Emotion Regulation

This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs register@allceus.com counselortoolbox you I'd like to welcome everybody today's presentation. We're continuing the Journey to Recovery series and today we're going to be talking about emotion regulation. So on Tuesday we talked about the biopsychosocial aspects of emotion. So the fact that there are a lot of things, including lack of sleep sickness, pain, as well as stressful environments and other things that can impact how we feel in our emotional state. But today we're going to really talk about, okay, once you are triggered in some way or you're starting to dysregulate, what can you do to deal with that? And we're going to talk a lot about some principles of dialectical behavior therapy today. So we're going to review the basic premises of dbt, define emotion regulation, identify why it's important and how it can help clients. Because we remember with adult education, we want clients to understand why do they care? Why is it important for them to pay attention. And we'll explore some emotion regulation techniques. So dialectical theory says that everything is interconnected, reality is not static, and a constantly evolving truth can be found by synthesizing different points of view. So I usually, I don't draw well, so I usually have this printed out and I give it to clients as a handout and I ask them, you know, what is it that they're seeing? You know, what is it that the girl in the white dress sees? You know, when she looks at this diagram? Well, she probably sees that side of a black shape. You know, this person here is seeing the front, trying to figure out what that is. This person here is seeing something that's white. So we have three different points of view, all looking at the exact same thing. But they're all very certain that about what they're seeing, because what they're seeing is only an aspect of the totality. You can also do this with, you know, if you have a beach ball or something and have pictures on different sides of the beach ball. There are different experiential ways that you can demonstrate this. But it's important to help people understand that we need to synthesize different points of view. So for these people to find the truth about what they're seeing, they need to talk to one another and recognize that from different perspectives this shape looks a little bit different. And then they can talk about it and Obviously, it's not just about physical perspective. It's about our learning perspective and how we can go through the same exact thing. And one person will think it's a big deal, another person may not. So these are different points of view. So some assumptions of dialectical behavior therapy that I really want clients to latch onto is the fact that people do their best. And since they are people, they are doing their best. I believe they're doing their best with the tools they have at any given time. Because people don't wake up in the morning and go, how can I screw up today? They're doing their best. They may look back in hindsight and go, ooh, that was a bad choice. But in the moment, for whatever reason, they made that choice, they were doing their best. People want to get better, and they want to be happy again. Nobody says, I really choose to be miserable. If they are not choosing recovery, and this is something we talk about in substance abuse a lot. If they are not choosing recovery, then we want to look at why. Why is it more painful to recover than to continue to use? And so we want to understand what's holding them back. What's the obstacle? Why is continuing to do what they're doing now more effective or more rewarding in some way than getting better? You know, as we define it, getting better, clients need to be more motivated to make changes in their lives. And that's true. A lot of clients are very unmotivated a lot of times because they've tried and failed, or they have been criticized, or people have said, well, it's just willpower. You just need to suck it up and the depression will pass. Or you've been grieving over this for six months. You need to just get over it, or whatever. They've been invalidated. They have been criticized, so the motivation is not there. And if they've tried to do it before and they haven't been successful, which is, you know, not surprising in a lot of cases, because, you know, we go to school for, you know, a bazillion years, and in order to understand some of the nuances of behavior, the average Joe doesn't have that under their belt. So they may not know everything that's feeding into causing their depression. And so when they try to get better, when they try to do what's right, it doesn't work. And then they're like, well, I feel helpless and hopeless. There's nothing I can do. So one of our goals is to help clients get motivated to make changes in their life, to help them Start seeing small changes to help them develop hope. And, you know, it's really important. Even if somebody's doing pretty much a self help thing or you're engaged in motivational enhancement therapy, which only has like four sessions, it's important for clients to get motivated. So doing motivational enhancement exercises regularly is really important. Because during change, it's not always possible to feel good about what's going on. Change is hard. Change causes crisis, and crisis causes change. So when the going gets tough, the clients need to know why they're motivated. So we need to regularly encourage them to. Remember why they're motivated. Even if people didn't create their problems, they still got to solve them. And it is unfair. You know, that whole fallacy of fairness, we can talk about that until the cows come home. But sometimes people do things that create problems in your life that you've still got to fix because that's what you need to do to be happy. So maybe you grew up, or the client grew up in a household that was dysfunctional, and it created all kinds of problems. And the