Treating Emotion Dysregulation in a Couples Context: A Pilot Study of a Couples Skills Group Intervention
Kirby, Jennifer S., Baucom, Donald H., Journal of Marital and Family Therapy
This article reports the development of a couple-based intervention in which at least one partner had experienced chronic difficulties in emotion regulation, operationalized as having participated in a yearlong dialectical behavior therapy (DBT) skills training group. Integrating dialectical behavior therapy and cognitive-behavioral couple therapy, this group intervention taught couples emotion regulation, communication, and problem-solving skills, and led them through an exploration of how strong feelings affect and are affected by their relationship. The effects of treatment were evaluated in terms of relationship satisfaction and individual well-being. Sizeable treatment effects were found in several domains, including a reduction in DBT graduates' depressive symptoms and emotion dysregulation, and an increase in their partners' relationship satisfaction and confidence in their graduate spouses' ability to regulate emotions.
Empirically supported treatments that help individuals with chronic difficulties in emotion regulation are few in number, with the most well-researched intervention being dialectical behavior therapy (DBT), developed by Linehan et al. at the University of Washington. Evolving from standard cognitive-behavioral therapy as a treatment for borderline personality disorder (BPD), DBT balances an ongoing focus on behavioral change with acceptance, compassion, and validation of the client (Linehan, 1993a, 1993b). Research evidence to date indicates that DBT reduces severe dysfunctional BPD behaviors that are targeted for intervention (e.g., parasuicidal behavior, substance abuse), reduces psychiatric hospitalization, increases treatment retention, and improves global functioning (see Robins & Chapman, 2004, for a review). Follow-up data suggest that these results may hold up to 1 year (Linehan, Heard, & Armstrong, 1993). With a less severe population of patients with BPD, DBT appears to decrease suicidal ideation, depression, and hopelessness (Koons et al., 2001). In addition, these findings have been replicated by independent investigators and have been obtained within naturalistic clinical settings. In a recent review of empirically validated treatments (Chambless et al., 1998), DBT was the only treatment for BPD listed as "probably efficacious," whereas no treatments for BPD were included in the "well-established category."
Using a biosocial model, DBT conceptualizes BPD as a dysfunction of the emotion regulation system (Linehan, 1993a, 1993b). This dysfunction stems from and is maintained by an ongoing transaction between the individual's emotional vulnerability and the environment's invalidation of the individual. DBT proposes that invalidating environments "negate and/or respond erratically and inappropriately to private experiences," which more specifically are "punished, trivialized, dismissed, or disregarded..." (Linehan, Cochran, & Kehrer, 2001, p. 481). As a consequence of being emotionally vulnerable and raised in an invalidating environment, BPD individuals never learned the following: (a) how to label and regulate their emotions, (b) how to tolerate feelings of distress, or (c) when to trust their own emotions and cognitions as being valid and accurate responses to events. As a result, BPD individuals may vacillate between suppressing their emotions and displaying extreme behaviors (e.g., overdosing, cutting), the latter of which may serve to regulate emotions and elicit assistance from an environment that otherwise ignores efforts to decrease distress. Although originally conceptualized as a treatment for BPD, DBT's biosocial model and therapeutic strategies have been applied by researchers and clinicians to emotion dysregulation difficulties beyond the BPD diagnosis. Research investigations have demonstrated the empirical benefits of using DBT to target emotion dysregulation in other disorders (e.g., binge-eating disorder, Telch, Agras, & Linehan, 2001) and populations (e. …