Introduction 

Imagine feeling like your emotions are always on a rollercoaster, with intense highs and lows, that seem uncontrollable. Dialectical Behavior Therapy (DBT) offers a lifeline for those grappling with such intense emotional experiences. Originally designed for high-risk individuals with borderline personality disorder (BPD), DBT has evolved to help a broader range of people develop healthier coping mechanisms. By focusing on self-acceptance and validation, DBT transforms how individuals perceive and manage distressing emotions, moving beyond mere tolerance to active improvement.

What are heightened emotions? 

 A wide range of emotions is a natural and part of our everyday experiences, however, heightened emotions refers to when these emotions interfere with interpersonal relations or may feel overwhelming, getting in the way of day-to-day life. Heightened emotions may be perceived as out of proportion, intense reaction to emotional or physical triggers.¹ There is a myriad of reasons why people may experience heightened emotions, the most common ones being: 

• Trauma and PTSD: panic, anger or rage are common reactions to triggers among those suffering from trauma and PTSD²
• Mental health issues: disorders such as anxiety and bipolar disorder may make people more fearful and reactive to the environment. This may amplify feelings of depression, sadness and joy^3,4
• Hormonal changes: such as hypothyroidism, menopause or even puberty can cause mood shifts and irritability^5,6,7
• Stress can cause fatigue and irritability and can lower a person’s ability to regulate emotions, prompting a stronger emotional reaction than usual⁸
• Gaslighting: bias against women can result in dismissal or devaluation of experiences and even poorer quality of care; this can prompt intense emotions and reactions to stressors⁹
• Physical health issues such as chronic illnesses and chronic pain have been correlated with higher levels of negative emotions¹⁰
• Physical needs such as lack of sleep, low blood sugar and diabetes are also correlated to intense and sudden emotions such as anger - aka, being “hangry”^11,12

Heightened emotions are often associated with borderline personality disorder (BPD).¹ It is possible that other issues may be at the heart of heightened emotions and, in the long term, can contribute to angry outbursts, anxiety, depression, self-harm, suicidal thoughts, substance abuse and other damaging behaviours.^13,14

DBT background and theory 

Dialectical behaviour therapy (DBT) is an evidence-based model of treatment that was created in an attempt to support highly suicidal patients. Initially it was tested on chronically suicidal individuals, which overlapped with the population experiencing BPD. Nowadays, DBT is still one of the most common treatments for BPD, a population at high risk of suicide.¹⁵

DBT treatment is known as an emotion-focused treatment, based on the dialectical and biosocial theory.¹⁵ Dialectical theory is a philosophical approach to reasoning which aims to understand, examine, and combine opposing ideas to create a new understanding.¹⁶ Dialectical theory highlights that two opposing things can both be true, and that reality often lies between the two truths. It highlights that acceptance of these truths can help promote change, acceptance and promote better coping mechanisms which can help regulate and manage heightened emotions.¹⁶ 

The biosocial theory states that an invalidating environment, where your thoughts, feelings and emotions have been judged, ignored, or rejected and emotional vulnerability leads to dysfunction in emotional regulation. This can be a key cause in experiencing heightened emotions.¹⁷

Emotional reactivity has also been linked to feeling emotionally vulnerable, and poor coping mechanisms.^17,18 It is suspected that those who experience heightened emotions do so due to a tendency to highly rely on external factors for moderating their emotions and internal physiological responses (e.g. high heart rate linked with feeling nervous). This makes participants more likely to report intense negative reactions in uncomfortable environments. DBT emphasises that distress tolerance is a critical skill, prior to a crisis, which can help control impulsive behaviours and lower our demand to change the environment.^15,16 

Initially, the population treated with DBT was high risk and complex, however, it has been re-adapted over the years to accommodate a much wider range of symptoms and experiences.¹⁹ DBT focuses on managing troubling behaviours and situations, by creating healthier mechanisms; replacing the old ones. With a strong emphasis on self-acceptance and validation. This can support patients in changing the perception and management of distressing experiences, instead of just tolerating them.¹⁵

DBT elements and aims for heightened emotions. 

DBT is comprehensive and can be delivered in many modalities, including individual, group, online, and in person and tackles not only the immediate difficulties posed by intense emotions, but also fosters enduring emotional strength and wellness.²⁰ There are five functions of treatment within DBT that maximise the benefits to cope with heightened emotions: 

• Function 1: enhance the clients’ capabilities, by improving skills such as emotional regulation, focusing on current experiences, through mindfulness, navigating interpersonal situations and tolerating distress.^20,15 These skills support the client in staying focused in the present, reducing the intensity of the overwhelming emotion. This equips the client to manage crisis, prevent escalation and emotional overload
• Function 2: ensures that capabilities and skills are applied and translated into daily life, this is often done in the form of homework assignments to troubleshoot through practice and experience.²⁰ This helps bridge the gap between therapy and real life, helping to teach clients how to manage their emotions in various and unexpected situations
• Function 3: improving the patient’s motivation and reducing unhelpful behaviours that do not align with a fulfilling life. The therapist will analyse what leads to problematic behaviours or feelings and how they can change them, they do this through self-monitoring that the client conducts through the weeks.^20,15,16 The therapist will encourage the client to commit to change and enhance their motivation. This can help address behaviours that cause significant emotional distress and replace harmful behaviours with healthy alternatives, leading to better emotional regulation and reduced intensity of emotions
• Function 4: the fourth function of DBT involves providing the therapist with feedback, support and training.²⁰ All qualified DBT therapists commit themselves to continuous professional development. They receive support to help prevent burnout so that their patients can receive consistent high standard care
• Function 5: structuring the environment. The primary therapist ensures all DBT elements are incorporated and effective within the treatment to reinforce positive behaviour and discourage maladaptive behaviours. This means that the therapist will encourage clients to take an active role in changing their environments or social circles to set them up for success. For example, drug-using patients will be encouraged to avoid social circles that promote drug use.²⁰ A structured environment provides patients with a stable and supportive framework that reinforces their efforts to manage emotions and reduce emotional crises.²⁰ This consistency helps patients feel secure and more capable of handling their emotions.

By addressing these five functions, DBT provides a comprehensive approach to help patients with heightened emotions develop the skills, motivation, and support they need to manage their emotional responses and improve their overall quality of life.

Summary 

Dialectical Behavior Therapy (DBT) is a robust, evidence-based approach that addresses the intricate challenges of heightened emotions through two key theories and a comprehensive treatment framework. By enhancing patients' capabilities through skills training in emotional regulation, mindfulness, interpersonal effectiveness, and distress tolerance, 

DBT equips individuals with the tools they need to manage their emotional responses effectively. The generalisation of these capabilities ensures that patients can apply what they learn in therapy to their everyday lives, bridging the gap between treatment and real-world application. DBT's structured approach not only addresses the immediate challenges of heightened emotions but also fosters long-term emotional resilience and well-being. 

This therapy has proven to reduce self-injurious behaviors, suicidal ideation, and psychiatric hospitalisations, while improving social adjustment and overall quality of life. For anyone struggling with intense emotions, DBT offers a path towards greater emotional control and a fulfilling life. 

A word of parting

 There is no shame in being emotional or feeling intense emotions. Triggers and circumstances can be powerful. Heightened emotions can be an indicator of underlying factors mentioned above. If you’re experiencing prolonged emotional issues, you can seek advice and professional help via the following links: 

• Your local GP
• Find your local mental health services
• Are you considering suicide?