Coming Out, Staying Grounded—DBT Skills for LGBTQ+ Mental Health
If you’re here, maybe you’re carrying something that feels heavy. Maybe you're thinking about coming out—or maybe you’ve already come out and now you're wondering what to do with all the feelings that have followed. You might be afraid of how people will respond, or you might be wrestling with your own doubts, shame, or uncertainty. And if that’s true, I want to start by saying: you’re not alone.
Coming out is a deeply personal process, and it’s not just a one-time thing—it’s something that often happens again and again, in different ways, with different people.
It can be beautiful, freeing, and affirming.
And it can also be scary, exhausting, and painful.
What you’re feeling is valid. You don’t have to have all the answers. You don’t need to be “sure enough” or “brave enough” to start exploring what feels true for you.
That’s where DBT—Dialectical Behavior Therapy—can offer some support. It’s a set of skills designed to help people navigate intense emotions, feel more in control during hard moments, and build a life that feels more aligned with who they are. And while DBT wasn’t created specifically for LGBTQ+ folks, its tools can be incredibly grounding when you’re facing the emotional ups and downs that often come with coming out.
Let’s talk about how these skills can help you stay connected to yourself—your truth, your peace, your power—no matter where you are in your journey.
Radical Acceptance—Honoring Your Truth
At the heart of DBT is a skill that many LGBTQ+ folks find both challenging and liberating—radical acceptance. It’s about fully acknowledging your reality—your identity, your feelings, your experience—without judgment, denial, or resistance.
For many of us, this isn’t easy. You might have internalized messages over the years that told you something was “wrong” with you. You might have learned to hide, to shrink, to shape-shift into what others expected. Maybe you’ve questioned whether your identity is valid enough, real enough, queer enough. If any of that feels familiar, I want you to take a breath here and let this land gently: You do not have to earn your identity. You do not have to apologize for who you are.
Radical acceptance means saying, “This is my truth. I may still be exploring it. I may still feel scared. And I no longer have to fight it.”
This isn’t about giving up or resigning yourself to pain—it’s about letting go of the suffering that comes from constant self-doubt and self-criticism.
When we resist our truth—when we say, “I shouldn't feel this way,” or “I wish I could be different”—we create a kind of internal war.
Radical acceptance helps you call a truce with yourself.
It’s okay if you don’t have all the language yet. It’s okay if your identity changes or deepens over time. Coming out doesn’t require perfection—it requires presence. Just being with yourself, as you are, is an act of courage. You deserve peace in your skin, in your mind, and in your heart. Radical acceptance is a way to begin creating that peace—not by changing who you are, but by finally honoring it.
Wise Mind—Balancing Emotion and Reason
When you’re navigating something as deeply personal and vulnerable as coming out, your emotions can feel like they’re running the show—and understandably so. You might feel fear one moment, hope the next, then suddenly doubt or anger or numbness. It can be exhausting to be pulled in so many emotional directions, especially when your sense of safety or belonging feels uncertain.
DBT gives us a helpful way to understand what’s happening inside us in these moments. It teaches that we all operate from three different states of mind:
Emotional Mind is where your feelings take the lead. It’s reactive, passionate, often intense. In emotional mind, you might catastrophize, spiral, or want to run and hide.
Reasonable Mind is the opposite. It’s logical, detached, focused on facts and problem-solving. In reasonable mind, you might dismiss your feelings entirely or shut down emotionally to protect yourself.
Wise Mind is the middle path. It’s the quiet, steady voice inside you that knows how to hold both emotion and reason. It’s where your deepest intuition lives.
Wise mind doesn’t rush. It doesn’t shout. It whispers, “Let’s take a breath. Let’s find a way forward that honors both how you feel and what you need.”
