DBT for Self-Destructive Behaviors

People sometimes react to emotional stress by turning to destructive coping behaviors such as substance abuse, aggression, eating disorders, and other forms of self-harm. Adolescents typically use self-destructive behaviors to manage depression, anxiety, anger, stress, impulsivity and feelings of emptiness.

Understanding Self-Destructive Behaviors

There are many potential causes of self-destructive behaviors, but they often start with an emotional crisis, relationship conflict, or feeling overwhelmed by one’s emotions. At times of stress, at school or at work, people may feel intense emotions that they find extremely difficult to manage, such as shame, guilt, sadness, anger and fear. Self-destructive behaviors become ways of coping with these unbearably intense and negative emotions.

These feelings may become worse if other people invalidate them, by not responding with understanding and emotional support. Instead of asking for help, people learn to cope with the emotional pain by starting to hurt themselves in order to control their pain. This may include cutting or burning their skin, attempting suicide, or getting involved in risky activities such as drug and alcohol abuse.

The Cycle of Suffering

Continuing with self-destructive behaviors can create a cycle of suffering, where people who respond to emotional pain and life problems in destructive ways end up with additional problems, causing them to feel worse than before. While they may temporarily feel in control, their emotional problems are not being resolved, and may become compounded by physical problems. Instead of working through the emotional pain and asking for help, the cycle of self-destructive behavior intensifies. This can endanger their lives in very real ways, or lead to long-term medical problems accompanied by pain and suffering.

How DBT Can Help

DBT helps break the cycle of destructive coping behaviors through teaching skills and dialectical ways of thinking in order to promote better coping. DBT does not just see self-destructive behaviors as the client’s main problem; rather, these behaviors are seen as unhealthy ways of coping with difficult emotions that get in the way of building a life worth living. Consequently, the goal isn’t just to stop the behavior, but to replace it with a new set of life-enhancing behaviors. In DBT,  clients learn to think dialectically about accepting their reality and their emotions while changing them. Clients also learn to identify and experience their painful emotions while holding on to the idea that this emotion is a temporary experience and does not define their eternal reality. 

The DBT skills modules are also helpful with this. Mindfulness skills help clients become aware of situational and emotional triggers for self-destructive behavior, and help them focus attention toward or away from it as needed. Distress tolerance skills help clients accept their current situation and emotion and get through it skillfully, without needing to hurt themselves in the process. Emotion regulation skills help clients cope more effectively with painful emotions, avoid triggers, and build positive life experiences. Interpersonal effectiveness skills help clients better navigate current relationships, end destructive relationships, and build helpful relationships.