When Your Mind Will Not Stop Circling
The house is quiet. Everything on the list got done, or close enough to done, and there’s nothing scheduled until morning. Then a thought shows up about a conversation from Tuesday. It brings a second thought about how that conversation landed. A third arrives about what happens if it comes up again next week.
An hour goes by. Nothing outside the room has changed. Inside it, the same four or five thoughts have taken a dozen laps.
Anxious thinking has a way of feeling productive while it’s happening. It reviews. It rehearses. It looks like preparation right up until morning, when the thoughts are still there and the sleep never came.
If that hour sounds familiar, one of the approaches available at Montgomery Counseling Group (MCG) in Charlotte, North Carolina is Dialectical Behavior Therapy (DBT). It’s a skills-based approach, and several of those skills apply directly to the loop described above.
What DBT Is, in Plain Terms
Dialectical Behavior Therapy was developed by psychologist Marsha Linehan in the late 1980s. The word dialectical describes one specific idea: two things that look like opposites can both be true at the same time. In therapy, that translates to accepting where you are today while working toward change at the same time, with both given equal room.
That combination matters for anxiety in particular. An approach built only on change can be read as an instruction to stop feeling something, which tends to add a second layer of pressure on top of the first. An approach built only on acceptance can leave a person sitting inside the loop with no way out of it. DBT holds both sides on purpose.
The skills themselves are organized into four areas, and people learn them the way anyone learns a practical skill, through instruction and repetition in ordinary situations. Dialectical Behavior Therapy at Montgomery Counseling Group covers the approach more broadly, across the full range of concerns it addresses.
How DBT Helps With Anxiety
Anxiety runs on a few repeating mechanics. A thought predicts something. The body responds as though the prediction already happened. Behaviors follow that reduce the discomfort in the short term while quietly teaching the loop to run again tomorrow. DBT skills work on each of those parts rather than on the content of any single anxious thought.
The four skill areas applied to anxious thinking
Mindfulness. In DBT, mindfulness means paying attention to what’s happening right now, on purpose, without adding commentary about whether it should be happening. For anxious thinking, the shift is small and specific. A thought about next Monday gets recognized as a thought about next Monday rather than as information about next Monday. What changes in daily life is the amount of time spent inside the loop. The thought still arrives. The pull to follow it for an hour loses some of its grip.
Distress tolerance. These skills address the moments when anxiety spikes and the urge to make it stop immediately takes over. Cancelling the plan or sending a fourth clarifying text brings the discomfort down within a minute or two, and each one makes the next spike slightly more likely. Distress tolerance builds the capacity to stay with a surge until it drops on its own. People often describe making fewer decisions at the peak of the feeling, and fewer decisions they revisit later with regret.
Emotion regulation. Anxiety rarely arrives at full volume out of nowhere. It builds on top of whatever state a person is already in: short sleep, a week with no space anywhere in it. Emotion regulation skills work on that underlying state, alongside the ability to name an emotion accurately while it’s still happening. Naming reduces the sense that a feeling is one large undifferentiated mass. The practical result is a lower spike and a faster return to baseline. The American Psychological Association overview of stress describes what sustained activation does to the body over time, which is part of why the groundwork matters as much as the in-the-moment skills.
Interpersonal effectiveness. Anxious thinking has a relational shape for many people. The reply that hasn’t come. The request that felt too large to make. The disagreement that got smoothed over and then replayed for three days. These skills cover asking directly, declining without over-explaining, and staying present in a conversation where the other person disagrees. When those conversations get more manageable, a large source of the rehearsing goes quiet on its own.
What DBT Was Developed For, and Who It Serves Now
A common assumption about DBT is that it belongs to one clinical population and one only. Linehan developed the approach for people experiencing Borderline Personality Disorder, and for years that was where it was studied and applied.
The research base widened considerably after that. DBT skills are now used across a range of concerns, anxiety among them, and the skills themselves were never specific to any single presenting concern. Mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness describe capacities that most people use every day without naming them. The National Institute of Mental Health information on anxiety gives a sense of how widely anxiety shows up across adults in the United States.
DBT and CBT for Anxiety: How They Differ
Cognitive Behavioral Therapy (CBT) and DBT share a family resemblance, and both have a substantial research base behind them for anxiety.
CBT examines the relationship between thoughts, feelings, and behavior, then tests anxious predictions against what happens in practice. A person learns to identify the prediction, look at the evidence for it, and run small experiments that check it against reality.
DBT keeps that change-oriented work and adds the acceptance side alongside it. When intensity climbs past a certain point, examining a thought becomes difficult, because the part of the mind that does the examining is already occupied. DBT gives someone something to do at that intensity, then returns to the thinking work once the volume comes down.
Neither approach ranks above the other, and plenty of people work well with either one. Some clinicians draw on both. Cognitive Behavioral Therapy at Montgomery Counseling Group describes that side of the work in more detail.
Is DBT a Fit If You Experience Anxiety?
DBT tends to be a good match when anxiety arrives at high intensity, when it shows up alongside strong emotional shifts, or when previous work focused on examining thoughts and the intensity kept outrunning the examination. It also fits people who prefer a structured, skills-first format with something concrete to practice between sessions.
