The Beginners Guide to DBT with ADHD

Photo by Arthur Brognoli

Let's face it. ADHD is hard. Between the working memory issues, emotional dysregulation, focus issues, communication problems, and all the other complications that come with this form of neurodivergence, it can leave us with a lifetime of emotional scars and unhealthy coping mechanisms that send us down the spiraling path of poor self-esteem and perceived failures. It's all of these issues that make therapy so important for those of us with ADHD. Sure, medications can make some of these things easier to manage, but they're not a cure all. Disclaimer: I am not a therapist, nor do I play one on TV. This information is not designed to be a replacement for therapy. In fact, if you find the tips helpful in this series of articles, then I highly recommend bringing it up to a therapist to see if they recommend DBT treatment for you.

Dialectical Behavioral Therapy (DBT) is one type of therapy that can help those of us with ADHD. It focuses on our problems regulating emotions and behavior, both when they are under control and when they are out of control. Emotional dysregulation is a key problem for those with ADHD because it causes patterns of instability in how we control our emotions, our impulses, our relationships, and – most importantly – how we see ourselves. Through DBT skills, these bad habits are given direct attention. The main goal of DBT is to help us change social, emotional, and behavioral patterns that cause problems in our daily lives.

DBT focuses on a set of four main skills that anyone can use to solve everyday problems. These skills are mindfulness skills, emotional regulation skills, interpersonal effectiveness skills, and distress tolerance skills. These skills often build off of each other, which may make it sound complex, but I promise to keep it as short as possible, ant take it slow so that everything makes sense. Remember: this isn’t meant to be a substitute for therapy.

Four Options to Solve Any Problem

If there is one thing that those of us with ADHD can all attest to is that we tend to be amazing at solving other people’s problems, and yet we are somehow terrible at figuring out how to solve any of our own problems. Whether they are self-inflicted, or external problems that somehow have made their way to our doorstep, we always seem to find ways of collecting them and letting them pile up until they become so overwhelming that we go into ADHD paralysis trying to figure out what to do with the problems, much less how to start solving them. Well, thankfully, DBT gives us four options to do whenever we have a problem.

1. Solve the problem. You can try to end or change the problem situation or find a way to avoid it, find a middle ground, or get out of it for good. We do this using interpersonal effectiveness skills and emotional regulation skills. If there is one piece of sage advice from my father that I have kept with me after he passed away, it is this: “A problem is not a problem anymore if you solve it.” 2. Feel better about the problem. You could try to control how you feel about the problem or find a way to turn something bad into something good using emotional regulation skills. 3. Tolerate the problem. Even if you can't fix the problem that's making you upset and you can't feel better about it, you can still do things to make yourself feel better using distress tolerance skills and mindfulness skills.

4. Stay miserable. Or, you can just not do anything and stay miserable, or even make things worse. Choosing not to choose is still a choice. This requires no skills.

DBT Assumptions

Before we get into the nitty gritty of DBT skills, a few assumptions must be made. First, people are doing the best they can at any given time, and they want to be happy and improve. Second, people have to WANT to change. Any new behavior skills people learn have to be continually practiced when they are needed, not just when they are first learned. People may not cause all their problems, but they still have to solve them anyway. There is always a cause to a person’s behavior, even if we don’t know what it is. Figuring out and changing the cause of that behavior works far better than judging or blaming.

Biosocial Theory

For those of us with ADHD, emotional dysregulation makes us extremely sensitive to, well, just about everything. DBT breaks it down into three things that could trigger those emotions to run high. First, some people are just born that way. It could very well be biological. For many of us with ADHD, this is the case, and we are just highly emotional 24/7. This, combined with our impulsivity – which is also biological – and you’ve got a recipe for disaster. The second cause for emotional instability is an invalidating social environment. This could come from people calling your feelings invalid, weird, bad, or even sometimes just ignoring your feelings altogether. When we are constantly ignored or told things like "Don't be such a baby!", or "Normal people don't get this frustrated", this will only add fuel to the fire. This doesn’t necessarily mean that these people have bad intentions. They may, in fact, be doing the best they can but just don’t know exactly how to validate and/or support you. They may also be under a lot of stress at the time as well. And in some cases, they may just be a poor fit for your social environment. The third potential for emotional escalation is that you are in an ineffective social environment. Even if you are attempting to learn how to regulate your emotions, you may still struggle if those around you have grown accustomed to adapting to your out-of-control emotions and are unaware that you are attempting to change things. As a result, it is critical that you communicate to those closest to you your desire to improve and the steps you are taking to do so.

Ultimately, it’s all about the interactions that take place between the person and the social environment. Biology and the social environment influence the person. The person reciprocates and influences their social environment. The social environment responds and influences the individual. The cycle repeats.

And now that we know how our emotions can get out of control, we'll begin learning about the DBT Mindfulness skills in Part 2 of this article where we will learn how to bring our mind back to the present and start using our Wise m=Mind instead of our Emotional Mind.

For Part 2 of this series, click here.

---

If you find this article interesting and want to learn more or have a comment, feel free to leave a comment below. Or better yet, come talk to us about it on our discord server! We have a lot of great people who love to talk about ADHD, neurodivergence, nerdy stuff, and all the things. We've also got a lot of links to resources for further reading and personal growth.