Emotion Regulation Therapy For People With Borderline

A core problem for someone with Borderline Personality Disorder(BPD) is their inability to control their emotions. This causes intense emotional episodes and (self)destructive behavior, which are dysfunctional attempts to handle the overwhelming emotional pain. The goal of Emotion Regulation Therapy is to learn how to deal with these emotional episodes.

During an emotional episode, people are overwhelmed by the intensity of their emotions and often unconsciously do a lot of damage to themselves and others. When these episodes occur repeatedly, everything they built up for themselves gets broken down. This way, it might be impossible for someone to build a stable life. This can be extremely frustrating for people and for the ones around them.

People who get this therapy show intense emotions that are easily triggered, take longer to calm down and have their emotions often piled up. This is a suitable therapy for someone with Borderline.

What happens during Emotion Regulation Therapy?

The therapy is for learning and using skills to regulate one's emotions. It is often held in a group setting, but can also be kept individually. In this therapy, 5 skills are taught to the patients to better deal with their emotions. Each week the patients track the intensity of their emotions and try to use their newly learned skills.

The group dynamic can get intense at times, with emotions running high due to the patients sharing their experiences. When a patient experiences an emotional episode during a session, the therapists might use it to highlight the skills they're learning.

During the sessions, patients dive deeper into situations where they couldn't control their emotions. It is often new for patients that their emotions rise in phases, because it may feel like their emotions are instantly elevated. When the patients learn to pay attention to the phasing, they have a better chance of intervening before it gets out of control.

Dysfunctional patterns, also known as schemas, are triggered by situations and are often the drivers of intense emotional episodes. These dysfunctional patterns are related to unhealthy childhood events. A few sessions in this therapy are dedicated to these schemas, but for more detailed treatment, schema therapy is required.

This therapy is also focused on balancing elementary areas of life. The areas covered are eating, sleeping, exercise, physical health, prevention of self-harm, work/education/daily activities, finance, and relationships. The group discusses what healthy and unhealthy behavior is within these areas.

What do you learn with Emotion Regulation Therapy?

Within this therapy, there are five skills to better handle emotions: distancing and observing, describing, challenging thoughts, shifting attention, and problem-solving.

1. Distancing and Observing: Patients tend to take feelings and thoughts as the absolute truth and respond to situations accordingly. With the skill of distancing and observing, one learns to judge, observe and investigate the situation in which one finds himself. Thoughts, emotions, (physical) feelings, and behavior are observed from a distance, and as a result, awareness can gradually increase. With various exercises during the sessions, old patterns with which people react to situations can change to respond more appropriately.

2. Describe: Patients often have a limited repertoire to put their experiences into words. Instead of perceiving emotions only as fear, sadness, anger, and joy, they learn to describe them more thoughtfully. They practice through a poem, an image, or a drawing. They learn to better understand their feelings and to communicate them better to themselves and their environment.

3. Challenge thoughts: An important part of the therapy is becoming aware of automatic negative thoughts, beliefs, and schemas. Patients are hindered by old, dysfunctional patterns in their thinking, feeling, and doing. During the sessions, a start is made with challenging negative thoughts and replacing them with more helpful ones.

4. Shifting attention: A technique to consciously shift attention to activities and thoughts that give a positive or neutral feeling. It's a combination of shifting attention and seeking distraction. This leads to more neutral and positive feelings, thoughts, and behavior. This may be accomplished in a variety of ways, including finding a safe place or object, as well as engaging in enjoyable, useful, and comforting exercises.

5. Problem-solving: When patients are somewhat able to reduce the intensity of their emotions, problem-solving skills can become useful. With this skill, one learns to come up with different solutions for old dysfunctional patterns.