Emotional Regulation

We're not born with the ability to regulate our emotions. (Case in point: Have you ever witnessed a toddler having a temper tantrum?) The ability to regulate—or manage—our emotional responses is a skill that can be improved with practice.

For many who struggle with substance use disorders, the inability to cope with difficult emotions in healthy ways contributes to the use of substances. Why? Because using alcohol or other drugs helps to numb negative emotions. Successful, long-term recovery often involves learning to manage negative emotions and enhance positive ones. Paying attention to our emotions, practicing mindfulness techniques and implementing these skills in daily life can make a substantial difference. Having the skills to cope with life stressors in healthy ways not only helps in preventing relapse but also in improving emotional and mental health, strengthening recovery and enjoying life.   

We asked clinicians at the Hazelden Betty Ford Foundation to discuss this therapeutic approach as it relates to substance use disorders, treatment and recovery.

What Is the Self-Medication Hypothesis of Addiction?

The basic idea is that some people use substances as a way to "regulate" emotions—anger, anxiety, sadness, distress. This self-medication hypothesis also applies to several types of co-occurring disorders such as eating disorders.

What Is Dialectical Behavior Therapy?

Dialectical Behavior Therapy (DBT) incorporates elements of Cognitive Behavioral Therapy (CBT) with an added focus on emotional regulation, mindfulness and distress tolerance. The idea behind cognitive therapy is that thoughts and behaviors influence our feelings. If we reframe our inner dialogue and the way we think, we can more effectively respond to challenging situations and improve our quality of life. Rather than thinking: "I'm a failure; I can't do anything right," the tools gained in CBT help individuals flip the script and recognize their positive strengths, replacing destructive thoughts with constructive self-talk, such as: "I'm too hard on myself. I don't have to succeed at everything. Making one mistake doesn't mean I'm a failure. The next time I make a mistake, I won't waste my energy dwelling on the negatives. I'll focus on what I can learn from this experience."

The term "dialectical" refers to the Buddhist concept of opposing forces, or in this case, the opposite pulls of change and acceptance. DBT therapists guide clients in making changes that will help in reaching personal goals, with the understanding and acceptance that change is a constant in life and everything is interconnected.

DBT skills focus on identifying and transforming negative thinking patterns, ultimately learning how to effectively cope with stress/distress, regulate emotions, change unhealthy behaviors and live more fully in the moment. 

In 1991, the first controlled trial of Dialectical Behavior Therapy was published by psychologist Marsha Linehan, PhD, and her colleagues who—after discovering that cognitive-behavioral therapy alone wasn't effective for patients with borderline personality disorder—added specific therapy techniques to better meet their clinical needs. During a DBT session, the clinician typically offers validation while encouraging change. In this way, the therapist helps the client understand that, while their actions might make sense within the context of unique experiences, emotions can be misleading and don't provide a solid basis for problem solving. Linehan's DBT research found the therapy approach resulted in significant improvements among chronically suicidal individuals diagnosed with borderline personality disorder, a clinical population previously considered untreatable. Since then, DBT has been adapted to treat other mental health conditions that threaten overall a person's emotional well-being and/or relationships.

How does the mindfulness component of DBT relate to emotion regulation and substance use disorders?

Mindfulness involves paying attention to the present moment and experiencing—not pushing away or avoiding—one's emotions. It is critical that individuals in recovery learn to slow down and "ride out" their emotional states using mindfulness in order to reduce risk for relapse.

What Are the Four Strategies of Dialectical Behavior Therapy?

The core strategies of DBT are:

• Mindfulness, or the ability to gain control over your mind, which involves the practice of staying in the present rather than worrying about what might happen in the future (anxiety) or what has happened in the past (depression)
• Emotion regulation, the heart of the DBT approach, which involves learning to manage emotions in different situations 
• Distress tolerance, which involves coping with stress and difficult emotional reactions in the moment
• Interpersonal effectiveness, which involves the ability to interact and effectively communicate with others—skills that can significantly impact the quality of our relationships 

A growing body of evidence shows that DBT skills training has promising implications for both clinical and nonclinical populations.

Do People Who Suppress Their Emotions Successfully Express Fewer Negative Emotions?

To the contrary, research suggests that individuals who suppress emotions experience MORE negative emotions over time and have more difficulties managing emotions and coping with life. While the coping mechanism may seem to work in the short-term, suppressing emotions is ineffective and harmful over time.  

Is there a Downside to Developing Emotional Regulation Skills?

No, improving emotion regulation skills is entirely healthy and beneficial for everyone. Difficulties in managing our emotions (i.e., emotion dysregulation) and deficits in emotion regulation are problematic.

Can Anyone Learn Emotion Regulation Skills or DBT Skills?

Yes, emotion regulation skills can be developed throughout life, beginning at a young age. These skills are especially important given that emotion regulation deficits are implicated across a range of mental health and behavior disorders, including substance use disorders, mood disorders and anxiety disorders. In order to benefit, people need to commit to doing the work of making changes that support healthier thinking, healthier behaviors and healthier living. Small steps can make a big difference.

DBT is a form of psychotherapy practiced by qualified, licensed mental health professionals. DBT is one of several clinical therapies that may be used in treatment and recovery from alcohol or other drug addictions, as well as for those with co-occurring disorders. A quality treatment provider may employ a number of different evidence-based therapies, including Twelve Step Facilitation Therapy.