How DBT Was Developed to Help with Suicidal Thoughts and Self-Harm

DBT is a structured therapy that teaches skills for surviving intense emotional pain, reducing harmful coping behaviours and building a life that feels more manageable. It can be part of care for some people experiencing suicidal thoughts or self-harm, but urgent safety comes first. If you may act on thoughts or have seriously harmed yourself, seek emergency help now before reading further.

Key Takeaways

• Suicidal thoughts can change, and support is available
• DBT is not an emergency service or a promise that thoughts will disappear immediately
• The safest next step depends on how immediate the risk is
• NHS 111, 999 and A&E, and Samaritans can help in the UK

What Should I Do If I Need Help for Suicidal Thoughts Right Now?

If you are looking for help for suicidal thoughts at this moment, the right response depends on how immediate the risk is. There are three levels of response:

1. Immediate danger or serious self-harm: call 999 or go to A&E now.
2. Urgent mental-health support but able to stay safe for the moment: call NHS 111 and select the mental-health option, or contact your GP or local crisis team.
3. Need someone to talk to: Samaritans are available 24 hours a day on 116 123. You can also text SHOUT to 85258.

For more practical help for suicidal thoughts, if possible, tell a trusted person what you are experiencing. Do not stay alone when you feel unable to keep yourself safe.

How to Stop Suicidal Thoughts: What Is a Safer, More Realistic First Goal?

The question of how to stop suicidal thoughts is one many people ask, and it is worth being honest about what is possible. No article, technique or single intervention can guarantee that thoughts stop. The immediate goal is to reduce danger, create time, and connect with a person or service that can help you stay safe.

Personalised safety planning is one evidence-informed approach: identifying warning signs, coping strategies, trusted contacts and emergency contacts, and reducing access to means of harm where possible. This is done collaboratively with a clinician, not as a checklist a person fills in alone. ^³

Help for suicidal thoughts: How Did DBT Develop, and What Does It Try to Change?

DBT was developed for people experiencing severe, persistent emotional distress, self-harm and suicidal behaviours. It combines acceptance (“your pain is real and your feelings make sense”) with change (“there are skills and support that can reduce harm”). This combination matters because people in serious distress often feel they need to be told their experiences are valid before they can engage with the idea that things can change.

Within a structured DBT programme, life-threatening behaviours are addressed first, then behaviours that disrupt treatment or daily life, then quality of life more broadly. The four skill areas are mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. Each is taught within a therapeutic relationship rather than through self-directed practice alone.

Can Therapy for Suicidal Thoughts or Self-Harm Help?

Therapy for suicidal thoughts is tailored to the person’s experiences, co-occurring conditions, support system and current safety needs. There is no single “best” approach.

NICE guidance on self-harm recommends a structured, person-centred CBT-informed psychological intervention for adults who self-harm, typically 4 to 10 sessions based on need. ^³ For children and young people with significant emotional dysregulation and frequent self-harm, DBT-A (a version of DBT adapted for adolescents) may be considered. ^³

Therapy for suicidal ideation and suicide prevention therapy both describe approaches that work within a wider care plan. NICE’s BPD guideline adds that a comprehensive DBT programme may be considered for women with BPD where reducing recurrent self-harm is a priority. ^⁴ The phrase “best therapy for suicidal ideation” implies a single answer that does not exist. What matters is professional assessment of the individual’s needs, current safety, and what support is available.

What DBT Skills Can Help in a Crisis, and What Can They Not Do?

DBT distress tolerance skills are designed for crisis moments: grounding attention in the present, getting through a surge of feeling without acting on it, and identifying what is making the person more vulnerable. Mindfulness skills help observe what is happening without being completely pulled into it. Interpersonal effectiveness skills help the person ask for support and communicate what they need.

These skills can create a pause. They cannot replace contacting emergency or urgent support when safety is at risk. For a fuller explanation of how emotional dysregulation drives distress and how DBT skills address it, see emotional dysregulation. 

What Are Signs of Someone That Is Suicidal?

The phrase “signs of someone that is suicidal” reflects a real concern, and it is important to explain that no checklist can predict suicide. ⁵ Possible concerns can include talking about wanting to die, saying they feel trapped or hopeless, marked withdrawal, saying goodbye, giving away valued possessions, or a sudden change in behaviour after a period of severe distress. This list is not exhaustive and not predictive.

If you are worried about someone, the most important step is to ask them calmly and directly whether they are safe. Take their answer seriously. If you believe they are in immediate danger, stay with them and call 999.

What Does Suicide Prevention Support in the UK Look Like?

Suicide prevention efforts in the UK recognise that no single person carries the responsibility for prevention of suicides. Prevention includes compassionate conversation, timely healthcare, safer environments and sustained support over time. ⁵

In the UK, verified support contacts include: 999 or A&E for immediate risk; NHS 111 (mental-health option) for urgent but not immediately dangerous situations; Samaritans on 116 123, available 24 hours a day; and Shout, where you can text SHOUT to 85258.

Where Does Therachange Fit?

For people who are not in immediate crisis and can safely engage in scheduled care, a qualified therapist may help explore whether DBT-informed therapy is suitable as part of a wider plan. Therachange is not an emergency or crisis service. It offers online DBT-informed therapy with accredited UK therapists for people at a stage where structured, non-emergency support is appropriate.

If you are unsure where you are on that spectrum, your GP or a mental-health professional is the right first point of contact. When you are ready to explore online therapy as part of a wider plan, book an initial session to discuss whether DBT-informed support may be suitable.

References

[1] NHS (2021). Help for suicidal thoughts. https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/help-for-suicidal-thoughts/

[2] NHS (2021). Where to get urgent help for mental health. https://www.nhs.uk/nhs-services/mental-health-services/where-to-get-urgent-help-for-mental-health/

[3] National Institute for Health and Care Excellence (2022). Self-harm: assessment, management and preventing recurrence (NG225). https://www.nice.org.uk/guidance/ng225/chapter/Recommendations

[4] National Institute for Health and Care Excellence (2009). Borderline personality disorder: recognition and management (CG78). https://www.nice.org.uk/guidance/cg78/chapter/Recommendations

[5] Samaritans (accessed 2026). Suicide facts for journalists and programme makers. https://www.samaritans.org/about-samaritans/media-guidelines/suicide-facts-journalists/

Rebecca Wilson

Author

Mental Health Specialist and Advanced Clinical Practitioner with over a decade of experience across NHS community and crisis services. Registered with the NMC, she is a qualified Mental Health Nurse and Independent Prescriber, holding a Master’s degree in Advanced Clinical Practice and V300 prescribing qualification. Her clinical background includes complex mental health and neurodevelopmental presentations, trauma-informed care, and evidence-based therapeutic approaches such as CBT and DBT skills. She leads clinical operations and quality assurance at Therachange, with a strong focus on safe, compassionate, and person-centred care.