Dialectical behavioral therapy (DBT) has come a long way from its origins as a treatment for borderline personality disorder. Designed to help individuals learn to manage intense emotions, reduce self-harm, and improve interpersonal relationships, DBT has been modified to address a constellation of conditions, especially those where emotional dysregulation features prominently, like ADHD.
DBT can help obvious forms of emotional dysregulation in ADHD, like overblown reactions. It can also address other ADHD-related challenges like low motivation problems and high procrastination. Its principles and skills target common frustrations with both emotional regulation and executive function that lead to distractibility to disorganization.
What Is DBT?
DBT is a skills-based form of talk therapy designed to help people manage intense emotions, improve relationships, and make thoughtful decisions. It used to treat ADHD, anxiety, depression, and more.
DBT focuses on four core areas:
- Emotion Regulation: Understanding and balancing emotions
- Distress Tolerance: Managing crises without making them worse
- Mindfulness: Staying present and aware in the moment
- Interpersonal Effectiveness: Communicating clearly and setting boundaries
1. Master Emotional Regulation
Emotions Are Not the Problem
Many adults say emotional dysregulation is the most impairing aspect of living with ADHD. DBT reminds us that emotions are important because they tell us about our environment and move us to action. Ignoring emotions is not the answer; learning to dance with them is key. With frequent practice, the following skills can improve emotional regulation.
- Understand and label emotions. Investigating your emotions will allow you to become clearer about what’s really going on. Labeling is also an act of mindfulness that cools the amygdala and limbic system. You can say to yourself, “I am experiencing ___ right now.”
- Accept emotions. Experiencing emotions intensely does not make you an irrational or bad person. Fighting their presence only depletes energy that is better used taking positive action to regulate them.
Improve Your Emotional Baseline
Taking care of your overall emotional health can reduce the frequency and intensity of emotions and improve your regulation of them.
- Practice daily mastery. When you actively seek challenges, you are exerting influence on your immediate environment, which builds self-efficacy and self-esteem. So do something every day that improves your sense of competence. Mastery can be found in the mundane, whether it’s doing the laundry or the dishes. (It isn’t important whether the activity you find challenging is also challenging to others.)
- Seek pleasant experiences. Focusing on positive experiences will help you break out of negative rumination cycles and build resilience against life’s stressors. Each day, engage in activities that bring you a sense of interest, satisfaction, and joy. These activities can be simple, from gardening and listening to music to watching a show with your family.
[Get This Free Download: Emotional Regulation & Anger Management Scripts]
2. Reverse ADHD Paralysis
“Opposite Action” is a DBT skill for calming emotions that are disproportionate to a situation. It entails doing the opposite of what your emotions tell you to do to interrupt and eventually change your feelings. Feel the urge to yell? Speak softly or adopt a half smile instead. Feel like withdrawing? Call a friend instead.
Opposite action is also helpful for overcoming ADHD paralysis. This skill can help you generate the emotional energy you need to start and complete tasks that you find boring or overwhelming. Are you frozen on the couch and know that you need to wash the dishes? Try wiggling your toes. Bring one leg off. Then the other. Stand on your feet for a few moments. Bring one foot in front of the other and make your way to the sink. Adopt a determined facial expression. Roll up your sleeves. Say aloud, “I’m going to wash this dish.”
3. Cope with Discomfort
Discomfort is a core part of our lives. We feel it when we try to control impulsive behaviors or emotional outbursts. We feel it when fielding comments and criticism. And sometimes when we try to manage this discomfort, we may end up engaging in self-sabotaging behaviors that worsen feelings of shame.
[Read: 13 Ways to Beat ADHD Paralysis]
Enter distress tolerance — a core DBT module that centers on the ability to endure stressful, overwhelming thoughts, feelings, and situations without engaging in self-defeating behaviors. Distress tolerance skills help you cope with tough feelings and reduce their intensity. The following distress tolerance exercises activate the parasympathetic nervous system in real time and downregulate flooded emotional states:
TIPP
- Temperature: Hold an ice cube or splash cold water on your face.
- Intense exercise: Do jumping jacks or sprint in place.
- Paced breathing: Take slow, deep breaths, extending your exhale.
- Paired muscle relaxation: Tense a muscle group while inhaling, then release as you exhale.
STOP
- Stop. Physically don’t move a muscle. Freeze.
- Take a step back. Create some distance, literally and/or figuratively, from the person you’re in conflict with or the frustrating task. Leave the room if possible. Think, “What’s happening here? What are the thoughts and emotions I’m having?”
- Observe. Notice what’s happening without holding onto anything.
- Proceed mindfully. Move forward with intention and in a way that aligns with your values.
4. Practice a Mindful Life
Mindfulness is at the root of all DBT skills. Learning how to pay attention to the present moment — an ongoing practice — will allow you to balance reason with emotion and act in ways that better serve you. In DBT, this state is called “Wise Mind,” and it is activated by practicing the following skills:
DBT Skills for ADHD: Next Steps
- Free Download: What Is Dialectical Behavior Therapy (DBT)?
- Read: DBT — The Emotional Control Therapy You Need Now
- Read: The Emotional Resilience Playbook for People with Big Emotions
The content for this article was derived from the ADDitude ADHD Experts webinar titled, “How DBT Promotes Emotional Regulation, Distress Tolerance, and Mindfulness” [Video Replay & Podcast #527] with Scott Spradlin, LPC, which was broadcast on October 31, 2024.
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Updated on March 19, 2025