An excerpt from Calming the Emotional Storm: Using Dialectical Behavior Therapy Skills to Manage Your Emotions and Balance Your Life (2012)
Introduction
Pain is a natural part of life. We all experience disappointments: not getting the promotion we wanted at work; finding out the person we had a crush on is involved with someone else. We grieve when we lose the people we love: when a relationship doesn’t work out, our best friend moves away, or someone we care about dies. We may feel anger when something happens that we feel is unjust, whether it be a killing oil spill, a racist comment, or someone cutting us off in traffic. Anxiety, too, is a natural part of being human; we may feel anxious when we have to give a presentation at work, when we’re out on a first date, or when we’re asking someone for something really important to us.
All of these emotions are painful for us. And yet we understand them, they make sense to us, and so we allow ourselves to experience them and move on. But what happens when the emotions you’re experiencing don’t seem to make sense and you can’t understand them? When the emotions you have are so strong that you can’t manage them appropriately and move on, and instead you act out in negative ways as you try to get rid of them? What happens when other people don’t understand your emotions either, and these emotions wreak havoc on the relationships in your life? This experience is known as emotion dysregulation.
What Is Emotion Dysregulation?
Emotion dysregulation means that you react emotionally to things that most people wouldn’t typically react to, your reaction is more intense than the situation warrants, and it takes you longer than the average person to recover from it or to get back to feeling like your usual self. People who have difficulty regulating or managing their emotions usually also find it difficult to tolerate their emotions and often have trouble identifying, understanding, and expressing how they feel.
Take Mary, for example. Mary has always had a hard time holding down a job. Many times, she’s gotten lucky and found a job that she mostly really likes. But once she’s been there for a while, feeling comfortable and confident, she always starts to criticize her superiors and how the organization is being run. Inevitably, she has a conflict with someone, and her anger gets out of hand; she loses her temper, says things that she will later regret, and loses her job as a result.
Tim is another good example. Divorced for five years, Tim has been looking for that special someone. He’s been spending a lot of time dating online, but each time he goes out on a date and it doesn’t work out, he finds himself devastated all over again. He can’t help thinking that he’s going to be alone for the rest of his life. Not only does this worry him, but it causes him to feel so sad at times that he doesn’t even want to get out of bed.
Emotion dysregulation is not uncommon. It often goes hand in hand with mental health problems, such as borderline personality disorder or mood and anxiety disorders, but it can also be present in people who have no specific mental health problems. Difficulties regulating your emotions can often lead to all sorts of other problems in your life. Trying to avoid or tolerate your emotions, you may engage in unhealthy behaviors, such as drinking or using drugs, disordered eating, gambling, overspending, or dangerous sexual practices (such as having sex with strangers). The list goes on and on.
In addition, your relationships and your self-esteem may suffer, as a result of your inability to manage your emotions or as a result of the unhealthy behaviors just mentioned. I work with people on a daily basis who have difficulty regulating their emotions, and I see firsthand the problems it causes in their lives, and all because they didn’t learn certain skills to help them deal with their emotions as they were growing up. The good news is that it’s not too late. You can learn these skills at any time.
What Causes Emotion Dysregulation?
Unfortunately, when it comes to the brain, there’s a lot we still don’t know. With mental illness of any sort, the prevailing theory is that there is no one cause. Rather, it takes a genetic or biological predisposition, along with certain environmental factors, for a particular mental disorder to evolve.
With respect to emotion dysregulation problems, this theory applies as well. There is evidence that the way we experience emotions is hardwired into us; some people are simply born more emotionally sensitive than others. When this is the case, you are more vulnerable to emotion dysregulation problems because you are more likely to be overwhelmed by your emotions.
But our environment also plays a large role in the development of emotion dysregulation, and trauma is a common factor for people who have problems managing their emotions: having been physically or sexually abused or having been neglected as a child, for example.
According to dialectical behavior therapy (DBT), which will be discussed shortly, one of the most common contributing factors to emotion dysregulation is growing up in an emotionally invalidating environment, an environment in which you were taught that your emotions were wrong, inappropriate, or not okay. Whether these messages were direct (such as “Stop crying or I’ll give you something to cry about”) or subtle (for example, your mother gets anxious every time you express anger, so you learn that anger isn’t okay), the lesson is that your feelings are bad. As a result, children growing up in this kind of environment learn to suppress, ignore, and avoid their emotions, causing their feelings to be increasingly foreign, scary, and confusing to them.
