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Dialectical Behavior Therapy TechniquesEmotion Regulation

Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUsPodcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery with Doc Snipes President: Recovery and Resilience International

Objectives Review the basic premises of DBT Learn about the HPA-Axis Define emotion regulation Identify why emotion regulation is important

and how it can help clients Explore emotion regulation techniques

Basic DBT Premises Dialectical Theory

Everything is interconnected Reality is not static Constantly evolving truth can be found by

synthesizing differing points of view

DBT Assumptions People do their best People want to get better/be happy Clients need to work harder and be more motivated

to make changes in their lives Even if people didn’t create their problems, they still

must solve them The lives of suicidal [or addicted] people are

unbearable People need to learn how to live skillfully in all areas

of their lives. People cannot fail in treatment

What is Emotion Regulation Emotional dysregulation results from a combination of

High emotional vulnerability Extended time needed to return to baseline Inability to regulate or modulate one’s emotions

Emotional vulnerability refers to [situation] in which an individual is more emotionally sensitive or reactive than others

Differences in the central nervous system and HPA Axis play a role in making a person more emotionally vulnerable/reactive

The environments of people who are more emotionally reactive are often invalidating

What is Emotion Regulation According to Linehan, “Emotional regulation is the

ability to control or influence which emotions you have, when you have them, and how you experience and express them.”

Emotion Regulation Prevents unwanted emotions by reducing vulnerabilities Changes painful emotions once they start Teaches that:

Emotions in and of themselves are not good or badSuppresses emotions makes things worse

Emotion Regulation Emotions are effective when:

Acting on the emotion is in your best interest. Expressing your emotion gets you closer to your

[ultimate] goals. Expressing your emotions will influence others in

ways that will help you. Your emotions are sending you an important

message.

The HPA-Axis Hypothalamic Pituitary Adrenal (HPA) axis is

our central stress response system Hypothalamus

releases a compound called corticotrophin releasing factor (CRF)

PituitaryTriggers the release of adrenocorticotrophic

hormone (ACTH) Adrenal

ACTH is released and causes the adrenal gland to release the stress hormones, particularly cortisol and adrenaline

HPA Axis The Adrenals

Control chemical reactions over large parts of your body, including your ‘fight-or-flight’ response.

Produce even more hormones than the pituitary glandSteroid hormones like cortisol (a glucocorticoid)

increasing availability of glucose and fatSex hormones like DHEA, estrogenStress hormones like adrenaline

Once the perceived threat passes, cortisol levels return to normal What if the threat never passes?

HPA Axis The amygdala and hippocampus are intertwined with the

stress response (Higgins & George, 2013) The amygdala modulates anger and fear / fight or flight The hippocampus helps to develop and store memories

The brain of a child or adolescent is particularly vulnerable because of its high state of plasticity. Bad things are learned Emotional upset prevents learning new, positive things to

counterbalance People who live in a chronically stressful environment

may also have an overactive HPA-Axis

The Brain and Stress What happens to the brain when there is a chronic

threat to safety and a constant underlay of anxiety? As it learns, people’s brains forge synaptic connections

from experience and prune away connections that are not utilized.

People who feel a lack of control over their environment are particularly vulnerable to excessive stimulation of the HPA response. Abused and neglected children Abused and neglected adults Adults with anxiety or depressive disorders

The Brain and Stress The synaptic connections that form the

foundation people’s schema of themselves and the world become skewed towards the traumatic event at the expensive of a synaptic network based on positive experiences and healthy relationships.

The hypervigilant state activated by the HPA response: Disrupts the ability to focus and learn Impairs the ability to form new memories and recall

information due to the physiologic changes to the hippocampus (cannot rebalance a skewed system)

Is associated with emotional and behavioral dysregulation.

Example: A Relationship

https://campuspress.yale.edu/exploringmentalhealth/stress-and-the-hpa-axis/

Emotion Regulation Transdiagnostic or useful with many different

disorders Increasing present focused emotion awareness Increasing cognitive flexibility Identifying and preventing patterns of

Emotion avoidance Emotion-driven behaviors

Increasing awareness and tolerance of emotion-related physical sensations

Using emotion focused exposure procedures

Understanding Emotions Emotional behavior is functional to the

person To change the behavior, it is necessary to

identify the functions and reinforcers of that behavior

Emotions function to: Communicate to others and influence and control

their behaviors Serve as an alert or alarm which motivate one’s

own behaviors

Identifying Obstacles to Changing Emotions Biological factors

Organic Situationally caused by

Chronic stressAddictionSleep deprivationNutritional problems +/-

Skills factors Cognitive responses Behavioral responses

Identifying Obstacles to Changing Emotions Environmental Factors

People Places Things

Identifying and Labeling Emotions Identifying/observe personal responses in context Identify

The event prompting the emotion Thoughts Physical Sensations Urges Expressive behaviors associated with the emotion Interpretations of that event History prior to the event that increased vulnerability to

emotional dysregulation After effects of the emotion on other types of functioning

Changing Unwanted Emotions Check the facts

For and Against Emotional vs. Factual reasoning

Problem Solving Changing the situation that is causing the

unpleasant emotion Prevent vulnerabilities

Reduces reactivity by turning down the stress responseHelping the person be aware of and able to

learn/remember positive experiences

Reducing Vulnerability to the Emotional Mind Building mastery through

Activities that build self-efficacy, self-control and competence

Mental Rehearsal Physical Body-Mind Care

Pain and illness treatment [Laughter] Eating to support mental and physical health Addictive or mood altering drugs or behaviors Sleep Exercise

Mindfulness Nonjudgmental observation and description of

current emotions Primary emotions are often adaptive and

appropriate Much emotional distress is a result of

secondary responses: Shame over having it Anxiety about it being “wrong” Rage due to feeling judged for it

Mindfulness serves as an exposure technique

Mindfulness Exposure to intense emotions without

negative consequences (Nonjudgmental acceptance) extinguishes the secondary emotional responseScenario 1• Unpleasant experience• Unpleasant emotion• Guilt/Shame/Anger • Acting to stop the avalanche of

negativity in the absence of adequate skills

Scenario 2• Unpleasant experience• Unpleasant emotion• Ability to deal with one

emotion

Summary Emotional dysregulation is common in many disorders People with dysregulated emotions have a stronger

and longer lasting response to stimuli Emotional dysregulation is often punished or

invalidated, increasing hopelessness and isolation Emotional regulation means

Using mindfulness to Be aware of and reduce vulnerabilities Identify the function and reinforcers for current emotions

Checking for facts Problem solving

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