Dialectical Behaviour Therapy (DBT) was developed by Dr. Marsha Linehan as a way of treating individuals who experience high levels of emotional sensitivity and struggle with various emotional and behavioral dysregulation difficulties. Many people who benefit from DBT have experienced complex/developmental trauma and may have a diagnosis of Borderline Personality Disorder , though many individuals without this diagnosis also benefit from the skills taught in DBT. Whether or not the term BPD is familiar or applies to you, you may find aspects of the following information relevant.
People who experience emotional dysregulation may be:
- particularly sensitive to their environment (a small event triggers emotion)
- particularly responsive to certain events (the emotional response is intense)
- slow to return to baseline (the emotions lasts a longer time)
They may struggle in five areas of dysregulation:
- Emotional dysregulation: emotions may feel overwhelming, moods may change rapidly and feel out of control, and a person may feel very angry, sad or fearful and have emotional outbursts.
- Behavioral dysregulation: as a response to emotional suffering, a person may have urges to self-harm, and/or they may engage in various impulsive behaviours such as drugs, alcohol, spending, gambling, eating binges, unsafe driving or unsafe sex.
- Interpersonal dysregulation: a person may go back and forth between love and hate in close relationships. Relationships may be stormy. There may be deep fear of abandonment and frantic efforts to avoid losing connection.
- Cognitive dysregulation: in stressful situations, a person may become hyper-vigilant or dissociate. They may feel that others are deliberately mean to them or out to hurt them them. At other times they may feel spaced out or emotionally numb as if watching things from a distance
- Dysregulation or fragmentation in one’s sense of self: a person may feel empty inside, unsure of who they are, or questioning if they even have an identity. They may feel that they change all the time according to the people they are with. They may feel like they don’t even exist.
Dialectical means that two apparently opposing things can be true at the same time. For example, we can feel very angry with someone while at the same time be extremely fearful of loosing them. From a DBT perspective, each of these experiences are equally valid; rather than labelling our emotional reactions as “right” or “wrong”, we focus on how we can act skillfully in any given moment. For example, we may want to express our disappointment to the person we are angry with, while at the same time making sure that we don’t push them away.
One of the main areas of focus in DBT is to help us regulate our emotions with the use of various skills. It is a highly supportive approach where the therapist takes great care to validate the emotions of the client while also supporting their efforts towards change. Together the client and therapist explore what emotions, actions, and situations are causing distress in daily life and what skills might help to alleviate the suffering.
There are four different sets of skills taught in DBT:
- Mindfulness skills
- Distress tolerance skills
- Emotion regulation skills
- Interpersonal effectiveness skills
DBT is considered a top down approach to self-regulation, that teaches clients to manage symptoms through mindfulness and skill-based strategies. This often pairs well with the bottom up work that is done in other therapies like Somatic Experiencing and EMDR, by working at the level of the body to achieve similar goals to lay the foundation and build one’s capacity to work on deeper trauma processing.