Transformative DBT Skills for 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@Allce.com Counselortoolbox you I'd like to welcome everybody to today's presentation. Dialectical Behavior Therapy Emotion Regulation. We are going to start out by reviewing the basic premises of dbt. The reason we're doing that, and we're only going to do it in this one, is because obviously emotion regulation, we're starting kind of at the beginning, but we want to go over what is the theory underlying a lot of what we're going to talk about. We'll learn about the HPA axis and this isn't something that Linehan talks about in dbt, but it is important for understanding our physiological stress reaction. We'll define emotion regulation, identify why emotion regulation is important and how it can help clients, ourselves, staff, yada yada. And we will finally explore some emotion regulation techniques. There are things besides just preventing vulnerabilities that we can provide to clients to help them regulate their emotions prior to moving into that distress tolerance realm of skills and activities. So, basic DBT premises. Everything is interconnected. When you get up in the morning, if you're having a bad day, you know, you didn't sleep well, your back hurts, you're cranky, you got a lot of stuff to do, it's raining outside, you know, yada yada yada, you're noticing all the negatives. Your thoughts may be more negative. You may be more likely to notice the negative. You may be more likely to have what we commonly call a bad attitude. If you start to have a better attitude, what happens to what you observe? And we'll talk about that in a little while. Reality is not static. What is true right now in the present may not be true right now, which is, you know, was the future from what the present was half a second ago. So reality changes when we look at a situation, when we look at an event, we're looking at how am I reacting and what is my feeling about this situation right now. You know, we can learn to change where we're at, but with the information I have right now, what's going on? And a constantly evolving truth can be found by synthesizing different points of view. Because most of the time as humans, it's just kind of part and parcel of being human. We don't have the whole picture. And I did the best I could with these little graphics here. Think back, if you will, to some of Piaget's Experiments when he was trying to demonstrate egocentrism. When we're looking at this yin and yang sort of model, the girl, stick figure, what does she see? If you ask her, what color is this orb? She would probably say black, because we're assuming she sees the black side. If we ask this little stick figure model over here, what color is the orb? He's seeing the white side, so he'd say white. Now, if we ask the little confused guy who is standing kind of on the third side or the south side, he sees both of them. So he hears the stick figure girl say it's black. He sees the stick figure boy say it's white. And he's going, well, it's kind of both. You can synthesize both perspectives and figure out that this is an orb that has multiple colors. And even though she can't necessarily see those colors and he can't necessarily see those colors. So DBT says, let's try to take a look and see if there are blind spots. See if there are things we're not seeing or things we didn't observe. The basic assumptions of dbt. And, well, people do their best. If we didn't think that, we probably wouldn't be in this profession. So people are doing the best with the tools they have and the knowledge they have at any given time. And I obviously added that extra part. People want to get better and be happy. Most people don't want to be miserable. If it seems like they don't want to get better, then we need to ask ourselves, what is the benefit to them to staying miserable? Why is it scarier, more threatening, more awful to look at getting better or being happy? And that's one of those motivational things. We're not going to go there today, but in general, people are going to choose the most rewarding option when presented with multiple options. Okay, now this is one area that I kind of diverge. The official statement is clients need to work harder and be more motivated to make changes in their lives. I've had a lot of clients who have been working their butt off, but they may not have the right tools. It's like trying to unscrew something that is Phillips head with a butter knife. They're working really hard, but it's not going anywhere because they can't get any traction. So I crossed out the work harder, and I tend to replace it with work smarter. Clients need to work smarter. They need to have more tools. They need to have more effective tools. And some of the tools they have may be really awesome. If we just tune them up a little bit, sharpen them, oil them, grease them, whatever you need to do. And more motivated to make changes in their life. And you're saying, well, they're in therapy, they're coming here for whatever reason. Why aren't they motivated to make changes? Well, again, let's look back at motivation. What's the most rewarding choice? If they've tried to make changes before and it hasn't worked out and they've been told that it was their fault, they were being resistant, or they were blamed in some way, or they just felt disempowered, what's going to make them motivated to try to do that again? Please let me run the gauntlet again. Most people don't want to do that. So we need to help clients work smarter, understand that they are working