client now is struggling with anxiety and PTSD and other things. Well, the child did not choose to be born into that environment. The child did not choose to experience some of those things, but they did. Other people did it to them or in circumstances did it to them. All right, they didn't cause it, but you know what? It affected them. And if they want to be happy, then they have to fix it. They can't go back and go, all right, you know, so and so, so and so, whoever it was that, you know, injured them in the past, it's time for you to fix me now. We have to fix ourselves. So it's important for clients to recognize that we want to also help them understand that the lives of, and I put a lot of not characteristics but adjectives in here, dysregulated, suicidal, or addicted people are unbearable because emotion regulation is something that can be used in just about, with just about any client, with just about any diagnosis. So we want to understand that for some people, life feels unbearable. And for most people, life feels unbearable, at least occasionally. You know, we all occasionally feel like life just punched us in a gut. So it's important to recognize that people are doing the best they can with the tools they have to survive unbearable emotional and or physical pain. All right, so we added on to that definition. People need to learn how to live skillfully in all areas of their life. So it's not just about working harder. It's not just about being Motivated. But it's also about having certain skills. And there's not a lot of them, but it's about having a handful of skills that work for each individual person. And when I start groups with people, I tell them, you know, if there are 10 people in this group, none of you are probably going to have the exact same toolbox when you're done with this group, the session of groups, because what works for one person may not work for another, and that's okay. But you need to have your own skills. And we're going to start with what has worked for you in the past. So let's go back and say when you have felt depressed in the past, what helped you feel a little bit better? And you can go around the room, because most everybody has felt depressed at some time in their life. And we can talk about what people have used that's worked, and we'll just start making a brainstorming list on the whiteboard. And one thing I do when I use whiteboards, because not everybody likes to take notes, is before I erase it, I will take a picture of it. You know, there's no phi on there or anything. I will take a picture of it, and then I can print it out. So clients who didn't want to take notes can still have an array of ideas there that they can sort through later at their convenience, if they want to. And finally, people can't fail in treatment. And that relapse is often seen as a failure, whether it's depression relapse or addiction relapse, or any kind of relapse. Relapse is a return to prior functioning because that prior functioning is more rewarding than what you're already doing. That's all it is. So encouraging people to really understand that they didn't fail. All they did was identify either something that wasn't working or the fact that there were some weaknesses in their recovery plan. And I always try to call it, instead of calling it a relapse prevention plan, I call it a recovery life plan, because I want this plan that they're using. Yes, I want it to prevent them from having those symptoms again, but I want it to help them live a rich and meaningful and happy life. If they're doing that, then they're probably not going to have those symptoms. So helping them work forward. So emotional dysregulation results from a combination of high emotional vulnerability. And this can start. We talked about this Tuesday. This can start when somebody's born or even, you know, maybe it started before they were born, because of exposure to certain chemicals or drugs. But they are. They go from 0 to 240 in like 2.3 seconds. They are highly emotional, they're highly sensitive. They can be seen as fussy or difficult. So it's important to think about that when you're talking to parents who have a challenging child. That's another euphemism that's used for it. This is a person who has high emotional vulnerability. This is a person who, when they were growing up, you know, something would happen and, you know, it would. Instead of upsetting them, it would devastate them. So they've often probably been referred to as drama queens or, you know, something else like that. And that is so pejorative and so disempowering because the person doesn't have control at this point a lot of times over that emotional regulation. So high emotional vulnerability. It's important to recognize that they may get upset and they may be more sensitive than other people. And this is true for males and females. Extended time needed to return to baseline. So once they get upset, calming down again, it's not one of those things that they can just let go, you know. And I tend to be a little bit more on the high emotional vulnerability than other people. And when I get upset, when I get frustrated about something, I can't just take a deep breath and it's gone. I don't work that way. I've got to get up and go walk around or something. My husband, on the other hand, he's just like, that's so annoying or whatever. He'll get frustrated for a little longer than half a second, but you know what I'm talking about. And then he'll be fine and he'll move on and do other things. And I'm looking at him going, how in the world did you do that? And an inability to regulate or modulate one's emotions. So people who are emotionally dysregulated have difficulty or don't have the skills yet in order to modulate their emotions so they don't go from fine to devastated, you know, helping them find that gray area in there. Emotional vulnerability refers to the situation in which an individual is more emotionally sensitive or reactive than other people or than they