialectical behavior therapy (DBT)?

Although fairly new to psychotherapy, DBT is one of the most researched treatments for borderline personality disorder and other mood disorders. It has been shown to be significantly effective in reducing suicidal ideation common to those diagnosed with BPD, as well as improving a client’s ability to resist acting impulsively in stressful situations.

DBT is based on cognitive behavioral therapy (CBT), which has been used effectively for many years to treat individuals with mood and anxiety disorders. CBT is not effective for everyone - particularly for people who engage in self-injury, attempt suicide frequently, or struggle with intense emotions. Dr. Marsha Linehan adapted traditional CBT by adding therapeutic work focused on validation, acceptance and dialectics to meet the unique needs of these patients.

The overall goal of DBT is to help clients create a “life worth living.” Clients are encouraged to define what a "life worth living" looks like for them, and it varies from client to client. As a group then, clients work toward addressing problem behaviors that are barriers to accessing that life.

CBT helps clients understand the relationship between their thoughts, feelings and behaviors. While traditional CBT asks clients to change unhealthy thinking patterns and maladaptive behaviors, DBT also validates a client's lived experience and acknowledges the truth in the client's point of view. 

DBT treatment also teaches clients to recognize what they have the power to change and what they must learn to accept. If they must accept the experience of pain, clients learn skills to cope with it. As they practice those skills, clients learn that they can stand the pain and still live a meaningful life.

The "dialectical" part of dialectical behavior therapy helps clients challenge rigid thinking patterns and discover that the "truth" is often more gray than black-and-white. A friend can be late for an appointment AND still respect you. You can make a mistake AND still be a good person. If you cannot tolerate your boss, can we look at the other side of the coin and see if the reverse could also be true to some extent?

Clients participating in DBT therapy receive weekly one-on-one counseling sessions with their primary counselor, participate in skills groups, and have access to 24 phone coaching as needed. Clients also complete homework assignments and are asked to apply DBT skills learned in group to real-life experiences.

DBT skills are taught in four modules: 

  1. Emotion Regulation
  2. Distress Tolerance
  3. Mindfulness
  4. Interpersonal Effectiveness

Acceptance and Change: An Interview with DBT Creator Dr. Marsha Linehan

"DBT combines acceptance and change. There is a dialectic tension between accepting reality and changing reality, and you really need to have both of those to go forward," says Marsha Linnehan, creator of DBT.  

Read interview with Dr. Linehan >

Results of DBT treatment

Learning healthy coping and interpersonal skills after years of relying on maladaptive behaviors to handle stress is challenging and difficult work. But with a new set of skills as a resource, our clients can benefit more fully from less intensive, ongoing therapy and supportive social relationships.

After leaving Skyland Trail, our dialectical behavior program graduates often transition to weekly therapy with an outpatient psychotherapist who can continue to help them manage stress appropriately, build meaningful relationships and achieve their goals. Dr. Marsha Linehan, who developed DBT, described the goal of dialectical behavior therapy as creating "a life worth living."

Recovery Is Possible: Shelley's Story

"For the first time in my 25+ years of living with bipolar disorder and borderline personality disorder traits, I began to learn practical coping skills for handling extreme sensitivity, mood swings, and how to survive – a word used often in DBT – emotionally difficult or painful circumstances and events without hurting myself or those around me."
Read Shelley's Story >

Outpatient DBT coaching and outpatient DBT groups for clients and families

Skyland Trail also offers an Outpatient DBT program in Atlanta including DBT therapy and skills training groups for clients as well as family members and friends. The outpatient program may be an appropriate next step for clients stepping down from residential or day treatment. However, the outpatient dialectical behavior therapy program also is open to clients and families with no prior relationship with Skyland Trail.

Learn more about Outpatient DBT

Doughnuts and the Beach: The Importance of DBT

"Dialectics can open a new way of seeing the world and provide relief to patients who historically saw only one option in difficult situations," says Dr. Ray Kotwicki, Skyland Trail Chief Medical Officer.  

Read the Importance of DBT >

Expert Insight: Cutting and Self-Harm

"Individuals who cut themselves or engage in other self-injurious behaviors often are dealing with emotional pain or confusion that they do not know how to process in any other way," says Dr. Ray Kotwicki, Skyland Trail Chief Medical Officer.  

Read Cutting and Self-Harm >