When you’re preparing to come out—or processing a tough reaction afterward—you might notice yourself swinging between emotional and reasonable mind. Maybe you’re overwhelmed and think, “I can’t do this, it’s too risky.” Or maybe you try to talk yourself out of your feelings entirely: “It’s not that big of a deal, I should just suck it up.” Wise mind steps in and says: “Both of those reactions make sense. And what do I actually need in this moment? What choice will take care of me—not just now, but in the long run?”
Tuning into your wise mind often means slowing down. It might look like pausing before sending that text. Taking a walk to let your nervous system settle. Journaling. Meditating. Talking it out with someone safe. It’s less about having the “right” answer and more about acting from a place of self-respect and clarity.
Wise mind won’t always eliminate the fear or pain—but it can help you move through it with a little more grace. A little more steadiness. A little more you.
Distress Tolerance—Surviving the Hard Moments
Let’s be real: coming out can be beautiful, and it can also hurt. Maybe someone you trusted didn’t respond the way you hoped. Maybe they were silent, or angry, or confused. Maybe they said something that stuck to your ribs in the worst way. Or maybe no one reacted at all—and that silence felt just as painful. In those moments, when your heart is pounding, your chest is tight, or you’re feeling exposed and alone, it’s easy to feel like you’re drowning in it. That’s where distress tolerance comes in.
It’s not about fixing what’s broken or pretending it doesn’t hurt. It’s about finding ways to survive the pain without creating more of it.
It’s about holding on through the storm, so you can make it to the other side.
DBT offers several powerful tools for this:
TIP SKILL
These are fast-acting strategies that help your body calm down when your mind is in overdrive. Because when your nervous system is in crisis, logic doesn’t help—you have to go through the body.
T - Temperature: Splash your face with cold water, hold an ice cube, or press something cool to your neck or wrists. This can help “reset” your stress response.
I - Intense Exercise: Even 20 jumping jacks, a sprint up the stairs, or dancing to a loud song can discharge pent-up adrenaline.
P - Paced Breathing / Progressive Relaxation: Slowing your breath or tensing and releasing muscles helps your body remember it’s safe.
These techniques don’t solve the problem—but they give you a few inches of space from the pain. And sometimes, that’s everything.
Self-Soothing with the Senses
When everything feels chaotic, your five senses can help ground you in the here and now. Light a candle that smells like home. Put on a playlist that makes you feel seen. Wrap yourself in something soft, drink something warm, hold a weighted object. Soothing yourself isn’t weakness—it’s self-respect. It’s saying, “I deserve care, even when I’m hurting.”
IMPROVE the Moment
This skill helps you shift your emotional state, even a little, by tapping into imagination, meaning, or spiritual connection.
Imagery—Close your eyes and picture a safe place—real or imagined—where you feel totally accepted.
Meaning—Ask yourself, What am I learning about myself right now? How does this pain connect to my values?
Prayer or Spirituality—If you have a spiritual practice, lean on it. If not, just placing your hand on your heart and saying, “I am still here” can be powerful.
Other aspects of this skill include using encouraging statements, one-moment-at-a-time thinking, or brief distractions (watching a comfort show, doodling, baking something simple) to ride out the wave.
Interpersonal Effectiveness—Setting Boundaries with Confidence
Coming out doesn’t happen in a vacuum. It often unfolds in the spaces where our most important relationships live—family, friends, partners, coworkers, chosen family. These relationships can be a source of deep love and belonging, but they can also bring fear, tension, and the possibility of rejection.
That’s why interpersonal effectiveness—another pillar of DBT—is so important. It’s not just about “saying the right thing” or managing conflict. It’s about honoring your truth and your self-respect at the same time. It’s about learning how to express your needs, hold your boundaries, and ask for support in ways that feel grounded, not defensive.
This can be incredibly difficult, especially if you’ve been taught that keeping the peace means staying silent. Or if you’ve learned that your safety depends on making yourself smaller. Let’s start here: you don’t owe anyone your pain for them to believe you. You don’t have to overexplain, prove, or perform your identity to make it valid.
