Dialectical Behavior Therapy (DBT) was specifically developed for individuals with Borderline Personality Disorder, suicidal thinking, and self-harm, but has grown into one of the most widely used forms of therapy today. This form of psychotherapy is now used to treat patients with a range of mental health disorders such as eating disorders, bipolar disorder, and substance use disorders.
DBT works by teaching patients four main modules: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. Each module builds off the others and helps patients learn skills necessary to alter behavior patterns that prevent them from living a happy, well-adjusted life.
Almost everyone struggles with managing emotions at some point. But those with certain mental health issues have a much harder time controlling their emotions and controlling behaviors that result from intense emotional responses. That difficulty is exactly why emotional regulation is incorporated into Dialectical Behavior Therapy.
There several mental health conditions that can be accompanied by high emotional intensity. Personality disorders such as BPD, some mood disorders, and even traumatic brain injuries can feature extreme emotional reactions that fluctuate frequently. DBT teaches patients how to identify emotions, be mindful of how they’re impacting their behaviors, and apply distress tolerance skills to self-regulate. The idea is to preemptively address emotional problems using evidenced-based skills before they convert into self-destructive actions.
Emotional regulation builds off of two other DBT modules, mindfulness and distress tolerance. Patients are first taught to identify and label emotions. Patients then get coaching in how to be mindful of current emotions and actions. And, get both individual DBT therapy sessions and group DBT settings distress tolerance techniques to correct any destructive behavior that would normally arise from overwhelming emotions.
Emotional regulation skills are based on the theory that intense emotions are a response to invalidating past experiences, which has conditioned the individual to react in a certain, maladaptive way. Therefore, patients must alter their conditioned responses to emotions. DBT skills within this module are classifiable in four different groups: understanding and naming emotions, changing unwanted emotions, reducing vulnerability, and managing extreme conditions.
One skill used in understanding emotions is the “story of emotion”. During DBT, patients will describe:
Most dialectical behavior therapy courses start with two weeks on mindfulness, then spend six weeks on distress tolerance. Knowledge of these two modules is important before beginning emotional regulation. This is because the emotional regulation modules build from them. The ER modules also use mindfulness and distress tolerance skills as part of overall emotional management. DBT typically spends around six weeks on emotional regulation.