How Dialectical Behavior Therapy Can Help
For most people, learning to regulate emotions is something that occurs naturally as we mature. As we grow, we gradually develop these skills, due to our maturing brain and the people around us who teach us how to regulate our emotions. For example, when we fell and scraped our knee or awoke in the night crying because of a nightmare, a caregiver would often be there to soothe us, teaching us how to do this on our own. Or when we were feeling angry, a caregiver would let us know that our anger made sense and was understandable and would then help us figure out what to do to help reduce our anger. As previously noted, however, not everyone receives this kind of teaching, but if you didn’t automatically learn how to regulate your emotions, you can still learn skills that will help you to manage your emotions consciously.
Dialectical behavior therapy (DBT) is a psychotherapy created by psychologist Marsha Linehan (1993) in Seattle, Washington. Linehan’s work has its roots in cognitive behavioral therapy (CBT), which she was using to treat people with an illness called borderline personality disorder, of which emotion dysregulation is a primary symptom. The basic premise underlying CBT is that our emotions, thoughts, and behaviors are all interconnected, and that by changing one of these, we can impact the other two. In other words, by changing how you think about a situation, you can change your emotions and behaviors in that situation; by changing how you behave in a situation, you can change your thoughts and emotions, and so on.
From her work with patients with borderline personality disorder, Linehan came to realize that CBT wasn’t enough, and this led her to create a new therapy. As with cognitive behavioral therapy, DBT skills stem from the basic premise that our emotions, thoughts, and behaviors are all interconnected, but Linehan added the concepts of mindfulness and acceptance to this idea. Mindfulness is about living in the present moment with awareness and with acceptance; what this means in terms of emotion dysregulation is that you learn to become aware of your personal experience, including your emotions, thoughts, and behaviors, giving you the opportunity to make changes in any of these areas. Also key to DBT is the idea of acceptance, for example, learning to accept or acknowledge your emotions rather than trying to push them away or ignore them.
The DBT Skills
This book focuses on the four sets of DBT skills, all of which target emotion regulation in one way or another:
The major emphasis of DBT is to learn to bear emotional pain skillfully (Linehan 1993). For it to be most effective, however, you need to think of DBT not just as a therapy or set of skills but as a way of living. Learning these skills and applying them to your life will help you make positive changes. But you must remember that DBT won’t take away your pain; it will just help you learn to live with it more effectively and act in ways that will result in less pain for you in the long run.
Who This Book Is For
This book is written for anyone experiencing difficulties with the emotions in their life. If you have trouble managing your anger, sadness, or worry, this book can help you. This book is not meant to take the place of a professional psychotherapist. If you work your way through this book and find that you’re still struggling, you may want to seek a professional who can help you apply these skills to your life. If you have thoughts of suicide or engage in self-harming behaviors such as cutting yourself, you should seek help from a professional as soon as possible.
This book will also be helpful for any health care professional who is treating people with emotion regulation problems and who wishes to learn the DBT skills. You may find that these skills not only help you help your clients but that they also help you in your own life.
How to Use This Book
It’s important to take your time as your work your way through this book. You may choose to read it cover to cover, or you may decide to focus first on reading the chapters that seem to apply most to your own difficulties. Either way, you’ll get more out of the experience if you’re doing the exercises discussed in each chapter.
Again, you should take your time so that you really absorb what you’re reading. You don’t have to master each skill before moving on to the next—many of the skills presented here will take years for any of us to master, if we ever do—but make sure that you’re comfortable enough with what you’ve learned before you move on.
Last but not least, keep in mind that this book is about changing the way you live your life. So have patience with yourself, be kind to yourself, and when you’re ready, turn the page.
Introduction
Pain is a natural part of life. We all experience disappointments: not getting the promotion we wanted at work; finding out the person we had a crush on is involved with someone else. We grieve when we lose the people we love: when a relationship doesn’t work out, our best friend moves away, or someone we care about dies. We may feel anger when something happens that we feel is unjust, whether it be a killing oil spill, a racist comment, or someone cutting us off in traffic. Anxiety, too, is a natural part of being human; we may feel anxious when we have to give a presentation at work, when we’re out on a first date, or when we’re asking someone for something really important to us.
