The main course – as I like to call it – I take in outpatient treatment is called DBT. DBT stands for: Dialectical Behavior Therapy. It is an intense therapy method used for many different reasons. I call it a course because it is just as hard as the courses I take in college! Maybe even a little harder, because the homework I get for the lectures are all about being mindful and in touch with myself and being in the process of actively changing my “wiring” so to speak. I hope that sharing DBT with you will be beneficial and hopefully not to challenging to understand in this medium.
Here goes. I am starting from the very beginning.
Introduction to Dialectical Behavioral Therapy (DBT)
1. Dialectical: Any systematic reasoning or argument that places opposed or contradictory ideas together and seeks to resolve this conflict.
2. Biosocial Theory of DBT: This involves a biological disposition (not necessarily hereditary) in an environmental context.
A. Emotion Regulation: The combination of an emotional response system that is oversensitive and overactive with an inability to modulate (manage) the resulting strong emotions and actions.
1. Emotional Vulnerability Characteristics:
- Increased sensitivity
- Increased intense response
- Slow return to baseline
2. Emotion Modulation Goals:
- Decreased inappropriate behavior
- Increased organization to act appropriately
- Self-soothe physiological arousal
- Refocus attention when “emotional”
B. Invalidating Environment & Effect on Emotional Vulnerability:
1. High emotional sensitivity, plus a lack of validation of emotional experiences, teaches the child to distrust his/her emotional responses, leading to either overreaction to emotions or under-reaction (ignores) of needs or preferences.
2. This combination leads to behavior changes reinforced by the invalidating environment and may result in a Vicious Cycle: the invalidating environment leads to inappropriate behavior by the individual which results in more invalidation. Both the environment and the child (now adult) may exhibit the following behaviors:
- Responds erratically & inappropriately to the individual’s experience (thoughts, feelings, sensations, etc). The invalidating environment is especially insensitive when individual’s experiences are not validated by the public (outside of invalidating environment).
- Responds in extreme fashion (overreact or under react) to the individual’s experiences that DO have public agreement/validation.
- Ignores or disregards needs and/or preferences, as well as beliefs and communications. Further, the invalidating environment might punish the individual’s assertiveness.
- Emphasizing controlling emotional expressiveness, especially “negative” feelings. Emotional pain is trivialized and attributed to the person’s negative traits. For example, the invalidating environment may blame the individual for their emotional pain, such as accusing them of lack of discipline, lack of motivation, or failure to adopt a positive attitude.
- Restricts demands a child may make upon the environment.
- Discriminates against the child based on arbitrary characteristics of the individual.
- Using abusive punishment to control behavior.
C. Effect of Invalidating Environment:
It increases emotion dysregulation by failing to teach the child to label and manage arousal, to tolerate stress, and to trust his/her own emotional responses as valid interpretations of events. The child learns to invalidate his/her own experiences, making it necessary for them to scan the environment for cues about how to act and feel. The invalidating environment oversimplifies life’s experiences and the task of solving life’s problems. Therefore, it fails to teach how to set realistic goals. Moreover, by punishing the expression of “negative” emotions and erratically reinforcing emotional communication only after escalation by the child, the invalidating environment teaches the individual to adopt an all or nothing emotional expression style that vacillates between extreme suppression and extreme reaction.
3. Consequences of Emotion Dysregulation and Invalidating Environment
A. Impulsive Behavior (especially parasuicide) is maladaptive but effective. EX:
- Overdosing: increased sleep, which decreases emotion dysregulation;
- Parasuicide Act: distract or get attention to decrease emotional pain.
B. Inadequate Development and Maintenance of Sense of Self: One’s sense of self is formed by observations of oneself and of others’ reactions to one’s actions.
- Emotional consistency and predictability, across time and similar situations, are prerequisites of identity development. Unpredictable emotional changes lead to unpredictable behavior and inconsistent thought, which interferes with identity development.
- In addition, the numbness associated with suppressing emotions is often experienced as emptiness, which decreases sense of self.
- If an individual’s sense of events is never “correct” or unpredictably “correct” (the situation is an invalidating environment), then the individual may develop an over-dependence on others.
C. Chaotic Relationships: Effective relationships depend on a stable sense of self, capacity for spontaneity in emotional expression, appropriate regulation (management) of emotions and toleration of emotional pain. Emotion dysregulation interferes with these abilities.
Note: In a healthy, non-chaotic relationship, both people feel ‘free to be me’.