What is the 24 Hour Rule In DBT?
Dialectical Behavior Therapy (DBT) is a highly structured and evidence-based treatment designed to help individuals struggling with emotional dysregulation, self-harm, suicidal thoughts, eating disorders, and trauma. One of the key policies in DBT is the 24-hour rule, which plays an important role in promoting long-term recovery and skill use.
What does the rule mean?
The 24-hour rule states that if a client engages in self-harm or a suicide attempt, their individual DBT therapist will not provide coaching calls or additional crisis support for 24 hours following the incident.
This rule does not mean clients are abandoned or their regularly scheduled therapy sessions are canceled. Instead, it specifically applies to between-session crisis coaching calls, an important component of DBT meant to help clients generalize skills in real-life situations.
Why Does the 24-Hour Rule Exist?
At first glance, this rule may seem harsh, but it is designed to support clients in their recovery. The primary goals of the 24-hour rule are:
Preventing reinforcement of self-harming behaviors – In behavioral therapy, any response that follows a behavior can inadvertently reinforce it. If a therapist provides immediate support after self-harm, it could unintentionally increase the likelihood of the behavior occurring again. The 24-hour rule prevents this cycle.
Encouraging skill use – DBT emphasizes learning and applying coping strategies independently. By removing immediate access to therapist coaching after self-harm, clients are encouraged to rely on DBT skills rather than external support.
Maintaining treatment effectiveness – The rule helps ensure that therapy focuses on long-term growth rather than crisis-driven interactions.
What Should Clients Do Instead?
During the 24 hours after self-harm, clients are encouraged to:
Use DBT skills – Clients can use distress tolerance, emotion regulation, and mindfulness strategies to manage urges and emotions.
Reach out to their support system – While coaching calls are restricted, clients can still seek support from trusted friends, family, or crisis hotlines if they need immediate help.
Reflect on the situation – Taking time to identify what led to self-harm and what skills could have been used instead is an important part of learning and growth in DBT.
Addressing Concerns About the 24-Hour Rule
Some clients worry that this rule means they won’t get help when they need it most. However, it’s important to remember:
The rule is not a punishment. It’s meant to encourage independence and prevent reinforcing harmful behaviors.
Scheduled therapy sessions continue as planned. Clients can still discuss what happened and problem-solve with their therapist in their next session.
In emergencies, crisis services are always available. If a client is at immediate risk, they should contact emergency services or a crisis hotline such as 988.
