Alternative therapies for borderline personality disorder that complement DBT

Understanding alternative therapies for borderline personality disorder (BPD) matters because it helps people access safer, evidence-informed options alongside standard treatments. While dialectical behavior therapy (DBT) remains the cornerstone for many with BPD, complementary approaches can support emotional regulation, reduce self-harm risk, and improve daily functioning in ways that fit different preferences and life circumstances.

In this post, we survey evidence-based alternatives, explain how they fit with DBT and other standard care, and offer practical tips for safe integration with professional guidance.

Evidence-based alternative approaches

Mindfulness-based therapies and mindfulness-informed interventions

Mindfulness practices — cultivating nonjudgmental awareness of thoughts, feelings, and bodily sensations — have been studied as a complement to standard therapies for BPD. Mindfulness-based interventions (including MBCT and adapted mindfulness programs) aim to reduce emotional reactivity, improve distress tolerance, and support skill generalization beyond formal sessions. While the strongest evidence for mindfulness comes from broader mood and anxiety research, several small-to-moderate studies in BPD show improvements in emotion regulation, impulsivity, and interpersonal functioning when mindfulness is included alongside standard care. Mindfulness can be a practical way to slow down reactions and create space for DBT skills to take effect.

Partnering with a clinician is important because mindfulness practice varies in intensity and can initially feel challenging. When used consistently, it can reinforce the DBT emphasis on awareness, nonjudgment, and skilled responses to stress.

Schema therapy

Schema therapy combines cognitive, behavioral, and experiential techniques to address long-standing patterns (or “schemas”) that underlie BPD symptoms. A growing body of research supports schema therapy as an effective option for BPD, with randomized trials and comparative studies showing substantial improvements in self-harm, mood instability, and overall functioning. Schema therapy tends to be longer in duration than typical short-term approaches and often focuses on early-life root causes while teaching present-day coping strategies. For many, schema therapy offers a coherent framework to understand how past experiences shape current behavior and relationships, which can complement DBT skills and phase-based treatment plans.

Because schema therapy is a structured, therapist-guided approach, it should be delivered by clinicians trained in this modality and coordinated with any ongoing DBT work.

Mentalization-based therapy (MBT)

MBT centers on improving mentalization — the ability to understand one’s own and others’ thoughts, feelings, and intentions. In BPD, difficulties with mentalization can fuel interpersonal conflicts and emotional volatility. MBT has robust evidence supporting its effectiveness in reducing self-harm and improving social functioning, with some studies showing comparable outcomes to DBT on certain measures. MBT can be used as a stand-alone treatment or alongside other therapies, and many clinicians integrate mentalization work into broader care plans to enhance relationship skills and reflective capacity.

Exercise, sleep, and nutrition as supportive care

Physical activity and good sleep are not standalone cures for BPD, but they play a meaningful role in mood regulation and cognitive functioning. Regular aerobic exercise, strength training, and consistent sleep routines have been linked to reductions in depressive and anxious symptoms and improvements in cognitive control. For people with BPD, these lifestyle factors can support daytime energy, impulse control, and resilience, making it easier to engage with therapy and apply DBT skills in daily life. Nutrition — particularly omega-3 fatty acids and adequate vitamin D — has shown provisional benefits for mood and inflammation in broader mental health research; while promising, these should be discussed with a clinician and not used as a substitute for evidence-based psychotherapies.

Neurofeedback and brain-body approaches

Neurofeedback (a form of biofeedback that trains brain activity) and other brain-body techniques are being explored as adjuncts for emotion regulation. Some small studies report reduced impulsivity and improved regulation after neurofeedback training, but larger, well-controlled trials are needed to confirm benefits for BPD. If considered, these approaches should be pursued in clinical settings with qualified professionals and clear safety monitoring, rather than as a replacement for established therapies.

