DBT Skills: Emotion Regulation

This is the final installment of the DBT Skills series. I want to say a special thank you to Breyonne for her hard work in writing this series – I know it will be useful for so many of our readers!

When I first heard the words ’emotion regulation’, the first thing I thought was, Oh great. Another therapist trying to tell me that feelings are just feelings, they can’t hurt me, they can’t kill me, blah blah yadda yadda. And I’ve been to enough therapy, enough counseling, enough self-help meetings to know this, even if only theoretically. So I wasn’t prepared to learn a whole lot from this module. I couldn’t have been further from the truth.

The three goals of Emotion Regulation Training, as outlined by the Skills Training Manual for Treating Borderline Personality Disorder, by Marsha Linehan, are understanding the emotions you experience, reducing emotional vulnerability, and decreasing emotional suffering. Already it’s different from a lot of other programs. It offered me much more information than even my eating disorder therapy (which I am still undergoing) in the way of actually identifying emotions and learning how to deal with them, not just giving me the standard ‘Buck up, kiddo, nothing to worry about’. Which is helpful, because I hate that stuff. I need concrete answers. I don’t need to be patronized.

So…let’s start with some myths about emotions, taken straight from the manual.

• There is a right way to feel in every situation.
• Letting others know that I am feeling bad is weakness.
• Negative feelings are bad and destructive.
• Being emotional means being out of control.
• Emotions can just happen for no reason.
• Some emotions are really stupid.
• All painful emotions are a result of a bad attitude.
• If others don’t approve of my feelings, I obviously shouldn’t feel the way I do.
• Other people are the best judge of how I am feeling.
• Painful emotions are not really important and should be ignored.

There are probably more, unique to each person doing the work. And I know what you may be thinking, because I thought it too, initially: those are obvious. Cheesy. Everybody knows that. But is that really true? Think about it. What are the messages most of us receive, either as kids growing up, as adults, and from our cultures? It’s manly to be strong. It’s not manly to show weakness. And to be weak is to have feelings. If you cry, you’re a girl (whatever that means). Never let anyone see that something bothers you. Whatever you’re feeling must be wrong, and the fact that you think anything is wrong makes you a freak and we don’t want anything to do with you. I grew up being the sensitive one in my family. There were a lot of things that went unsaid, things that were passed on through body language and passive aggressiveness. And every time I’d react to it, or call it out, I was attacked. So I learned about anger. I learned to keep things to myself. I learned that feelings were bad. Now, as an adult, I constantly have people tell me that they have no idea how to ‘take’ me, that I’m the ‘master of deadpan’, that I don’t react to anything. Cool! Not. I am working really hard as an adult now to undo a lot of the damaging ideas instilled in me from a younger age. I encourage you to consider the above myths and even come up with some of your own, and begin to formulate challenges to each of them. For example, looking at the first myth, ‘There is a right way to feel in every situation’, we could counter it like so: ‘Everyone is different, every situation is different, and how I’m feeling going into any given situation is different; therefore, there is not a right way to feel in every situation’.

The first goal of Emotion Regulation – understanding the emotions you experience – has two areas of exploration. The first is identifying (read: observing and describing) the emotion you’re having, and the second is understanding what emotions do for you. Now, I don’t know about you, but already this is a hell of a lot more helpful than most of what I’ve heard and been taught about emoting. I have heard a million times that anger is healthy, and nothing to be afraid of. But why? I mean, I get it on a logical level. When I feel angry, I feel motivated. I feel like I want justice. I want to create change in my life. But why is anger a good thing? What is it actually supposed to do? Because when I was in early recovery I was scared to death of anger, and in fact, I still sometimes cringe and feel like hiding when I am around another person who is angry. And it seems to me that if you want to teach a person that anger is nothing to be afraid of, and that it’s a healthy emotion – especially if they’ve grown up in an abusive household or have been in abusive or volatile relationships, or otherwise been the brunt of someone else’s anger when they were unable to defend themselves – then you’d better have something to back it up with.

