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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, “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 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 ‘fight-or-flight’ 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
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 “wrong”
~ 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

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