DBT Handouts

Introduction to Dialectical Behavior Therapy & Application to Eating Disorders
UC San Diego Eating Disorders Center
General Biosocial Model
“Some people are born more sensitive to emotion than others. Not only do they feel emotions more
quickly and intensely than other people, but their emotions tend to last longer. That can work out fine if
you learn skills for coping with strong emotions early in life within your family or elsewhere. This means
that people around you acknowledge the reasonableness of your feelings, help you learn ways to soothe
yourself, and/or show you what to do with strong emotions by demonstrating skillful behavior when
they themselves have strong emotions. However, if you are raised without the opportunity to learn to
cope skillfully with strong emotion AND you’re emotionally sensitive, everyday life -- and the emotions
that accompany it -- can be quite difficult. This can happen when someone is raised in an invalidating
environment. An invalidating environment can be something obvious, like abuse or neglect, or it can be
having people around who don’t validate your emotions, because they don’t understand them, or don’t
have time, or don’t know how to talk about them. A lot of times we see kids who are a mismatch with
their parents in this way- the kid has really strong emotions, and the parent doesn’t validate them, so
the kid displays emotion, and the parent doesn’t validate them, so the kid gets louder with the
emotion or engages in some kind of behavior to further express their dysregulation, and then the
parent gets confused or angry, and the kid feels that they need to express their dysregulation more
loudly so they get taken seriously. (or some kids learn that since their emotions aren’t being validated,
they should just stop expressing them, and hold them all inside). Keep in mind that the invalidating
environment may have nothing to do with the parents, it could be more with teachers or peers, or other
relatives, or siblings. (For example, strict teachers who strongly reward quiet compliance and punish
expressions of emotions).
When there is this transaction that happens it can lead to dysfunction in the emotion regulation system.
So, you’ve got this person who is more vulnerable to negative emotions than other people are, and their
emotions aren’t validated by the environment, so they become ashamed of them, or afraid. And then
when they start to feel an emotion, they just want to do whatever they can think of to stop feeling the
emotion. They may use different behaviors to avoid the emotion or to feel numb. These behaviors can
be ED (R, B, P, OE) or other types (SH, SI, substance use). The problem is that these behaviors work
well in the short term and that it doesn’t take long before they end up causing more emotional
dysregulation. Often the person feels ashamed or embarrassed or their family gets mad, or they end up
having to go to the hospital and missing school or work, and then they have an entirely new set of
problems that impact them emotionally. AND, whatever the problem that caused the negative emotion
in the first places doesn’t get solved. So that’s why an important thing that we do in our program is
teach patients and their families how to use skills to regulate their emotions. We also help them identify
emotions, and normalize them, and reduce the shame around feeling them.”
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Levels of Validation
1. Staying Awake. These are in order from most basic to least basic. If you can stay awake,
that’s the most basic thing you can do. Unbiased listening and observing. Overall show interest
in the other person (through verbal, nonverbal cues), show that you are paying attention
(nodding, eye contact, etc.)
2. Accurate reflection. Accurate reflection is not parroting. How do we differentiate? When I’m
trying to validate, I’m working to understand their perspective. For it to land, they’ve got to
perceive me as trying to get them.
3. Articulating the unverbalized emotions, thoughts, or behavior patterns. Try to "read" a

person's behavior, imagine what they could be feeling, thinking or wishing for. It feels good
when someone takes the time to think about our life experiences. Remember to check for
accuracy. It is best to not make assumptions.
4. Validation in terms of past learning or biological dysfunction. Validate the person's

behavior in terms of causes like past events present events even when it may be triggered
based on dysfunctional association. use the biosocial model here- it guides on what is going on
biologically or in their learning history. Validating in terms of the past or biology.
5. Validation in terms of present context or normative functioning. Communicate that the

person's behavior is reasonable, meaningful, effective.
6. Radical Genuineness. Treat the person as valid - not patronizing or condescending.

Recognize the person as they are with strengths and limitations.
Give the person equal status, equal respect.
Be genuine with the person about your reactions to them and about yourself.
Believe in the other person while seeing their struggles and pain.

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Introduction to Dialectical Behavior Therapy & Application to Eating Disorders

UC San Diego Eating Disorders Center

General Biosocial Model

3. Articulating the unverbalized emotions, thoughts, or behavior patterns. Try to "read" a

4. Validation in terms of past learning or biological dysfunction. Validate the person's

5. Validation in terms of present context or normative functioning. Communicate that the

6. Radical Genuineness. Treat the person as valid - not patronizing or condescending.

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