For some people with bipolar disorder, dialectical behavioral therapy (DBT) can help increase emotional stability. It can also help people navigate mood changes and improve their relationships.
DBT was originally designed as a treatment for borderline personality disorder. It focuses on mindfulness, distress tolerance, emotional stability, and interpersonal skills.
DBT can help a person manage manic and depressive episodes. But people with bipolar disorder may also need medication and other forms of therapy.
Bipolar disorder is a mood disorder characterized by intense, destabilizing mood changes. People with bipolar disorder experience a combination of depressive and manic episodes.
Depressive episodes can look like a decline in mood, loss of interest in activities, and low motivation. Manic episodes, on the other hand, can look like a sense of euphoria and a burst of energy, little need for sleep. Someone in a manic episode might engage in reckless behavior or seem particularly impulsive.
While there’s no cure for bipolar disorder, it can be managed with the right support. Dialectical behavioral therapy (DBT) can be an effective treatment [1] for mood disorders. Like all types of therapy, it isn’t necessarily right for everyone. But learning more about this approach can help you decide if it’s something you’d like to explore.
What happens in DBT for bipolar disorder?
Unlike some forms of therapy, which can be more free flowing, DBT is a structured program. It became well known as a frontline treatment for borderline personality disorder (BPD). But it can help people living with other conditions, including bipolar disorder.
DBT may include individual and group therapy sessions and usually lasts six months to a year [2]. Sessions occur weekly and can take between 40 and 60 minutes [2].
During that time, you’ll focus on the four main themes of DBT [3]:
Mindfulness: When a manic or depressive episode occurs, it can be hard to stay in the “here and now.” Practicing mindfulness can help you slow down to notice what’s happening in your mind, body, and environment (without judging what comes up). Activities like breathwork or body scans can help you maintain a present focus.
Emotional regulation: Many people with bipolar disorder struggle to control their emotions. And unfortunately, emotional volatility can worsen other symptoms. Emotional regulation isn’t about suppressing or avoiding uncomfortable feelings. It’s about identifying your triggers and learning coping skills to make those feelings more manageable.
Distress tolerance: Everyone experiences emotional distress sometimes. But it’s how you respond to it that counts. In DBT, people learn how to sit with discomfort without turning to harmful behaviors. For example, when you’re upset, your therapist might encourage you to pause, assess the situation, set an intention, and then take action.
Interpersonal skills: Left untreated, bipolar disorder can take a toll on relationships. So part of DBT is helping people learn to communicate effectively, solve problems collaboratively, and view situations from other perspectives. DBT also focuses on setting healthy boundaries and cultivating self-respect.
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How does DBT help with bipolar disorder?
Research [4] shows that DBT is a promising treatment for bipolar disorder. This is likely due to its emphasis on improving emotional regulation. Because DBT was originally designed as a treatment for BPD, it targets some of the shared symptoms. These include mood instability, impulsive behavior, and suicidality.*
One of the benefits of DBT is that it can be used as part of a broader care plan. Treatment for bipolar disorder typically includes therapy, medication, and lifestyle changes. DBT can be used alongside these other interventions [1] to increase stability and promote positive outcomes.
*A note on safety: The 988 Suicide and Crisis Lifeline provides 24/7, confidential support with trained crisis counselors. If you or a loved one is in emotional distress or a suicidal crisis, please call or text 988.
If experiencing a life-threatening emergency or you need immediate help, please call 911.
Common questions about DBT for bipolar disorder
If you have bipolar disorder, you’re probably wondering if DBT could be right for you. The following questions can help you evaluate this treatment type and if it makes sense for your situation and goals.
What’s the difference between CBT and DBT for bipolar disorder?
Cognitive behavioral therapy [5] (CBT) is one of the most common forms of mental healthcare — often referred to as “talk therapy.” CBT promotes positive behavior change by helping people identify and replace unhelpful thoughts. It’s often used to address common mental health concerns like depression and anxiety.
Technically, DBT is a form of CBT [2], and that’s likely why they’re frequently compared. However, DBT has been adapted to focus on improving emotional regulation and increasing distress tolerance. It’s typically used to treat conditions that cause emotional instability, major mood changes, and self-harm or suicidality.
Can you do CBT and DBT at the same time for bipolar disorder?
You can combine CBT with DBT. But you should discuss the pros and cons of this approach with your provider(s) first. Combining these treatments could be helpful, depending on your diagnosis, the presence of co-occurring conditions, and other considerations.
