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Dialectical Behavior Therapy Techniques
Emotion Regulation
Presented by: Dr. Dawn-Elise Snipes  Executive Director, AllCEUs
Podcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery with Doc Snipes
President: Recovery and Resilience International
~    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, ‚ÄúEmotional regulation is the ability to control or influence which emotions you have, when you have them, and how you experience and express them.‚ÄĚ
~    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 bad
~    Suppresses 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)
~    Pituitary
~    Triggers 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 ‚Äėfight-or-flight‚Äô response.
~    Produce even more hormones than the pituitary gland
~    Steroid hormones like cortisol (a glucocorticoid) increasing availability of glucose and fat
~    Sex hormones like DHEA, estrogen
~    Stress 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

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 stress
~    Addiction
~    Sleep deprivation
~    Nutritional 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 response
~    Helping 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

~    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 ‚Äúwrong‚ÄĚ
~    Rage due to feeling judged for it
~    Mindfulness serves as an exposure technique
~    Exposure to intense emotions without negative consequences (Nonjudgmental acceptance) extinguishes the secondary emotional response
~    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