normally are. And this is a fun activity to do with clients, is to ask them, you know what, tell me about some times when you are more, you know, emotionally sensitive, when you get upset easier than other times, and, you know, they may start just telling you about situations or something, and then you can start talking about, okay, what was going on in that situation and what happened before that, you know, initially, let's think about it. You know, my husband, you know, I can pick on him, has hypoglycemia. So when his blood sugar gets low, he can be a great big old cranky pants. And when we look at emotional vulnerability, I know that if something goes wrong when his blood sugar is low, look out, you know, for him, that means he may get red in the face or something, but that's him getting really upset. It's important for him in order to modulate his vulnerability to make sure that he has those little glucose tablets with him all the time. So it's important for clients to start identifying. Oh, that makes sense. Now I understand why I got so upset over that on Thursday. But when it happened two months ago, it didn't bother me. When people are getting ready to get sick, sometimes they're more emotionally vulnerable. If they're in pain, if they are sleep deprived, if they are in a particularly stressful situation, if they had a lot of stress building up, they may be more vulnerable. So little things could be the straw that broke the camel's back, so to speak. So we want to talk about what makes people vulnerable, and it'll differ for people in your group. Differences in the central nervous system and HPA axis play a role in making people more emotionally vulnerable or reactive. So, you know, again, that is important to be aware of. Some people have hypocortisolism, which we talked about yesterday, or hypercortisolism. Hypocortisolism is a lot of times the person feels flat, almost depressed, energyless, fatigued. But then when they get upset, when their body perceives a threat, they go from 0 to 240. People who have hypercortisolism tend to always be really wound up and on edge and hyper vigilant. So it may make them more vulnerable and reactive. So when somebody, you know, walks up behind them and says something, they may jump out of their skin, as opposed to other people who are just like, yeah, just a second. So it is important to pay attention to your environment. It's important to pay attention to your physical health, and it's important to pay attention to your trauma history. And those are things that I really want clients to take home with them, because all of those things affect how they interact and act and react in the present. The environments of people who are more emotionally reactive are often invalidating. And we talked about that a little bit earlier, because people who don't have emotional dysregulation issues don't understand why we can't just get over it. Why can't you just let it go? Now, there's a difference between perseverating on something for six months versus being upset for 30 minutes after an incident happens. Both can be modulated, but we're talking more about the person who needs 20 or 30 minutes to calm down, as opposed to two or three. According to Linehan, emotional regulation is the ability to control or influence which emotions you have when you have them, and how you experience and express them. Now, I don't necessarily totally agree with that because I believe that our emotions are pretty much hardwired. When our brain perceives a threat, then we're going to react with excitation. You know, the HPA axis will kick off and say, hello, you might need to fight or flee. You better check it out like when your fire alarm goes off at the house. So we need to accept when we feel that way. It's important for us to accept how we feel, and then we can choose how to experience and express them. So we're not going to be able to choose never to be angry. We're not going to be able to choose never to be depressed. But we can recognize that emotion and say, okay, I'm going to choose not to stay stuck in this and improve the next moment. Emotion regulation prevents unwanted emotions by reducing vulnerabilities. It changes painful emotions once they start. So like I said, sometimes we can't prevent them. And it can teach that emotions in and of themselves are not good or bad, they just are. So when you get angry again, you just. You are. You notice and you say, I feel angry. Right now. Your body's saying there might be a threat. When you're depressed, it's your body saying, you might be helpless and hopeless. You might have lost something that was important to you. There are a couple things that underlie depression. Or you might not have enough glucose going through your system, maybe something else going on. But our feelings, our emotions are simply there to cue us in to what's going on. When we feel happy, that's an emotion that we assign to something that produces pleasurable responses and we're going to do again. So when we feel happy, we don't generally struggle with that emotion. We're like, how can I continue this awesome moment? As opposed to how can I improve the next moment? Emotion regulation teaches that suppressing emotions makes things worse. If you say, I shouldn't feel angry, I need to just let it go. I need to ignore it. I need to just do something else. A lot of times that doesn't address the issue. So that amygdala is going, I was telling you there was a problem and you haven't done anything about it yet. Emotions are effective. They're there for a reason. We are given emotions for a reason. And they're effective when acting on the emotion is in your best interest. When you're. You get angry or scared and you find out that there's a threat, you know, okay, you know, we're not going to try to make that go away right now. We're going to try to get away from the threat. When we act on the emotion that's pleasurable, it's generally in our best interest, too. They're effective when expressing your