How Do I Know if DBT is for Me (or My Loved One)?
In the 1970s, when Marsha Linehan began the process of developing dialectical behavior therapy (DBT), her goal was to establish a treatment for people who were severely suicidal. Marsha’s motivation goes back to an experience she had as a suicidal teenager herself. In her memoir, she writes that, “I made a vow to God that I would get myself out of hell and that, once I did, I would go back to hell and get others out.” She succeeded, and now decades later, DBT is an empirically-supported treatment for borderline personality disorder (a diagnosis associated with high rates of suicidal behavior, and which Marsha has said she believes she had as a teenager). But, DBT has also been shown to be helpful for treating a wide range of emotional difficulties including suicidality, self-harm, depression, PTSD, eating disorder, and co-occurring substance use disorders. What unites all of these difficulties is that they are all forms of emotion dysregulation. DBT is a treatment for emotion dysregulation.
What is emotion dysregulation?
“Emotion dysregulation” refers to emotions that are out-of-control. How do emotions get to be out-of-control? Typically this results from either quick changes in emotion (i.e., from happy to intensely angry to intensely sad, back to happy again) – or a lasting negative emotional state, such as depression (Rathus & Miller, 2014). Both of these types of emotional experiences can lead to emotions being “in the driver’s seat” (i.e., determining the person’s actions), without much consideration for other things, such as long-term goals, problem solving, or potential down sides of acting on the emotions.
Alan Fruzzetti uses a comparison to a headache to illustrate what dysregulation looks like: most of the time, when a person has a headache, it might be bothersome (even painful), but it doesn’t keep them from going about their life. With most headaches, you can “take them with you” as you go to school, work, or whatever else you have to do. But some headaches, like severe migraines, can keep you stuck in bed with the lights off, unable to do much of anything. The pain becomes overwhelming, and your soul focus is on managing the pain. This is a dysregulated headache. You can’t take it with you–it keeps you stuck in bed, and you can’t go about your daily life. It gets in the way.
Dysregulation is separate from the intensity or severity of the emotion. The intensity can be related–more intense emotions may be more likely to become dysregulated, but it’s possible to have a very intense emotion that you still “take with you”, and it’s also possible to have a more moderate emotion that becomes dysregulated.
The core characteristic: Emotional sensitivity
The key question we ask to understand whether someone may be a good fit for DBT is whether the difficulties they are experiencing come from emotional sensitivity. Emotional sensitivity refers to having a very finely tuned emotional radar. When you are highly sensitive, if something happens around you (e.g., another person makes a slight grimace), you are unlikely to miss it. This doesn’t mean that you react to things that aren’t there–highly sensitive people are not imagining emotional content. It just means you’ll pick up on even subtle emotional cues. Take for example, someone who is highly sensitive to noise. They will pick up on noises that other people - who are less sensitive to noise - will not hear. It’s not that one person is wrong and the other is right, it’s that their genuine perceptions are different given their varying levels of sensitivity.
Emotional sensitivity is a characteristic like any other. Intelligence and physical flexibility are other examples of characteristics that vary in the population. Sensitivity isn’t necessarily “bad” or “good” – it just varies in the population. To illustrate this point, I like to point out that therapists, as a group, tend to be highly sensitive individuals. Artists also tend to be highly sensitive. The difficulty with emotional sensitivity arises if you do not have the skills to manage it. In DBT, we teach the skills to manage emotional sensitivity. If you are highly sensitive, and you don’t have the skills to manage it, you have a recipe for emotion dysregulation. By supporting you in learning the skills to manage your sensitivity, DBT can help you act in line with your long-term goals, rather than being driven by dysregulated emotions.
What does it look like when a highly sensitive person has problems with dysregulated emotions?
Emotion dysregulation can take many forms. Often, it looks like difficulties with suicidality, self-harm, relationships, impulsivity, depression, anxiety, trauma symptoms, eating difficulties, and substance use. In all of these cases, the core feature is that the problem (e.g., self-harm behavior) is a result of out-of-control (i.e., dysregulalted) emotions.
I think I (or my child/loved one) is struggling with emotion dysregulation and might benefit from DBT. What’s the first step?
Give us a call at (978) 440-2168 or send us an email at admissions@dbtworks.com anytime. We’ll set up a complimentary 30 minute zoom call to help you figure out if DBT is the right fit right now.
