DBT uses a formulation from CBT to frame how emotions and their role in event chains can be recognised and understood. Clients are guided through the exploration of six questions to analyse situations that have involved strong emotions and negative outcomes
What happened? (Stimulus) This question pinpoints the events that led to the primary emotional response
Why do you think that situation happened? (Thoughts) This question aims to elicit the thoughts that may have been involved in generating secondary emotions;
How did the situation make you feel, both emotionally and physically? (Emotions or feelings) Clients are encouraged to identify both the primary and secondary emotions. Showing the client a list of Commonly Felt Emotions can be helpful here.
What did you want to do as a result of how you felt? (Urges) When you start to realise what you want to do and compare it to what you actually do, the results can be cause for hope.
What did you do and say? (Behaviours)
How did your emotions and actions affect you later? (Consequences)
The instruction phase can involve working through a case study of a fictional person and ensuring that the client understands the meaning and purpose of the questions. Then supervised practice can be provided by working through one or more situations that happened to the client recently. Finally, clients should be encouraged to do independent practice focusing on one situation a day for two weeks. Worksheets are available for clients to use.
The ‘Emotional Record’ is another exercise that helps clients to recognise emotions and to pay additional attention to what they are experiencing. First clients are encouraged to simply label emotions out load when they are happening, including positive as well as negative emotions. Second at the end of each day a record is made of at least one emotional event including 4 pieces of information: the situation, the emotion, whether or not they said it out loud, and what happened after they recognised how they felt.