emotions gets you closer to your ultimate goals. So, you know, sometimes you may get frustrated about something, so you acknowledge that you feel frustrated. That's how it is. It is what it is. It's not good, not bad. It's just what it is. What are you going to do to improve the next moment? Well, that may mean that you need to express that emotion to someone and say, I'm frustrated at this situation. Because if that will help you get closer to an environment that is less stressful, more validating, and helps you work towards your rich and meaningful life. When expressing emotions will influence others in ways that will help you. Now, this one's a little, you know, we got to be careful with this one because we don't want people to take this to mean, well, I can be angry and I can be a bully because then I can make other people do what I want. When we express our emotions, we're communicating assertively how we feel so that others can help out if they want to. When we express our emotions, it's getting it out there so we're not expecting others to read our mind. And when I work with clients, we do talk a lot about mind reading and the fact that if you don't express your emotions, then how does anybody supposed to know how you feel? If you were excited about going to a concert and you didn't express that, and you know, your spouse decided, no, let's sell the tickets and just stay home tonight, and then you were disappointed. You know, he didn't know you were excited, and he didn't know you were disappointed, and now you're just feeling like he doesn't care, but he may be clueless as to how you felt about things. So it's important to help clients learn how to assertively communicate their emotions in a helpful way. And emotions are effective when they're sending you an important message. Do it again, don't do it again, or get the heck out of here. Emotional regulation is trans diagnostic, which means it's useful with, like I said, just about anything. So think about your client with depression. When they are experiencing oppressive depression, know we want to help them re regulate. What are some things that happen with clients that are really, really depressed? Well, sometimes they may get really, really sad. Sometimes they. And they need help regulating that so they don't go further down into it. They also may become extremely irritable. So helping them understand that depression itself may be creating a vulnerability for irritability and for further depression. We want to help them recognize that and identify things that they can do to improve their mood. Emotion regulation means mitigating any of these vulnerabilities that we can. So let's look at sleep. You know, we talked and several of you pointed out on Tuesday that a lot of your clients who are clinically depressed sleep a lot. Well, it makes sense because they're fatigued all the time, they're not getting good sleep, and that's making it more difficult. But when they're not getting good sleep and they're sleeping all the time, their circadian rhythms are out of whack. So their serotonin levels are going to be wonky too, which means they're probably going to experience more depression. Emotion regulation helps increase present focused emotion awareness. People need to figure out, how do I feel? A lot of our clients don't know how they feel. They've always been told how to feel, or it's not been safe to feel, or they just gave up feeling a long time ago because feeling was too painful. It's important for them to start learning how they feel because they can't feel happy if they can't feel anything. Emotion regulation helps increase cognitive flexibility so they can see the good and the bad. The fact that maybe this bad thing happened. However, there are other good things going on in their life or they had the strength to survive it, or helping them look at positive options. And cognitive flexibility also isn't just about dialectics. It means identifying how they feel, identifying what's going on in the present moment, saying, okay, I've got choices, I can go to sleep, I can drink a fifth of vodka, I can do all these other things. I can yell, I can scream, I can put my fist through the wall, whatever it is. But is that going to get me closer to happiness and what I define as a rich and meaningful life? Probably Not. So what are some options that I could do and what are some thoughts that I could have that would help me improve the next moment and get back on track towards, you know, a rich and meaningful life? And when they're in this mindfulness state and they're accepting, you know, accepting the moment as it is, if it's an unpleasant moment, you know, sometimes I talk about it like you're on. They're on a car trip and they get a flat tire. Well, they have some options here. But what is it that they need to do right now with this flat tire so they can get back on the road towards their destination of a rich and meaningful life? Identifying and preventing patterns of emotion avoidance. We don't want people to go, oh, I can't feel that, or I don't want to feel that, or that's too painful. Learning how to feel emotions and tolerate them is really important. And preventing patterns of emotion driven behaviors. When we feel an emotion, when something triggers an emotion, we have whatever we label the emotion as. And let's go with fear this time. Fear, then we have behavioral urges that go with it and physiological sensations. So when you're afraid, you breathe more quickly and more shallowly, your heart rate speeds up, you may start to sweat, your urges are probably to, you know, make it stop somehow and you may become more frantic. And then you generally label that as, you know, fear at that point. But those emotion driven behaviors are often the impulsive behaviors designed to make it stop. And we need to help people learn that they can tolerate this, that this is just a feeling and this is, and maybe an urge and it will pass. Emotion regulation increases awareness and tolerance