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September 13, 2019 Friday 10:54:11 AM IST

Tackling Emotional Flare-UPS


Lisa, a 19-year-old college student, tall, pretty, talented and intelligent, was brought forcounseling, by her parents. In fact, the parents were so afraid of Lisa’s emotional flare-ups, that they gave her the reason for their visit, “to fix her dad’s drinking problem”. Lisa’s father used to drink during weekends, and the family was apprehensive about it. Besides, Lisa’s parents live in a faraway city, and her grandparents, uncle and aunt look after her. The parents explained about the explosive situation at home. Lisa has been showing signs of emotional flare-ups, antagonistic behaviour, threats of suicide, inflicting injuries on her body, etc. The precipitating factor appears to be the family’s objection to her dating a boy from their neighbourhood. Lisa’s endless chatting on the mobile phone with her boyfriend was another source of discord. Lisa, for sure, was not a typical client. Unlike CBT (Cognitive Behavioural Therapy), DBT was found effective in this case. So, let’s learn a little more about DBT (Dialectical Behaviour Therapy).  

Skill deficit

Dialectical Behaviour Therapy is based on the assumption that the problems faced by clients are caused by a deficit of skills. DBT is a type of psychotherapy or talk therapy that uses a cognitive-behavioural approach which emphasizes the psycho-social aspects of treatment. The theory behind the approach is based on the idea that some people are likely to react in a much more intense and out of the ordinary manner when it comes to certain emotional situations. It may be more likely in relationships that involve romance, family or friends. Certain individuals’ level of arousal in such situations may increase much more quickly in comparison to compared to the average individual. These types of individuals, like Lisa, seem to attain a higher level of emotional stimulation and take a significant amount of time to return to baseline levels. This may also manifest as an extreme swing of emotions.

These kinds of personalities see things in black and white, as opposed to different shades of grey. They may jump from one crisis to another because they lack the necessary coping skills. DBT teaches them the necessary skills to cope with the problem in a healthier manner. In addition to the unique structure of therapy, DBT also recognizes the fact that most people are doing the best they can with the types of skills they have. If someone is not doing well, they may simply be missing the necessary skills.

The ideas of acceptance and change are, in a sense, incompatible agendas. It is difficult to accept something and try and change it without invalidating someone’s experience. Dr. Marsha Linehan’s solution to the problem of integrating the seemingly incompatible goals is to simply move back and forth between them during therapy. The idea of the ‘dialectical’ manner came into being in this context.

DBT can be used as a treatment for different sorts of situations faced by individuals. It could be applied on Individuals with borderline personality disorder; individuals with eating disorders; individuals with substance-abuse disorders; those at high risk of suicide, adolescents;college students with emotional dysregulation, etc.

Four stages of DBT treatment

There are four stages of DBT treatment. Stage One - Moving to gain control. Stage Two - Moving to express emotions in an appropriate manner. Stage Three - Learning to solve problems as a part of living a normal life. Stage Four - Moving to feeling complete as a person.

Four skills that DBT utilises are:Mindfulness; Interpersonal effectiveness; Distress tolerance; Emotional regulation 


This skill is all about developing self-awareness and living in the present moment. Mindfulness also teaches the reasonable mind, the emotional mind, and the wise mind.The reasonable mind is logical and functions according to rules.The emotional mind provides meaning to things and informs us about the importance of things such as the complexity of relationships.The wise mind creates a sense of balance as clients are taught how to return to the wise mind when it is necessary.

Interpersonal effectiveness

Developing interpersonal skills helps one get along better with others. Some great ways to do this include the G.I.V.E. and F.A.S.T. exercises.

THE G.I.V.E exercise helps with relationship effectiveness. Relationships aren’t only about getting what we need, but about other’s needs as well. G – Gentle. Being gentle means not attacking, threatening or expressing judgment during interactions. It’s about accepting the occasional NO for your requests.  I – Interested. This is about showing genuine interest to someone else without interrupting.  V – Validate. Validating means outwardly validating the other person’s thoughts and feelings. It’s also about acknowledging someone else’s feelings and recognizing when your requests are demanding and respecting others opinions. E – Easy. This is about having an easy attitude and remembering to smile and act light-hearted.

The F.A.S.T. exercise is about self-respect. Sometimes in relationships, we might find ourselves betraying our own beliefs in order to receive approval for what we want. F – Be Fair. This is about being fair not only to yourself but to others. A – Apologies. Don’t apologize unless it’s warranted. Don’t apologize for making a request, having an opinion or for disagreeing. S – Stick to values. Don’t compromise your values just to be liked or to get what you want. Stand up for what you believe in. T - Truthful. Avoid dishonesty such as exaggeration, acting helplessly as a form of manipulation or outright lying.

Distress tolerance

Radical acceptance is a distress tolerance skill. Sometimes we will run into a problem that is simply out of our control. It’s easy to think that it isn’t fair or we shouldn’t have this problem even though thinking in this manner only makes things worse. Radical acceptance is a healthier way to think about something. Instead of focusing on how you would like something to be, you can recognize the problem or situation as it is.


Checking the facts helps reduce the intensity of extreme emotions. Try asking yourself the following questions as you think about a situation.What event triggered my emotions?What interpretations or assumptions did I make about the event?Did my emotions and the intensity of the emotions, match the facts of the situation or did they match my assumptions of the situation?

As we have seen, Dialectical Behaviour Therapy is an effective therapy for those who are prone to reacting in a much more intense and out-of-the-ordinary way towards certain emotional situations. Although DBT was originally created for Borderline Personality Disorder, it can be used for many other mental health issues far beyond its original purpose. Practising some of the above mentionedexercises will be of benefit to most people.

Dr. Jose Cletus Plackal

Licensed clinical psychologist, BET-MRT, Jeevas Centre, Aluva, Kerala.

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