In the tradition of CBT, DBT theorises that Thoughts, Emotions and Behaviours work in a triad to stimulate and reinforce each other. If a person is caught up in self-critical thinking and self-destructive behaviours, this leads to a vicious cycle for the emotions (p132). Conversely, strong emotions often lead to bigger behavioural reactions. As a result many people with overwhelming feelings also struggle with out-of-control behaviours.
Two behaviours that are commonly out of control for clients with overwhelming emotions are self-mutilation and manipulating others. These behaviours persist because in the short-term at least they are reinforced by the effects they have on emotions – self-harm generally leads to relief from painful emotions, and manipulation generally leads to the person getting something they want. But as the behaviour is repeated over the long term, negative consequences begin to accrue (e.g. scarring and infections, or worsening conflict in relationships) (p133).
Techniques from Cognitive Therapy are used to help the client recognise the sequences of feelings, behaviours, and short-term rewards that become cycles of out-of-control behaviours spiralling into further misery.
‘Cost-benefit analysis’ is used to help the client identify the short term rewards of the behaviour and the long term costs and dangers.