of emotion related physical sensations such as a beating heart or breathing quickly and recognizing when they're doing that. If they can recognize that, then they can probably slow it back down. When people start breathing fast and shallowly, they can start getting dizzy and their heart rate starts beating faster and then they can, you know, mistake that for something really devastating going on. And emotion regulation can use emotion focused exposure procedures to help people learn those distress tolerance skills so they can think about something. And one of the things that y' all know who've been here before, those awful, awful ASPCA commercials, I will not watch them. But if I were going to do an emotion focused exposure procedure, maybe I would sit there and watch it and then tolerate the emotions as I experienced them, knowing that once the commercial was over, I could move on to something else. I didn't have to stay stuck in that sense of depression and anger. That those commercials trigger in me, helping people recognize and learn tools to tolerate the distress. And you don't want to just throw them into it. You know, this is a gradual exposure, systematic desensitization. You know, y'. All. Mindfulness is a nonjudgmental observation and description of the current emotions and current needs and vulnerabilities. That's a lot of stuff in order to radically accept and improve the next moment. So that's five things that have to go on in mindfulness. And people are like, ah, so when I teach mindfulness, I encourage people to start out, well, actually, at 6, we talk about what is nonjudgmental observation? And you know, for a lot of clients, that's a strange concept because everything comes with a should, I should feel this way, I should do this. Nonjudgmental observation just follows it is what it is. And I encourage them, whether they keep that as their mantra forever, I encourage them while they're learning mindfulness to follow whatever their observation is with it is what it is, so they can start developing that radical acceptance. It's a description of current emotions. So when people do their mindfulness check in, they go, how am I feeling? You know, if they're angry, I feel angry. It is what it is. I feel scared. It is what it is. What are my current needs? I need. And this could be biological needs, this could be emotional needs, this could be social needs, Whatever those needs are. Encouraging people to look around and go, okay, I'm feeling stressed out right now. It is what it is. What. What are my current needs in this situation in order to improve the next moment? Maybe it means shutting the door for a few minutes. Maybe it means going out on a walk. What do they need? Doesn't mean they necessarily get to do it or have to do it. But at least becoming aware of what their needs are gives them an opportunity to get connected with, okay, this might make it better. The next step is to say, all right, these are my needs. What are my vulnerabilities? And sometimes you can flip flop them. Is there anything else that's going on right now that could be contributing to this? If the person says, I'm really stressed out right now. It is what it is my current needs. I really need to go out and just walk around the complex for a little while and clear my head for a second so I can get refocused. Okay? And that's partly because I didn't sleep well last night and I forgot to eat breakfast this morning. So my blood sugar is low and I'm feeling more irritable. Well, that also identifies some more needs that we can probably take care of. But recognizing those vulnerabilities, what things happen before this current moment that may have predisposed you to feel stressed out, that helps the person just objectively look at the situation and radically accept it and go, okay, so with all that knowledge in mind, what am I going to do to improve the next moment? It's a lot easier said than done initially because when people feel a dysphoric feeling, especially when it's a dysregulated dysphoric feeling, so it's really intense, it's hard to back up and non judgmentally observe. So we're going to talk about some distress tolerance skills later that they may need to implement the interim until they can get into their wise mind. Primary emotions and secondary emotions are interesting. Primary emotions are often adaptive and appropriate. That first emotion you feel, whatever it is, much emotional distress is a result of your secondary emotions. So you get angry and then you have shame over being angry or anxiety about, you know, you're afraid that people are going to judge you and think that you were wrong for getting angry. Or you may get enraged because you feel judged that people didn't think that you should have gotten angry. So all these other emotions start building up. When people are depressed. Sometimes they feel too depressed to go do things, then they start feeling guilty that they don't have the energy to go do things. And then they start feeling angry that they don't have the energy to do things. So they, they're feeling guilt, they're feeling anger at themselves, they're feeling all these other emotions and it's just, it's starting to pile on, which makes them more vulnerable because it's more like this. And thankfully my kids are in martial arts, so we watch a lot of martial arts movies and we found, I found a Jackie Chan clip where he's fighting multiple people. And you know, he can do it because he's Jackie Chan. But in scenario one, when people are emotionally dysregulated and fighting with all these emotions, you know, thinking about how it is, and you can find other fight scenes where one hero is fighting off like four or five bad guys in a bar room brawl or something. But that's kind of what's going on. When people are struggling with their emotions and they're acting just, you know, impulsively in order to stop the avalanche of negativity. They're just like, make it go away, make it stop, make it stop. Make it stop in scenario