Handling Overwhelming Emotions with Dialectical Behavior Therapy

“I just don’t know what to do,” I sobbed. “I don’t know how to feel better. You’re saying all the right things and I’m still crying. And my usual ways of feeling better aren’t working.”

For almost the entirety of May and also several days in June, I cried pretty much every other day. I can easily feel overwhelmed, stressed and inadequate. I worry about the past; I worry about the present; I worry about the future. I feel emotional for other people’s problems as much as I do for my own — and I feel quite emotional about my own. I’m sensitive to criticism and rejection, no matter how small.

Being an emotional, stressed and empathetic person is tiring both mentally and physically.

However, if you find yourself in this position too, know we aren’t stuck.

Dr. Marsha Linehan created dialectical behavior therapy (DBT) originally for people with borderline personality disorder, but it’s been used to treat people struggling with other challenges as well, such as depression, post-traumatic stress disorder (PTSD), eating disorders and more.

DBT helps people regulate themselves through four modules: mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness.

Below are some examples of how to use these modules to help you handle your emotions and tough situations.

Mindfulness

Mindfulness exercises help you ground yourself in the current moment and distract yourself from your overwhelming, racing thoughts. They help you recenter yourself and calm your mind and body down.

• Mindful listening: Pick a song you like to listen to and focus on the lyrics. Did you hear anything new? Is a lyric repeated? Did a lyric stand out to you?
• Progressive muscle relaxation: Beginning with your toes, squeeze and relax your muscles all the way up your body, one body part at a time. Focus on the physical feelings you’re experiencing.
• 5–4–3–2–1 senses: List five things you see, four things you hear, three things you see, two things you smell and one thing you taste.

Emotion Regulation

Emotion regulation exercises help you effectively handle your emotions in healthy and helpful ways. They provide tools for coping.

• Opposite action: Act the way that’s the opposite and more helpful way of the way you want to act. For example, if you want to withdraw from others, text or hang out with a friend. If you want to restrict your eating, have a snack.
• Schedule positive activities each day: Each day, schedule something that makes you feel good. This could include hanging out with friends, watching your favorite TV show, taking a walk outside, playing a game and other hobbies you have.
• Change your perception of a situation: Gently ask yourself if you might be blowing a situation out of proportion. Gently ask yourself if this problem will be an issue in six months. Gently ask yourself if there’s a more positive way to look at the situation.

Distress Tolerance

Distress tolerance exercises help you handle a stressful feeling in the moment in a healthy and positive way. They help you survive the moment at its worst until you can handle the situation more fully.

• ACCEPTS: This stands for activities, contributing, comparisons, emotions, pushing away, thoughts and sensations. You can help yourself cope with a tough moment through engaging in an activity you enjoy (a sport, a movie), helping others (cook dinner, write a card), changing our perspective (realizing the situation could be worse or that you’ve handled worse before), trying to change the emotion you’re feeling (look at pictures of cute animals, watch a funny video), pushing away negative thoughts by thinking of something else (something you have to look forward to, what to make for dinner), engaging in a mental activity that distracts you (a crossword, saying the alphabet backwards) or engaging your senses (taking a warm bubble bath, eating your favorite snack).
• Radical acceptance: Sometimes we have to go through tough situations and deal with difficult people. Under those circumstances, we just have to realize this is the case, push through and take care of ourselves before and after.
• Pros and cons list: When you’re in a distressing situation, acting on an unhealthy urge can be tempting, especially if it relieves stress quickly. In these moments, make a pros and cons list. You can use this to decide if you should act on or tolerate and urge, and which action will be more beneficial to you.

Interpersonal Effectiveness

Interpersonal effectiveness tools can help you handle awkward or scary social situations in a helpful way. They can help you maintain relationships that are beneficial to both you and the other person.

• GIVE: This stands for gentle, interest, validate and easy manner. When you’re trying to keep a relationship, be gentle with the other person, show interest in what they’re saying, validate their emotions and be easy with them.
• Self-respect: Ask yourself what you want to feel about yourself after this interaction and what actions will help you feel that way. Relationships are about give and take, so don’t forget to take care of yourself when you’re taking care of another person.
• FAST: This stands for fairness, (no) apologies, sticking to values and truthfulness. When you’re maintaining self-respect in a relationship, make sure you’re being fair to yourself and others, you’re not apologizing for being alive, you’re sticking to your values and you’re truthful about yourself and your situation.

Know that these are not the only ways to handle emotions. Other types of therapy can also be helpful, such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

While engaging in these types of therapy with a therapist is best, you can also find worksheets online to help you, like those here.

You are not powerless in handling your emotions and coping with tough situations. Take a deep breath and refer back to this or another helpful tool if you need to, and be patient and gentle with yourself.