Dialectical Behavior Therapy Skills for Borderline Personality Disorder

Imagine standing in the surf as one wave after another hits. You get your footing for a second, and then the next one pulls you off balance. For many people living with borderline personality disorder (BPD), that’s what daily life can feel like. This can feel like repeated intense emotions coming in unpredictable waves.

In the DBT groups and sessions I’ve led over the years, I’ve seen how learning new skills can help people find steadier ground. DBT invites us to do something incredibly brave: to turn toward emotions that feel too big and practice meeting them differently. Bit by bit, those small shifts, such as a pause before reacting, a breath in the middle of chaos, start to add up. DBT offers more than coping skills. It helps people build a life that feels stable, meaningful, and worth living.

The good news is that the storm can be weathered. Pioneered by Dr. Marsha Linehan, PhD, dialectical behavior therapy (DBT) was originally developed specifically for people with BPD, especially those living with chronic self-harm, suicidal thoughts, or emotional pain that other therapies have struggled to address. The term dialectical reflects the balance between two forces: acceptance (you are okay exactly as you are) and change (you can learn and grow). DBT helps you hold both truths—that your pain is real, and that change is possible.

As a psychologist who has delivered DBT both in person and virtually, I’ve seen firsthand how transformative this balance can be. I also find myself using DBT skills in my own daily life, whether that’s practicing mindfulness in moments of stress or using “Check the Facts” when emotions feel strong. DBT isn’t only a therapy for BPD, it’s a framework for living more intentionally.

How does DBT work?

DBT weaves together several therapeutic components to address the core challenges of BPD: emotion dysregulation, impulsivity, and interpersonal conflict. A standard DBT program typically includes:

• Individual therapy, which focuses on applying DBT skills to real-life situations.
• Group skills training, where clients learn and practice the core skills together.
• Between-session coaching, such as brief phone check-ins, to support using skills in the moment.

Not every DBT program includes all of these pieces. Some people participate in “comprehensive DBT”, which combines individual therapy, group, and phone coaching. Others might join a DBT skills group only, or work on DBT-informed skills within individual therapy. There’s a range of options depending on what fits your needs and what’s available. Even learning the skills of DBT alone can make a meaningful difference.

In individual sessions, you and your therapist might discuss a recent conflict or urge to self-harm, trace the thoughts, emotions, and behaviors that led up to it, and identify which DBT skills could help interrupt that cycle next time.

DBT is one of the most well-researched treatments for BPD. It’s a structured, skills-based therapy designed to help people move toward what DBT calls “a life worth living.” For instance, in a 12-month community study, participants saw significant reductions in five key areas: borderline symptoms, anxiety, hopelessness, suicidal ideation, and depression.

The DBT skills toolkit: Four core modules

A central part of DBT involves learning and practicing concrete skills that help you handle strong emotions, stay present, and connect with others. These are organized into four core skill areas, with each addressing a different area of life. These skills form the heart of DBT. They’re practical tools that help people move from feeling out of control to feeling more grounded in daily life.

1. Mindfulness
Mindfulness helps you stay present and observe thoughts and emotions without judgment. It’s about noticing what’s happening inside and around you before reacting automatically. For instance, instead of being swept away by the thought “I’m worthless,” you might notice, “I’m having the thought that I’m worthless,” and allow it to pass like a wave.

2. Emotional regulation
Emotion regulation skills help you understand, name, and manage your emotions so they don’t take over. They teach you to notice feelings as signals and respond intentionally rather than impulsively. For example, you might use Check the Facts to see whether your emotions fit the situation, or use Opposite Action to do the reverse of what your emotion urges—like reaching out when sadness tells you to isolate. Practicing the PLEASE habits can also make emotions easier to manage over time.

3. Distress tolerance
Distress tolerance skills help you get through intense emotions and painful situations without making things worse. They’re about surviving the moment safely when you can’t immediately change what’s happening. For example, you might use ACCEPTS to distract yourself with an activity, connect with others, or focus on different sensations until the emotion passes. Or you might use IMPROVE—Imagery, create Meaning, Prayer, Relaxation, One Thing in the Moment, Vacation, Encouragement—to “improve the moment” by visualizing a calm scene or taking slow, deep breaths to ground yourself until the storm settles.

4. Interpersonal effectiveness
Interpersonal effectiveness skills help you communicate clearly, maintain relationships, and set healthy boundaries. They’re about asking for what you need and saying no when you must—while still showing care and respect for others. For example, you might use the DEAR MAN skill to express your needs calmly and directly, or the GIVE and FAST skills to keep your relationships strong while honoring your own values and self-respect.

Together, these four skill sets work like a toolkit: mindfulness grounds you, distress tolerance helps you through crises, emotion regulation steadies you over time, and interpersonal effectiveness strengthens your connections with others.

What about medication for BPD?

While DBT focuses on building skills to manage emotions and relationships, some people also benefit from medication as part of their treatment plan. Medication doesn’t replace therapy, but it can make it easier to engage in the work by helping stabilize mood, reduce anxiety, or manage co-occurring symptoms.

Currently, there’s no single medication approved specifically for borderline personality disorder. Instead, medications are often used to target particular symptoms like depression, mood swings, or impulsivity. They can also be used to treat co-occurring conditions such as anxiety or post-traumatic stress disorder.

The decision to use medication is highly individual. It’s best made collaboratively with a psychiatrist or prescribing provider. When combined thoughtfully, medication can support the work of therapy by creating more stability so those skills have room to take hold.

DBT skills are for everyone

Although DBT was originally developed for people with borderline personality disorder, anyone can benefit from its skills. We all face moments when emotions feel bigger than our ability to manage them. For example, snapping at someone we care about, shutting down under stress, or reacting before we’ve had a chance to think. DBT skills give us practical tools for those moments.

For example, mindfulness can help you stay grounded when your mind starts to spiral. Distress tolerance offers healthy ways to manage a bad day without falling into habits that make things worse. Emotion regulation builds the ability to notice and adjust emotions before they take over, and interpersonal effectiveness helps you communicate clearly while maintaining self-respect and connection.

As both a clinician and someone who uses these skills personally, I believe DBT’s greatest gift is that it teaches us how to live more skillfully. You don’t need a diagnosis to benefit from learning how to observe emotions, communicate needs clearly, and care for yourself during difficult times. These are human skills, and they help each of us build what DBT calls “a life worth living.”

DBT can help manage BPD

Living with BPD can feel like riding emotional waves that crash without warning. DBT offers a life raft. Through learning skills to build acceptance and change, structure and compassion, DBT helps people build stability, connection, and meaning.

For anyone curious about DBT, whether you’re struggling with intense emotions, supporting a loved one, or simply seeking healthier coping tools, know that these skills are learnable and effective. They’ve helped thousands of people, and they can help you, too.

Because at its core, DBT isn’t just about managing crises, it’s about learning to live fully, with awareness, intention, and hope.

If you or someone you know is in crisis, call or text 988 to reach the Suicide and Crisis Lifeline, or dial 911 in an emergency.