Dialectical Behaviour Therapy (DBT) in Toronto
Build skills for emotional regulation, distress tolerance, and meaningful relationships
Book a SessionWhat is Dialectical Behaviour Therapy?
Dialectical Behaviour Therapy (DBT) is an evidence-based cognitive-behavioural treatment developed in the late 1980s by psychologist Dr. Marsha Linehan at the University of Washington. Originally designed to treat individuals with borderline personality disorder (BPD) and chronic suicidality, DBT has since been adapted and validated for a wide range of conditions characterized by emotional dysregulation, impulsivity, and interpersonal difficulties.
The term "dialectical" refers to the synthesis of opposites—a core philosophy of DBT. The primary dialectic in DBT is between acceptance and change: accepting yourself and your current reality exactly as it is, while simultaneously working to change patterns that no longer serve you. According to research from the Centre for Addiction and Mental Health (CAMH), this balance between validation and change strategies is what makes DBT uniquely effective for individuals who struggle with intense emotions (Dimeff & Koerner, 2007).
DBT is structured around teaching four core skill sets: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. These skills provide concrete, practical tools you can use in everyday situations to manage intense emotions, navigate crises, improve relationships, and build a life worth living.
The Four Core DBT Skills
DBT teaches four interconnected skill modules:
1. Mindfulness
The foundation of all DBT skills. Mindfulness teaches you to be present in the moment, observe your thoughts and feelings without judgment, and engage fully in your current experience. Skills include "Wise Mind" (balancing emotion and reason), "What" skills (observe, describe, participate), and "How" skills (non-judgmentally, one-mindfully, effectively).
2. Distress Tolerance
Skills for surviving crises without making things worse. These include TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation), ACCEPTS (activities, contributing, comparisons, emotions, pushing away, thoughts, sensations), self-soothing with the five senses, and radical acceptance of painful realities.
3. Emotion Regulation
Understanding and managing intense emotions. Skills include identifying and labeling emotions, understanding the function of emotions, reducing emotional vulnerability through self-care (PLEASE skills), increasing positive emotional experiences, and using opposite action and problem-solving to change unwanted emotions.
4. Interpersonal Effectiveness
Navigating relationships while maintaining self-respect and effectiveness. Skills include DEAR MAN (describe, express, assert, reinforce, mindful, appear confident, negotiate) for asking for what you need, GIVE (gentle, interested, validate, easy manner) for maintaining relationships, and FAST (fair, no apologies, stick to values, truthful) for self-respect.
Research from the University of Toronto's Department of Psychiatry demonstrates that learning and practicing these skills leads to significant reductions in emotional dysregulation, self-harm, suicidal ideation, and interpersonal conflict (Links & Shah, 2011, Canadian Journal of Psychiatry).
What DBT Helps With
According to the American Psychological Association and Canadian Psychological Association, DBT has strong empirical support for:
- Borderline Personality Disorder (BPD) - The gold standard treatment
- Emotional Dysregulation - Intense, rapidly shifting emotions
- Self-Harm and Suicidal Ideation - Non-suicidal self-injury, chronic suicidality
- Eating Disorders - Binge eating disorder, bulimia
- Substance Use Disorders - When combined with emotional dysregulation
- Post-Traumatic Stress Disorder (PTSD) - Especially with emotion dysregulation
- Depression - Treatment-resistant or chronic depression
- Bipolar Disorder - Emotion regulation during mood episodes
- Anxiety Disorders - Particularly when paired with emotional intensity
- Anger Management - Explosive anger, rage episodes
- Relationship Difficulties - Conflict, instability, communication issues
- Attention Deficit Hyperactivity Disorder (ADHD) - Impulsivity and emotional regulation
Research published in the Canadian Journal of Psychiatry demonstrates that DBT is effective across diverse populations and age groups, from adolescents to older adults, and can be delivered in individual, group, and virtual formats (McMain et al., 2017).
Is DBT Right for You?
DBT may be particularly helpful if you:
- Experience intense emotions that feel overwhelming or out of control
- Struggle with impulsive behaviors (spending, substance use, binge eating, self-harm)
- Have difficulty in relationships marked by conflict, instability, or fear of abandonment
- Find it hard to regulate emotions or return to baseline after becoming upset
- Engage in self-destructive behaviors when distressed
- Have been told you're "too sensitive" or "too emotional"
- Want concrete, practical skills you can use immediately
- Have tried other therapies without sufficient improvement
Important note: While standard DBT programs typically include both individual therapy and a skills training group, DBT skills can also be effectively taught in individual therapy. We'll discuss the best format for your needs during your initial session.
