DBT: a therapy that can help with self-harm and impulsive behaviours

Dialectical Behaviour Therapy, DBT, is a structured talking therapy developed specifically for people who struggle to manage very intense emotions, and it has a strong evidence base for reducing self-harm.

It works by teaching skills, in four groups, that help someone recognise a difficult emotion building, understand it, and respond to it in a way that does not cause further harm.

Mindfulness

The first skill set is about staying present with a feeling rather than being swept along by it. DBT distinguishes three states of mind: a reasonable mind, which is rational but can miss what matters emotionally; an emotional mind, which is fast and strongly felt but can miss the facts; and a wise mind, which holds both. The aim of mindfulness practice in DBT is to spend more time in the wise mind, particularly in the moment before an urge to self-harm takes over.

Distress tolerance

The second skill set is about getting through an intense moment without making it worse. This does not mean the distress disappears. It means having a way to ride it out, such as an intense but safe physical sensation, a change of environment, or a fixed activity to turn to, until the urge passes rather than acting on it.

Emotion regulation

The third skill set is about understanding what an emotion is doing and why. Many people who self-harm describe the act as a way of making an unbearable feeling stop. Emotion regulation skills work upstream of that moment: noticing patterns, naming the feeling accurately, and reducing how often someone reaches crisis intensity in the first place.

Interpersonal effectiveness

The fourth skill set is about asking for what you need and setting a boundary, without the relationship or your own self-respect being the cost of doing it. Many people who struggle with self-harm also struggle with these conversations, and the two are often connected.

Getting support

DBT is usually delivered as a structured programme, often with both individual sessions and group skills training, over several months. It is available through the NHS and through some employers, and InsideOut® therapists can talk you through what a referral or a private course would involve.

If you are self-harming now, or have thoughts of harming yourself, please reach out.

In an emergency, call 999.

• Samaritans, 116 123, free, 24 hours a day

• Shout, text SHOUT to 85258 for free, confidential text support

• Harmless, a UK charity specifically for people who self-harm, at info@harmless.org.uk

Get in touch with InsideOut® to talk about what support could look like for you.