is the experience of emptiness, which is an intense feeling of disconnectedness, aloneness, and feeling misunderstood.
Cognitive dysregulation: Cognitive dysregulation is characterized by relatively brief episodes of paranoid thinking, and this is particularly true during periods of stress. This means that when the person with BPD has high stress levels, they can begin to imagine that others are intentionally out to get them, even when there is no evidence that this is true. People with BPD can also experience dissociation, which is the feeling or thought that they are not real or that the rest of the world is not real.
Behavioral dysregulation: Behavioral dysregulation in people with BPD is characterized by extreme, sometimes impulsive, and at times dangerous behaviors. These behaviors are often used as a way to deal with intense and unbearable emotions, and can include self-injurious behaviors, such as cutting and suicide attempts. Other such behaviors include eating behaviors, such as binge eating, substance use as a way to fit in or self-medicate, dangerous sexual behaviors as a way to feel connected, and dangerous driving or excessive spending as ways to feel a rush of positive emotions.
The invalidating environment
The environmental factor that Dr. Linehan proposed was most significant in the development of BPD in a person who had the emotional makeup in the previous section was what she termed the invalidating environment. The invalidating environment has certain characteristics, as you find out in the following sections.
Intolerance of emotional expression
The invalidating environment is intolerant of another person’s expression of private emotional experiences and, in particular, emotions that aren’t supported by observable events. For instance, if a person believes that they are unlovable and becomes extremely sad because of this, it’s typical for others to tell them that it isn’t true and that their statement that they aren’t lovable isn’t supported by the facts. A person feeling unlovable isn’t something that another person can observe, and so simply telling the person who is struggling with such thoughts that what they are thinking isn’t true is invalidating because it takes away the validity of that person’s emotional experience.
In other words, it may be factually incorrect that that person isn’t loved, and yet the emotion that they experience is real and is not readily dispelled simply by someone saying that they shouldn’t feel it.
Reinforcement of strong emotions
Another feature of the invalidating environment is that it can reinforce displays of strong emotions. Reinforcement is any consequence that comes after a behavior that increases the likelihood that the behavior will either increase or be maintained at current levels.
Shame
Another feature of the invalidating environment is that when a person is told that their displays of emotional upset are unacceptable, unwarranted, or unjustified, they often begin to feel shame for having behaved in the way they did or even for having any emotions at all. The problem with this is that shaming someone doesn’t teach them what to do when they are feeling strong emotions, and as such, they don’t learn what to do the next time strong emotions show up. It also prevents a person from learning how to accurately name and label their emotions.
Imagine that a person could not name and label vegetables and that they were told to go buy vegetables but instead came back with bread and milk and were then ridiculed for not having bought vegetables. Shaming this person wouldn’t teach them what they had to do, and long-term shame can cause significant psychological damage. In such situations, what the person actually learns is to oscillate between going to great lengths to prevent the display of big emotions for fear of being punished and then having big emotional eruptions without knowing how to manage them.
Dismissal of problems and reactions
Finally, the invalidating environment tells emotionally sensitive people that their problems are easy to solve. “Oh, just calm down. That’s what I do,” a parent might tell an emotionally sensitive adolescent. Whereas this may be easy for the parent, it might not be for the child. When people who are emotionally sensitive and, according to the biosocial theory, have a biologically hard-wired temperament or disposition toward being emotionally vulnerable, they have a relatively low threshold for responding to factors in the environment that are emotionally arousing.
It would be like a child having been born with a peanut allergy and being sensitive to peanuts in the environment. Telling the child not to have a reaction to peanuts would ignore what the child’s biology is. Similarly, telling a person with emotional sensitivity not to have the reaction they are having ignores their neurobiology.
Focusing on the Functions and Goals of a Comprehensive Treatment
Based on the conceptualization of disorders characterized by difficulties in emotion (see the earlier section “Beginning with the Biosocial Theory”), DBT specifically focuses on helping people regulate their emotions in more adaptive ways. And so, DBT includes many behavioral skills that specifically aim to teach patients how to recognize, understand, label, and regulate their emotions.
A comprehensive treatment is needed to help people who are emotionally sensitive. For any treatment to be comprehensive, it must address five essential functions, and DBT is no different. A comprehensive treatment must accomplish the tasks in the following sections.
Motivating the patient and the therapist
A comprehensive treatment motivates a patient to participate in and complete the treatment, and various strategies are used to keep both the patient and the therapist in the therapy. Motivation comes from understanding the person’s goals while at the same time identifying their relevant strengths and relative weaknesses. The therapist works to ensure that they themselves are clear as to what the patient’s goals are, that they have explained how DBT can help the person attain their goals, and then that they and the patient can collaborate in the process. Motivation goes beyond just the patient. It also targets the therapist’s motivation, particularly
