Online DBT Therapy: How Skills Groups and Individual Sessions Work Virtually

DBT Was Designed With Remote Components Built In

Here is something most people do not realize about Dialectical Behavior Therapy: one of its four core components — phone coaching — was always designed to happen remotely. When Marsha Linehan developed DBT — through the training and research organization now known as Behavioral Tech — she built in the expectation that clients would call their therapist between sessions for real-time skills coaching during crises. DBT has been partly a telehealth treatment from the start.

The remaining three components — individual therapy, skills group, and therapist consultation team — have now been extensively adapted to video delivery. And the research shows it works.

Non-inferior

Source: Behaviour Research and Therapy, 2023

How Each DBT Component Works Online

Comprehensive DBT includes four components that work together. Here is how each one translates to telehealth.

Individual Therapy via Video

The weekly individual therapy session is the backbone of DBT. In these sessions, you and your therapist review your diary card, identify the most important issues from the past week, and work through them using behavioral analysis and skills application.

This component translates to video almost seamlessly. The session structure — reviewing the diary card, identifying targets, conducting chain analyses — works identically on screen. Many therapists use shared screen features to review diary cards together or use digital diary card apps that both therapist and client can access.

The one adjustment some therapists make is spending slightly more time on grounding and check-in at the start of sessions to compensate for the reduced nonverbal information available on video.

Skills Group via Video

The DBT skills group is the component people worry about most when it comes to telehealth. Skills groups are classroom-style sessions where a group leader teaches DBT skills — mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness — and members practice together.

Online skills groups use several features of video platforms to replicate the in-person experience:

• Screen sharing allows the group leader to present skill materials, worksheets, and visual aids
• Breakout rooms enable paired practice exercises, such as role-playing interpersonal effectiveness skills
• Chat functions let members share responses without interrupting the flow, which some quieter members actually find easier than speaking up in person
• Digital whiteboards replace physical flip charts for brainstorming and recording group input

Many participants report that online skills groups feel surprisingly close to in-person groups after the first few sessions. Some find them easier to attend consistently because there is no commute, which matters in a treatment where attendance is tracked and missing sessions has consequences.

Phone Coaching

This component requires no adaptation at all. Phone coaching in DBT means calling your individual therapist between sessions when you need help applying skills to a real-life crisis or difficult situation. It was always remote. Some therapists now also offer text-based coaching for less urgent situations, which many clients find even more accessible.

Therapist Consultation Team

The fourth component — a weekly meeting where your DBT therapists consult with each other to stay effective and motivated — has also moved online. This does not directly involve you as a client, but it matters because it helps maintain the quality of your treatment. Video consultation teams function well, and some programs report that the flexibility of online meetings has actually improved attendance among their clinicians.

What the Research Shows

The evidence base for online DBT has grown considerably.

A 2023 study in Behaviour Research and Therapy examined telehealth DBT for borderline personality disorder and found outcomes that were non-inferior to in-person DBT. Participants showed significant reductions in self-harm behaviors, emotional dysregulation, and depression, with improvements comparable to those seen in traditional in-person programs.

Earlier research during the rapid telehealth expansion found that DBT skills groups adapted well to video platforms, with comparable skills acquisition and group cohesion. A 2022 study specifically examining online DBT skills groups found high participant satisfaction and no significant difference in skills usage compared to in-person groups.

It is honest to note that the research is still catching up to clinical practice. Most studies involve adaptations of existing programs rather than large randomized controlled trials designed specifically to test online delivery. But the direction of the evidence is consistently positive.

The Access Problem Online DBT Solves

One of the most compelling arguments for online DBT is practical: comprehensive DBT programs are hard to find.

DBT requires extensive specialized training — as outlined by the APA and Behavioral Tech — that goes far beyond a weekend workshop. A true comprehensive DBT program needs a team of therapists who are all trained in the model, running individual therapy, skills groups, phone coaching, and consultation team simultaneously. Many areas — including large cities — have few or no comprehensive DBT programs.

Online delivery means you can access a comprehensive program regardless of where you live. If the closest in-person DBT program is two hours away, attending weekly individual sessions and weekly skills groups in person is nearly impossible. Online makes it feasible.

This matters because research consistently shows that comprehensive DBT — all four components together — produces better outcomes than partial implementations. Online delivery makes comprehensive treatment accessible to far more people.

What Works Well Online

• Diary card review works naturally on screen, especially with digital diary card apps
• Skills teaching translates well with screen sharing and digital materials
• Behavioral chain analysis in individual sessions is conversation-based and works identically online
• Mindfulness exercises at the start of skills group can be deeply effective when practiced in your own space
• Between-session coaching was always remote
• Homework review is straightforward on video

What Requires Adjustment

• Reading emotional cues in group. Group leaders have to work harder to notice when a member is struggling, since they see less body language and can only view small video tiles
• Interpersonal effectiveness practice. Role-playing exercises require more intentional facilitation in breakout rooms than they do in person
• Crisis management. If a group member is in acute distress during an online session, the therapist cannot physically intervene. Programs address this by having clear safety plans and protocols in place before treatment begins
• Group cohesion. Some members find it harder to bond with other group members through a screen, though many report that cohesion develops naturally over time

The Bottom Line

DBT was already a partially remote treatment before telehealth became widespread. All four components — individual therapy, skills group, phone coaching, and consultation team — work online, and research supports comparable outcomes. The most important advantage of online DBT may be the simplest one: it makes comprehensive DBT programs accessible to people who would otherwise have no realistic way to attend. If you have been told you need DBT but cannot find a local program, online therapy is not a consolation prize. It is a legitimate path to the treatment you need.

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