Mindfulness Over Molecules: DBT Strategies to Counteract Low Serotonin and Emotional Dysregulation

Serotonin is well known as one of the key neurotransmitters that impact mood and emotional wellbeing. Low serotonin levels are associated with numerous maladies including:

• Depression
• Anxiety
• Panic
• Sleep issues
• Self harm and suicide
• Post-Traumatic Stress Disorder (PTSD)
• Borderline Personality Disorder

There is a growing body of evidence linking DBT to improvements in low serotonin subjects. A 2022 study found that DBT “was effective in elevating blood serotonin and cognitive-emotional regulation among drug abusers.”

DBT has also been combined with serotonin-boosting medication with positive effects. A study from 2025 on adolescents who engaged in non-suicidal self harm found that both DBT and cognitive behavioral therapy (CBT) were effective in reducing these behaviors when combined with the SSRI sertraline, and DBT performed better than CBT across a range of metrics at a six-month checkup. This is backed up by another study that found DBT to be more effective in reducing self-harm than enhanced self care. Interestingly, one study on borderline personality disorder patients who were already receiving DBT found that adding the SSRI fluoxetine did not improve results compared to subjects who continued to only receive DBT sessions.

Studies on DBT have corroborated these findings, showing that DBT is associated with reduced amygdala activity and increased prefrontal cortex activity, both of which are associated with improved emotional regulation.

DBT addresses issues associated with low serotonin from a psychological level, training clients to recognize and handle troubling feelings as they arise. This can restore a sense of emotional control, and help clients improve their overall mood stability.

For anxiety, DBT’s mindfulness and distress tolerance skills offer powerful tools to reduce physiological arousal and increase present-moment awareness. Mindfulness, in which clients observe their thoughts and feelings without reacting to them, undergirds all of DBT, and can be effective in reducing anxiety.

DBT teaches three aspects of mindfulness. After clients learn to observe their internal processes, they strengthen this ability by describing their feelings and emotions. Mindfulness can be a more active process when clients learn to participate in an activity with full focus. This can help bring mindfulness from something the client practices in a quiet, controlled setting to something they employ throughout the day. By regularly practicing different forms of mindfulness, the client learns to see their thoughts and feelings more clearly, and create space between their impulses and their actions.

Mindfulness also promotes radical acceptance, a notion in DBT that encourages clients to accept reality as it is with all of its imperfections. This skill helps clients dispel any shame around their emotional state and move forward with actions to improve their wellbeing.

Once they are better able to recognize their anxiety, clients can layer on distress-tolerance skills like self-soothing with their senses. Clients can learn to calm themselves by seeking out or noticing pleasant visuals, grounding touch, enjoyable sounds or music, and pleasurable tastes and smells. 

In some situations, clients can use a more active distress tolerance skill, like TIPP (Temperature, Intense exercise, Paced breathing, Progressive muscle relaxation). Learning to modulate their feelings through physiological interventions help clients regulate acute stress or panic. Over time, mindfulness and distress tolerance recondition the client’s relationship to anxiety itself — less as something to escape, and more as an experience that can be observed and survived.

For clients with depression, DBT’s emotion regulation skills, such as Accumulate Positive Experiences and Opposite Action, are particularly impactful. Depression often creates a feedback loop in which low energy, hopelessness, and anhedonia reinforce behavioral withdrawal and avoidance of pleasurable or meaningful activities. Accumulate Positive Experiences encourages clients to schedule small, manageable activities that promote mastery and joy, even when motivation is low. Over time, this increases behavioral activation and helps restore access to positive emotion. 

Similarly, Opposite Action teaches clients to act counter to the urge to withdraw — such as reaching out to a friend or going for a walk when sadness suggests staying in bed. Repeating these actions builds new neural pathways and fosters resilience.

Taken together, these skills help clients with depression and anxiety interrupt self-reinforcing cycles, retrain emotional habits, and build new cognitive and behavioral patterns.

DBT was not designed to directly address low serotonin in clients, however it does alleviate many of the same issues that are correlated with low serotonin, and there is evidence that DBT can actually increase serotonin in some clients. This insight provides an important counterweight to the notion that neurochemistry is destiny when it comes to mood and emotions. Working with clients on regulating their feelings through DBT skills may have a real impact on their neurochemistry. 

Training:

Live: 2025 Cohort | Comprehensive Dialectical Behavioral Therapy (DBT)

Introduction to Dialectical Behavioral Therapy (DBT)

Blog Posts:

Exploring Serotonin Deficiency From Neurobiology to Treatment Strategies

MDMA-Assisted Psychotherapy for PTSD

Positive Reinforcement in DBT: Rewiring Neuroplasticity to Reduce Self-Harm and Boost Emotional Regulation

What is DBT & How Does it Work?

eBook:

Dialectical Behavioral Therapy