Tips for implementing the Opposite Action skill in DBT. Includes 2 examples, Anger and Shame

1. Emotions are Messages
 Emotions help us live more effectively
 They are meant to impact us – to elicit motion (E-motion)
 Each emotion has a different message (like in Disney’s Inside Out)
 If we do not learn how to discern the message and act on it if necessary it
keeps coming back
 Most emotions have SOME validity
 Always seek out the valid part of the emotion or you will lose your client –
they will say, “you don’t understand”
 You cannot regulate emotions together – each has different properties and a
different message

2. Regulating Emotions Step by Step
 Name the emotion (ONE only at any one time)
 Ask – does it fit the facts? Is it too big or too small?
 Act in line with the justified bit of the emotion – what is it trying to tell you
to do? If it fits the facts then do that thing.(Tip – spend time on discerning
the message or you just invalidate the emotion)
 Is it too big? If so act opposite until the emotion is at the required level –
teach discernment
 Is it too small? – teach the client to notice and practice components of the
emotion
 When you get to the required level take the appropriate action

3. A mindfulness-based therapy
 Emotions fit or don’t fit the facts in the moment.
 E.g job loss – client is sad at 8:30am when others going to work
 Loss is = I am not getting ready for work, as no work to go to, so sadness fits the
facts
 Client is sad at 7:30 in the evening when he or she would be home from work
anyway – what is loss in the current moment? It’s less
 Not discerning means clients experience more than their fair share of sadness –so
become overwhelmed.
 Teach clients to do one ‘bit’ of sadness at a time
 Discernment is dialectical, contextual factors are constantly changing
 E.g. 7:30 pm friend drops in unexpectedly and says, “how’s work going?” sadness
fits the facts – loss of something to say.

4. Components of Emotions
 Temperature
 Breathing
 Facial expression
 Muscle tone
 Posture
 Gesture
 Actions in the environment
 Voice tone

5. Anger
 Fits the facts if we are under threat or blocked in pursuit of a goal
 Action urge – to attack
 Function – to give energy to fight off an attack or bust through an obstacle
 Temp-hot. (OA –cool down)
 Face – screwed up lips pursed(OA –smooth out face, use fingers if necessary)
 Muscles – tense –(OA relax muscles, go floppy)
 Breathing –fast/shallow – (OA slow deep breaths)
 Posture – big body space, chin jutting forward, fists clenched (OA drop arms down etc)
 Gesture – finger jabbing, fist shaking, standing over (OA willing hands, lay back)
 Voice tone – loud (OA soften)
 Actions in the environment, banging things, pushing, (OA walk away, be kind)
Regulation is incremental – How much have you got? How much is needed?

6. Shame
 Fits the facts when there is a risk of expulsion by the group
 Action urge –to hide
 Function – to conceal our ‘crime’, allow it to blow over
 Temp-hot(burning cheeks). (OA –cool down)
 Face – looking down or from under hooded brows (OA head up, direct look)
 Muscle tone –loosely contorted (OA firm up and open out)
 Breathing –slow– (OA shorter, quicker)
 Posture – small body space, hiding, covering face or body (OA stand up straight, tall)
 Gesture – turtle-necking, cringing (OA make confident gestures)
 Voice tone – soft, subservient (OA firm up voice, neutral factual tone)
 Actions in the environment, hiding, not speaking out(OA, stay in full view, make confident
statements)
Regulation is incremental – How much have you got? How much is needed?

7. Now do
 Disgust
 Sadness
 Joy
 Guilt
 Fear
 Jealousy

8. The Bad News: There are No Shortcuts
Emotion regulation is a painstaking process
You HAVE to stay mindful - work in the moment
You HAVE to separate the emotions out and regulate one at a time
You HAVE to know each emotions and it’s action urges
You HAVE to do these steps
You are tempted to do things that work for some emotions, e.g. relax your muscles
(won’t work for shame) or cool down (won’t work for pure fear) or slow your
breathing (won’t work for sadness)
You are tempted to distract the client, because it is quick
You are busy, you don’t want to do this, it’s too much to remember, it’s hard to get
them to do it, you have to repeat it again and again
The Good News: IT WORKS!!!