If someone responds to your coming out with confusion, resistance, or even hostility, you’re allowed to say:
“I’m not open to discussing this right now.”
“I need you to respect my identity, even if you don’t fully understand it yet.”
“This is who I am, and that’s not up for debate.”
This is self-respect effectiveness—protecting your dignity, even when someone else can’t meet you where you are.
Interpersonal effectiveness also includes being able to ask for support in ways that honor your vulnerability. Sometimes, people who love us just don’t know what to say—and their awkwardness or silence can feel like rejection. But often, they’re waiting for guidance.
You might say:
“This is really hard for me to share. I don’t need advice—I just need you to listen.”
“I’m scared right now. Could you stay with me while I talk this through?”
“I don’t expect you to get it all right. I just need to know you’re trying.”
These aren’t demands—they’re invitations into connection. You’re letting someone know what support looks like for you, which is a generous and powerful act.
And finally, sometimes interpersonal effectiveness means walking away. Not out of anger, but out of self-protection. If someone continues to disrespect your identity, you have every right to say:
“This conversation isn’t healthy for me, and I need to step back.”
Setting that kind of boundary doesn’t mean you’re giving up—it means you’re choosing yourself. Because coming out isn’t just about being honest with others. It’s also about building relationships
Emotion Regulation—Building a Life That Feels Good to Live
Coming out can stir up a storm of emotions—fear, shame, relief, joy, anger, grief. Sometimes all in the same hour. It’s a lot for any one heart to carry, especially when you're also trying to manage daily life. That’s why DBT’s emotion regulation skills are so essential—they help you not just survive emotionally, but start to build a life that feels livable, even fulfilling.
Emotion regulation is not about controlling or suppressing your feelings.
It’s about learning to understand them, honor them, and take care of yourself in ways that reduce the emotional chaos over time.
It’s a form of emotional hygiene—a way to tend to your inner world with intention and compassion.
One of the first steps is checking in with your emotional baseline. Ask yourself:
Am I sleeping enough? Sleep deprivation amplifies everything. Anxiety gets louder. Confidence shrinks. Emotional wounds sting sharper. If your sleep has been off, even a small change—turning off your phone earlier, creating a calming bedtime routine—can make a meaningful difference.
Am I nourishing my body? Food isn’t just fuel—it’s part of how we feel connected and cared for. When you’re stressed or dysphoric, you might forget to eat, or not feel up to it. But making space for a favorite snack, a warm meal, or even just a cup of tea is an act of self-compassion.
Am I connecting with people who truly see me? Isolation can make the hard moments feel unbearable. Even one person who affirms your identity—a friend, a support group, a therapist, or someone online—can be a lifeline. Let yourself reach out, even if it's just to say, “Hey, I’m struggling a little today.”
These basic needs may sound simple, but when you’re emotionally overwhelmed, they’re often the first things to slip away. That’s why emotion regulation invites you to build daily habits that support your emotional stability—before you’re in a crisis.
In DBT, this includes:
Identifying and naming your emotions. Naming a feeling gives it shape and reduces its power. Instead of, “I’m just off today,” you might say, “I’m feeling anxious because I’m scared of how people might react.” Naming creates clarity.
Checking the facts. Our brains love to run worst-case scenarios, especially when we feel vulnerable. Emotion regulation teaches you to pause and ask: Is this feeling based on current facts, or on fear? That question alone can calm the nervous system.
Increasing positive experiences. This isn’t about toxic positivity. It’s about choosing to create moments of joy, even when life is hard. Watching a queer film that makes you feel seen, going to a park you love, listening to music that lifts you—these are all ways of signaling to your brain, “Life can still be good.”
And perhaps most importantly, emotion regulation is about patience.
Healing isn’t linear.
Some days will feel heavier than others.
Some days you might slip back into doubt or sadness or numbness.
That doesn’t mean you’re failing—it means you’re human.
