Low and unstable self-esteem is one of the central features of borderline personality disorder (BPD), yet it rarely gets its own spotlight in conversations about DBT. A new study in Medical Research Archives examines how music therapy informed by DBT might support self-esteem in people with BPD, and the findings raise useful questions about how skills training and creative approaches can work side by side.
A Mixed-Methods Look at Music Therapy Inside DBT
The study was conducted by Irina Simonet of the Hamburg University of Music and Drama and published in September 2026. It used an exploratory mixed-methods design, which combines interviews with statistical analysis. Patients were interviewed along with DBT co-therapists and music therapists.
The research asked two questions. The first was whether elements of the German-language DBT skills training module on self-esteem show up in music therapy. The second was whether music therapy can contribute to higher self-esteem in patients with BPD.
Most Respondents Saw Music Therapy as Supporting Self-Esteem
The author found overlap between the DBT self-esteem module and music therapy. Respondents described the experience of one’s own person and self-expression as relevant parts of DBT-informed music therapy, along with increased self-esteem. Patients reported greater self-assurance and self-confidence as well as more positive evaluations of themselves.
Of the 23 respondents, 78.3% perceived music therapy as contributing to self-esteem. Sessions that included self-esteem-related content were also rated as more helpful, and that association was statistically significant.
Promising Perceptions, but Not Yet Proof of Improvement
The study is early and exploratory. The sample was small, and much of the evidence reflects how participants perceived their experience rather than a controlled measurement of self-esteem change. The author concludes that music therapy offers opportunities to promote self-perception and self-efficacy, along with self-disclosure, and states that further research is needed to test how effective these interventions are.
In other words, the study suggests that self-esteem work is an important part of DBT-informed music therapy. It does not yet show that adding music therapy to DBT improves self-esteem.
Self-Esteem Is Not a Standalone Module in Linehan’s Manual
Marsha Linehan’s skills training manual organizes DBT skills into four core modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Self-esteem is not a standalone module in that manual. The German-language DBT skills training includes a dedicated self-esteem module, and that module served as the reference point for this study.
Self-esteem and a stable sense of identity are central concerns in BPD, which makes the question of how to address them directly a reasonable one for researchers and clinicians to ask. More background on how structured skills support people with BPD is available in our comprehensive guide on DBT for BPD.
What Does a DBT Skills Group Session Look Like?
Skills training sessions commonly begin with a mindfulness practice and a review of homework. A new skill is then taught and practiced, and a new homework assignment follows. Discussion, worksheets, and role-plays are common ways to practice.
Music therapy is a separate clinical discipline led by trained music therapists, and the study drew on interviews with both music therapists and DBT co-therapists. It is not a component of a DBT skills group. At TheraHive, DBT is offered as skills training and psychoeducation rather than as therapy, so the study speaks to the broader field and not to any one program’s format.
DBT Skills Already Work Through the Body
DBT already includes skills that work through the body. The mindfulness skills Observe and Describe ask a person to notice physical sensations and put words to them without judgment. The distress tolerance skill TIPP uses Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation to change the body’s response to intense emotion.
The study did not test these skills, and it did not examine how any music-based element might be taught in a skills group. The overlap is worth noting because it shows that DBT has long treated learning as something that happens in the body as well as in the mind.
Is Online DBT as Effective as In-Person?
Research so far suggests that online DBT can produce results comparable to in-person delivery, but the evidence is still limited. This question is separate from the music therapy study, which did not examine online delivery. It matters because many DBT skills groups, including those at TheraHive, meet online.
A 2022 scoping review of online DBT included seven articles reporting on five clinical trials with 437 participants in total. Attendance was reported to be greater online, and clinical improvements were comparable to face-to-face delivery for participants who stayed in treatment. The authors concluded that online delivery is feasible and may be as safe and effective as in-person delivery. They also noted that the studies were small and that no large trials had compared online DBT with high-fidelity in-person treatment for people with BPD.
Individual studies add detail. A nonrandomized study of 107 people with BPD compared an email-based DBT skills program with an in-person group, and both groups improved significantly on measures that included difficulties with emotion regulation. More than half of participants in both groups ended the program early. A small comparison of video-based and in-person DBT groups found lower group cohesion online, but satisfaction was similar and weekly attendance was higher online (91% compared with 75%). A study of 143 clients in Australia and New Zealand found no significant difference in attendance between telehealth and face-to-face sessions, and its authors noted that comparisons of clinical outcomes are still needed.
Most of this research examined DBT delivered as clinical treatment, often for people at higher risk. The reviewed studies also point to practical challenges, including technology problems, privacy, managing risk, and keeping participants engaged. Quality of instruction, fidelity to the DBT model, and the way a group is facilitated all appear to matter, whatever the format.
Takeaways for People Living With BPD and Low Self-Esteem
For people with BPD or chronic low self-esteem alongside intense emotions, the research supports treating self-esteem as a topic worth raising directly. Those in treatment can ask a provider whether self-esteem is a specific focus of care. People interested in creative approaches can speak with a licensed music therapist about what that work involves and whether it fits alongside their current care.
Those who want to learn the core DBT skills with a trained facilitator and a small group of peers can explore TheraHive’s online DBT skills groups or the Adult DBT Skills Group. TheraHive’s programs are educational and are meant to complement, not replace, therapy or other care.
A Small Study Points Toward a Bigger Conversation
This study is a small but useful step toward asking how self-esteem can be addressed more directly alongside DBT skills. The results are preliminary, and the author is clear that more research is needed. Even so, they point to a part of recovery that deserves more attention.
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