Treating Emotional Dysregulation in ADHD | Embracing DBT Skills Can Help

Written by: Angela Derrick, Ph.D. & Susan McClanahan, Ph.D.

Date Posted: August 15, 2024 10:35 pm

Treating Emotional Dysregulation in ADHD | Embracing DBT Skills Can Help

Emotional Dysregulation from ADHD Symptoms, Anxiety, and Depression—Dialectical Behavior Therapy (DBT) is Here to Help.

Regulating emotions effectively involves managing and responding to emotional experiences in a healthy manner. Therapy, particularly Dialectical Behavior Therapy (DBT), tops the list as a therapy of choice for treating individuals who struggle with regulating emotions for a variety of reasons. Depending on the severity of your day-to-day experience, you may find certain activities beneficial as general coping techniques. For others, especially those with trauma (PTSD or CPTSD) in their backgrounds, a more intense approach might be needed, but in any case, the good news is that emotional dysregulation symptoms are highly treatable.

Any difficulty regulating emotions, from experiencing symptoms that are somewhat bothersome to severe impairment, this struggle can cause a great deal of emotional pain and confusion and lead to turmoil and conflict in many areas of life, including interpersonal relationships. According to the National Institutes of Health (NIH), Almost every mental disorder is accompanied by problems in this respect. Frequently, a basic cause of conflict with other people is the presence of some psychiatric disorder.

It’s no wonder that stress, anxiety, and overwhelm are often in the mix when our emotions feel out of control. Let’s look at some examples of emotional dysregulation symptoms and explore their causes.

Between stimulus and response, there is a space. In that space lies our freedom and power to choose our response. In our response lies our growth and freedom. —Viktor E. Frankl

What Does Dysregulated Behavior Look Like?

Emotional dysregulation refers to an inability to manage and respond to emotionally charged experiences in a controlled and adaptive manner. It often involves experiencing intense feelings that are difficult to manage and can feel impossible to self-soothe, leading to inappropriate or harmful reactions. Dysregulated behavior can present as:

• Extreme Mood Swings: Often described as a roller coaster of emotions–intense and fluctuating.
• Intense Emotions: Experiencing emotions more intensely than others, for instance, feeling overwhelming sadness, anger, or anxiety in situations where others might feel mildly upset or stressed.
• Impulsivity: Acting quickly without a pause–having no thought of the consequences.
• Self-Soothing: Unable to make yourself feel better after experiencing intense feelings leading to prolonged periods of distress.
• Overreactions: Easily frustrated over what is generally considered minor inconveniences.
• Difficulty Understanding and Expressing Emotions: Trouble identifying feelings and expressing them in a healthy, clear, or straightforward manner.
• Chronic Feelings of Sadness, Anxiety, or Anger: This can be exhausting and demoralizing.
• Difficulty Maintaining Relationships: Communication, trust, conflict resolution, and emotional intimacy are crucial for healthy relationships, and these skills can be quite challenging for individuals with emotional regulation issues.
• Self-Destructive Behaviors: Engaging in escapism or numbing behaviors such as alcohol abuse, binge eating, gambling, or self-harm, to name a few.
• Mental Health Difficulties: Increased risk of developing mental health disorders such as depression, anxiety, or substance abuse issues.
• Physical Issues: Chronic emotional distress can lead to physical health problems such as high blood pressure, heart disease, and weakened immune function.
• Work and School Performance: Emotional dysregulation can affect concentration, decision-making, and productivity, impacting performance in professional and academic settings.

What Causes Emotional Dysregulation?

• Early Childhood Experiences: Trauma, neglect, or inconsistent caregiving can contribute to difficulties in emotion regulation.
• Chronic Stress: Prolonged exposure to stress can overwhelm the body’s ability to manage emotions.
• Biological Factors: Genetics and neurochemical imbalances can play a role in emotional dysregulation.
• Mental Health Disorders: Conditions like eating disorders, anxiety, major depressive disorder (MDD), bipolar disorder, ADHD, and personality disorders often involve challenges with emotion regulation.
• Post-Traumatic Stress Disorder (PTSD) and Complex Post-Traumatic Stress Disorder (CPTSD): Intense emotions and mood swings are common in individuals with PTSD & CPTSD.
• Lack of Skills: Not having learned effective emotion management strategies can make handling feelings more difficult.
• Traumatic Brain Injuries.
• Physical Pain or Bodily Discomfort: For instance, someone with an eating disorder may experience chronic discomfort in their bodies via the impact of self-starvation, the cycle of purging, or overexercise

The Overlap Between ADHD Symptoms & Emotional Regulation

ADHD symptoms may include the following:

• Hyperactivity
• Difficulties regulating emotions
• Reduced self-awareness
• Decreased self-monitoring
• Poor working memory
• Problems concentrating
• Having a hard time finding motivation
• Troubles with decision-making abilities
• Struggles with problem-solving issues. 

