Chapter 1

Beginning Your DBT Journey

IN THIS CHAPTER

Overviewing the origins of DBT

Diving into dialectics

Focusing on the function of behavior

For people all over the world, these past several years of unrest, divisiveness, fear, and uncertainty have increased stress significantly. Stress often precedes the emergence of emotional disorders, especially anxiety and depression. In the United States, recent surveys suggest that about 40 percent of the adult population suffers from notable symptoms of anxiety or depression. The rates of anxiety and depression among adolescents have also risen dramatically due to disruptions in their lives during these tumultuous times.

This workbook is designed to help with troubling emotions. It isn’t meant to be a comprehensive review of emotional disorders. Many people choose to use this book along with professional counseling or therapy, and some use it on their own. If you want more information and an in-depth discussion of DBT, take a look at DBT For Dummies. If you want more about anxiety or depression, take a look at the latest editions of Anxiety For Dummies or Depression For Dummies.

If your symptoms are numerous and severe or your life seems out of control, you should consult your primary care provider or a mental health professional. These worksheets aren’t meant to replace trained mental health professionals — they’re the only people who can really diagnose your problem.

The Origins of DBT

Dialectical Behavior Theory (DBT) was initially developed by Dr. Marsha Linehan PhD, a psychologist at the University of Washington. Her motivation was to help adult women with a condition known as Borderline Personality Disorder (BPD). BPD is characterized by a person having intense and painful mood swings, difficulties in intimate and close relationships, negative ways of thinking about oneself, self-destructive behavior, and suicidal behavior. For many people with BPD, this confluence of symptoms paired with the reality of the risk of suicide makes it one of the most difficult mental health conditions to treat. In fact, before DBT, BPD was considered a uniquely difficult psychiatric condition to treat and contributed to stigma about BPD.

What Dr. Linehan realized was that certain conditions and disorders such as borderline personality disorder (BPD) were characterized primarily by emotion dysregulation. In other words, some people had difficulty controlling their emotions and emotional expressions.

She hypothesized that these difficulties arose from the transaction between an individual’s biological and genetic makeup and specific environmental factors, and she called her theory the biosocial theory. She noted that people with conditions like BPD had three prominent characteristics:

• Sensitivity: They tended to be emotionally sensitive, which means that they experienced emotions more quickly and with more intensity than the average person in response to events that led to emotional expression.
• Reactivity: Next, she noted that when emotions showed up, emotionally sensitive people had difficulty controlling their emotions and that this led to behavior dictated by their mood state. When emotionally sensitive people were in a good mood, they could get almost anything done, and when they were in a bad mood, they had a difficult time meeting the expectations of the moment. This type of behavior based on mood is termed mood-dependent behavior.
• Slow return to baseline: And finally, she noted that when the emotionally sensitive person experienced these intense and heightened emotions, it took them longer than the average person to get back down to their emotional baseline.

Don’t worry if the worksheets in this chapter reveal that you have a few symptoms of emotional dysregulation. Almost everyone has struggles; that’s human. However, you should be concerned when these symptoms significantly interfere with your life. As mentioned in the Introduction, you can find blank versions of these worksheets online (at www.dummies.com/go/dbtworkbookfd) that you can print and use.

Take some time to go through Worksheet 1-1 and identify areas in which you have experienced intense emotional reactions.

Linehan recognized that there were five types of dysregulations that impacted people who had problems with managing their emotions. Dysregulation is a term used by therapists, and it means an inability to regulate or to control. Linehan noted that for emotionally sensitive people — and in particular those who did not have the skills to manage difficult situations and relationships in their lives — difficulties regulating the following five areas of daily experience persisted. These types of dysregulation are not one-time events, but rather are patterns of behavior that persist over time.

The five areas of dysregulation and areas for which DBT has been found to be most useful, are as follows:

• Emotion dysregulation: Emotion dysregulation is the inability to flexibly respond to and manage emotions in the context of difficult circumstances. Instead of a measured response, for people who struggle with emotion regulation, their responses are highly reactive. Typically, these moments of reactivity are brief, lasting at most a few hours. These emotions nevertheless feel overwhelming and out of control.

• Interpersonal dysregulation: Interpersonal dysregulation is the experience of being ineffective in close relationships. This can happen because of fear, whether the fear is real or imagined, that the person will be abandoned by those closest to them. In this context, the person with BPD will then become desperate to prevent the abandonment from occurring and will behave in ways to prevent the abandonment from happening. These desperate ways will often appear to be extreme to others.

  Another hallmark of interpersonal dysregulation is that people with BPD tend to develop intense relationships with others, characterized by extremes. Sometimes they idealize the other person and other times they devalue the other person. These fluctuations can happen very quickly and leave the other person feeling bewildered.

• Sense-of-self dysregulation: Sense-of-self-dysregulation is the experience of having very little consistency in one’s identity. People with BPD can have a very difficult time defining themselves in terms of who they are as people, what their values are, and what their long-term goals and life-direction is. At times, they look to others and try to copy their behavior in order to fit in, but in many cases, this doesn’t feel authentic. Another aspect of self-dysregulation is the experience of emptiness, which is an intense feeling of disconnectedness, aloneness, and feeling misunderstood.
• Cognitive dysregulation: Cognitive dysregulation is characterized by relatively brief episodes of paranoid thinking or misperceiving reality, and this is particularly true during periods of stress. This means that when the person with BPD has high stress levels, they can begin to imagine that others are intentionally out to get them, even when there is no evidence that this is true. Then, at times when emotions are powerful and painful, and this is especially true if the person has experienced significant trauma, people with BPD can have episodes of dissociation, which is the feeling or thought that they are not real or that the rest of the world is not real. The physical seems to disconnect from the emotional self.
• Behavioral dysregulation: Behavioral dysregulation is the manifestation of extreme, sometimes impulsive, and at times dangerous behaviors. These behaviors are often used as a way to deal with intense and unbearable emotions, and can include self-injurious behaviors, such as cutting and suicide attempts. Other such behaviors include eating behaviors such as binge eating, substance use as a way to self-medicate, dangerous sexual behaviors as a way to feel connected, and dangerous driving or excessive spending as a way to feel a rush of positive emotions. People often report that they feel out of control in these instances; like they don’t have the ability to refrain from engaging in the behavior.

These five areas of dysregulation can often intertwine in very painful ways. For instance, emotional dysregulation can lead to cognitive, behavioral, and interpersonal dysregulation. Interpersonal dysregulation can lead to emotional dysregulation, and so on. For many, feeling like they don’t have a stable sense of who they are can lead to feeling out of control. Use Worksheet 1-2 to reflect on the areas of dysregulation that you've experienced personally.