All of these emotions are painful for us. And yet we understand them, they make sense to us, and so we allow ourselves to experience them and move on. But what happens when the emotions you’re experiencing don’t seem to make sense and you can’t understand them? When the emotions you have are so strong that you can’t manage them appropriately and move on, and instead you act out in negative ways as you try to get rid of them? What happens when other people don’t understand your emotions either, and these emotions wreak havoc on the relationships in your life? This experience is known as emotion dysregulation.
What Is Emotion Dysregulation?
Emotion dysregulation means that you react emotionally to things that most people wouldn’t typically react to, your reaction is more intense than the situation warrants, and it takes you longer than the average person to recover from it or to get back to feeling like your usual self. People who have difficulty regulating or managing their emotions usually also find it difficult to tolerate their emotions and often have trouble identifying, understanding, and expressing how they feel.
Take Mary, for example. Mary has always had a hard time holding down a job. Many times, she’s gotten lucky and found a job that she mostly really likes. But once she’s been there for a while, feeling comfortable and confident, she always starts to criticize her superiors and how the organization is being run. Inevitably, she has a conflict with someone, and her anger gets out of hand; she loses her temper, says things that she will later regret, and loses her job as a result.
Tim is another good example. Divorced for five years, Tim has been looking for that special someone. He’s been spending a lot of time dating online, but each time he goes out on a date and it doesn’t work out, he finds himself devastated all over again. He can’t help thinking that he’s going to be alone for the rest of his life. Not only does this worry him, but it causes him to feel so sad at times that he doesn’t even want to get out of bed.
Emotion dysregulation is not uncommon. It often goes hand in hand with mental health problems, such as borderline personality disorder or mood and anxiety disorders, but it can also be present in people who have no specific mental health problems. Difficulties regulating your emotions can often lead to all sorts of other problems in your life. Trying to avoid or tolerate your emotions, you may engage in unhealthy behaviors, such as drinking or using drugs, disordered eating, gambling, overspending, or dangerous sexual practices (such as having sex with strangers). The list goes on and on.
In addition, your relationships and your self-esteem may suffer, as a result of your inability to manage your emotions or as a result of the unhealthy behaviors just mentioned. I work with people on a daily basis who have difficulty regulating their emotions, and I see firsthand the problems it causes in their lives, and all because they didn’t learn certain skills to help them deal with their emotions as they were growing up. The good news is that it’s not too late. You can learn these skills at any time.
What Causes Emotion Dysregulation?
Unfortunately, when it comes to the brain, there’s a lot we still don’t know. With mental illness of any sort, the prevailing theory is that there is no one cause. Rather, it takes a genetic or biological predisposition, along with certain environmental factors, for a particular mental disorder to evolve.
With respect to emotion dysregulation problems, this theory applies as well. There is evidence that the way we experience emotions is hardwired into us; some people are simply born more emotionally sensitive than others. When this is the case, you are more vulnerable to emotion dysregulation problems because you are more likely to be overwhelmed by your emotions.
But our environment also plays a large role in the development of emotion dysregulation, and trauma is a common factor for people who have problems managing their emotions: having been physically or sexually abused or having been neglected as a child, for example.
According to dialectical behavior therapy (DBT), which will be discussed shortly, one of the most common contributing factors to emotion dysregulation is growing up in an emotionally invalidating environment, an environment in which you were taught that your emotions were wrong, inappropriate, or not okay. Whether these messages were direct (such as “Stop crying or I’ll give you something to cry about”) or subtle (for example, your mother gets anxious every time you express anger, so you learn that anger isn’t okay), the lesson is that your feelings are bad. As a result, children growing up in this kind of environment learn to suppress, ignore, and avoid their emotions, causing their feelings to be increasingly foreign, scary, and confusing to them.