These symptoms can significantly impact various aspects of a person’s life, especially in the area of emotional regulation.

Individuals with ADHD often struggle with managing their feelings, which can manifest in heightened reactivity, difficulty dealing with stress, and challenges in maintaining stable moods. They may turn to substances or other maladaptive behaviors to regulate their moods, which further exacerbates the problem. 

The impacts are far-reaching and can cause problems at work, within families and friendships, and in any area where social interactions are required. Problems with balance and accessing emotional intelligence can be debilitating, lead to isolation, and a lowered quality of life.

Relationships

One of the primary ways ADHD affects emotional regulation is through impulsivity. Impulsivity in ADHD can lead to rapid, intense emotional responses that may seem disproportionate to the situation. For instance, a person with ADHD might react with extreme frustration or anger to minor inconveniences. This heightened emotional reactivity can result in outbursts or mood swings, making it challenging to maintain stable relationships and navigate social situations. Additionally, individuals with ADHD may find it difficult to recover from negative emotions, leading to prolonged periods of sadness, anxiety, or irritability.

Executive Function

The executive function deficits commonly associated with ADHD also play a significant role in dysregulated emotions. Executive functions are cognitive processes that help with planning, decision-making, and self-control. When these functions are impaired, individuals may struggle to pause and assess their internal and external state before reacting. When individuals find themselves unable to stop and think before responding, the result can be unfiltered outbursts of big feelings, making it nearly impossible for the affected individual to regulate emotions in the present moment or anytime soon after the incident. Moreover, the stress and frustration from dealing with these ADHD symptoms can exacerbate feelings of distress and shame, which might manifest as statements such as, “I’m so stupid,” What is wrong with me?” or “I can’t do anything right.” This suffering creates an enduring cycle of dysregulated feelings, depression, and chronic anxiety.

ADHD and Eating Disorders

We find there is often an intersection between ADHD and Eating Disorders. We know that an individual’s attempts not to feel (numb out) coincide with emotional regulation difficulties. When feelings are intense, and we lack the skills to identify and process them, we will often turn to substances or maladaptive behaviors to try to combat and relieve the pain. Because these issues are seamlessly intertwined, taking a holistic approach when rendering treatment is crucial because there is no extracting one from the other.

Management

Individuals experiencing difficulties with emotional regulation can benefit significantly from professional guidance, self-help techniques, and support from loved ones. Effective management of individuals with ADHD often involves skills training, particularly in mindfulness and emotion regulation techniques as well as executive functioning techniques. We will discuss skills training and mindfulness in more depth later. DBT Therapy and learning new regulation skills can equip you with practical tools for managing emotional responses. These steps can make a huge difference in personal healing and provide better coping skills. We are talking about highly effective, practical solutions leading to improved quality of life and more stable interpersonal relationships.

How Can Dialectical Behavior Therapy Help?

Dialectical Behavior Therapy (DBT) is a comprehensive therapeutic approach that treats a range of mental health conditions, particularly those involving emotional dysregulation, such as depression, anxiety, post-traumatic stress disorder (PTSD), and borderline personality disorder, to name a few. One of the core components of DBT is its focus on emotional regulation—the ability to understand, manage, and constructively respond to intense feelings. By fostering a deeper understanding of emotions and promoting healthy coping techniques, DBT empowers individuals to lead more balanced and fulfilling lives.

DBT teaches four main sets of skills, known as modules:

• Mindfulness
• Distress Tolerance
• Emotion Regulation
• Interpersonal Effectiveness.

The emotion regulation module includes strategies for identifying, naming, and processing feelings, thereby reducing vulnerability to emotional dysregulation. This module helps individuals recognize the triggers and patterns of their maladaptive responses and learn ways to influence their experiences proactively, thereby increasing positive emotional experiences.

A key aspect of emotion regulation in DBT is the development of coping strategies to deal with intense emotions. Techniques for reducing emotional intensity include self-soothing activities, distraction, and grounding exercises. DBT also emphasizes the importance of building a life worth living, encouraging individuals to engage in activities that bring joy and fulfillment.

