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The Role of Emotion Regulation in DBT (Part 1)

The Role of Emotion Regulation in DBT Part 1 - Featuring Dr. Sara Schmidt

We sat down with Behavioral Tech Trainer, Dr. Sara Schmidt, to learn all about the role that emotion regulation plays in DBT.  With emotion regulation being such a central topic to the practice of Dialectical Behavior Therapy, Sara shed light not only on how it factors in, but specifically how DBT allows therapists to work with clients to regulate emotions in a way that will enable them to change problematic behaviors.

In part 1, we started by uncovering what emotion regulation is and what it means for clients when they have trouble regulating their emotions.

Question: What is the definition of emotion regulation?

There is the definition of emotions, there is the definition of emotion regulation, and then, conversely, emotion dysregulation. First and foremost, DBT thinks about emotions as brief and voluntary full system responses to stimuli, either internal or external. 

The average emotion lasts for 90 seconds. When we tell our clients this, they are typically surprised. Emotions tend to refire.  That is, something else happens either internally or externally, which perpetuates the emotion.  There are several interacting subsystems that influence what emotions we’re going to experience, when, and how intensely: the cues in the environment, the thoughts we have, the beliefs we have, the physiological sensations, appraisal and interpretations of what has occurred, and how we tend to respond.  Some of this is hard-wired, and some is dependent on other factors.

So, emotion regulation is essentially just that ability to control and influence the emotions that you have, including when you have them, how you’re experiencing them, and how you’re expressing them. 

Question: So why is emotion regulation important in general?

Emotion regulation is important for so many reasons. But taking a step back, what does it mean when we struggle to regulate our emotions?

Emotion dysregulation is an inability – even when you’re making your best efforts – to change or regulate your emotional experiences, actions, and responses.  For our clients in DBT, this tends to be pervasive across contexts, across problems, across emotions. 

It is incredibly hard for many of our clients to sit with intense emotions, and they often try to regulate them in ways that exacerbate other problems. For example, behaviors like self-harm, substance use, or impulsive, risky sex often function to avoid or regulate intense emotions such as sadness, shame, or fear.

But through DBT, clients learn a variety of skills and problem-solving strategies that help them regulate their emotions and modify their behavior.

Question: What does it look like when someone is having trouble regulating their emotions?

When talking to clients about difficulty regulating emotions, I tend to use the metaphor of a toddler trying to drive a Ferrari. You’ve got these intense, powerful emotions, and they completely overpower you. If your emotions are running the show it’s hard to planfully organize your behavior.

It is not always effective to act on our emotions; you need to be able to inhibit impulsive, ineffective behavior when the context calls for it.  For example, if a colleague says something that angers you during a meeting, it is likely not going to be useful to start yelling and cursing at your colleague.  It could be that you still want to express anger in that context, but it’s important to pause and figure out how to do so in a way that is more effective and less likely to result in negative consequences (e.g., further conflict, getting fired).

Or if you think about fear: you’re really afraid that you’re going to fail a test, so you just don’t go to take the test. The fear is reduced in the short-term, but in the long-term, you’re still afraid. And sometimes this can lead to more avoidance of other tests, of class, of going back to school, and thus the fear sticks around.

So, always acting on our emotion urges can get us into trouble.

Question: What can we do to start breaking down the concept of emotion regulation for clients?

When I think about emotions, I think of the words valid, justified, and effective.  These words are a good framework.

Emotions are always “valid.” That means they are always understandable in some way, shape, or form.

Then we look at this idea of “justified.” Does the emotion seem to fit the facts of the situation?  For example, there are many assault survivors who experience guilt. This is understandable for a variety of reasons. We tend to judge our own behavior, and many survivors hold trauma-related beliefs such as “I shouldn’t have been drinking,” or “I shouldn’t have left with this person” that would be related to guilt. However, does guilt fit the facts? Regardless of what a person did or did not do, being assaulted is never the fault of the survivor. So, guilt is not justified in this situation. It doesn’t fit the facts.

Lastly, is it “effective” that you are having this emotion? Is this emotion working for you at the current intensity you are experiencing it?  As an example, anger would be a valid, totally understandable feeling to have at someone who hurt you. It also fits the facts. They have done something to you.  However, if you are so angry that you don’t trust anybody, you’re lashing out at people at the slightest hint of invalidation or feedback, then it’s not effective.  In DBT, we sometimes say that anger is like taking poison and expecting the other person to die. If you’re so angry that it’s interfering with your day to day functioning, then it’s likely not effective.

I find it to be really useful to think about emotions in this way, especially with our clients who start out thinking their emotions aren’t even valid – as if they shouldn’t have them.  On the road to addressing behavior, you can validate emotion without validating action.

As we learn more about the impact that emotion dysregulation has, it becomes clear how an inability to regulate emotions would lead to problematic behaviors. Be sure to check out part 2 of this conversation, where Sara addresses the DBT tools that therapists use to support clients in the journey to regulate their emotions and change behavior.

Sara Schmidt, PhD is a Research Scientist, Trainer, and Consultant at Behavioral Tech, LLC, where she assists in developing training content, methods, and customized implementation plans, and provides training and consultation in both DBT and the DBT Prolonged Exposure (DBT PE) protocol for PTSD. Concurrently, she is a Research Scientist at the Seattle Institute for Biomedical and Clinical Research, part of the VA Puget Sound Health Care System, where she collaborates with Dr. Melanie Harned as a Co-Investigator on NIMH-funded research focused on the evaluation and implementation of DBT and DBT PE. Previously, Dr. Schmidt was a Research Scientist at the Behavioral Research and Therapy Clinics (BRTC) at the University of Washington, where she directed the graduate training program in DBT and currently maintains a Clinical Instructor position supervising advanced doctoral students.