How Dialectical Behavior Therapy Can Help
For most people, learning to regulate emotions is something that occurs naturally as we mature. As we grow, we gradually develop these skills, due to our maturing brain and the people around us who teach us how to regulate our emotions. For example, when we fell and scraped our knee or awoke in the night crying because of a nightmare, a caregiver would often be there to soothe us, teaching us how to do this on our own. Or when we were feeling angry, a caregiver would let us know that our anger made sense and was understandable and would then help us figure out what to do to help reduce our anger. As previously noted, however, not everyone receives this kind of teaching, but if you didn’t automatically learn how to regulate your emotions, you can still learn skills that will help you to manage your emotions consciously.
Dialectical behavior therapy (DBT) is a psychotherapy created by psychologist Marsha Linehan (1993) in Seattle, Washington. Linehan’s work has its roots in cognitive behavioral therapy (CBT), which she was using to treat people with an illness called borderline personality disorder, of which emotion dysregulation is a primary symptom. The basic premise underlying CBT is that our emotions, thoughts, and behaviors are all interconnected, and that by changing one of these, we can impact the other two. In other words, by changing how you think about a situation, you can change your emotions and behaviors in that situation; by changing how you behave in a situation, you can change your thoughts and emotions, and so on.
From her work with patients with borderline personality disorder, Linehan came to realize that CBT wasn’t enough, and this led her to create a new therapy. As with cognitive behavioral therapy, DBT skills stem from the basic premise that our emotions, thoughts, and behaviors are all interconnected, but Linehan added the concepts of mindfulness and acceptance to this idea. Mindfulness is about living in the present moment with awareness and with acceptance; what this means in terms of emotion dysregulation is that you learn to become aware of your personal experience, including your emotions, thoughts, and behaviors, giving you the opportunity to make changes in any of these areas. Also key to DBT is the idea of acceptance, for example, learning to accept or acknowledge your emotions rather than trying to push them away or ignore them.
The DBT Skills
This book focuses on the four sets of DBT skills, all of which target emotion regulation in one way or another:
- Core mindfulness skills will help you to focus on living in the present moment. This decreases the painful emotions that come from constantly thinking about the past or the future. Living in the present moment also helps to increase your awareness of yourself—what you’re thinking and how you’re feeling and behaving—allowing you the choice of changing any of these things.
- Distress tolerance skills will help you cope with crisis situations in healthy ways rather than in unhealthy ways (such as using substances, overspending, eating unhealthily, or lashing out at others) that have long-term negative consequences.
- Emotion regulation skills will help you to manage your emotions more effectively (for example, reacting less intensely or coming back down from your reaction more quickly) and to tolerate your emotions when you can’t change them or reduce their intensity.
- Interpersonal effectiveness skills will help you maintain or even improve your relationships as you learn to act assertively to balance the give-and-take in your relationships and how to take good care of yourself.
The major emphasis of DBT is to learn to bear emotional pain skillfully (Linehan 1993). For it to be most effective, however, you need to think of DBT not just as a therapy or set of skills but as a way of living. Learning these skills and applying them to your life will help you make positive changes. But you must remember that DBT won’t take away your pain; it will just help you learn to live with it more effectively and act in ways that will result in less pain for you in the long run.
Who This Book Is For
This book is written for anyone experiencing difficulties with the emotions in their life. If you have trouble managing your anger, sadness, or worry, this book can help you. This book is not meant to take the place of a professional psychotherapist. If you work your way through this book and find that you’re still struggling, you may want to seek a professional who can help you apply these skills to your life. If you have thoughts of suicide or engage in self-harming behaviors such as cutting yourself, you should seek help from a professional as soon as possible.
This book will also be helpful for any health care professional who is treating people with emotion regulation problems and who wishes to learn the DBT skills. You may find that these skills not only help you help your clients but that they also help you in your own life.
How to Use This Book
It’s important to take your time as your work your way through this book. You may choose to read it cover to cover, or you may decide to focus first on reading the chapters that seem to apply most to your own difficulties. Either way, you’ll get more out of the experience if you’re doing the exercises discussed in each chapter.
Again, you should take your time so that you really absorb what you’re reading. You don’t have to master each skill before moving on to the next—many of the skills presented here will take years for any of us to master, if we ever do—but make sure that you’re comfortable enough with what you’ve learned before you move on.
Last but not least, keep in mind that this book is about changing the way you live your life. So have patience with yourself, be kind to yourself, and when you’re ready, turn the page.
