Dialectical Behavior Therapy : Emotional Regulation An Overview

Dialectical behavior therapy is a synthesis of cognitive behavioral therapy and Eastern meditative practices created by Dr Marsha Linehan in the early 1990’s. The framework of DBT is based around a core mindfulness foundation of learning to observe our emotions, describe our emotions, and participate in our experiences in the moment. The four other skills training components of DBT are emotional regulation, distress tolerance, interpersonal effectiveness, and reality acceptance. This article details the foundations for emotional regulation skills training.

The three goals of emotional regulation skills training are to understand your emotions, reduce emotional vulnerability, and decrease emotional suffering. In congruence with each goal are skill building exercises that help in achieving the goal.

To understand emotions, we first analyze myths about emotions. We debate ideas like there is a right and wrong way to feel in a given situation. This idea is a myth about emotions that would lead to judging our feelings not giving us space to fully understand our emotional experience. The next part of the skill training consists of learning to describe emotions mindfully in a six step process: looking at words to describe a emotion, look at prompting events for the emotion, interpretations that promote the feeling, how we experience the feeling, how we express the feeling behaviorally, and the aftereffects of the feeling. This six step process is very detailed and helps to slow down and evaluate an emotional experience in a mindful way so that we learn fully about our own emotional system. Finally, we understand what emotions do for us, validating the need for emotions in the first place. Emotions are shown to help us communicate to others, organize and motivate action, and assist in self-validation.

In order to learn to reduce emotional vulnerability, we must understand and avoid emotional mind (the state of mind in which we act out of pure emotion versus using emotions and logic to make our decisions- -this is the state of mind where we would get angry and act out versus thinking that we know we are angry and why and then deciding what action will serve us and our goals)
The first skill set to help reduce emotional vulnerability is an acronym “PLEASE MASTER” to reinforce the need to build mastery in our lives. For PL- the skill is to treat physical illness exemplifying the need to take care of our physical health as there is a connection between mind, body, and spirit. It also advocates taking medication as prescribed. E- Stands for balanced eating, which describes the need for self care and awareness of our physical needs in emotional wellbeing. A- Avoid mood-altering drugs, which details the need to refrain from taking non-prescribed drugs and alcohol to help with emotional stability. Many people who take an antidepressant do not understand that drinking alcohol invalidates the effectiveness of their antidepressant medication. S- stands for balanced sleep further validating the benefits of regular (similar time each night), adequate (6-8 hours) sleep in emotional regulation. E- represents getting exercise, this helps to reinforce the mental health benefits of endorphins released in exercise. The last component of this skill is to build MASTERy stressing the need to do things every day that help us feel confident and competent.

In the goal of reducing vulnerability to negative emotions, there are steps to increasing positive emotions. This skill emphasizes the need to build positive experiences by looking at our short term and long term options. For experiencing joy in the short term, we need to do pleasant things now by integrating activities we enjoy every day. Through this practice, we create a life worth living. In the long term, we can make changes that will improve the quality of our lives like attending to relationships, “avoid avoiding”, and accumulating positives. Then we want to be mindful of positive experiences, meaning if we are doing what we love stay present mentally with the experiences. Be unmindful of worries by not thinking of when the positive experience will end, not contemplating deserving the positive or fearing what may be expected of you after having something positive.

The last component of the skill set is letting go of emotional suffering. There are two parts to the skill; letting go and taking opposite action. Letting go of emotional suffering through mindfulness to the current emotion emphasizes emotional awareness and the ability to externalize the experience to learn from it. This skill also points out that the best way to get rid of negative emotions is to let them go. Letting go and pushing away are not the same thing. Fighting emotions normally leads to them staying longer, whereas just letting go is from more of a non attachment premise. The final step is learning to respect our emotions as they hold valuable information for us.

Finally, my favorite part of the emotional regulation training is taking opposite action. I describe this skill by telling someone who is depressed to tell me how they would advise someone who wanted to become depressed to get depressed. I ask them to give me details, and they usually start like this…I would tell them to lie in bed, close the blinds, turn off the phone, sleep all day, etc. Then I tell them to learn the skill, they just do the exact opposite to the depressed actions and make themselves follow through. To take opposite action, if your depression tells you to stay in bed- get up. If the depression tells you to turn off the phone, reach out to someone. (I know that I personalize the depression here, but it often helps to externalize the “enemy” to change it.)

Overall the emotional regulation skills of DBT help you to learn to understand your emotions more fully, take care of yourself in ways to reduce emotional intensity, and empower your actions through awareness and steps for change. These skills give you power over your emotions. If you would like to learn more about DBT, please attend the NASW GA annual conference on Saturday October 27th and sign up for the DBT workshop in the evening. If you have questions about DBT or want to use it in an individual or group setting, don’t hesitate to contact Tara Arnold, PhD, LCSW at 404-964-6629.

- By Tara Arnold, Ph.D., LCSW