Mindfulness, another core component of DBT, plays a crucial role in emotional regulation. Mindfulness involves being present in the moment and observing thoughts and emotions without judgment. This practice helps individuals better understand their emotional experiences and reduces the tendency to react impulsively. By cultivating mindfulness, individuals can create a space between their emotions and actions, allowing for more deliberate and thoughtful responses.

Do not judge me by my success, judge me by how many times I fell down and got back up again. —Nelson Mandela

DBT Distress Tolerance Skills

Distress Tolerance Skills are part of Dialectical Behavior Therapy (DBT), designed to help individuals manage intense emotions and improve their ability to cope with stressful situations. Distress tolerance focuses on getting through crises where emotions are running high and might lead to destructive behaviors. These skills are instrumental in helping during moments of intense emotional pain or distress. The goal is to endure distress in a healthy way and prevent the situation from escalating.

1. TIPP (Temperature, Intense Exercise, Paced Breathing, Paired Muscle Relaxation):
   • Temperature: Changing your body temperature quickly (e.g., holding ice or splashing cold water on your face) can reduce emotional intensity.
   • Intense Exercise: Engaging in short, intense physical activity to burn off excess energy or adrenaline.
   • Paced Breathing: Slowing your breathing to calm down and regain control.
   • Paired Muscle Relaxation: Tensing and relaxing muscle groups to reduce physical tension.
2. Distract with ACCEPTS:
   • Activities: Engage in activities that take your mind off distress (e.g., hobbies, cleaning, reading).
   • Contributing: Volunteer or help someone else to shift focus from your distress.
   • Comparisons: Remind yourself of less fortunate people or compare your current situation to worse times to help balance your emotions.
   • Emotions: Generate different emotions to change your mood, like watching a funny video.
   • Pushing Away: Temporarily put the situation out of your mind.
   • Thoughts: Focus on other thoughts, like counting backward or doing puzzles.
   • Sensations: Engage your senses in new experiences (e.g., taking a hot shower and listening to music).
3. Self-Soothing with the 5 Senses:
   • Engage in comforting activities that involve the five senses: sight, sound, smell, taste, and touch—for example, looking at calming images, listening to relaxing music, smelling a favorite scent, eating comfort food, or wrapping yourself in a soft blanket.
4. IMPROVE the Moment:
   • Imagery: Visualize a peaceful place or situation.
   • Meaning: Find meaning or purpose in the situation, such as considering what you can learn from it.
   • Prayer: If you are spiritual or religious, use prayer or spiritual practices to find comfort.
   • Relaxation: Engage in relaxation techniques like deep breathing or meditation.
   • One Thing in the Moment: Focus on one task or object in the present moment to ground yourself.
   • Vacation: Take a short break from stress, mentally or physically.
   • Encouragement: Give yourself positive affirmations and remind yourself of your strengths.
5. Pros and Cons:
   • Weigh the pros and cons of tolerating the distress versus acting on impulse. This can help you stay motivated to use your skills rather than giving in to potentially harmful behaviors.
6. Radical Acceptance:
   • Fully accept the situation as it is without fighting reality. Acceptance doesn’t mean you condone it, but rather that you acknowledge it precisely as it is and let go of the struggle against it.
7. Reality Acceptance Skills:
   • Turning the Mind: Make an active decision to accept reality.
   • Willingness vs. Willfulness: Willingness is being open and accepting; willfulness is resisting or rejecting reality.
   • Half-Smiling and Willing Hands: Relax your face and hands to release tension and increase acceptance.

The present moment is filled with joy and happiness. If you are attentive, you will see it. —Thich Nhat Hanh

DBT Mindfulness Exercises

DBT mindfulness exercises focus on increasing awareness and acceptance in the present moment. These exercises help individuals observe their thoughts, feelings, and surroundings without judgment, reducing emotional reactivity and promoting a sense of calm. Below are some core DBT mindfulness skills and exercises that can improve emotion regulation, reduce stress, and garner a stronger sense of inner peace.

Core Mindfulness Skills

The Mindfulness module incorporates the “What” skills of Observe, Describe, and Participate and the “How” skills of Non-Judgmentally, One-Mindfully, and Effectively.

To practice the Observe skill, we notice what is happening both internally (thoughts, feelings, body sensations) and externally (sights, sounds, smells) without judgment or trying to change our reality. We simply observe, like watching clouds pass by overhead.

