How Does Dialectical Behavioral Therapy Work?

Self-harm is often a way someone tries to cope with overwhelming emotions, emotional pain, stress, shame, or feelings they do not know how to manage yet. While behaviors like cutting yourself may provide temporary relief, self-harm usually does not resolve the deeper emotions underneath the urge. Therapy can help people understand why self-harming happens and learn healthier ways to handle intense feelings.

Important Note:  If you feel at risk of hurting yourself or are in immediate danger, call or text 988 for the Suicide & Crisis Lifeline, text HOME to 741741 for Crisis Text Line, or call 911 for emergency support. 988 and Crisis Text Line both offer free, confidential crisis support.

Key Takeaways

• Self-harm is often a coping response to emotional distress, not a sign of attention-seeking.
• Many people who self-harm are trying to manage overwhelming feelings, not necessarily end their lives.
• Safer coping strategies and therapy can reduce self-harm urges.
• Dialectical Behavior Therapy (DBT) can help teens build skills in emotion regulation and distress tolerance.
• Support from trusted people can make recovery feel more possible.

Table of Contents

• What emotions or situations trigger self-harm urges?
• Is self-harm always connected to suicidal thoughts?
• What can I do instead when I feel the urge to self-harm?
• How do I tell someone I’ve been self-harming?
• How can therapy help with self-harm?
• Frequently Asked Questions

What emotions or situations trigger self-harm urges?

Self-harm urges often happen when emotions feel too intense, overwhelming, or difficult to express. Many people who self-harm describe feeling trapped by emotions such as sadness, anger, guilt, loneliness, anxiety, or shame.

For some teenagers, self-harm can become a response to stressful situations at school, relationship conflicts, family challenges, bullying, trauma, or struggles with self-esteem. The urge may feel like an attempt to gain control when everything else feels unpredictable.

Self-harming can also happen when someone feels emotionally numb. Some people use self-harm because they are trying to feel something when they feel disconnected from themselves or their emotions.

Understanding triggers is an important part of recovery. Therapy often helps people identify emotional patterns, recognize warning signs, and develop coping skills before urges become overwhelming.

Is self-harm always connected to suicidal thoughts?

Self-harm is not always connected to suicidal thoughts, but any self-harm behavior should be taken seriously. Some people self-harm as a way to manage emotional pain without wanting to die, while others may experience suicidal thoughts along with self-harm.

The reasons behind self-harm can be different for every person. Some individuals may use self-harm to release intense emotions, communicate distress, punish themselves, or regain a sense of control.

A mental health professional can help identify what self-harm means for each individual and determine what type of support is needed. Open conversations about self-harm can help reduce shame and create opportunities for healing.

If you or someone you know is struggling with suicidal thoughts or self-harm behaviors, Southlake Counseling provides support for suicidal and self-harm behaviors through compassionate, evidence-based care.

What can I do instead when I feel the urge to self-harm?

Healthy alternatives to self-harm focus on managing intense emotions until the urge passes. The goal is not to ignore emotions but to create a safer way to move through them.

Some coping strategies may include:

• Taking slow breaths and focusing on the present moment
• Writing down thoughts and emotions without judging them
• Listening to calming music
• Talking with a trusted friend, family member, or therapist
• Using grounding techniques to reconnect with the current moment
• Practicing skills that reduce emotional intensity

Different strategies work for different people. Finding effective coping tools often requires practice and support.

Dialectical Behavior Therapy (DBT) is one therapy approach that teaches skills for managing strong emotions, tolerating distress, and improving relationships.

A 2021 systematic review and meta-analysis found that Dialectical Behavior Therapy for Adolescents was effective in reducing self-harm and suicidal ideation, supporting DBT as a helpful treatment option for young people struggling with intense emotions and self-harm urges.

How do I tell someone I’ve been self-harming?

You can tell someone you have been self-harming by choosing a trusted person and explaining that you need support. You do not have to explain everything perfectly to ask for help.

You can start with a simple statement such as, “I have been struggling and I have been hurting myself. I need support.” Choosing someone who is likely to respond with care, such as a parent, trusted adult, counselor, or therapist, can make the conversation easier.

People who self-harm carry feelings of guilt or embarrassment. Remembering that self-harm is a sign of emotional distress—not a personal failure—can make it easier to reach out.

A supportive person can help you find professional resources and create a plan for managing difficult moments.

Frequently Asked Questions

What is considered self-harm?

Self-harm is any behavior where someone intentionally hurts themselves as a way of coping with emotional distress. Self-harm can take different forms, but the underlying reason is often connected to managing difficult emotions.

Self-harm is usually a sign that someone needs support, understanding, and healthier coping tools.

Why do people self-harm even when they want to stop?

People may continue self-harming because the behavior can temporarily reduce emotional distress or provide a sense of relief. Over time, the brain can begin associating self-harm with emotional regulation.

Therapy can help people break this pattern by replacing self-harm with safer coping strategies.

Can self-harm become a habit or coping pattern?

Self-harm can become a repeated coping pattern when someone relies on it during moments of intense emotional distress. The behavior may feel difficult to stop because it has become a familiar response.

Learning new emotional regulation skills can help reduce reliance on self-harm over time.

What type of therapy helps with self-harm?

Dialectical Behavior Therapy (DBT) is one evidence-based therapy approach that can help people struggling with self-harm. DBT teaches skills related to emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness.

Other therapy approaches may also be helpful depending on a person’s individual needs and experiences.

How can parents support a teen who is self-harming?

Parents can support a teen who self-harms by responding with compassion, listening without judgment, and helping the teen access professional support. Staying calm and focusing on understanding the teen’s emotions can encourage honest communication.

A mental health professional can help families learn how to provide support while also helping the teen build independence and coping skills.

Important Note:  If you feel at risk of hurting yourself or are in immediate danger, call or text 988 for the Suicide & Crisis Lifeline, text HOME to 741741 for Crisis Text Line, or call 911 for emergency support. 988 and Crisis Text Line both offer free, confidential crisis support.