hard and they need to continue to do so. And we're going to help them get more effective tools and we need to help them get more motivated. We need to help them see that this time it's going to be different, maybe just a little bit different, but this time we're trying something new. It may be different. Even if people didn't create their problems, they still must solve them even. Yep. You know, if you grew up in a dysfunctional household, you didn't create that problem, but it is negatively impacting you today. So you're going to have to fix it if you want to be happy, which obviously is the whole goal. The lives of suicidal or addicted people are unbearable. And when we're talking about dbt, we're generally talking about people who are highly emotionally reactive. Suicide, self harm, those behaviors are a way at this point that they're trying to figure out how to tolerate what seems like an unbearable situation in their head. Addiction is much the same way. It provides some relief from something they feel they have no control over. People need to learn how to skillful live skillfully in all areas of their life. Well, yeah, because every area is interconnected. If you're really stressed out at work, do you just leave work, go home and you are not stressed out anymore? No, that's not the way it works. It would be great if it did, but it's just not. Even if you don't take all your stresses of work home with you, it has taken a toll on your energy level. So when you get home, you are more vulnerable to emotional upset or just falling asleep on the couch at 6pm or whatever it is. We need to help people learn how to live skillfully in each area. So the exhaustion or negativity or whatever it is from one area doesn't bleed over into the other area. So we need to learn how to juggle stresses in all of our areas to prevent vulnerabilities. And people cannot fail in treatment. When someone relapses, when someone, you know, backslides. Whatever word you want to use, I look at it as a learning opportunity. I say, okay, you made a different choice than we wanted you to make, a different choice than you were hoping you would make. So let's learn from it and figure out why that was the more rewarding choice than what was on your treatment plan, the goal that you're working toward, why what happened? What were you more vulnerable? So, you know, you didn't choose the newer behaviors because they weren't as readily available. Let's use this as a learning opportunity to figure out what's going on. It's not a failure. It's a learning moment or a teachable moment. So what is emotion regulation? Emotional dysregulation. We'll start out there. Results from a combination of high emotional vulnerability. So emotional you've got somebody who is kind of reactive. Extended time needed to return to baseline. So when they get upset, it takes them longer to de escalate and get back to baseline. And an inability to regulate or modulate one's own emotions. So I want you to think about some time that you've been driving on the interstate and you're just driving along, cruising along, and heaven forbid if this has happened. I hope not, but if it did, you can probably just relate. A semi comes along and runs you off the road onto the shoulder. And oh my gosh, you get onto the shoulder, your legs just a going like this. You can't even press the gas pedal because you are so stressed out. You're gripping, your knuckles are white from gripping the steering wheel so tight. Your heart's racing, you're breathing fast, you're in full out fight or flight mode. So you went from a one on the stress meter, kind of cruising along, aware of the fact that you need to be cognizant of dangers to a five of oh, crap, that could have been really, really bad. All right, so you take a couple deep breaths, your breathing goes down a little bit. You get to the point where you can actually press the gas pedal and you pull back out onto the highway. Now are you returning back to baseline and just like la de da poke, putting around like you were before? Most likely not. Most likely you're a little bit more on edge and you're checking your back rearview mirror more often, you're looking back, making sure nothing's in your blind spot more often. So you're not returning to that same level of less stressedness, if you will. You're staying a little bit elevated because your brain has gone. You know, I thought it was kind of a safe situation, but I'm realizing now that not so much so I'm going to keep you on higher alert, and it's going to take longer for you to return to baseline because you're looking for those threats now. You're much more aware that it could happen. People who come from invalidating environments, people who are regularly, chronically stressed, they're constantly looking around for anything else that is going to threaten them, anything else that's going to stress them out. So they're not going from a one to a five, back down to a one again. They're going from a one to a five, back down to a two, and then back up to a five, and then now we're only going down to a three. That stress is ramping up. So we need to figure out how to help people de escalate, get back down to that one and realize, okay, I got this. That was a really unpleasant situation, but I got this. Now. Emotional vulnerability refers to the situation in which an individual is more emotionally sensitive or reactive than others or than they normally would be. You know, some people, this is kind of. And when we're talking about personality disorders, this is pervasive. When we're