Guide
DBT (dialectical behaviour therapy) was created by Marsha Linehan for people who experience very intense emotions and repeated crises. Today its skills are used far more widely, by anyone whose emotions overwhelm them.
Why some emotions are so intense
The DBT model explains that some people have greater emotional sensitivity (they react quickly, strongly, and take a long time to return to calm). When that sensitivity meets an environment that doesn’t validate what they feel, it becomes hard to learn to regulate emotions. It is nobody’s fault, and it can be learnt.
A little theory · For Marsha Linehan, some people have greater emotional sensitivity: emotions are triggered sooner, rise higher and take longer to come down. When that sensitivity meets an invalidating environment (“don’t make a mountain out of a molehill”), it is hard to learn to regulate them (Crowell et al., 2009).
Four families of skills
- Mindfulness: observing and describing without judging.
- Distress tolerance: getting through a crisis without making it worse.
- Emotion regulation: understanding emotions and reducing vulnerability.
- Interpersonal effectiveness: asking, saying no and looking after relationships.
A little theory · Naming an emotion is no small thing: in a neuroimaging study, naming the emotion on a face reduced activity in the amygdala, a region involved in the alarm reaction (Lieberman et al., 2007). This is the idea behind worksheet 75.
A little theory · DBT is the most studied psychological treatment for very intense emotions and borderline personality disorder; a Cochrane review finds that it reduces the severity of symptoms and self-harm (Storebø et al., 2020).
The word “dialectical”
It means holding two ideas at once: accepting yourself as you are and working to change.
If crises come with suicidal thoughts or dangerous behaviour, these worksheets aren’t enough: specialist support is important. In an emergency: 112, 3114 (France) or your local emergency number.
Worksheets to practise
- 75 · Naming my emotion · Breaking an emotion down to understand it better
- 79 · Bringing the body’s intensity down (TIP) · Acting quickly on the body when emotion is extreme
- 82 · Radical acceptance · Fully accepting what cannot be changed
- 84 · Checking the facts · Does my emotion fit the situation?
- 86 · Asking for what I need · A clear request in four steps, while standing firm
- 88 · Observing, describing, participating · DBT mindfulness
Sources
Linehan, M. M. (2015). DBT Skills Training Manual (2nd ed.). Guilford.
Crowell, S. E., Beauchaine, T. P. & Linehan, M. M. (2009). A biosocial developmental model of borderline personality: Elaborating and extending Linehan’s theory. Psychological Bulletin, 135(3), 495-510.
Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H. & Way, B. M. (2007). Putting feelings into words: Affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science, 18(5), 421-428.
Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271-299.
Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., Kongerslev, M. T., Mattivi, J. T., Jørgensen, M. S. et al. (2020). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, CD012955.
These worksheets do not replace therapy. If you are in distress or having suicidal thoughts, call your local emergency number (112 in Europe; 3114 in France, free, 24/7).
