The document presents an overview of Dialectical Behavior Therapy (DBT) techniques focusing on emotion regulation, detailing the role of the HPA-axis, the importance of emotional regulation, and methods to manage emotions effectively. It emphasizes that emotional dysregulation is prevalent in many disorders and provides strategies for recognizing and altering emotion-driven behaviors while incorporating mindfulness practices. The content aims to equip professionals to assist clients in understanding and regulating their emotions to lead healthier lives.

1. Dialectical Behavior Therapy
Techniques
Emotion Regulation
Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs
Podcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery with Doc Snipes
President: Recovery and Resilience International
AllCEUs.com Unlimited CEUs and Specialty Certifications $59

2. Objectives
 Review the basic premises of DBT
 Learn about the HPA-Axis
 Define emotion regulation
 Identify why emotion regulation is important and
how it can help clients
 Explore emotion regulation techniques

3. Basic DBT Premises
 Dialectical Theory
 Everything is interconnected
 Reality is not static
 Constantly evolving truth can be found by synthesizing
differing points of view

4. DBT Assumptions
 People do their best
 People want to get better/be happy
 Clients need to work harder and be more motivated
to make changes in their lives
 Even if people didn’t create their problems, they still
must solve them
 The lives of suicidal [or addicted] people are
unbearable
 People need to learn how to live skillfully in all areas
of their lives.
 People cannot fail in treatment

5. What is Emotion Regulation
 Emotional dysregulation results from a combination of
 High emotional vulnerability
 Extended time needed to return to baseline
 Inability to regulate or modulate one’s emotions
 Emotional vulnerability refers to [situation] in which an
individual is more emotionally sensitive or reactive than
others
 Differences in the central nervous system and HPA Axis
play a role in making a person more emotionally
vulnerable/reactive
 The environments of people who are more emotionally
reactive are often invalidating

6. What is Emotion Regulation
 According to Linehan, “Emotional regulation is
the ability to control or influence which emotions
you have, when you have them, and how you
experience and express them.”
 Emotion Regulation
 Prevents unwanted emotions by reducing vulnerabilities
 Changes painful emotions once they start
 Teaches that:
Emotions in and of themselves are not good or bad
Suppresses emotions makes things worse

7. Emotion Regulation
 Emotions are effective when:
 Acting on the emotion is in your best interest.
 Expressing your emotion gets you closer to your
[ultimate] goals.
 Expressing your emotions will influence others in ways
that will help you.
 Your emotions are sending you an important message.

8. The HPA-Axis
 Hypothalamic Pituitary Adrenal (HPA) axis is our
central stress response system
 Hypothalamus
releases a compound called corticotrophin releasing
factor (CRF)
 Pituitary
Triggers the release of adrenocorticotrophic hormone
(ACTH)
 Adrenal
ACTH is released and causes the adrenal gland to
release the stress hormones, particularly cortisol and
adrenaline

9. HPA Axis
 The Adrenals
 Control chemical reactions over large parts of your
body, including your ‘fight-or-flight’ response.
 Produce even more hormones than the pituitary gland
Steroid hormones like cortisol (a glucocorticoid)
increasing availability of glucose and fat
Sex hormones like DHEA, estrogen
Stress hormones like adrenaline
 Once the perceived threat passes, cortisol levels
return to normal
 What if the threat never passes?

10. HPA Axis
 The amygdala and hippocampus are intertwined with
the stress response (Higgins & George, 2013)
 The amygdala modulates anger and fear / fight or flight
 The hippocampus helps to develop and store memories
 The brain of a child or adolescent is particularly
vulnerable because of its high state of plasticity.
 Bad things are learned
 Emotional upset prevents learning new, positive things to
counterbalance
 People who live in a chronically stressful environment
may also have an overactive HPA-Axis

11. The Brain and Stress
 What happens to the brain when there is a chronic
threat to safety and a constant underlay of anxiety?
 As it learns, people’s brains forge synaptic connections
from experience and prune away connections that are not
utilized.
 People who feel a lack of control over their
environment are particularly vulnerable to excessive
stimulation of the HPA response.
 Abused and neglected children
 Abused and neglected adults
 Adults with anxiety or depressive disorders

12. The Brain and Stress
 The synaptic connections that form the
foundation people’s schema of themselves and
the world become skewed towards the traumatic
event at the expensive of a synaptic network
based on positive experiences and healthy
relationships.

