Therapy Approaches for RSD
12 min read
Therapy can help you understand your RSD patterns, develop coping strategies, and fundamentally change how you respond to perceived rejection. Different approaches work better for different people - here's what to know.
Cognitive Behavioural Therapy (CBT)
CBT helps you identify and change unhelpful thought patterns. For RSD, this means learning to recognise when your thoughts are distorted by rejection sensitivity.
What You'll Learn
- Identifying cognitive distortions (catastrophising, mind-reading)
- Challenging automatic negative thoughts
- Building more balanced thinking patterns
- Behavioural experiments to test beliefs
- Problem-solving skills
Best For
- • People who want practical, structured tools
- • Those whose RSD involves a lot of negative self-talk
- • Short to medium-term therapy (typically 12-20 sessions)
Limitations
- • May not address deeper emotional patterns
- • Requires homework and practice between sessions
Dialectical Behaviour Therapy (DBT)
DBT was originally developed for emotional dysregulation and is particularly helpful for RSD because it directly addresses intense emotional responses.
The Four Modules
- Mindfulness: Staying present instead of spiraling
- Distress Tolerance: Surviving crises without making things worse
- Emotion Regulation: Understanding and managing intense emotions
- Interpersonal Effectiveness: Communicating needs while maintaining relationships
Best For
- • People with intense emotional reactions
- • Those who struggle with emotional flooding
- • When RSD causes relationship difficulties
- • Co-occurring with borderline traits
Limitations
- • Full DBT programs are intensive (often 1+ year)
- • May not be widely available
Other Helpful Approaches
Schema Therapy
Addresses deep-seated patterns (schemas) from childhood that drive RSD.
- • Good for: Chronic RSD with roots in early experiences
- • Focus: Healing core beliefs about yourself and others
- • Duration: Typically longer-term therapy
ACT (Acceptance and Commitment Therapy)
Focuses on accepting difficult emotions rather than fighting them.
- • Good for: Learning to coexist with RSD
- • Focus: Values-driven living despite emotional pain
- • Duration: Typically short to medium-term
EMDR
Helpful if RSD is connected to traumatic experiences of rejection.
- • Good for: Processing specific traumatic memories
- • Focus: Reprocessing painful past experiences
- • Duration: Can be relatively brief for specific events
Psychodynamic Therapy
Explores how past relationships shape current patterns.
- • Good for: Understanding the roots of your RSD
- • Focus: Insight and relationship patterns
- • Duration: Typically longer-term
Finding ADHD-Informed Therapy
If your RSD is connected to ADHD, finding a therapist who understands ADHD is crucial. Many traditional therapists don't understand how ADHD affects emotions.
What to Expect from Therapy
Early sessions
Assessment, building rapport, understanding your history, setting goals. You might not see immediate change.
Working phase
Learning and practicing new skills. May feel harder before it feels easier as you confront difficult patterns.
Progress
RSD episodes may become less frequent, less intense, or easier to recover from. Progress is rarely linear.
Maintenance
You'll develop tools you can use independently. Some people continue therapy long-term, others don't.
Therapy Is an Investment in Yourself
Finding the right therapist and approach takes time, but the skills you learn can fundamentally change how you experience rejection. It's not about becoming someone who doesn't feel - it's about developing the tools to handle what you feel.