For Describe, we can put words to our experience, describing what we are observing without adding interpretations or judgments. For example, “I feel tension in my shoulders” rather than “I feel tense because of my stressful day.”

And the final “What” skill is Participate. We fully engage in the present moment with whatever we are doing. We immerse ourselves in the activity without distraction, letting go of self-consciousness or overthinking.

The “How” skills simply explain how to practice DBT skills. Starting with Non-Judgmentally, we learn to practice noticing our thoughts and feelings without labeling them as good or bad. We observe them as they are. If we catch ourselves judging, we gently bring our attention back to the present moment.

One-Mindfully has us focusing on one thing at a time, fully experiencing it as it happens. For example, when doing the dishes, we can observe our hands in motion, notice the feel of the water and the smell of the soap, observe the beauty of the bubbles, and let our minds go quiet by complete immersion in the task. If our minds wander, we gently bring them back to the experience right before us.

The “How” skill of Effectively has us doing what works in the moment rather than what we think “should” work. We can be practical and flexible, focusing on achieving our goals rather than adhering to rigid thought patterns or rules, which can turn us brittle and get us stuck.

Mindfulness Exercises

1. Mindful Breathing:
   • Focus your attention on your breath. Notice the sensation of the air entering and leaving your nostrils, the rise and fall of your chest or abdomen. When your mind wanders, gently bring it back to your breath.
2. Body Scan:
   • Slowly move your attention through your body, starting from your toes and moving up to your head. Notice any sensations, tension, or discomfort without trying to change anything. Simply observe each part of your body with curiosity.
3. Five Senses Exercise:
   • Bring your attention to the present moment by focusing on your five senses.
     • Sight: Look around and notice five things you can see.
     • Sound: Close your eyes and notice four things you can hear.
     • Touch: Notice three things you can physically feel (e.g., the texture of your clothing or the temperature of the air).
     • Smell: Notice two things you can smell.
     • Taste: Notice one thing you can taste (or imagine the taste of something familiar).
4. Mindful Eating:
   • Take a small bite of food and focus on the experience of eating. Notice the texture, taste, and smell of the food. Chew slowly, savoring each bite. Pay attention to the sensations in your mouth and the movement of your jaw.
5. Mindful Walking:
   • Saunter and pay attention to the sensations in your feet and legs as they move. Notice the feeling of the ground beneath your feet, the movement of your body, and your surroundings. Walk without rushing, fully experiencing each step.
6. Leaves on a Stream:
   • Imagine your thoughts as leaves floating down a stream. Visualize each thought or feeling as a leaf, observe it, and let it float away without holding onto it. This exercise helps to create distance from your thoughts and reduce over-identification.
7. Urge Surfing:
   • When experiencing a strong urge or craving, observe it as a wave that rises, peaks, and eventually subsides. Notice the physical sensations and thoughts associated with the urge without acting on it. Ride the wave until it passes.
8. Loving-Kindness Meditation:
   • Focus on cultivating feelings of compassion and kindness toward yourself and others. Repeat phrases like “May I be happy, may I be healthy, may I be safe, may I live with ease,” and then extend these wishes to others, including loved ones, acquaintances, and even difficult people.
9. Mindful Stretching or Yoga:
   • Engage in gentle stretching or yoga, focusing on the sensations in your body as you move. Notice your breath and how it coordinates with your movements. Move slowly and mindfully, paying attention to how your body feels in each position.
10. Thought Labeling:
    • When you notice a thought, label it (e.g., “worrying,” “planning,” “judging”). Then, gently return your focus to the present moment, such as your breath or current activity. This redirection exercise helps create distance from your thoughts and prevents them from overwhelming you.

The greatest weapon against stress is our ability to choose one thought over another. —William James

What is Radical Acceptance in DBT?

Radical Acceptance is a concept within Dialectical Behavior Therapy (DBT) that focuses on fully and completely accepting reality as it is rather than fighting against it or wishing it were different. It’s not about approving of or liking the situation but rather about recognizing and accepting it without judgment or resistance. Radical Acceptance is used as a tool to reduce emotional suffering and to prevent the escalation of distress in situations that cannot be changed.