Evidence & Research Supporting DBT
DBT is one of the most extensively researched psychotherapies, with robust evidence for its effectiveness:
Borderline Personality Disorder
Multiple randomized controlled trials, including landmark Canadian research at CAMH by Dr. Shelley McMain, demonstrate that DBT significantly reduces self-harm, suicidal behavior, emergency room visits, and psychiatric hospitalizations in individuals with BPD (McMain et al., 2009, American Journal of Psychiatry).
Suicidal Behavior
Research shows that DBT reduces suicide attempts and non-suicidal self-injury more effectively than other treatments. A study by Linehan et al. (2006) found that DBT reduced suicide attempts by half compared to treatment-as-usual.
Eating Disorders
DBT adapted for eating disorders shows significant reductions in binge eating and purging behaviors. Research from the University of Toronto demonstrates that DBT skills, particularly emotion regulation and distress tolerance, are highly effective for binge eating disorder (Safer, Telch, & Chen, 2009).
Long-Term Outcomes
Follow-up studies show that improvements gained in DBT are maintained over time. Clients report continued skill use and sustained reductions in emotional dysregulation years after completing treatment (Linehan et al., 2015, JAMA Psychiatry).
Learn more about DBT research:
DBT Therapy Across the Greater Toronto Area
Innera provides DBT-informed individual therapy to clients throughout Toronto, Markham, North York, Scarborough, Richmond Hill, Mississauga, and across Ontario. Virtual sessions via secure, PIPEDA-certified Google Meet make accessing life-changing DBT skills convenient and accessible from anywhere in the province.
Convenient for:
- University of Toronto students and young adults seeking emotion regulation skills
- Professionals in downtown Toronto, Financial District, and surrounding areas
- Individuals throughout the GTA who prefer virtual therapy
- Anyone in Ontario looking for evidence-based skills for emotional wellness
- Clients who have struggled with other therapeutic approaches
Accessible, flexible, and effective therapy—no commute required.
About Your DBT Therapist
Elif Gökçe is a Registered Psychotherapist (Qualifying) trained in DBT principles and skills. She completed her Master's degree in Pastoral Studies with a Psychotherapy certificate from Emmanuel College at the University of Toronto, where she received training in evidence-based therapeutic modalities including DBT.
Elif's approach balances the core dialectic of DBT: radical acceptance of where you are right now, paired with compassionate encouragement toward change. She understands that intense emotions are not character flaws but understandable responses to life experiences, and that with the right skills, you can build a life that feels worth living.
Fluent in English and Turkish, Elif brings cultural sensitivity and over 20 years of counseling experience to her work, creating a warm, validating therapeutic space where skills are taught with compassion and practicality.
Frequently Asked Questions About DBT
Do I need to attend a DBT skills group?
While comprehensive DBT includes both individual therapy and a skills training group, DBT skills can also be effectively taught in individual therapy. Many clients benefit from learning DBT skills one-on-one, especially if group settings feel overwhelming or inaccessible. We'll discuss the best format for your needs and circumstances.
How long does DBT take?
Standard DBT programs typically run for 6-12 months, though this varies based on your needs and progress. Some clients benefit from shorter DBT-informed therapy focused on specific skill modules, while others engage in longer-term work. We'll regularly assess your progress and adjust accordingly.
Will I have homework between sessions?
Yes. DBT involves active between-session practice. You'll be asked to practice new skills in your daily life and complete diary cards to track your emotions, behaviors, and skill use. This practice is essential to skill mastery—just like learning a musical instrument or sport, reading about skills isn't enough; you must practice them regularly.
Do I need to have borderline personality disorder to benefit from DBT?
Absolutely not. While DBT was originally developed for BPD, its skills are helpful for anyone struggling with emotional intensity, impulsivity, relationship difficulties, or distress tolerance. You don't need a specific diagnosis to benefit from learning mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills.
Can DBT be done virtually?
Yes. Research supports the effectiveness of virtual DBT delivery. In fact, virtual sessions can be particularly beneficial because you can practice skills in your natural environment and have immediate access to your therapist's guidance without travel barriers.
Related Therapeutic Approaches
If you're interested in DBT, you might also find these approaches helpful:
Mindfulness-Based Therapy
Since mindfulness is a core component of DBT, mindfulness-based therapies offer complementary practices.
Acceptance and Commitment Therapy (ACT)
Shares DBT's emphasis on acceptance and mindfulness while adding values-based action and cognitive defusion.
Cognitive Behavioural Therapy (CBT)
DBT builds on CBT foundations; traditional CBT may be helpful for specific anxiety or depression symptoms.
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Build the skills you need to regulate emotions, tolerate distress, and create meaningful relationships. Start your journey today.
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