Dialectical Behaviour Therapy for Emotional Regulation

  • Sophie Arundel Bachelor of Medicine and Bachelor of Surgery – MBChB- University of Birmingham

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Introduction

Emotional regulation is the ability to process emotions and respond appropriately. How we respond can be influenced by our upbringing and genetics. Dialectical behavioural therapy is a type of talking therapy that allows us to accept why we feel a certain way and learn skills to process these emotions healthily.

This article will discuss emotional regulation, the impact of poor emotional regulation, and treatment via dialectical behavioural therapy.

Understanding emotional regulation

Emotions are what we feel in response to the events around us.1 Emotional regulation ensures that we can appropriately deal with our emotions to face our current circumstances. We learn how to regulate our emotions from a young age through family and other external influences. 

Everyone has different ways of regulating emotion, such as talking to others, exercising, or having some alone time. Good emotional regulation allows us to remain in control and adapt to the current situation.

Emotional dysregulation is when emotions are difficult to control and feel more intense.1 Unfortunately, this can lead to harmful response mechanisms, including self-harm and impulsive behaviours, such as gambling or drinking. Emotional dysregulation can also harm social relationships and the ability to complete daily tasks or work.1,2  Emotional dysregulation is typically discussed as a symptom of borderline personality disorder (BPD). 

Borderline personality disorder

BPD is a term that is used to describe a group of symptoms linked to emotional dysregulation, including heightened emotions, mood swings, distressing thoughts, or sometimes hallucinations.2,3 Unfortunately, self-harm and suicidal thoughts are common in BPD so treatment is essential to reduce this risk and keep you safe. Those with BPD also often have difficulty with self-image, self-acceptance, and fear of abandonment, which can impact relationships in other areas of life.4

The terminology used to describe this set of symptoms varies and can also be referred to as emotionally unstable personality disorder (EUPD) and complex emotional needs (CEN). There are mixed opinions on the use of the term ‘personality disorder’ due to associated stigma and the implication that something is wrong with their personality. Some research refers to ‘complex emotional needs’ as a more acceptable term, however, the best phrasing has not been clearly defined.5,6 

These symptoms often overlap with other conditions, so it can be difficult to establish a single diagnosis. Some individuals with BPD feel that their diagnosis is helpful as they can seek specific treatment advice and support groups.4 However, BPD is not to be confused with bipolar disorder, which has a longer fluctuation between mania and depression

Causes of emotional dysregulation

Emotional dysregulation and BPD tend to develop from childhood and adolescence.1,2 

Emotional dysregulation is thought to be due to a combination of:

  • Genetics - borderline personality disorder is seen to have a hereditary component and often runs in families
  • Social and environmental factors - trauma and childhood neglect are two of the most common social factors linked to emotional dysregulation and BPD.
  • Biological factors - BPD can be linked to reduced brain development and differences in brain signals through the neurotransmitter serotonin 2,3

Impact of emotional dysregulation

Emotional dysfunction can have a wide range of impacts on a person, including difficulties with:

Those caring for individuals with mental health problems may face their own financial and psychological challenges. It is important for these individuals to also seek support.

Treatment

Medication is not always recommended for people with BPD. However, some cases may use medication if there are co-occurring conditions that can be managed with antidepressants.2

Talking therapies are generally the most effective treatment for BPD as they specifically target emotional regulation.2 Talking therapies can help you understand why you are feeling a certain way and give you the necessary skills to process these feelings. Options include cognitive behavioural therapy (CBT), mentalisation-based therapy (MBT) and dialectical behavioural therapy. These can be accessed through the NHS from GP or self-referral.

It is important to find personal coping mechanisms for processing emotions, such as listening to music, maintaining good sleep habits, exercising, and eating healthily. Along with individual support networks, there are also online communities where you can connect with others who have similar experiences. This can be a useful tool to share advice and support one another through treatment.

Dialectical behavioural therapy 

Dialectical behavioural therapy (DBT) is a form of talking therapy that was initially developed for use in BPD. It can also be used in the treatment of other conditions like depression and eating disorders.

The word dialectic refers to discussing ideas on a topic that may traditionally contradict each other. Dialectical discussions involve learning how opposing ideas can both be true and logical. In DBT, the opposing ideas are the idea of self-acceptance alongside challenging and changing unhelpful thoughts. 