A consultation is a conversation about what’s been happening and what has already been tried, and the fit question gets answered there rather than in advance. Plenty of people arrive without a clear sense of which approach they want, having read a few pages and recognized parts of themselves in several of them at once. That’s a reasonable place to start from. The clinician’s job in that first conversation is to describe what each option would look like week to week, so the choice gets made with concrete detail behind it. The page on anxiety support in Charlotte covers the broader range of approaches MCG clinicians use, in case another one turns out to be the better starting point.
Individual Work and Group Work
DBT skills get taught in both formats, and they do different things.
Group work builds shared skill practice. Skills are taught in sequence, everyone works on the same material, and there’s something steadying about practicing in a room where other people are learning the same thing at the same pace.
Individual work applies those skills to one person’s specific patterns. The 2 a.m. loop that belongs to one person has its own particular content, its own triggers, and its own history, and individual sessions are where that gets addressed directly.
At MCG, groups form as interest builds rather than running on a fixed annual calendar. A free consultation is how a person finds out what’s currently forming and whether the timing works. The page on group therapy at Montgomery Counseling Group describes how the practice approaches group work generally.
Working With the DBT Clinicians at MCG in Charlotte or by Telehealth
Two clinicians on the Montgomery Counseling Group team work with DBT.
Naila McConnell, LCMHCA, Certified Dialectical Behavior Therapist is a Licensed Clinical Mental Health Counselor Associate. The Certified Dialectical Behavior Therapist designation confirms completion of formal training in the DBT model along with assessed competence in delivering it. She works with adults, children, adolescents, couples, and families.
Meredith Turner-Toth, LCSW is a Senior Clinician and Licensed Clinical Social Worker, a credential that authorizes independent clinical practice in North Carolina. She is trained in Dialectical Behavior Therapy (DBT) and draws on it alongside Cognitive Behavioral Therapy (CBT), Motivational Interviewing, and trauma-informed approaches. She works with adolescents and adults.
Montgomery Counseling Group offers in-person psychotherapy at the Park Road office in Charlotte, NC and telehealth therapy across North Carolina, so the format follows what works for a person’s week rather than the other way around. The practice is in network with Aetna, Blue Cross/Blue Shield, Magellan, Medicare, and United Healthcare, bills out of network, and offers a sliding scale based on income. Current figures are listed on the rates and insurance page.
If the circling hour has been going on long enough that you’ve started planning around it, you can schedule a free consultation and talk it through with someone.
Frequently Asked Questions
I experience anxiety. Is DBT a fit for me?
DBT tends to fit well when anxiety arrives at high intensity, when it appears alongside strong emotional shifts, or when work focused on examining thoughts kept getting outpaced by the intensity itself. It also suits people who prefer a structured, skills-first format with concrete practice between sessions. Fit is a conversation rather than a checklist, and a consultation with a clinician at Montgomery Counseling Group in Charlotte, NC is where that question gets answered.
How does DBT help with anxiety?
Dialectical Behavior Therapy organizes its skills into four areas, and each one addresses a different part of how anxiety operates. Mindfulness skills change a person’s relationship to anxious thoughts, so a prediction about next week gets recognized as a thought rather than as a forecast. Distress tolerance skills build the capacity to stay with a spike until it passes rather than acting at the peak of it. Emotion regulation skills work on the underlying state that anxiety builds on, including sleep and daily structure. Interpersonal effectiveness skills address the relational situations that generate a great deal of anxious rehearsing.
How does DBT differ from CBT for anxiety?
Cognitive Behavioral Therapy examines the link between thoughts, feelings, and behavior, then tests anxious predictions against what happens in practice. Dialectical Behavior Therapy keeps that change-oriented work and pairs it with acceptance-based skills for tolerating distress and regulating emotion when intensity runs high. Both approaches have substantial research behind them for anxiety, both are used at Montgomery Counseling Group, and many clinicians draw on elements of each.
What is the difference between DBT skills in a group and DBT in individual sessions?
Group work teaches DBT skills in sequence to several people at once, which builds shared practice and a common vocabulary among participants. Individual work applies those same skills to one person’s specific patterns, triggers, and history. Many people use both formats, and either format can work by itself. At Montgomery Counseling Group, groups form as interest builds, and a free consultation is how a person finds out what’s currently forming.
Which DBT skills help most with anxious overthinking?
Mindfulness and distress tolerance skills speak most directly to rumination. Mindfulness practice shifts how a person relates to a repetitive thought, so the thought registers as mental activity rather than as reliable information about the future, which shortens the time spent circling. Distress tolerance skills address the discomfort that repetitive thinking generates, building the capacity to sit with a surge rather than acting to end it immediately. Which skills matter most varies by person, and that gets sorted out in the work itself.
Was DBT only designed for one clinical population?
Dialectical Behavior Therapy was originally developed for a specific clinical group in the late 1980s, and its research base and clinical use have both widened substantially since then. The four skill areas, mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, describe general human capacities rather than anything tied to a single presenting concern, and DBT skills are now applied across a broad range of concerns, including anxiety.
