UvA-DARE (Digital Academic Repository) Emotion Regulation in Schema Therapy and Dialectical Behavior Therapy Fassbinder, E.; Schweiger, U.; Martius, D.; Brand-de Wilde, O.; Arntz, A. DOI 10.3389/fpsyg.2016.01373 Publication date 2016 Document Version Final published version Published in Frontiers in Psychology License CC BY Link to publication Citation for published version (APA): Fassbinder, E., Schweiger, U., Martius, D., Brand-de Wilde, O., & Arntz, A. (2016). Emotion Regulation in Schema Therapy and Dialectical Behavior Therapy. Frontiers in Psychology, 7, [1373]. https://doi.org/10.3389/fpsyg.2016.01373 General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). 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UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl) Download date:30 Sep 2021 METHODS published: 14 September 2016 doi: 10.3389/fpsyg.2016.01373 Emotion Regulation in Schema Therapy and Dialectical Behavior Therapy Eva Fassbinder 1*, Ulrich Schweiger 1, Desiree Martius 2, Odette Brand-de Wilde 2 and Arnoud Arntz 3 1 Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany, 2 De Viersprong, Netherlands Institute of Personality Disorders, Halsteren, Netherlands, 3 Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands Schema therapy (ST) and dialectical behavior therapy (DBT) have both shown to be effective treatment methods especially for borderline personality disorder. Both, ST and DBT, have their roots in cognitive behavioral therapy and aim at helping patient to deal with emotional dysregulation. However, there are major differences in the terminology, explanatory models and techniques used in the both methods. This article gives an overview of the major therapeutic techniques used in ST and DBT with respect to emotion regulation and systematically puts them in the context of James Gross’ process model of emotion regulation. Similarities and differences of the two methods are highlighted and illustrated with a case example. A core difference of the two approaches is that Edited by: DBT directly focusses on the acquisition of emotion regulation skills, whereas ST does Alessandro Grecucci, University of Trento, Italy seldom address emotion regulation directly. All DBT-modules (mindfulness, distress Reviewed by: tolerance, emotion regulation, interpersonal effectiveness) are intended to improve Gideon Emanuel Anholt, emotion regulation skills and patients are encouraged to train these skills on a regular Ben-Gurion University of the Negev, Israel basis. DBT assumes that improved skills and skills use will result in better emotion Harold Dadomo, regulation. In ST problems in emotion regulation are seen as a consequence of adverse University of Parma, Italy early experiences (e.g., lack of safe attachment, childhood abuse or emotional neglect). *Correspondence: These negative experiences have led to unprocessed psychological traumas and fear Eva Fassbinder [email protected] of emotions and result in attempts to avoid emotions and dysfunctional meta-cognitive schemas about the meaning of emotions. ST assumes that when these underlying Specialty section: problems are addressed, emotion regulation improves. Major ST techniques for trauma This article was submitted to Emotion Science, processing, emotional avoidance and dysregulation are limited reparenting, empathic a section of the journal confrontation and experiential techniques like chair dialogs and imagery rescripting. Frontiers in Psychology Keywords: emotion regulation, emotional avoidance, Schema therapy, dialectical behavior therapy, experiential Received: 27 April 2016 techniques, skills Accepted: 29 August 2016 Published: 14 September 2016 Citation: INTRODUCTION Fassbinder E, Schweiger U, Martius D, Brand-de Wilde O and Arntz A (2016) Emotion Regulation in Schema Dialectical behavior therapy (DBT) and Schema therapy (ST) have both shown to be effective Therapy and Dialectical Behavior treatment methods especially for borderline personality disorder (BPD) (Zanarini, 2009; Stoffers Therapy. Front. Psychol. 7:1373. et al., 2012), a disorder that is specially associated with emotional dysregulation. Although both, ST doi: 10.3389/fpsyg.2016.01373 and DBT, have a cognitive-behavioral background, there are major differences in how both methods Frontiers in Psychology | www.frontiersin.org 1 September 2016 | Volume 7 | Article 1373 Fassbinder et al. Emotion Regulation in ST and DBT deal with emotions and emotion dysregulation. This paper • Mindfulness is central to all skills in DBT. The mindfulness provides an overview of background and theory of both skills derive from traditional Buddhist meditation practice, treatment approaches, a model how both methods conceptualize though they do not involve any religious concepts. In DBT emotion dysregulation and the major therapeutic techniques with it means the practice of being fully aware and present in respect to emotion regulation. Further it is discussed how DBT the present moment, experiencing one’s emotions, thoughts and ST concepts and techniques map onto the process model of or body sensations without judging and without reacting emotion regulation from James Gross (Gross, 2015). Similarities to them. The mindfulness skills are divided into “what and differences of the two methods are highlighted and illustrated skills” (observing, describing and participating) and “how- with a case example. skills” (non-judgmentally, one-mindfully and effectively). An important concept of this module is “wise mind,” which BACKGROUND AND THEORY allows to base decision making on a balance between intuition and facts. The implicit goal is to provide the Dialectical Behavior Therapy (DBT)– experience that emotions and cognitions are internal events Background and Theory that are a patterned response to external and internal stimuli. Development of Dialectical Behavior Therapy and the Mindfulness allows watching cognitions and emotions from Dialectic of Acceptance and Change an observer perspective as separate both from the external DBT was developed in the late 1980s by Linehan (1993a,b), world and the self. • originally for chronically (para)suicidal patients, then extended Emotion regulation compromises detailed psychoeducation on to patients with BPD. To that time, these patients had been emotions in general and a broad spectrum of specific emotions considered as “untreatable.” A focus on problem solving to foster an in depth understanding of emotions and emotion or cognitive restructuring, according to standard cognitive regulation. It teaches skills in problem solving, checking reality behavioral therapy (CBT), had been experienced as potentially and taking opposite action to behavioral tendencies associated invalidating by the patients and had led to frustration, angry with specific emotions as well as skills reducing emotional reactions, resistance and treatment drop outs. On the other side, vulnerability. The module intends to give the patient a fresh focusing on acceptance and validation has also been perceived as look on emotions and to decrease emotional and experiential problematic by patients since their problems and behaviors did avoidance. A critical feature is to enable the patient to make an not change. This led to one of the most important features of active choice between acting with an emotion or opposite to it. • DBT, the “dialectic” of acceptance and change. This means, that Interpersonal effectiveness teaches how to obtain objectives therapists, on the one hand accept patient as they are and provide skillfully and how to act effectively with respect to objectives, validation for their thoughts, emotions and behaviors, while on relationship and self-respect. The implicit objective is to the other hand therapists acknowledge the need for change and reduce interpersonal avoidance which is the key to change foster the learning of new skills to deal with problems and to experiential and emotional avoidance and to increase reach personal goals (Linehan and Wilks, 2015). This dialectic interpersonal behavior that has a high probability of being stance has been inspired by principles of dialectic philosophy positively reinforced. • (e.g., everything is transient and finite, everything is composed of Distress tolerance focusses on teaching crisis survival skills. contradictions, passage of quantitative into qualitative changes, It fosters acceptance in situations that cannot be otherwise change results from a helical cycle of thesis, antithesis and changed or avoided without making things worse. There synthesis). is an emphasis on self-soothing, improving the moment DBT is currently the most extensively studied and used and adaptive distraction. Important concepts are “radical approach to treat BPD (Stoffers et al., 2012). In