Emotional Dysregulation and Dialectical Behavioral Therapy (DBT)

Many young people who suffer from disorders such as borderline personality disorder or intense depression have great difficulty regulating their emotions. They may be prone to relational drama, experience steep and sudden emotional shifts or lapse into extreme black or white thinking. This kind of emotional dysregulation can make it difficult for a young person to tolerate traditional therapy because the introspection it requires can trigger powerful reactions, making things worse instead of better.

Dialectical Behavioral Therapy, or DBT, is a synthesis of several therapeutic approaches that was designed primarily to treat disorders involving emotional dysregulation—including borderline personality disorder, extreme emotional lability and poor anger management. DBT teaches young people suffering from emotional dysregulation a number of skills, including

  • Identifying and labeling emotions
  • Identifying obstacles to emotional control
  • Reducing vulnerability to the “emotion mind”
  • Cultivating positive emotional events
  • Increasing mindfulness of current emotions
  • Taking “opposite action,” i.e. acting in a way that is opposite to current negative emotions
  • Applying distress tolerance techniques

In contrast to free-flowing and introspective talk therapies, DBT is a highly structured approach to treatment. Using a combination of western cognitive-behavioral techniques, psycho-educational modules and eastern mindfulness practices, DBT fosters the systematic learning of new emotional coping skills. It also gradually challenges the negative and fallacious thoughts or beliefs that are often the source of emotional turmoil.

DBT is based in part on the idea that, unlike the black and white thinking that often accompanies emotional dysregulation, opposites can actually coexist and be synthesized. Working patiently to foster this “shades of grey” approach to thinking and feeling has proven quite effective for adolescents experiencing mood dysregulation and impulsivity. DBT emphasizes taking responsibility for one’s problems and examining how one habitually deals with conflict and negative feelings. Goals of DBT include identifying maladaptive coping patterns and learning adaptive coping strategies that promote psychological well-being. DBT calls on the student to accept current reality while maintaining a strong and conscious commitment to change.

DBT has also been modified for use with a wide range of difficulties such as eating disorders, substance use, self-harm and anger management. DBT targets situations that cause intense distress and teaches practical skills that allow the young person to avoid habitual self-defeating behaviors in reaction to those situations. DBT helps young people understand that on the one hand they are doing the best they can right now, but on the other hand there is great hope for specific and positive change.