For some people, CBT can be a way to explore what’s driving their thoughts, feelings, and behaviors. These insights may help you identify your triggers and prevent mood episodes. DBT skills, on the other hand, may be more useful “in the moment.” In other words, if you’re already experiencing a manic or depressive episode, you can use what you learn in DBT to reduce escalation, regulate your emotions, and stay safe.
Is there anyone DBT isn’t recommended for?
Like all types of therapy, DBT isn’t right for everyone. To benefit from DBT, a person must be able to understand the concepts and do the activities. Therefore, DBT might not be helpful for a person who’s under the influence of substances or experiencing psychosis, or who has significant cognitive impairments.
What’s the outlook with DBT for bipolar disorder?
According to a 2019 study [1], the outlook for treating bipolar disorder with DBT is somewhat mixed. The study found that DBT can reduce the severity of mood episodes and improve executive functioning for people with bipolar disorder. However, DBT may be less effective for other bipolar symptoms like emotional instability and impulsivity.
Getting started with DBT for bipolar disorder
If you’re interested in trying DBT for bipolar disorder, keep in mind that you may need other supports. Most people with bipolar disorder benefit from integrated care that includes therapy and medication. If you’re working with a therapist, you can ask them about their experience with DBT. Let them know why you’re interested in it, and ask about incorporating it into your sessions.
If you don’t have a therapist, you can ask one of your other providers for a referral. Tell them that you’re looking for someone who specializes in DBT and bipolar disorder.
You can also check teletherapy platforms and online therapist directories. Look for providers who have specific training in DBT. When you meet with them, you can ask about how they adapt DBT concepts for bipolar disorder treatment and any other questions you may have.
A common misconception is that DBT replaces medication for bipolar disorder. DBT works best as a support skill set alongside medication, helping patients manage emotions and behaviors while mood symptoms are treated medically.
Brandy Chalmers, LPC
Clinical reviewer
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DBT is a structured treatment that can help people manage the symptoms of bipolar disorder. It usually involves weekly sessions and lasts about 6 months to a year. This approach focuses on mindfulness, distress tolerance, emotional regulation, and building healthy relationships. These skills help people manage the mood changes brought on by bipolar disorder.
At Rula, we’re here to help you feel better. Rula makes it easy to find a licensed therapist or psychiatric provider who takes your insurance. That way, you don’t have to choose between great care and a price you can afford.
Rula patients pay about $15 per session with insurance, and 93% say they feel better after getting care through Rula. We have 21,000+ providers, and appointments are available as soon as tomorrow. We’re here to help you take the next step — wherever you are in your mental health journey.
References
- Effectiveness of Dialectical Behavioral Therapy on Executive Function, Emotional Control and Severity of Symptoms in Patients with Bipolar I Disorder https://pmc.ncbi.nlm.nih.gov/articles/PMC6796294/#sec1-5
- Dialectical Behavior Therapy (DBT) https://my.clevelandclinic.org/health/treatments/22838-dialectical-behavior-therapy-dbt
- The Dialectical Behavior Therapy Skills Workbook: Practical DBT Exercises https://books.google.com/books?hl=en&lr=&id=CjqvDwAAQBAJ&oi=fnd&pg=PT10&dq=Mindfulness+Emotional+regulation+Distress+tolerance+Interpersonal+skills&ots=D2LNoI9Xvm&sig=tTyobewhNx4U24Bhit7VOAbeO88#v=onepage&q=Mindfulness%20Emotional%20regulation%20Distress%20tolerance%20Interpersonal%20skills&f=false
- A systematic review on the effectiveness of dialectical behavior therapy for improving mood symptoms in bipolar disorders https://link.springer.com/article/10.1186/s40345-023-00288-6
- What is Cognitive Behavioral Therapy? https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
Liz Talago
Liz Talago, M.ed. is a mental health professional turned content writer and strategist based in the Detroit metro area. As an independent consultant for mental health organizations, Liz creates meaningful connections between brands and their audiences through strategic storytelling. Liz is known for championing diverse perspectives within the mental health industry and translating bold ideas into inspiring, affirming digital experiences.
In her free time, you can find her hiking with her two German Shepherds, puttering around her dahlia garden, or spending time with her family.
Brandy Chalmers, LPC
Having faced challenges like childhood abuse, neglect, and the loss of her father to suicide, Brandy Chalmers is deeply passionate about providing compassionate care. She is a Licensed Professional Counselor, Nationally Certified Counselor, and Registered Play Therapist with a Master’s Degree in Clinical Counseling and Marriage and Family Therapy.
Brandy also teaches at a university, sharing her expertise with future mental health professionals. With over a decade of experience in settings like inpatient care and private practice, she specializes in helping clients with perfectionism, trauma, personality disorders, eating disorders, and life changes.
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