two when they start developing a sense of control and a sense of ability to tolerate their emotions. You know, can't necessarily make them go away, but we can tolerate them. It's just a feeling, and it will pass. Then they start being more like this one over here, where they're having one experience and it's them against this primary emotion, you know, and then they can deal with that a lot easier. So helping clients recognize the, you know, bloomin onion of emotion that happens a lot of times, start paring it down so then they can focus on that primary emotion, which, again, was generally serving a purpose of some sort. So we need to figure out what that was. But then it's a much more zen and controlled experience. Emotional behavior is functional to the person, and in order to change the behavior, we've got to identify the function and reinforcers of that behavior. So if somebody has a temper, you know, a bad anger management problem, you know, maybe they don't like it, maybe it causes conflict in their. In their relationships, Maybe it is frustrating to them, maybe it's embarrassing to them when they lose their temper. But we have to understand what is the function of that. Where is that anger coming from? What is it trying? What are you trying to accomplish when you get angry? And a lot of times I'll hear clients say things like, I'm trying to get somebody to finally hear me and pay attention. Okay. Or I'm trying to get somebody to do something that I want them to do or get my point across or get respect or whatever it is. And so one thing we can do in this exercise is have clients identify the function of different emotions. So again, you know, you can do the flip charts around the room if you want to, and have a different emotion on each one, but have them identify what is the function of that emotion for them. You know, when they get angry, what's the end goal? What are they trying to get? And if people struggle, then we talk about, well, give me an example of when you got angry. You know, when was the last time you got angry? And maybe they got angry at somebody who was driving too slow, or they got angry at their kids for not cleaning their room, or they got angry at their boss for doing something. Okay? What was the function of that anger? You know, what were you trying to accomplish with that anger? Helping them recognize that will help them find alternate ways to meet that need. So, you know, my boss. Oh, my gosh, my old boss. Love him to death. You know, he's a wonderful man. I worked for him for 14 years, but he could just frustrate the ever loving daylight side of me. And instead of getting angry and, you know, throwing a temper tantrum, which would have been inappropriate and wouldn't have solved anything, you know, I've asked myself, why am I getting angry? Why am I feeling frustrated? And the answer was, I need him to hear what I'm saying and weigh in on whatever this issue is. So I need some feedback, and I'm not getting the communication that I need. Okay, well, that tells me, you know, the way to accomplish that is, you know, probably again, not throwing a temper tantrum, but assertive communication. Sending him an email, calling his cell phone, whatever it took. But there were other ways to do it. The anger was merely telling me that something needed to be done. And the behavior I chose in response to that anger was what I had control over. You know, I could have thrown a temper tantrum, I could have pouted, or I could figure out how to assertively communicate to him. You know, when something like this happens, I really need your feedback. Emotions serve as an alarm or an alert, which motivate people's behaviors. You know, it tells you, do it again or don't do it again. When clients are taught to identify and label emotions, we want them to observe their personal responses in context. So. So I give people this as a handout so they can work on it over the week. And I have them ideally do one every day, and that's not too much to ask. But I try to keep out of session assignments to a minimum because I know they've got other things going on, but I want them to recognize what's going on. So when they have an emotion, and it can be happy or it can be upsetting, whatever kind of emotion they choose, what was the event that prompted the emotion? What were their thoughts about that emotion? When they were feeling that emotion, what were their physical sensations and what were their urges? Because a lot of times when people get angry, for example, they want to put their fist through a wall, or they want to hit somebody or they want to do something. Recognizing that is important. What expressive behaviors were associated with that emotion? What did they do? Did they scream? Did they cry? Did they hopefully not hit somebody? What are their interpretations of that event? Whatever the event was that prompted the emotion, what were the interpretations? What made it threatening or made it so urgent? What was their history prior to the event that increased their vulnerability to emotional dysregulation? This means going back and looking at and saying, was my blood sugar low? Did I not get enough sleep, Had I just had a angry discussion with my significant other on the phone, and then this happened. What happened that led up to that that made you more vulnerable to such a strong reaction? And finally, what are the after effects of the emotion on other types of functioning? So when you get that angry, when you get that upset, how does it affect the rest of your life afterwards? Because this is one of those motivating factors. Because then, you know, some people will be like, yeah, I was embarrassed, I was exhausted. I couldn't focus the rest of the day. You know, it just kind of threw everything out of whack. And that's unfortunate. Okay, so that helps people start identifying motivating reasons to start working on regulation. So what can they do? And somebody asked about this earlier, what can clients do in order to manage