Art, music, and other creative therapies

Arts therapies — including art, music, drama, and dance/movement therapy — offer safe channels for expressing difficult emotions and building self-awareness. Small studies and clinical observations suggest benefits for distress tolerance, self-expression, and social connectedness. While not a primary treatment for core BPD symptoms, these modalities can support engagement, motivation, and quality of life when used alongside evidence-based psychotherapies.

Psychedelic-assisted therapies: careful consideration and guardrails

Recent research has explored psychedelic-assisted therapies for various mental health conditions. For BPD, the evidence base is still emerging, and these approaches raise significant safety concerns, particularly around complex trauma, suicidality risk, and potential destabilization. Psychedelic-assisted treatments should only occur within rigorous, approved research settings or specialized clinics, with expert supervision and informed consent. They are not recommended as a routine alternative to standard care at this time.

How these approaches complement DBT and other standard treatments

• Enhancing skills application: Mindfulness, MBT, and schema work can deepen the self-awareness and reflective capacity that DBT teaches, helping individuals recognize triggers earlier and choose skills more consistently.
• Addressing co-occurring needs: Exercise and sleep interventions target physical health and daily energy, which can reduce the cognitive load of emotional distress and make therapy more tolerable and effective.
• Personalizing care: Some people respond better to schema therapy’s long-term, pattern-focused work, while others thrive with MBT’s emphasis on mentalization. Having multiple evidence-based options allows clinicians to tailor treatment to the person’s strengths and life context.
• Maintaining engagement: Creative and arts-based therapies can boost motivation and therapy attendance by offering meaningful, experiential ways to practice skills and process emotions.

Integration with professional care

When considering alternatives or complements to DBT, collaboration with a qualified clinician is essential. Practical steps include:

• Discuss goals and preferences with your treatment team. Explain which therapies feel appealing and why, so your providers can tailor a plan.
• Coordinate care among therapists. If you’re in DBT, ask how the other therapy will fit into the current structure (session frequency, homework, safety planning).
• Monitor safety and medications. Some approaches may influence sleep, appetite, or mood; it’s important to track any changes with your psychiatrist or prescribing clinician.
• Set clear boundaries and expectations. Clarify which therapies are concurrent (done at the same time) and which are alternate paths, to avoid fragmentation of care.

When professional guidance is essential

• Active suicidal ideation, self-harm risk, or rapid mood swings requiring urgent evaluation.
• Co-occurring psychosis, bipolar disorder, or substance use that could affect safety or treatment response.
• Consideration of high-intensity or invasive approaches (e.g., brain stimulation or psychedelic-assisted therapies) that require specialized settings, protocols, and informed consent.
• Limited access to trained providers for particular modalities (e.g., MBT, schema therapy) where credentialed supervision is essential.

Safety considerations

• Quality and credentials matter. Seek clinicians with formal training in the modality they offer (e.g., DBT-certified programs, MBT-trained therapists, licensed mental health professionals for neurofeedback).
• Be cautious about unproven “cures.” If a program promises rapid, all-encompassing results or asks you to abandon established care, discuss with your care team and seek a second opinion.
• Check for possible interactions. Supplements and nutrition strategies should be discussed with your physician, especially if you’re on medications or have medical conditions.
• Safety planning remains central. Regardless of the chosen therapy, continue to maintain a current safety plan and know whom to contact in crisis (hotlines, emergency services).
• Access and equity. Some approaches are costly or not readily available in all areas. Work with your clinician to identify feasible, evidence-based options within reach.

For further reading and reliable overviews of therapies related to borderline personality disorder, you may also explore credible mental health resources such as credible practice guidelines and patient-oriented materials. If you’d like to dive into specific resources, here are a few to start with:

• Borderline personality disorder — NIMH
• Brain stimulation therapies — NIMH
• Borderline personality disorder overview — APA
• Exercise and mental health — NIMH
• What is mindfulness? — Mindful.org

While exploring these options, remember that none of these therapies should replace a plan you already have with a qualified clinician. They are best viewed as parts of a broader, personalized strategy designed to reduce distress, improve daily functioning, and support lasting well-being.