DBT emotion regulation skills

Emotion regulation is one of the four skill sets in dialectical behavior therapy (DBT). It teaches you to understand your feelings, become less open to painful ones, and change the ones you want to change.^2,3

This does not mean pushing feelings away or never getting upset. It means feelings stop running your life. This lesson covers three core skills: check the facts, opposite action and the PLEASE skills for caring for your body. It also gives you steps to practice each one.

What emotion regulation means

Difficulty managing emotions is at the center of borderline personality disorder, the condition DBT was first built to treat.¹ But anyone can have days when a feeling hits too hard, too fast or lasts too long. Grief, pain, illness and caregiving can all make that more likely.

DBT sees emotions as signals from the body. Each one tells you something. Fear often points to danger. Anger often shows up when something you care about is threatened or blocked. Sadness often follows a loss. Guilt often comes when you act against your values.⁴

Each emotion also brings an urge to act, such as running from fear or hiding when you feel ashamed. Sometimes the urge helps. Sometimes it keeps the painful feeling going.⁶ Emotion regulation skills help you tell the difference and choose what to do.

These skills are "change" skills. In DBT, emotion regulation and interpersonal effectiveness are the two skill sets focused on changing things. Mindfulness and distress tolerance focus more on accepting things as they are.²

First step: notice and name the feeling

You cannot work with a feeling you have not noticed. The mindfulness skills come first for this reason.

1. Pause. Take one slow breath. A cyclic sigh can help.
2. Find it in your body. Where do you feel it? A tight throat, a hot face, a heavy chest or a knot in your stomach are common.⁸
3. Name it. Use one simple word: sad, angry, afraid, ashamed, guilty, jealous or lonely.
4. Ride the wave. Picture the feeling as a wave that rises, peaks and falls. You are having a feeling, but you are not the feeling. It has changed before, and it will change again.⁸
5. Ask what it is telling you. Is it pointing to a loss, a threat, a value or a need?⁴

Skill 1: Check the facts

Strong feelings often grow from our thoughts about an event, not just the event itself. Check the facts helps you separate the two.⁵ It works a lot like the thought checking in CBT.

1. Name the event. What happened right before the feeling started?
2. List only the facts. What did you see, hear or touch? What did someone say or do? A good test: would a stranger watching from the corner of the room describe it the same way?⁵
3. Spot the thoughts on top. Are you guessing what someone meant? Predicting the worst? Ignoring the good parts? Stuck on how things "should" be?⁵
4. Ask helpful questions. How likely is the worst outcome? What else could explain this? What would a wise friend say? If the worst did happen, how would you cope?⁵
5. Decide what to do. If the feeling fits the facts, try solving the problem. If it comes mostly from your thoughts, try opposite action or a calming skill.⁵

Here is an example.

Our thought check tool can walk you through this on paper.

Skill 2: Opposite action

Every emotion comes with an urge. Opposite action means you notice the urge and, when acting on it would not help, do the opposite.⁶ When sadness says "stay in bed all day," staying in bed can leave you feeling more alone. Getting up, even a little, can start to turn the feeling around.⁶

1. Accept the feeling. Do not scold yourself for it. Your emotions make sense.⁶
2. Name the urge. What does this feeling make you want to do?
3. Check if the urge helps. Would acting on it help or hurt, now and later?⁶
4. Do the opposite. Change what you do, what you say and where your attention goes. Even your face and posture count.⁶
5. Start small if needed. If the full opposite is too hard, take the smallest step, such as putting your feet on the floor.⁶
6. Keep at it. It may take many tries before the feeling eases.⁶

Skill 3: PLEASE — care for your body to steady your mood

Emotions live in the body. When you are sick, hungry or tired, painful feelings tend to be stronger and harder to manage.⁷ The PLEASE skills lower this "vulnerability" by taking care of the basics.

