Finding your own path in the landscape of mental health can be hard for people all across the LGBTQ+ spectrum. For bisexuals in particular, the trip through discovery and acceptance and into better mental wellbeing is marked by unique struggles. In this article, let’s explore how Dialectical Behavior Therapy (DBT) can be applied to our experiences as bisexual people. We’ll explore how the skills from the four key modules of DBT can be adapted to work for bisexual people specifically. Though DBT was not designed with us in mind, it can still provide valuable tools for exploring our identity and for accepting and challenging the specific stigma and discrimination we face as queer people. 

Understanding Bisexual Identity

Bisexuality is often misunderstood. Misrepresentations of our community can lead to stigma and judgment. This contributes to feelings of confusion, or shame, or isolation among bisexual individuals. So we must begin by recognizing bisexuality as a valid and legitimate sexual orientation, defined by the potential for romantic or sexual attraction to people of more than one gender. 

The Intersection of LGBTQ+ Identity and Mental Health

Research indicates that queer people are at a higher risk of experiencing mental health problems compared to our heterosexual counterparts. The National Alliance on Mental Illness (NAMI) reports that "LGB adults are more than twice as likely as heterosexual adults to experience a mental health condition.” And trans people are “nearly four times as likely as cisgender individuals to experience a mental health condition." 

As for bisexual people in general, a 2023 study conducted in England and published in the Journal of Sex Research has found that “bisexual adults report poorer physical and mental health outcomes compared to any other sexuality.” The increased risk of developing mental health struggles is often attributed to minority stress: the pressure faced by individuals that belong to marginalized communities. For bisexual people, navigating both heteronormative and queer spaces can contribute to an elevated sense of anxiety. Biphobia and bi erasure, which I’ve written about here, add to this weight. Having to handle these stressors can contribute to worse physical health as well, meaning that when facing universal struggles like work pressure or health problems, bisexual people are already using up their mental health resources on dealing with minority stress.

Core Principles of Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) was not originally designed for bisexual people, or for queer people in general. In fact, DBT as a therapeutic approach was initially developed to treat people with borderline personality disorder. Founded by Marsha Linehan, the concept was to combine the best in research-backed strategies with the philosophy of zen mindfulness in order to help the (straight, white, middle-class) people who hadn’t been helped by other kinds of therapies. In the time since it was created, the principles and techniques of DBT have since been adapted to address a wide range of mental health concerns, including those related to sexual orientation and identity. DBT consists of four key modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

Applying DBT Skills to Bisexual Individuals

Mindfulness:

Mindfulness practices can help bisexual people cultivate awareness of the present moment and acceptance of their thoughts, feelings, and experiences. Why is this particularly relevant for queer people? When it comes to minority stress, microaggressions, like people assuming your sexual orientation based on the gender of your current partner, are much more common that overt aggressions, like being fired for being queer. The trouble with microaggressions is that they can build up over time, much in the same way that one papercut can be tolerated while 5,000 papercuts cannot. The stress and the impact on your mental health may not be immediately obvious. You may have learned to numb out in order to withstand all the little indignities of being bi in a black-and-white world. These can be barriers to noticing what is really going on in your body. Perhaps you have a sense of outrage or anger and no real idea of where it came from. Perhaps you have difficulty even identifying what the emotion you currently are feeling is. By staying present in the moment and observing without judgment, you can develop a deeper understanding of yourself and plug back into your body. 

The DBT skill One-Mindfully is critical here. This is the skill designed to help you focus on doing just one thing at a time. When distractions arise, the one-mindfully skill is how you bring your focus back. Now for an example of fortuitous timing: as I’m typing these words today, in attempting to jump onto my lap, my bigger cat knocked over my water bottle. Water is soaking into the leather of my purse and my copy of the DBT workbook even as I try and write about staying mindful. After getting up to towel off my workbook, how do I bring back my focus to writing? I practice One-Mindfully by throwing myself back into writing, noticing the sensation of my fingertips on the keyboard, the shape of the letters, and the flow of my sentences. I stay concentrated, allowing other distractions and annoyance at my cat to fade into the background and out of my awareness.