  • Acceptance - This involves discussing your feelings and understanding triggers. It’s about recognising these emotions and accepting them as a response to your current circumstances, rather than being frustrated you are feeling that way.
  • Change - This refers to learning skills to help you process these intense emotions. The skills include mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness.4 Over time, these skills become embedded into daily life to help set appropriate boundaries, maintain relationships, and work effectively. 

DBT can be delivered through individual and group-led sessions with a therapist.4 Some individuals find group sessions difficult at first, but they allow you to learn through and meet others in a similar situation. You may be asked to complete home learning and keep a record of your thoughts and feelings, which can help identify any patterns. 

Outlook 

Most cases of personality disorder improve with time and many reach ‘remission’; where symptoms are less severe and no longer fit within formal diagnostics for a personality disorder.2 

DBT is often effective at reducing symptom severity but you may find your symptoms do not fit neatly in one category, or the style of DBT is not suited to you. A discussion with your health professional can give you guidance on other treatments such as CBT and MBT which may suit you better. 

Educating family and friends on emotional dysregulation and DBT can be beneficial to help them better support you.6 It is also important to improve public education and awareness of complex emotional needs and personality disorders to reduce stigma and judgement in health services. There must be increased accessibility to mental health and crisis support.

Crisis support

There is a wide team of health professionals involved in the care of those with emotional dysregulation and BPD. This can include GPs, community mental health teams, psychiatrists,  and psychologists.5

Those with BPD can frequently experience a crisis that involves overwhelming difficulty regulating emotion, leading to self-harm and suicidal thoughts. If you have any similar experiences, it is important to seek urgent help through A&E, GP, 111 or crisis helplines. You can use this NHS tool to find urgent mental health helplines near you.

Summary

Emotional regulation is an important part of everyday life to help us cope with challenging situations. It allows us to maintain healthy relationships, process stress, and avoid risky coping mechanisms. The main treatment for emotional dysregulation is talking therapies, which include dialectical behavioural therapy. Dialectical behavioural therapy teaches individuals various techniques to help with processing emotion in a variety of situations. Over time, these techniques become easier to use in daily life. This will hopefully lead to a reduction in symptoms and improved quality of life.

References

  1. Paulus, Frank W., et al. ‘Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review’. Frontiers in Psychiatry, vol. 12, 2021, p. 628252. PubMed, https://doi.org/10.3389/fpsyt.2021.628252.
  2. Storebøa, Ole Jakob, et al. ‘Psychological Therapies for People with Borderline Personality Disorder’. Cochrane Database of Systematic Reviews, no. 5, 2020. www.cochranelibrary.com, https://doi.org/10.1002/14651858.CD012955.pub2.
  3. Monk-Cunliffe, Jonathan, et al. ‘Crisis Interventions for Adults with Borderline Personality Disorder’. Cochrane Database of Systematic Reviews, no. 9, 2022. www.cochranelibrary.com, https://doi.org/10.1002/14651858.CD009353.pub3.
  4. Smith, Andrea, and Danielle MacDougall. Dialectical Behaviour Therapy for People with Borderline Personality Disorder: A Rapid Qualitative Review. Canadian Agency for Drugs and Technologies in Health, 2020. PubMed, http://www.ncbi.nlm.nih.gov/books/NBK567202/.
  5. Maconick, Lucy, et al. ‘Crisis and Acute Mental Health Care for People Who Have Been given a Diagnosis of a “Personality Disorder”: A Systematic Review’. BMC Psychiatry, vol. 23, no. 1, Oct. 2023, p. 720. BioMed Central, https://doi.org/10.1186/s12888-023-05119-7.
  6.  DeLeo, Kristiana, et al. ‘Experiences of Crisis Care among Service Users with Complex Emotional Needs or a Diagnosis of “Personality Disorder”, and Other Stakeholders: Systematic Review and Meta-Synthesis of the Qualitative Literature’. BJPsych Open, vol. 8, no. 2, Mar. 2022, p. e53. Cambridge University Press, https://doi.org/10.1192/bjo.2022.1.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Sophie Arundel

Bachelor of Medicine and Bachelor of Surgery – MBChB- University of Birmingham

Sophie is a Medicine graduate from the University of Birmingham. Her diverse experience in hospitals, General Practice, and care homes, has given her a strong understanding of healthcare challenges and a drive to improve the efficiency of care. She is enthusiastic about using patient-lived experiences to understand barriers in care and empower communities to better manage their health. Sophie is passionate about developing a career in Public Health to reduce healthcare inequalities.

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