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Can we trick our brains into helping us get a handle on our emotions?
Many people who are challenged with depression and anxiety have found relief using a set of tools and strategies for emotional regulation called Dialectical Behavior Therapy (DBT).
This form of therapy stresses acceptance of emotions and teaches skills for increasing self-awareness and techniques for calming heated emotions.
Behavioral health professionals find DBT emotion regulation skills useful when working with individuals and in group settings.
Dialectical Behavior Therapy
Dialectical Behavior Therapy (DBT) was created by Marsha Linehan, a pioneering psychologist and author. Early in her life, Linehan was diagnosed with schizophrenia and institutionalized. She underwent electroconvulsive therapy and seclusion, and she was medicated with Thorazine and Librium. She has come to believe she had borderline personality disorder. In her decades of research and practice, she specialized in working with people with borderline personality disorder, suicidal behaviors, and substance use disorders. She also became a practitioner of Zen Buddhism.
Linehan’s greatest contribution to the field of psychology was DBT, which can be considered a branch of cognitive behavioral therapy (CBT) that incorporates elements of mindfulness.
The website DBT Tools explains that DBT is “intended to help those who are highly sensitive to their environment, are highly reactive to events, often become overwhelmed with emotion, and are slow to return to calm. Their childhood environment may have been invalidating or chaotic. Many of these clients have experienced some form of trauma, and may seek perfectionism.”
Teaching Skills for Regulating Emotions
As trainer Charles Atkins, MD, shares in the CWC course, “A Day of DBT Skills Training,” DBT is a problem/solution-based approach. DBT skills training includes the following four elements:
- Mindfulness
- Interpersonal effectiveness
- Emotional regulation
- Distress tolerance/crisis survival
Metrics for DBT
Behavioral health professionals use a number of metrics to determine which tools or strategies to pursue with clients. Metrics allow clinicians to set goals and objectives and track progress over time. The measures don’t need to be complicated or expensive. In fact, a number of them are available for free.
- A Subjective Units of Distress Scale (SUDS) allows clients to rank their level of distress from 0 (no distress) to 100 (the most distress imaginable).
- The American Psychiatric Association offers a number of free online assessments for clinicians.
- The National Center for PTSD offers resources for families, patients, and providers.
- The Substance Abuse and Mental Health Services Administration (SAMHSA) has many resources for clinicians, including screening tools.
Diary Cards
Another useful tool for clinicians and clients is diary cards. Diary cards are available online at a number of locations and help clients keep track of their emotions and the skills they are working on.
Diary cards are helpful for identifying challenges that occur between sessions, and they can guide clinicians in creating behavioral chain analyses and solution analyses.
Samples of diary cards are available at Behavioral Tech, LLC or DBT Self Help.
DBT Emotional Regulation Skills
Emotional regulation skills help us to understand our own emotions and to reduce our emotional suffering. The DBT Tools website identifies a number of techniques for regulating emotions.
- The STOP Skill: Stop, Take a step back, Observe, and Proceed mindfully. This skill gives your brain time to catch up to your emotions.
- Opposite Action Skill teaches us to respond in the opposite way from our biological reaction. For example, if you feel angry, you would instead show kindness or concern or walk away. If you feel shame, you would lift your head, eyes, and shoulders.
- ABC Please Skill: Accumulate positive emotions by doing things that are pleasant. Build mastery by doing things you enjoy. Cope ahead by rehearsing situations so you are prepared to cope.
- Build Mastery Skill: When we do things we enjoy or explore new skills, we enjoy a sense of accomplishment and joy. We can build mastery in everyday activities, like cooking and cleaning, or building relationships with loved ones.
- Cope Ahead Skill: This skill helps reduce stress by planning and preparing for a situation or event that may cause discomfort. It involves imagining the situation in your mind and rehearsing how you will cope with the challenge.
- Positive Self-Talk Skill: This skill teaches us to reverse our automatic negative thoughts (ANTs) by identifying them and revising them to something we prefer to believe.
Resources for Clinicians
Clinicians who want to explore DBT further can find numerous tools and resources to help clients improve their ability to regulate emotions and find a path to recovery.
- DBT Skills-Emotional Regulation, CWC training taught by Jelan Agnew, LCSW
- DBT Skills Training Manual by Marsha M. Linehan
- Cognitive-Behavioral Treatment of Borderline Personality Disorder by Marsha Linehan
- DBT Skills Training Handouts and Worksheets
- The Dialectical Behavior Therapy Skills Workbook by Matthew McKay, Jeffrey C. Wood, and Jeffrey Brantley
- DBT Skills Manual for Adolescents by Jill H. Rathus and Alec L. Miller
Recovery Journey
DBT is one aspect of a person’s treatment and recovery, but it can be a powerful one. In this edition of Trauma Matters, Jackie Sandy, who has participated in ongoing DBT skills classes, writes to share insights from her journey of healing from abuse, suicide attempts, and substance use issues.
“It’s so easy to do the negative things in life,” writes Sandy. “To bring oneself out of chaos takes courage that lies within us, courage that is dormant until we activate it.”
She also quotes Marsha Linehan: “Acceptance is the only way out of hell. It is the way to turn suffering that cannot be tolerated into pain that can be tolerated. Pain is nature’s way of signaling that something is wrong, or that something needs to be done.”
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