There are several categories of emotions used in the manual, but since I’ve already used it, we’ll go with anger. The first thing we have is a list of anger ‘words’: words we can use to describe the emotion we’re having. They are, as follows: anger, aggravation, agitation, annoyance, bitterness, contempt, cruelty, destructiveness, disgust, dislike, envy, exasperation, ferocity, frustration, fury, grouchiness, grumpiness, hate, hostility, irritation, jealousy, loathing, mean-spiritedness, outrage, rage, resentment, revulsion, scorn, spite, torment, vengefulness, and wrath. I encourage you to add your own, as does the manual, if you feel that something is missing. Then it takes a look at prompting events for feeling anger. In this case they mention the following:

• Losing power.
• Losing status.
• Losing respect.
• Being insulted.
• Not having things turn out the way you expected.
• Experiencing physical pain.
• Experiencing emotional pain.
• Being threatened with physical or emotional pain by someone or something.
• Having an important or pleasurable activity interrupted, postponed, or stopped.
• Not obtaining something you want (which another person has).

Then come the interpretations that prompt feelings of anger. They are:

• Expecting pain.
• Feeling that you have been treated unfairly.
• Believing that things should be different.
• Rigidly thinking ‘I’m right’.
• Judging that the situation is illegitimate, wrong, or unfair.
• Ruminating about the event that set off the anger in the first place, or in the past.

Experiencing the emotion of anger may include (but is not limited to) the following:

• Feeling incoherent.
• Feeling out of control.
• Feeling extremely emotional.
• Feeling tightness or rigidity in your body.
• Feeling your face flush or get hot.
• Feeling nervous tension, anxiety or discomfort.
• Feeling like you are going to explode.
• Muscles tightening.
• Teeth clamping together, mouth tightening.
• Crying; being unable to stop tears.
• Wanting to hit, bang the wall, throw something, blow up.

This last category is my personal favorite. If a person has a difficult time identifying their emotions in the first place, what could be more helpful than giving a list of characteristics that one might experience in conjunction with that emotion? Next, there is a list of ways that people commonly express or act on anger. It includes:

• Frowning or not smiling; mean or unpleasant facial expression.
• Gritting or showing your teeth in an unfriendly manner.
• Grinning.
• A red or flushed face.
• Verbally attacking the cause of your anger; criticizing.
• Physically attacking the cause of your anger.
• Using obscenities or cursing.
• Using a loud voice, yelling, screaming, or shouting.
• Complaining or bitching; talking about how lousy things are.
• Clenching your hands or fists.
• Making aggressive or threatening gestures.
• Pounding on something, throwing things, breaking things.
• Walking heavily or stomping; slamming doors, walking out.
• Brooding or withdrawing from contact with others.

And finally, some of the aftereffects of anger:

• Narrowing of attention.
• Attending only to the situation making you angry.
• Ruminating about the situation making you angry and not being able to think of
• anything else.
• Remembering and ruminating about other situations that have made you angry in the past.
• Imagining future situations that will make you angry.
• Depersonalization, dissociative experience, numbness.
• Intense shame, fear, or other negative emotions.

Now, because I don’t want to leave it on a negative, I’ll outline a positive emotion. I’ll use joy. The words include joy, amusement, bliss, cheerfulness, contentment, delight, eagerness, ecstasy, elation, enjoyment, enthrallment, enthusiasm, euphoria, excitement, exhilaration, gaiety, gladness, glee, happiness, hope, jolliness, joviality, jubilation, optimism, pleasure, pride, rapture, relief, satisfaction, thrill, triumph, zaniness, zest, and zeal. Prompting events for feeling joy include being successful at a task; achieving a desirable outcome; getting what you want; receiving esteem, respect, or praise; getting something you have worked hard for or worried about; receiving a wonderful surprise; things turning out better than you thought they would; reality exceeding your expectations; having very pleasurable sensations; doing things that create or bring to mind pleasurable sensations; being accepted by others; belonging (being around or in contact with people who accept you); receiving love, liking, or affection; and being with or in contact with people who love or like you.