13.  The hypervigilant state activated by the HPA
response:
 Disrupts the ability to focus and learn
 Impairs the ability to form new memories and recall
information due to the physiologic changes to the
hippocampus (cannot rebalance a skewed system)
 Is associated with emotional and behavioral
dysregulation.
 Example: A Relationship
https://campuspress.yale.edu/exploringmentalhealth/stress-and-the-hpa-axis/

14. Emotion Regulation
 Transdiagnostic or useful with many different
disorders
 Increasing present focused emotion awareness
 Increasing cognitive flexibility
 Identifying and preventing patterns of
 Emotion avoidance
 Emotion-driven behaviors
 Increasing awareness and tolerance of emotion-
related physical sensations
 Using emotion focused exposure procedures

15. Understanding Emotions
 Emotional behavior is functional to the person
 To change the behavior, it is necessary to identify
the functions and reinforcers of that behavior
 Emotions function to:
 Communicate to others and influence and control their
behaviors
 Serve as an alert or alarm which motivate one’s own
behaviors

16. Identifying Obstacles to Changing Emotions
 Biological factors
 Organic
 Situationally caused by
Chronic stress
Addiction
Sleep deprivation
Nutritional problems +/-
 Skills factors
 Cognitive responses
 Behavioral responses

17. Identifying Obstacles to Changing Emotions
 Environmental Factors
 People
 Places
 Things

18. Identifying and Labeling Emotions
 Identifying/observe personal responses in context
 Identify
 The event prompting the emotion
 Thoughts
 Physical Sensations
 Urges
 Expressive behaviors associated with the emotion
 Interpretations of that event
 History prior to the event that increased vulnerability to
emotional dysregulation
 After effects of the emotion on other types of functioning

19. Changing Unwanted Emotions
 Check the facts
 For and Against
 Emotional vs. Factual reasoning
 Problem Solving
 Changing the situation that is causing the unpleasant
emotion
 Prevent vulnerabilities
 Reduces reactivity
by turning down the stress response
Helping the person be aware of and able to
learn/remember positive experiences

20. Reducing Vulnerability to the Emotional Mind
 Building mastery through
 Activities that build self-efficacy, self-control and
competence
 Mental Rehearsal
 Physical Body-Mind Care
 Pain and illness treatment
 [Laughter]
 Eating to support mental and physical health
 Addictive or mood altering drugs or behaviors
 Sleep
 Exercise

21. Mindfulness
 Nonjudgmental observation and description of
current emotions
 Primary emotions are often adaptive and
appropriate
 Much emotional distress is a result of secondary
responses:
 Shame over having it
 Anxiety about it being “wrong”
 Rage due to feeling judged for it
 Mindfulness serves as an exposure technique

22. Mindfulness
 Exposure to intense emotions without negative
consequences (Nonjudgmental acceptance)
extinguishes the secondary emotional response
Scenario 1
• Unpleasant experience
• Unpleasant emotion
• Guilt/Shame/Anger
• Acting to stop the avalanche of
negativity in the absence of
adequate skills
Scenario 2
• Unpleasant experience
• Unpleasant emotion
• Ability to deal with one emotion

23. Summary
 Emotional dysregulation is common in many disorders
 People with dysregulated emotions have a stronger and
longer lasting response to stimuli
 Emotional dysregulation is often punished or
invalidated, increasing hopelessness and isolation
 Emotional regulation means
 Using mindfulness to
 Be aware of and reduce vulnerabilities
 Identify the function and reinforcers for current emotions
 Checking for facts
 Problem solving

24. Subscribe
Counselor Toolbox Podcast
Youtube.com/AllCEUsEducation
Facebook: Facebook.com/AllCEUs/
AllCEUs.com Unlimited CEUs $59 | Specialty Certificates $89 | Live Webinars $5