People whose behavior is out-of-control usually report extreme, intense negative emotions.  They will often fluctuate between extremes of anger, anxiety, depression and shame.

When you are in the midst of emotional hell it is nearly impossible to find the life you want.  Chronic stressful events increase reactivity and make positive life goals feel unattainable.  Circumstances often seem to dictate the course your life is taking and you can feel like you’re at the mercy of your emotions.

Repetitive emotional reactivity and chronic crisis often make what you want impossible to imagine.  DBT starts with a focus on gaining behavioral control.  You can begin to build a life you want only with relief from constant crisis.

Core beliefs shape how to climb out of the abyss of problem behavior.

• PROBLEM BEHAVIORS ARE LEARNED RESPONSES:  people have learned to do things like self-injure, become aggressive, become hostile, drink or drug, in order to manage the extreme painful emotions they experience.

Because problem behaviors are viewed as learned responses, solving the problem involves gaining a better understanding of your behavior and the forces that impact it.  It also involves learning new skills to manage the intensely painful emotions that trigger problem behaviors.

Problem Solving involves:

• Behavioral Analysis—taking a detailed look at the events, thoughts and feelings that lead up to problem behaviors, as well as those that immediately follow it.
• Contingency management—Often cutting, drinking or binging result in a brief, but immediate relief from emotional pain.  Hostility and aggression can cause people to back off and leave you alone.  Understanding and managing what happens that makes you more likely to continue to engage in problem behaviors is important to changing them.
• Skills Training—Learning new ways to deal with intense and painful emotions.  These skills are not life threatening and don’t interfere with the quality of your life.
• Exposure—Facing situations and emotional cues that you typically avoid.  For exposure to be effective, it must occur without engaging in problem behaviors and last long enough for the intensity of your emotion to decrease.
• Cognitive Modification—changing the thoughts and self judgments that increase emotionality and keep you in the same cycle of problem behaviors.  Thoughts like “I’m stupid” “it’s not fair” and “I shouldn’t have to deal with this” increase emotional reactivity and the likelihood of problem behaviors.

Analyzing your behavior and learning new skills is complex and takes a significant amount of motivation.  In DBT individual therapy and skills training groups are designed to help you with both of those tasks.  Going it alone can be extremely difficult.  When you’re feeling hopeless and stuck or can’t see any options a therapist and skills trainer can help to keep you focused and moving forward.

In future posts I will continue with the topic of finding a life you want.  The next topic will discuss steps to take once your behavior is under control.

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    Last reviewed: 28 Jul 2010