The manual lists ‘interpreting joyful events just as they are, without adding or subtracting’ as the interpretation that prompts feelings of joy. People typically experience joy by feeling excited, feeling physically energetic, active, or ‘hyper’, feeling like giggling or laughing, or feeling their face flush. Common ways that people express and act on joy include smiling; having a bright, glowing face; being bouncy or bubbly; communicating their good feelings; sharing the feeling; hugging people; jumping up and down; saying positive things; using an enthusiastic or excited voice; and being talkative or talking a lot. Finally, aftereffects of joy include being courteous or friendly to others; doing nice things for other people; having a positive outlook and seeing the bright side; having a high threshold for worry or annoyance; remembering and imagining other times you have felt joyful; and expecting to feel joyful in the future.

Okay. So now we have a basis on which to explore the other goals of emotion regulation. And what good are emotions, anyway? Well, according to the manual, they help us communicate to and influence others. Also, emotions organize and motivate action. They inspire us to make the changes we need to make in our lives, and help us to save in time in doing so: we don’t have to think everything through. Strong emotions help us to overcome any obstacles we may be facing. And finally, emotions can be self-validating. They give us information about other people and situations, and can potentially alert us of any dangers. On the other hand, they can be taken to the extreme and interpreted as ‘facts’ when they are only feelings.

We can help ourselves identify our emotions by keeping a record of them. We can begin to observe and describe them. For instance, we can choose a time we experience a particular emotion (whether ‘positive’ or ‘negative’). Then we can rate the intensity, from 0-100. We can record the prompting event for the emotion, or who, what, when, where and why the emotion started. We can list the interpretations (beliefs, assumptions, and appraisals) of the situation that led us to have the feeling. Then we can describe any body changes and sensations we had in accordance with the feeling. For instance, did my face flush? Did my heart skip? Did I suddenly feel dizzy? Did my fists clench? Did my whole body just suddenly relax? Next, we can state what our body language was like. What was our facial expression like? Posture? Gestures? And what were the action urges? What did I feel like doing or saying in that moment? And what did I actually say or do in that moment? Finally, what aftereffect does the emotion have on me? What is my state of mind, what other emotions am I feeling, what are my behavior, thoughts, memory and body like right now? From this information we can ascertain what we believe the function of that particular emotion to be. It may take a few times to gather all of this information. Be patient. It won’t all come at once. Once we’ve got some idea of what we’re experiencing, we can take it a step further and create an emotion log. We can keep track of what we feel on a given day, and what the emotion was trying to communicate to us.

We now look at reducing vulnerability to negative emotions, or, in DBT-speak, staying out of ’emotion mind’. There are six tools to help us do this: treating physical illness, balancing our eating, avoiding mood-altering drugs, balancing sleep, getting exercise, and building mastery. Most of these speak for themselves. In treating physical illness, we take care of our physical bodies; we see a doctor when necessary and take prescribed medication. We balance our eating by not eating too much or too little, and by staying away from foods that make us feel overly emotional. This will, of course, mean different things for each of us. It is recommended to stay off nonprescribed drugs, including alcohol. We balance our sleep by trying to get the amount of sleep that helps us feel good, and keeping to a sleep program if we are having trouble doing so. For instance, we may try going to bed and waking up at the same time (or close to the same time) each day. It is recommended to do some sort of exercise each day, with the goal of building up to twenty minutes of vigorous exercise. And finally, in building mastery, we try to do one thing a day to make us feel competent and in control.

Another step in reducing emotional vulnerability is to increase positive emotions. A good way to do this is to build positive experiences. We try to do pleasant things that are possible now – from taking a relaxing bath, or a walk in nature, or playing a sport we enjoy, or having sex, or arranging flowers, or reading or listening to music (there is a list of well over one hundred things in the manual) – which is basically anything we can do on any given day that makes us feel good. In the long term, we try to make changes in our lives so that positive events will occur more often, or ‘build a life worth living’. For instance, work towards goals and accumulate positives; make a list of positive events you want, list small steps to achieve them, and take the first steps. Also, we can attend to relationships, repairing old relationships, reaching out for new relationships, and working on current relationships. Above all, it is important to ‘avoid avoiding’, or to avoid giving up.

