Q&A

Working Skillfully With Anger and Shame Using DBT Skills

Anger and shame can strongly shape how clients see themselves and their relationships. In this Q&A, DBT expert Annie McCall explains how DBT skills can help therapists work effectively with these emotions across a range of therapeutic approaches.

Anger and shame often emerge at pivotal moments in clinical work, shaping how clients interpret their experiences and respond to others. Yet despite their importance, anger and shame can receive relatively little focused attention in clinical training.

DBT skills offer a pragmatic set of tools for working with anger and shame across therapeutic modalities. Anger serves important functions: it can motivate action, help people set boundaries, and even cultivate self-worth. Shame, by contrast, often reflects earlier experiences of rejection, criticism, or invalidation.

Annie McCall explains how DBT skills can help clients develop a healthier relationship with anger and shame, allowing these emotions to become informative and constructive rather than destructive.

How does DBT conceptualise anger and shame, and what core assumptions guide how to work with them in treatment?

As an emotion-focused treatment, DBT focuses on the regulation of emotion. What that means is that we work from a basic assumption that two things can be true at the same time:

Emotions are valid, make sense, don’t come out of nowhere, and are communicating something real and important. And the experience and expression of emotion can be problematically intense, drive misery, and interfere with our goals and happiness.

Take anger as an example. Anger has some really important functions. It can motivate us to take action, communicate “STOP” to other people, and communicate self-worth to ourselves. When anger is too high, though, it can interfere with all of those functions and drive us to express anger in ways that create new problems.

In DBT, we may apply skills like Opposite Action or TIPP to down-regulate anger enough that we can choose a course of action that solves problems, maintains important relationships, and preserves our values and self-respect.

Shame is different. Shame is the emotion we feel when we experience rejection by other people, and it is often less “justified” by the current moment. It is more likely to be informed by historical experiences. If someone has been rejected, judged, demeaned, or criticised repeatedly across their life, they may predict and interpret rejection even when it is minor or not present at all.

While shame can serve a protective function by helping us stay in good standing with important people, it is often too intense and too global to be helpful. From a skills perspective, down-regulating shame often involves Non-Judgment, dialectical thinking about our shared humanity and imperfections, and Opposite Action for urges to avoid or hide.

Why do anger and shame so often show up together?

Anger and shame often function like two ends of a tug-of-war. Anger says, “They are the problem,” while shame says, “I am the problem.”

Sometimes anger feels better than shame. Shame can feel cringy and small, while anger can feel big and powerful. It can be a relief to focus on the other person’s role in a problem. At other times, when anger feels justified but scary, it may feel safer to take all the responsibility ourselves so we don’t have to take difficult steps, such as changing or ending a relationship.

This can create a teeter-totter dynamic where people feel stuck with only two options: hate myself or hate the other person. In DBT, our role is to help clients find the dialectical synthesis of Wise Mind, so they can decide how to respond most effectively.

Opposite Action for shame often involves staying present or allowing oneself to be seen. How do you help clients build willingness for this when the urge is to hide or escape?

One piece of good news about targeting shame in DBT is that it often shows up live in the room. Clients may feel embarrassed when disclosing behaviours on a diary card or during a chain analysis. Shame can show up as changing the subject, looking away, going quiet, making self-critical comments, or promising to do better.

When shame appears, a DBT therapist is likely to name it out loud with validation and psychoeducation. We might say things like:

It looks like you’re feeling some shame about this.
It makes sense that you might worry I’m disgusted, angry, or disappointed. You’ve had many experiences that taught you you’d be judged for being imperfect.
I’m not having those reactions. I’m on your side and committed to understanding how this behaviour came to be.
The only way we can create change is to accept and understand the present.
If you hide or avoid being candid, you’ll miss the corrective experience that I’m not rejecting you.

Practising Opposite Action for shame might involve sitting up straight, lifting the chin, dropping the shoulders, and making eye contact. These behaviours help the brain learn that rejection isn’t happening, and the intensity of shame often comes down.

Does DBT conceptualise anger and shame differently when working with neurodivergent clients, particularly when behaviours are driven by sensory overload rather than emotion dysregulation?

When working with neurodivergent clients, careful assessment of how emotions are experienced is especially important. Emotional experience is not universal. Some people experience emotions intensely as physical sensation, while for others the experience is more cognitive.

By understanding how emotions show up for a particular person, we can better distinguish emotion dysregulation from dysregulation driven by sensory input. For example, agitation, tearfulness, or overwhelm in a bright, noisy classroom may not reflect fear or anger, but rather the nervous system’s response to sensory overload.

Once we clearly understand the source of what looks like “dysregulation,” we can identify solutions that involve both skill use and environmental modifications.

Many clients with chronic anger and shame carry a long history of feeling ‘wrong’ or defective. How does applied DBT skills work support the development of a more compassionate sense of self?

DBT is grounded in the BioSocial Theory of Emotion Dysregulation, which proposes that long-term, pervasive invalidation increases emotional reactivity and intensity. As a result, many clients enter therapy having internalised painful messages: that they are broken, damaged, unlovable, defective, or wrong. Their problem behaviours can then seem to confirm those beliefs.

From a DBT skills perspective, we work to increase self-validation through Non-Judgment, dialectical thinking, Wise Mind, and Opposite Action. At the same time, we promote functional self-validation by coaching skills such as PLEASE, Accumulating Positives, DEAR, and Self-Soothing. These skills ask clients to behave as though they matter, have rights, and deserve compassion, joy, and connection.

For clients with PTSD related to historical trauma or traumatic invalidation, skills alone may not be sufficient. In these cases, DBT skills are also used to build readiness and motivation for evidence-based trauma treatments such as DBT-PE or DBT-PTSD.

Clients sometimes experience an increase in anger as they gain clarity about past invalidation or lost agency. How do you help them work with this anger skillfully rather than shutting it down or escalating it?

An interesting feature of anger in therapy is that sometimes we believe a client has too much anger, and other times we wish they had more. On one side, anger may feel disproportionate or global. On the other, high shame may lead clients to tolerate mistreatment rather than assert limits or advocate for themselves.

Our task is to help clients identify the most effective level of anger in service of their goals and values. That starts with validation, genuinely understanding the truth in their experience, and recognising that the “right” amount of anger may be exactly what’s needed.

From there, we help clients clarify what outcomes they want and apply skills to regulate and express anger in ways that align with their Wise Mind values and long-term goals.