Some versions, called PLEASES, add a second S for sensory input. Too much noise, harsh light or scratchy clothes can make feelings harder to manage.⁷

PLEASE in later life. A few points matter more as you age:

• Sleep. CDC suggests 7 to 9 hours for adults aged 61 to 64, and 7 to 8 hours for people 65 and older.¹⁰ See healthy sleep habits.
• Movement. CDC suggests that adults 65 and older aim for 150 minutes a week of moderate activity, such as brisk walking, plus strength and balance work. If that is too much, some activity is better than none.¹¹ A daily 30-minute walk can lift mood, and short walks add up.¹²
• Alcohol. Older bodies are more sensitive to alcohol. Drinking to cope with grief, loneliness or poor sleep gives brief relief but can make anxiety, depression and sleep worse. Alcohol also mixes badly with many medicines.¹³ See alcohol in later life.
• Illness and pain. Pain, illness and some medicines can affect mood. See medicines that can affect mood.

Building in more good moments

DBT emotion regulation also asks you to add pleasant events to your days on purpose. Small, regular good moments can lower your everyday stress and help you handle hard times.⁹

1. Make a list of things you enjoy or that leave you calm or content. Include some that are free and some that take five minutes or less.⁹
2. Keep the list where you will see it.
3. Do at least one thing from it every day.⁹

Ideas: sit in the sun with coffee, call a grandchild, water plants, listen to an old favorite song, or take a short walk. Naming a few things you are grateful for each day can also help.¹²

Using these skills as an older adult or caregiver

Caring for someone with dementia can bring guilt, anger, grief and worry, sometimes all in one day. Check the facts can help with guilt. Ask, "Did I truly do something wrong, or am I holding myself to an impossible standard?" Opposite action can help when you feel like pulling away from friends.

PLEASE matters for caregivers too. Skipped meals, broken sleep and no time to move can leave anyone on edge. If you feel worn down most days, read about caregiver burnout.

If memory or hearing is a challenge, write the skill steps on a card and keep it on the fridge. Practice for a few minutes at a calm time, so the skills are ready when you need them.

What the research shows

DBT has been tested mostly as a full package, not one skill set at a time. A 2020 Cochrane review (a careful summary of many studies) looked at 75 trials of talk therapy for borderline personality disorder. Compared with usual care, DBT reduced symptoms and self-harm and helped daily functioning. But the reviewers rated the evidence as low quality, so future studies could change the picture.¹⁴ Moderate evidence

This review looked at DBT as a whole, not at the emotion regulation skills by themselves. The self-care parts, such as regular sleep, exercise and less alcohol, are widely recommended for mental health.¹²

In standard DBT, these skills are taught in a weekly group of about 2.5 hours. The full set of DBT skills takes about 24 weeks, and many programs repeat it for a year.² Self-practice is a good start. A trained leader can help you apply the skills to your own life. To find one, see the DBT main page and how to find a therapist.

When to get help

Skills are not a substitute for care when things are serious. NIMH suggests getting professional help if distressing symptoms last two weeks or more. Examples include trouble sleeping, changes in appetite, trouble getting out of bed, losing interest in things you used to enjoy, or being unable to handle daily tasks.¹² Your primary care provider can refer you to a mental health professional.¹²

Does emotion regulation mean I should not feel angry or sad?

No. Every emotion has a purpose and carries useful information.⁴ The goal is to understand your feelings and lower how much they hurt, not to get rid of them.

What if the facts show my feeling is right?

Then your feeling fits the situation. Instead of trying to change the feeling, work on the problem behind it.⁵ Interpersonal skills can help if the problem involves another person.

Opposite action did not work the first time. Should I stop?

Not yet. It often takes repeated practice. If it still does not help, check again whether the urge was unhelpful, or whether a real problem needs solving.⁶

What should I learn next?

Next, try the interpersonal effectiveness skills. They help you ask for what you need and say no while keeping respect. If you are in a hard stretch right now, the distress tolerance skills may help first.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.