It is not enough to simply be doing positive things; we must focus on them, and be prepared to continually bring ourselves back when our minds return to the negative. It is helpful to be unmindful of worries, to distract from thinking about when the positive experience will end, or about whether we deserve this positive experience, or about how much more might be expected of us now.

When we do experience emotional suffering, there are some things we might employ to help make the most of the situation and prevent it from escalating, to help ourselves not feel hopeless or stuck in a negative situation. First, observe the emotion; note its presence, step back, and get unstuck from it. Simply take notice, as if you are a casual observer. It’s important, however, to experience the emotion. Try to think of it as a wave, coming and going; try not to block, suppress, get rid of, or push it away. Don’t try to keep it around; don’t hold onto or amplify it. Allow it to move freely, to come and go. It might help to remember you are not your emotion; it is not necessarily required of you to act on it. It might also help to remember times when you have felt differently than you feel right now. However, if, in the beginning, this only makes you feel worse (as it sometimes makes me feel), it might just be better to ride it out and wait until you are on steadier ground. The manual suggests to practice ‘loving’ your emotion. What they mean by this is not to judge it, and to practice willingness and radical acceptance.

To help change and overcome emotions, we can act opposite to the current emotion. For example, if we are feeling fear, we can do what we are afraid of doing. We can do it over and over and over, until we are no longer afraid of it. We can also approach things – events, places, tasks, activities, and people – that we are not afraid of, and do things to give ourselves a feeling of control and mastery (as mentioned before). When we are overwhelmed, we can make a list of small steps or tasks we can do and then do the first thing on the list. I would recommend that if you are unable to function in times of overwhelming fear, it might help to already have this list in place (ie. Write the list during a time of neutral emotion).

When dealing with guilt and shame, the manual suggests looking at it one of two ways: justified or unjustified. When guilt or shame is justified – when we have done or said something that has goes against our ‘wise mind’ values – we can repair the transgression: say we’re sorry, make things better, commit to avoiding the same mistake in the future, accept the consequences gracefully, and then let it go. If it is unjustified – when the emotion is something that is not the direct cause of something we have done or said, and does not fit our ‘wise mind’ values – we do what makes us feel guilty or ashamed, over and over and over, and we approach it, not avoid it.

Sadness and depression can be overwhelming to us, especially those of us who deal with other forms of mental illness. It’s important to get active, no matter how hard it is, and to approach, not avoid. I believe this means that we try to engage life to the best of our ability, even when we feel like hiding. We can also do things that make us feel competent and self-confident. And if it anger we are experiencing, we can gently avoid the person we are angry with rather than attacking in the moment, and avoid thinking about him or her rather than ruminating; we can do something nice rather than mean or attacking; and we can imagine sympathy and/or empathy for that person rather than blame. I believe this is not so that the other person gets off the hook, and there is no justice done. I believe this is for our own sanity and well-being. It is said – and I believe – that resentment is like drinking the poison ourselves and then waiting for the other person to die. If the anger is justified – if someone has done something to genuinely hurt or offend you – then perhaps you can approach them at a later time, once you have calmed down enough to act rationally.

There you have it, folks. Not easy, by a long shot. It can be a lot of work, especially if this is your first exposure to therapy or self work and you’re not used to looking at yourself. It can be uncomfortable; it can seem unnecessary. But I believe that this is perhaps one of the most crucial modules in all of DBT, because how can we change if we don’t know what it is that needs to change, or how to go about creating that change? Emotion regulation work not only helps us get to the root of what it is that we’re feeling, and how we react to certain situations, but it takes it a step further and gives actual steps we can take to improve our relationship to our emotions and, by extension, to ourselves. In my experience, this module provides a solid foundation for emotional recovery. I encourage you to keep an open mind, no matter how it may appear at first.