You don’t have to do everything right. You just have to keep taking small steps toward caring for yourself. Drinking water, stretching your body, replying to a text from someone who loves you—these little acts of care add up. They build the kind of emotional foundation you need not just to cope, but to thrive. Because at the end of the day, coming out isn’t just about revealing your identity to others. It’s about slowly, tenderly building a life that’s shaped around your truth. A life that feels good to live in. A life that feels like home.
Coming Home to Yourself
Coming out isn’t just a conversation—it’s a journey. A series of moments where you meet yourself more honestly, more gently, and more fully. It’s choosing, over and over, to live in alignment with who you really are, even when it’s hard. Even when it’s messy. Even when the world doesn’t always make space for you. And that takes courage. It takes strength. It takes care.
The truth is, you don’t have to walk that path alone. DBT offers more than just coping skills—it offers a way of being in relationship with yourself. A way to ride out the waves, to speak your truth without losing your grounding, and to take care of your heart along the way. You deserve tools that meet you in your pain and in your joy. Skills that remind you: You are not too much. You are not broken. You are already whole.
Whether you’re whispering your truth to yourself for the first time, or screaming it from the rooftops, may you know this:
Your identity is not a problem to solve—it’s a truth to honor.
Your feelings are not obstacles—they’re signals pointing you toward healing.
And your life? Your life is worth building around who you really are.
So take your time. Breathe deeply. Stay grounded. And above all—stay you.
Give Yourself the Support You Deserve
If you’re looking for support as you navigate your identity, your relationships, or the emotional weight that can come with coming out, know that you don’t have to do it alone. At Spilove Psychotherapy, we offer LGBTQ+ affirming care that meets you with compassion, respect, and a deep understanding of the unique challenges and beauty that come with living your truth. Whether you’re seeking individual therapy, relationship support, or simply a safe space to explore who you are, our clinicians are here to walk alongside you. You deserve to feel seen, grounded, and supported—exactly as you are. When you’re ready, we’re here to help..
Ready to begin? Reach out today for a free 15-minute consultation to learn more about trauma intensives at Spilove Psychotherapy.
Discover more about trauma intensives by exploring our blog posts.
We’re here to help you make this summer a turning point—not just a pause.
About the Author
Julia Castagna, M.S., LPC, is a seasoned trauma therapist licensed in Pennsylvania and New Jersey. She earned her Master of Science in Counseling from Villanova University and currently serves as the Assistant Clinical Director at Spilove Psychotherapy. Julia specializes in addressing complex trauma, including generational trauma, through a variety of therapeutic approaches such as Eye Movement Desensitization and Reprocessing (EMDR), Internal Family Systems (IFS), Dialectical Behavior Therapy (DBT), and mindfulness. More recently, ketamine-assisted therapy.
With a profound understanding of the dynamics of trauma, Julia is adept at fostering resilience, identifying emotional triggers, and building personalized coping strategies for her clients. Her approach is compassionate and client-centered, focusing on creating a safe space where individuals can explore their emotions and begin their journey towards healing.
Besides her clinical expertise, Julia's role as Assistant Clinical Director allows her to influence therapeutic practices and innovations within her team, ensuring that the care provided is both effective and empathetic. If you are ready to reclaim joy and fulfillment in your life, connect with Julia for virtual sessions available across Pennsylvania and New Jersey!
Other Therapy Services We Offer in Bryn Mawr and Philadelphia
Our experienced therapists offer a range of mental health services to support your well-being. Our offerings include Ketamine-assisted Psychotherapy, LGBTQIA+ therapy, and specialized treatment for eating disorders. We also provide couples therapy, EMDR therapy, and trauma intensives.
Additionally, we offer DBT skills groups for those looking to build emotional regulation strategies.
For those seeking guidance outside of traditional therapy, we provide in-person life coaching in Pennsylvania and virtual coaching services nationwide.
