Treatment for emotion regulation difficulties

If strong feelings keep causing trouble in your life, therapy can help. Some therapies were built to target emotion regulation directly. Others focus on a condition such as anxiety or depression, and emotion regulation tends to improve along the way.¹

This page explains the main therapies, how well they work, and what to expect. It also covers how to find a therapist. You do not need a diagnosis of borderline personality disorder (BPD) or any other condition to ask for help with your emotions.

Therapies at a glance

The badges show how strong the research is. See how we rate evidence.

Dialectical behavior therapy (DBT)

Psychologist Marsha Linehan created DBT for people with BPD who had repeated suicidal behavior. "Dialectical" means holding two ideas at once: accepting yourself as you are, and working to change.

What it includes. Standard DBT has four parts: weekly individual therapy, a weekly skills group, phone coaching between sessions, and a team that supports the therapists.⁶ In major trials, treatment lasted about a year.⁶ The skills group teaches mindfulness, distress tolerance, emotion regulation and getting along with others. See our DBT skills pages.

How well it works. A 2020 Cochrane review pulled together 75 trials with more than 4,500 people with BPD. Compared with usual care, DBT reduced BPD symptoms and self-harm and improved daily functioning. The review authors rated the evidence as low certainty, so future studies could change the picture.² We rate it moderate for that reason, even though DBT has more trials than any other therapy for BPD and UK guidelines recommend it for teens who self-harm.^2,5

Skills matter. In a trial of 99 women with BPD at high risk of suicide, all versions of DBT lowered suicide attempts. But versions that included skills training reduced self-harm and depression more than DBT without it.⁶

For adults who self-harm. A Cochrane review of 76 trials found that DBT may reduce how often people self-harm. It was less clear whether fewer people self-harmed again.³

For teens. In a Cochrane review of four trials, about 30 in 100 teens who had DBT for adolescents (DBT-A) self-harmed again during treatment. With other care, about 43 in 100 did. The reviewers rated this evidence as high certainty.⁴ UK guidelines advise considering DBT-A for young people with serious emotional dysregulation who self-harm often.⁵ See Emotion regulation in children and teens.

The Unified Protocol

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders is a form of CBT. Instead of using a different therapy for each diagnosis, it teaches one set of skills for understanding and handling emotions.⁸

One trial included 223 adults with panic disorder, generalized anxiety, OCD or social anxiety. Up to 16 sessions of the Unified Protocol worked as well as well-tested therapies designed for each disorder. People were also more likely to finish the Unified Protocol.⁷ A review of 15 studies with 1,244 people found large drops in anxiety, depression and BPD symptoms. People also used healthier emotion regulation strategies afterward.⁸

Cognitive behavioral therapy (CBT)

CBT teaches you to notice how thoughts, feelings and actions affect one another, and to change unhelpful patterns. Skills like reappraisal and problem solving come from CBT. Across many CBT trials for anxiety, depression and other conditions, emotion regulation improved along with symptoms.¹

For adults who self-harm, a Cochrane review found that CBT-based therapy may lower repeat self-harm at 6 and 12 months, though the evidence is low certainty.³ UK guidelines advise a structured CBT-informed therapy, usually 4 to 10 sessions, for adults who self-harm.⁵ See CBT and our 6-week CBT course.

Emotion regulation therapy (ERT)

ERT blends findings from emotion science with CBT. It targets worry and rumination, which often drive both anxiety and depression. One trial included 53 adults with generalized anxiety disorder, many of whom also had depression. Compared with a control condition, ERT led to large improvements in anxiety, depression, worry, rumination and quality of life. Gains lasted nine months after treatment.⁹ This was one small trial, so more research is needed.

Acceptance and commitment therapy (ACT)

ACT helps you make room for painful feelings instead of fighting them, step back from unhelpful thoughts, and act on what matters to you. A review of 39 trials with about 1,800 people found that ACT worked better than waitlists, usual care and placebo talks. It worked about as well as CBT for anxiety, depression, addiction and physical health problems.¹⁰ See ACT and our five ACT lessons, starting with finding your values.

Mentalization-based therapy (MBT)

Mentalizing means understanding the thoughts and feelings behind your own actions and other people's. When emotions run high, this ability can switch off. MBT helps people keep it going under stress.

In the Cochrane review of BPD therapies, MBT reduced self-harm and suicidal behavior compared with usual care, based on low-quality evidence.² A review of self-harm in adults found that MBT reduced repeat self-harm in one trial.³ In a long-term study, people who had MBT were followed for 8 years. Only 23% had suicidal behavior in the later years, compared with 74% of those who had usual care. But the study was small, with 41 people, and their social functioning was still limited.¹¹ See Treatment for personality disorders.

Emotion-focused therapy (EFT)

EFT helps people become aware of their emotions, accept them, make sense of them and change painful emotional patterns. A 2026 review of 13 studies found that EFT clearly beat no treatment for depression, anxiety and related problems. It did not work better than other therapies. Many studies were small or poorly designed, so the authors called EFT modestly effective.¹²

What about medicine?

No medicine teaches emotion regulation skills. A doctor may suggest medicine for a related condition, such as depression, anxiety, ADHD or bipolar disorder. UK guidelines say not to offer medicine as a specific treatment to reduce self-harm.⁵ If you already take a medicine, keep taking it while you start therapy. Talk with your doctor or pharmacist before changing anything.

What to expect

• A first assessment. The therapist asks about your feelings, your history, your safety and your goals.
• Clear goals. You agree on what to work on, such as fewer outbursts or less self-harm.
• Practice between sessions. Most of these therapies give homework, like tracking feelings or trying a new skill.
• Groups. DBT and some other therapies include a skills group. Groups can feel awkward at first, but many people find them supportive.
• Ups and downs. Progress is rarely smooth. Setbacks are part of learning, not failure.
• Length. Some therapies take a few months. The Unified Protocol uses up to 16 sessions.⁷ Full DBT usually lasts about a year.⁶

Finding a therapist

Look for a licensed professional trained in the therapy you want. Guidelines stress that staff should be properly trained and supervised in the therapy they offer.⁵ Questions to ask:

• What training do you have in DBT, CBT, ACT or another approach that targets emotions?
• Do you offer a full DBT program, or skills groups only?
• How will we measure progress?
• What happens if I am in crisis between sessions?
• Do you take my insurance or Medicare?

For step-by-step help, see How to find a therapist, Paying for therapy, Online therapy and apps, Support groups and our therapy finder.

Notes for older adults

Most trials of BPD therapies studied teens and adults up to their mid-40s, so less is known about later life.² Still, many skills in these therapies can be adapted for older adults. A geriatric psychiatrist or a therapist who works with older adults can help. See Geriatric psychiatry, What Medicare covers for mental health and Emotion regulation in later life.

Common questions

Do I need a BPD diagnosis to get DBT?

Usually not. Many programs accept people who struggle with strong emotions, self-harm or impulsive behavior. Guidelines say diagnosis, age or other conditions should not be reasons to deny people who self-harm a psychological therapy.⁵ Ask the program about its intake rules.

Is a DBT skills group enough?

For some people it is a good start. But in a major trial, people at high suicide risk did best with programs that included skills training plus therapist support.⁶ If you self-harm or have thoughts of suicide, ask about full DBT.

What if there is no DBT program near me?

Ask about CBT, ACT or the Unified Protocol. Online therapy can widen your choices. You can also start learning skills with our DBT skills pages while you wait.

When to get help now

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.