Distress Tolerance:

Dealing with minority stress and biphobia requires resilience and a toolbox of effective coping strategies. DBT offers strategies to tolerate painful experiences and emotions without resorting to harmful behaviors. These techniques may include grounding exercises, self-soothing activities, and distraction techniques to bear with stress or crisis. Another set of skills in the Distress Tolerance module is called Reality Acceptance, and this can be helpful for queer people to master as well. For more in-depth coverage on adapting the Radical Acceptance skill from this set of strategies, you can start here.

The Distress Tolerance tools are used in a crisis or when circumstances become overwhelming. If I could wave a magic wand and give every bisexual person I know complete mastery over one skill from this module, it would be the Distract with Sensations skill. When a bad fight or work pressure builds up and you want to give your brain a break, the Distract skill offers a way to help. Distracting with Sensations means using a prop like a lemon to provide a short, shocking experience to your body’s senses, that gets you out of your head and into your body. It’s particularly helpful for dissociation or numbing, two common reactions to minority stress. Using the lemon example, when things get heated and you feel in danger of yelling out the wrong thing or doing damage to your relationship, you bite down sharply on a piece of lemon. The extreme sour taste shocks you back into reality for a moment.    

Emotion Regulation:

Because American culture views sexuality through a strict binary (“gay” or “straight”), bisexual individuals often contend with complex and changing emotions related to their place in this dichotomy. Those emotions might include shame, guilt, or uncertainty. The Emotion Regulation skills taught in DBT can help everyone better identify and label their emotions, challenge unhelpful thought spirals, and develop healthy ways of coping with them.

One Emotion Regulation skill that bisexual people might find especially helpful is called Cope Ahead. It refers to preparing for upsetting situations ahead of time, by planning out what skills you want to rely on and what you need to do to have your best chance of staying patient or getting the situation to go your way. Tough conversations naturally bring up complicated emotions, like coming out to your boss or sticking up for yourself around other LGBTQ+ people. The Cope Ahead skill involves figuring out what problem-solving skills you want to use ahead of time, imaging the situation as if it was happening right now, and then imagining yourself using a helpful skill in that moment. Per 2017 research published in the Journal of Basic Applied Social Psychology under the title “Imagining Success: Multiple Achievement Goals and the Effectiveness of Imagery,” imagining a successful interaction ahead of time “has become one of the most popular psychological techniques to improve performance in athletic, academic, and work contexts.”

Interpersonal Effectiveness: 

Building healthy relationships within the queer community and beyond can be challenging for bisexual people. DBT equips you with effective communication skills and boundary-setting strategies so that you can navigate social interactions well, while still advocating for your needs. The assertiveness techniques are especially helpful for that last part. 

The FAST skill is designed to help you advocate for yourself without losing sight of your goal. It stands for:

Being Fair

Not Over-Apologizing

Staying True to Your Values

Being Truthful

The No Over- Apologizing step of the FAST skill comes in handy for advocating for your needs, an essential skill for people from a community that is so commonly misrepresented. This skill helps you be mindful when the urge to soothe ruffled feathers and keep the peace at the cost of your own sense of self-worth comes up. If you, like me, and like people-pleasers everywhere, find yourself apologizing over and over again for things that are genuinely not your fault, this is the skill for you. 

Cultivating a Supportive Community

In addition to individual therapy, bisexual people can see benefits from peer support and community resources, because we all need connection and belonging, regardless of identity. Seeking out bi-inclusive and affirming spaces within the LGBTQ+ community can provide validation. Using the skills from Interpersonal Effectiveness to help you advocate for inclusive policies and services can make a huge difference. It is crucial that bisexual people receive culturally-competent and affirming care.

Dialectical Behavior Therapy (DBT) offers a comprehensive and compassionate approach to supporting bisexual people. By integrating Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness skills, DBT equips you with the tools you need to navigate the complexities of life with resilience and authenticity.