their emotions? And there are a few tools that I give clients the first time we do this group, because I want them to start finding their own tools and finding things that work for them. When clients are coming to group and when they are learning about a topic and when they are learning about tools, it's good for them to be able to apply them immediately. So ideally, when you're presenting this information, have them apply it to something that is going on right now or happened last week. So one of the methods for dealing with emotions is check the facts. So, you know, Sally was home on Thursday and she had made dinner, and her roommate was late getting home and didn't call. And Sally got really upset because she felt it was rude and inconsiderate that her roommate didn't call. And yada, yada, yada, you know, this is not an unusual scenario to hear. So checking the facts for and against what are the facts for supporting the notion that her roommate was trying to be rude and inconsiderate and those sorts of things. And what are the facts against it? And there may not be a lot of facts at this point, which may point out that the next thing, Sally is basing everything on emotional reasoning. Because her roommate was late and didn't call, she felt disrespected. Therefore, she assumed that the roommate was disrespecting her, but she has no facts to support it. You know, could have been that the roommate got caught in traffic and her cell phone died and she couldn't call, and she was stuck on I40 for 45 minutes because of a traffic jam or something. Those are facts. Those are observable things. So helping clients look at the facts for and against it. And if they don't have Enough facts, recognize that they may be using emotional reasoning, and then try to get some facts so they can make a better, more informed decision about how to improve the next moment. Problem solving, Change the situation that's causing the unpleasant emotion. Go figure. So, for example, my boss, you know, there were times he was a busy man, but, you know, we developed the ability to work together. And I knew that if I needed him to weigh in on something, I would tell him that during my supervision session on Thursday that I needed feedback on it. And then I would ask him again on Monday because he needed time to ponder. He was a ponderer. But I would prompt him again on Monday and go, what are your thoughts on that thing we talked about on Thursday? So that was empowering to me because I was able to say, okay, he's not trying to be disrespectful. He's trying to run, you know, literally 50 different programs, and he's, you know, got a lot going on. Do I need his information and his input? Yes, I do. So instead of getting upset and feeling put upon or ignored or whatever, you know, and taking it all personally and very egocentrically, I was able to say, all right, this is how we're going to solve the situation. So from then on out, once I developed that system, I really didn't get frustrated with him anymore because I knew this is the way it's going to be. And y' all know I like structure. So Thursdays and Mondays, you know, those were our talk days. Prevent vulnerabilities in order to reduce reactivity by turning down the stress response and helping the person be aware of and able to learn and remember positive experiences. When we are upset, when we are dysregulated, what are we focusing on? We're focusing on survival. We're focusing on fight, flee, you know, keep us protected from whatever. We're helpless against whatever it is. We're not paying attention to the sunrise. It's just not what's happening. So we have a lot of difficulty learning positive things and noticing positive things when we are in a unpleasant dysregulated state. And remember, from Tuesday, it takes five positive experiences to balance out every one. Negative 1. Build mastery through activities that build self efficacy, self control, and competence. So encourage clients to start developing a sense of control over their environment and a sense of self esteem and self pride. Yeah, they're not going to be perfect at everything. They're probably not going to be perfect at anything. I don't know really anybody who's perfect at anything. There are people who are really good at things, but none of us is probably perfect. So encouraging them to work on some of those self esteem building activities and developing a sense of control over their environment as well as their emotions can help them feel lot more confident. Mentally rehearsing, handling stressful situations, because there are things we've got to do. Job interviews, discussions, you know, discussions with the big D that can be really stressful, or going to a funeral, that can be overwhelming for people. So mentally rehearsing how it's going to go and getting through it is really important for people who dysregulate. So they're basically exposing themselves a little bit ahead of time and desensitizing to the situation. Physical body, mind care, making sure that they are taking care of pain and illness. Pain and illness themselves can make us more vulnerable, but medications for pain and illness can also make us more vulnerable. Laughter, so important, it releases endorphins and it actually helps us release stress, especially good belly laughs. And good belly laughs also get oxygen going through the body, which helps improve cognitive functioning and alertness and relieves fatigue. So laughter is good even if you're laughing at yourself. Eat to support mental and physical health. Not just because it's the best fried thing you've ever seen. Not saying that fried things should be eliminated. I love fried food, but it needs to be moderated. Avoid addictive or mood altering drugs or behaviors, because whether it's gambling or cocaine, when you're flooding your synapses with dopamine and norepinephrine and glutamate all the time or regularly, you're going to have changes in your brain that make it, you know, more difficult to feel happy emotions