How Marsha Linehan’s Own battle with Mental Illness Inspired Dialectical Behavior therapy

Marsha Linehan and the History of Dialectical Behavior Therapy

by Chelsea Roff

Marsha Linehan changed the world when she created Dialectical Behavior Therapy (DBT). You’ve probably heard of DBT—maybe you’ve trained in it as a clinician, or perhaps you’ve experienced it firsthand as a patient. But what you might not know is that DBT was born from Marsha’s own lived experience of mental illness.

In the 1960s, long before DBT became a widely recognized and respected form of therapy, Marsha was a young woman battling severe mental illness. She struggled with self-harm and suicidality from a young age and spent years in psychiatric hospitals, where she endured intense treatments like electroconvulsive therapy, heavy medication, and even seclusion. At 17, she says she was one of the most disturbed patients at the hospital.

Her experiences with as a patient were traumatic, but they also led to an important realization that shaped her career: conventional psychological therapies often failed suicidal patients. At the time, most psychological treatments focused on changing behaviors. But that didn’t address the underlying pain and emotional turmoil Marsha was experiencing as a young girl. In her book, Building a Life Worth Living, she describes how in a moment of clarity, she made a vow to herself: she would get out of her hell and then come back to help others do the same.

Marsha’s turning point came when she left the hospital and spent time in a Zen monastery, where she learned the practice of radical acceptance. This profoundly simple yet life-changing concept was a significant departure from the change-focused therapies in vogue at the time. Importantly, “radical acceptance” isn’t about giving up or being passive — instead, it’s about deliberately being present with intense emotions, so that we can respond rather than react to what’s happening. Linehan drew on her spiritual experiences with Zen Buddhism and as well as her upbringing in Roman Catholicism to heal herself and later develop Dialectical Behavior Therapy

What is Dialectical Behavior Therapy?

After leaving the hospital, Marsha dedicated herself to the study of psychology. She obtained her Ph.D. in clinical psychology and started developing the framework that would become DBT. Unlike other forms of therapy at the time, DBT was different. It blended cognitive-behavioral techniques with acceptance-based strategies, teaching individuals to recognize and accept their intense emotions while also working on practical changes to improve their lives. This dual approach—the integration of acceptance and change—set DBT apart and made it a revolutionary treatment for people struggling with intense emotions, suicidality, and self-harm.

Today, DBT is recognized as the leading treatment for borderline personality disorder.

What makes DBT even more powerful is that it emerged not just from a place of academic study but from Marsha’s own lived experience of mental illness. She knew firsthand what it was like to suffer emotionally, struggle with relationships, and feel as if her life had no value. It was her own experience of finding a way forward that formed the foundation of DBT. In my opinion, this is why DBT skills—such as mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness—are so effective. Marsha herself had needed these very skills to survive.

What Does it Mean to Create a Life Worth Living?

Marsha Linehan's journey from patient to pioneering psychotherapist reminds us that we all have the ability to create a life worth living. But what does that really mean? In DBT, this concept is central to the entire therapeutic process. It’s about identifying what matters most to you—what brings joy, connection, and fulfillment—and taking steps toward building that life, even when the path forward seems impossible. It’s about learning to navigate the challenges that come your way with a sense of self-love and self-compassion.

In our recent How We Recover panel discussion, hosted in collaboration with The Eating Disorder Foundation, we invited a group of people at different stages of eating disorder recovery to share their stories and practical advice about creating a life worth living.

The conversation addressed one of the most important questions in eating disorder recovery: how do we find purpose, joy, and meaning after years of struggle? Our panelists explore the challenges they faced, the skills that helped them through tough moments, and the ways they began to build lives that were worth recovering for.

How Can Yoga and DBT Work Together?

The skills Marsha Linehan developed through DBT—mindfulness, acceptance, and the ability to change—are tools that anyone can use to in recovering from an eating disorder. Many of the principles at the core of DBT, such as emotion regulation and mindfulness, align with yoga and the approach we use at Eat Breathe Thrive . In some ways, that’s no surprise, as Marsha’s work was deeply influenced by Buddhism and her experiences in meditation.

At the heart of both DBT and yoga is the practice of mindfulness—staying present with what’s happening in the moment. In DBT, mindfulness helps people observe their thoughts and emotions without immediately reacting to them. Yoga encourages this same present-focused awareness — but it takes it one step further, by inviting mindful attention to the body. This is particularly important for people with eating disorders, who often have a disrupted relationship with their bodies. Yoga uses breath, movement, and meditation to help individuals become more aware of their physical and emotional needs so they can attend to them without disordered behaviors.

Just as DBT encourages individuals to work with intense emotions and stay present, we use yoga as an embodied practice to support emotional resilience and self-acceptance. More specifically, yoga and breathwork practices can give individuals skills to work actively with their own nervous system and foster desired states of mind. This is so important, as anxiety and depression are often key drivers of eating disorder behaviors. In some ways, yoga is an embodied practice of the DBT skills of mindfulness and emotional regulation.

What Can We Learn from Marsha Linehan’s Work?

Marsha Linehan’s story demonstrates that even the most profound experiences of suffering can lead to a meaningful life. Her experiences with mental illness and suicidality may have seemed intractable at the time, but ultimately they fueled her life’s mission and led to a therapy that has saved countless lives. DBT is now recognized as one of the most effective treatments for people with Borderline Personality Disorder, chronic suicidality, and other complex mental health challenges.

If you or someone you know is struggling, Marsha’s journey is a powerful reminder that there is always hope. So, what steps can you take today toward your own life worth living? It may start with acknowledging where you are now, reaching out for support, or beginning to practice some of the core skills of DBT. Wherever you begin, remember that change is always possible, even when it feels like it’s not. And sometimes, those who have struggled the most are the ones who end up finding the most powerful ways to help others.

About The Author

Chelsea Roff is the Founder and Director of Eat Breathe Thrive, a nonprofit organization that helps people recover from eating disorders. A certified yoga therapist, research collaborator, and educator, she has spent the better part of a decade developing and delivering somatic interventions to people with eating disorders. Prior to her work in the charitable sector, Chelsea worked as a researcher in psychoneuroimmunology under the supervision of Dr. Andrew Baum. She is currently working with Dr. Catherine Cook-Cottone on four studies to evaluate the efficacy of Eat Breathe Thrive as a preventative and complementary treatment intervention for eating disorders.