QUESTIONS WE HEAR
The short answer: DBT may help some people with bipolar disorder with emotion regulation, distress tolerance, impulsive behaviour, and relationship patterns, but the evidence is much less established than it is for borderline personality disorder. DBT should be considered an adjunct to—not a replacement for—appropriate psychiatric and medical care.
This is an important question because bipolar disorder and borderline personality disorder are often discussed together even though they are not the same condition.
Both can involve intense mood states, impulsive behaviour, relationship disruption, and periods of significant functional difficulty. But the underlying patterns, time course, and medical implications can be very different.
That difference matters for treatment.
DBT is not a substitute for bipolar disorder treatment
Bipolar disorder requires appropriate diagnostic evaluation and, when indicated, ongoing medical management. Decisions about medication, monitoring for mania or hypomania, and treatment of severe mood episodes belong with authorized medical professionals.
Psychotherapy can play an important role, but it should not be used to suggest that someone no longer needs psychiatric care simply because they are learning coping skills.
STG Health Clinical Perspective
For bipolar disorder, we think of DBT as a targeted psychotherapy tool within a broader care plan. The goal is to use DBT where it fits—without asking it to replace the parts of bipolar care that require medical expertise.
Where DBT may be useful
Even when mood episodes require medical treatment, people may still struggle with behavioural and emotional patterns that DBT is designed to address.
- responding impulsively when emotions are intense
- tolerating distress without making a difficult situation worse
- repairing relationships after conflict or episodes
- recognizing vulnerability factors such as sleep disruption and accumulated stress
- using structured tracking to notice patterns earlier
- building routines and coping strategies that support stability
These are reasonable psychotherapy targets. They are not the same thing as treating mania, hypomania, or bipolar depression with DBT alone.
What does the research say?
Research on DBT-based interventions for bipolar disorder is promising but still limited. A 2023 systematic review found preliminary evidence that DBT-based approaches may improve some mood-related and psychosocial outcomes, but many studies were small pilot or feasibility studies.
That means it is reasonable to continue studying and selectively using DBT-informed interventions in bipolar care, but it would be too strong to describe DBT as an established stand-alone treatment for bipolar disorder.
The evidence base and clinical role are different from DBT’s role in borderline personality disorder.
Why sleep and routine matter so much
Sleep disruption deserves special attention in bipolar disorder. Changes in sleep, energy, activity, or behaviour may have more clinical significance than they would in an ordinary stressful week.
DBT skills can help someone notice vulnerability and respond more deliberately, but significant changes in sleep or activation should also be discussed with the medical professional responsible for bipolar treatment.
The purpose of tracking is not to self-diagnose a mood episode. It is to make important changes visible sooner.
The Two-Track Bipolar Care Model
A useful way to think about DBT in bipolar care is to keep two tracks active at the same time:
- Medical track: diagnosis, medication decisions, physical-health considerations, monitoring for mania or hypomania, and urgent psychiatric assessment when needed.
- Psychotherapy track: emotion regulation, distress tolerance, relationship skills, behavioural analysis, routines, coping, and relapse-prevention behaviour.
The two tracks should support each other rather than compete.
What if I am not sure whether it is bipolar disorder or BPD?
That is a situation where careful assessment matters. Both diagnoses can involve emotional intensity, impulsivity, and relationship difficulties, but the pattern across time is not identical.
It is not useful to choose a diagnosis based on one symptom or an online checklist. A clinician needs to look at episode duration, baseline functioning, developmental history, sleep and energy changes, relationship patterns, impulsivity, trauma history, substance use, medication response, and other relevant factors.
DBT skills may still be useful while diagnostic clarification is occurring, but treatment planning should not ignore the diagnostic question.
Questions people also ask
Can DBT prevent a manic episode?
DBT should not be relied on as a medical prevention strategy for mania. It may support routines, awareness, and behavioural coping, but bipolar relapse prevention should include appropriate medical care.
Can I do DBT while taking bipolar medication?
Yes. Psychotherapy and medication are often used together. Medication changes should be discussed with the prescriber rather than made on the basis of DBT progress alone.
Can emotion regulation skills help during bipolar depression?
Some DBT skills may support coping, behavioural activation, distress tolerance, and relationships, but the broader treatment plan should still address the depressive episode clinically and medically where appropriate.
Does having bipolar disorder rule out BPD?
No. The conditions can co-occur, but determining that requires careful assessment rather than assuming one diagnosis excludes the other.
What can I do next?
Review DBT for Bipolar Patterns and the Bipolar Patterns resource. If you complete intake, include your current diagnosis, medication, prescriber involvement, episode history, sleep changes, and any safety concerns.
You may also be wondering
Do I Need a Borderline Personality Disorder Diagnosis to Benefit From DBT?
How Do I Know Whether I Need Comprehensive DBT or a Skills Group?
Clinical sources and further reading
- American Psychiatric Association: Practice Guideline for the Treatment of Patients With Borderline Personality Disorder (2024)
- NICE: Borderline personality disorder — recognition and management
- Behavioral Tech Institute: DBT Skills Training
- Jones et al. (2023): Systematic review of DBT for mood symptoms in bipolar disorders
Clinical review
Clinically reviewed by Chris de Feijter, EdD., MACP
Clinical Lead & CEO, STG Health Services Inc.
DBT Saskatchewan
DBT Saskatchewan is a specialized DBT service of STG Health Services Inc.
Educational information only. DBT does not replace psychiatric diagnosis, prescribing, medication monitoring, or emergency care. Discuss medication changes or major shifts in sleep, energy, activity, or mood with the clinician responsible for your medical treatment.