Key Components of Radical Acceptance

1. Acknowledging Reality:
   • Recognizing the reality of the situation, including all of its aspects, without denial or distortion. This ability involves seeing things clearly as they are, even when they are difficult or painful.
2. Letting Go of Fighting Reality:
   • Dropping the struggle against the facts of the situation. This means not resisting what is happening, not avoiding or suppressing emotions, and not getting caught up in “shoulds” or “what ifs.”
3. Acceptance Without Judgment:
   • Accepting the situation without labeling it as good or bad. It involves letting go of judgments and self-criticism, allowing yourself to experience emotions without adding layers of negativity.
4. Understanding the Difference Between Pain and Suffering:
   • Pain is an inevitable part of life, but suffering is often the result of our resistance to that pain. Radical Acceptance helps to reduce suffering by allowing us to feel pain without additional layers of distress caused by denial, anger, or avoidance.
5. Commitment to the Present Moment:
   • Fully embracing the present moment as it is, without trying to escape or avoid it. This includes accepting both internal experiences (like emotions and thoughts) and external realities (like situations or relationships).

How Radical Acceptance is Applied in Therapy

• Crisis Situations: In moments of intense distress or crisis, Radical Acceptance can help individuals avoid making the situation worse by resisting or denying reality. For example, instead of reacting impulsively to a painful event, Radical Acceptance encourages acknowledging the pain and choosing a more skillful response.
• Chronic Issues: For ongoing or long-term difficulties, such as chronic illness, difficult relationships, or persistent life challenges, Radical Acceptance helps individuals come to terms with the reality of their situation, which can lead to greater peace and less emotional turmoil.
• Emotional Regulation: Radical Acceptance can help in regulating emotions by preventing the escalation of negative emotions like anger, frustration, or despair. By accepting reality, individuals can avoid getting stuck in negative emotional cycles.
• Preventing Avoidance: It encourages individuals to face reality head-on rather than engage in avoidance behaviors, such as substance use, self-harm, or procrastination. Acceptance does not mean resignation; it allows for clear-headed decision-making and effective problem-solving. We have choices and agency in our process once we accept a situation exactly as it is.

Steps to Practice Radical Acceptance

• Notice When You’re Resisting Reality: Pay attention to when you reject or deny what is happening. This awareness might show up as anger, frustration, or thoughts like “This isn’t fair” or “This shouldn’t be happening.”
• Acknowledge What You Can and Cannot Control: Identify what aspects of the situation you have control over and what you do not. Accept the parts that are beyond your control.
• Use Mindfulness: Stay in the present moment and observe your thoughts and feelings without judgment. Notice any urges to resist reality and gently bring your attention back to acceptance.
• Practice Self-Compassion: Be kind to yourself as you practice Radical Acceptance. It’s okay to feel pain or discomfort as you accept reality.
• Remind Yourself of the Benefits: Consider how accepting reality can reduce your suffering and lead to more effective coping strategies.
• Repeat as Necessary: Radical Acceptance often requires ongoing practice, especially in challenging situations. It’s not a one-time event but a continual process.

Benefits of Radical Acceptance

• Reduces Emotional Suffering: By accepting reality, individuals often experience less emotional distress because they no longer add extra layers of resistance or judgment to their experience.
• Increases Emotional Resilience: Acceptance fosters a sense of inner strength and resilience, allowing individuals to cope more effectively with life’s challenges.
• Improves Relationships: By accepting others as they are, without trying to change them, relationships can become healthier and more harmonious.
• Enhances Decision-Making: Acceptance of reality allows for making decisions with a clear head, as it removes the emotional turmoil that can cloud judgment.

Radical Acceptance is a powerful tool for dealing with life’s most difficult situations. By fully embracing the reality of their experiences, individuals can find peace and strength even in the face of adversity.

Life is a balance of holding on and letting go. —Rumi

Conclusion

Understanding and addressing emotional dysregulation, no matter the origin, involves a combination of self-awareness, skill-building, and, when necessary, professional intervention. Difficulties with emotional regulation can significantly impact an individual’s life, including intense emotional responses, problems in managing these responses, and subsequent negative effects on behavior that affect intimate partner, family, work, and social relationships, as well as overall well-being.

There is hope and help — you are not alone!

At SpringSource Psychological Center, we are skilled in DBT and many other evidence-based therapies. We understand that the path to healing is varied, and we focus on compassionately addressing each individual’s unique needs. We are available for in-person and virtual appointments in our downtown Chicago and Northbrook, IL offices. Call us today at 224-202-6260 to learn more and set up your free initial consultation. We would love to hear from you.