and more difficult to feel pleasure without engaging in those behaviors. Sleep, get plenty of it. Exercise. And this means move your body. It doesn't necessarily mean run a marathon. It just means go out and play with the dog or weed the garden, or you know, clean your house with a toothbrush. Whatever it, whatever it is that does it for you, that gets you moving. So emotional dysregulation is common in many disorders. And it's important for us, especially from a trauma informed perspective, to recognize that most of our clients probably have experienced emotional dysregulation. People who have trauma histories, especially, you know, from as small children, tend to have more dysregulation issues because they often have hypocortisolism. So it's important to validate the fact that yes, you're different, you do get, you are more sensitive than somebody else. That's not necessarily a bad thing. It can feel oppressive right now, but there are tools to help you deal with that. And there are probably things that you can do to take the edge off, mitigate the vulnerabilities. But take the edge off is a lot less jargony. People with dysregulated emotions have a stronger and longer lasting response to stimuli. Unfortunately, this tends to be only in the negative. You know, they don't have a stronger and longer lasting response to positive things necessarily. But we do want to recognize that and help them understand that that's part of how you're wired right now. So you will need to develop some distress tolerance skills to learn to sit with that emotion until it passes. Recognizing that feelings come in and go out in about 20 minutes. And, you know, you can look up urge surfing or distress tolerance skills in order to help clients figure out, okay, when I'm feeling this feeling, when I'm feeling this urge, it's painful, it hurts, it's unpleasant, it's uncomfortable. I don't feel like I can tolerate it. What can I do? Well, sitting there thinking about it is probably not it. So we want to help clients figure out what are my options when I'm feeling this way, how can I accept and improve the moment? Emotional dysregulation is often punished or invalidated, which increases hopelessness and isolation. You know, people start withdrawing, going, nobody understands. Or they start trying not to feel because every time they express their emotions, somebody tells them they're being overly dramatic. Emotional regulation means using mindfulness to be aware of and reduce individual vulnerabilities. And those are emotional, mental, physical and environmental vulnerabilities. You know, looking around, if you're in an environment, you know, if you think back to the Myers Briggs and there are certain environments that are more stressful to introverts who, you know, don't tend to like to be interrupted. They tend to like to have quiet time where they can think before they have to talk. They don't want to have to process on the fly. And extroverts tend to just be the opposite. They tend to be like to be in environments that are active and busy and they can talk things out. Environments also are structured or spontaneous. I know as a structured person, being in an environment where I can't predict what's going to happen from one day to the next is really stressful for me. I like to have some predictability in things. Now, seeing clients, if I know that I'm seeing six clients today, you know, that's fine. I don't necessarily have to know what's going to happen with each client. But I like that predictability. My husband, on the other hand, he doesn't. He likes having different things. He gets bored really easily, which is why he did so well in law enforcement, because there was always something new going on. So understanding what environments and what situations are more stressful, because when you go into stressful situations, it increases your baseline stress level. Okay. Mindfulness also helps identify the function and reinforcers for current emotions. So if somebody's feeling happy, they're probably not going to question it, but okay, let's go with it. Happy tells you to do something. Again, this is positive. Let's do this. So what is this feeling telling you and what's rewarding it? And obviously it might be dopamine in this case, anger. On the other hand, if you feel angry about something, what's the function of anger? Well, anger is usually identified as a way of getting power of some sort. You feel disempowered, so you want to get that power back. Okay, so what is reinforcing that anger? What's keeping that anger going in this situation? If you recognize that inability to get heard or something is. Inability to get heard might be contributing. You know, if you're in an environment where you just feel completely like you have no voice, that may be contributing to the anger. So you can figure out ways to address that issue so you can stop feeling it. Check for facts. Make sure you have facts and you're not just acting solely on emotion. You know, this must be disrespectful because I feel disrespected. Not necessarily. And use good problem solving, because sometimes life just hands you lemons and you feel how you feel. It is what it is. But then how do you improve the next moment? And that's where the problem solving comes in. Alrighty. Are there any questions? And no problem. You know, you'll hear me say y' all a lot, but also I talk about things being knee high to a grasshopper. So, you know, I have these weird little colloquialisms that'll come out occasionally. Alrighty, everybody. Have an amazing weekend. I hope it's going to be cool where you're at and I will see you next week. You. If this podcast helps you help your clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. A direct link to the on demand ceus for this podcast is@allce.com podcastceus that's allceus.com podcastce to sponsor an episode of Counselor Toolbox and reach over 50,000 clinicians per week, go to allce.com Sponsor thank you. 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