talking about someone who has been under a bunch of stress for six months, this may be a situational sort of thing that we need to help them figure out how to get out of, but it may not be something that is completely and utterly pervasive. In any event, when you are stressed, you know, you're already kind of on edge and something happens, do you react the normal way that you normally would if you were just like sitting there and going, ugh, oh, well, okay, let's figure out how to handle this. Or does it throw you up sort of into the stratosphere? And for a lot of people with emotional dysregulation, when they're basically, their relaxation is the brink of chaos. So they're standing there teetering, and they're going, okay, I cannot take one more wind or it's going to push me over. And then they calm down, they get upset, and they're kind of on free fall for a while. They get their balance again, but then they're still right there on that precipice, they never come all the way down. So what we want to look at is what's going on with these people that's making them more reactive, that's making them more alert and more hypervigilant to stresses and stressors. Some of these may be because of differences in the HPA axis, which play a role in making people more vulnerable or reactive. And we're going to talk about the HPA axis in a minute. Environments of people who are more emotional reactive are often invalidating. And what does that mean? Well, take Jane. Jane has had a heck of a two year period. You know, there's just been death after death, a job loss, she lost her home. She's living in an apartment right now that she's not happy in. You know, yeah, you can just pile stuff, stuff on. Okay. So Jane's really struggling right now. She's holding on and really trying to do the next right thing. She's trying to make, make ends meet, trying to do what's right by her kids. She's feeling really stressed out. And then something happens, something that most of us would react with it to. You know, it's annoying, but it wouldn't throw us into utter chaos. Well, Jane's on that precipice. Jane's already at a four, maybe a four and a half depending on the day. So when this happens, that just. That two puts her over on a scale of one to five, that two puts her at a six and a half, which is in free fall. But people may not understand that. They may not understand what's going on in Jane's life. And they're like, this is not that big of a deal. Why are you just totally overreacting? Which makes Jane feel guilty, feel self conscious, and feel misunderstood. So then she feels isolated and rejected. And we've talked about basic fears being rejection, isolation, failure, loss of control, and the unknown. Well, Jane's kind of experiencing all of those right now. And the people around her, instead of being validating and going, okay, you were already stressed out. I can see how this was just the straw that broke the camel's back. They're going, what is your problem? So she doesn't feel like she's got social support. She's out there, an island unto herself. So we want to help Jane with emotional regulation because we know she's up here and we know she doesn't like going into that free fall. But how do we help her? Emotional regulation is the ability to control or influence which emotions you have when you have them. And how you experience or express them. And that's a quote straight out of line. Hand's book. So emotion regulation prevents unwanted emotions by reducing vulnerabilities. So you can go through life, you can go through the day, you can experience stress, but instead of feeling overwhelmed or enraged, you might feel mildly irritated for a second and then choose to move on. Emotion regulation helps people learn how to change painful emotions once they start so you don't get stuck nurturing that emotion or feeding into it and being angry with yourself because you got angry about something you have no control over. It teaches that emotions in and of themselves are not good or bad, they just are. It's your brain's hardwired way of responding based on, wait for it, the information that it has at this particular point in time. Spiders. If you're afraid of spiders, that is your brain's way. You see a spider and you feel fear. It's your brain's way of going, threat. Spiders can be poisonous, big threat, so you want to get away from it. That's your body's way, your brain's way of going, let's survive, we want to do this. Now you can figure out, you can learn more about spiders. So in the future, when you encounter them, you realize that they're not, you know, 99% of them are not threatening to humans. But right now in this moment, your brain is saying, warning, get away. You probably want to do that. So it teaches that emotions in and of themselves are just prompting us to do something. They are survival responses and suppressing them makes things worse. Telling yourself, I shouldn't feel afraid, does that do any good? If your kid comes to you and tells you that, you know, I'm having a really crappy day or I hate this, does it usually do any good to tell them, well, you shouldn't feel that way, feel better, you know, just be happy. Does that work? I've never had an experience where that worked. Now, it may work for some people, but. So we want to help people identify their emotions but not get consumed by them. Emotions are effective when acting on the emotion is in your best interest. So sometimes it's in your best interest. Expressing your emotion gets you closer to your ultimate goals. Sometimes expressing your emotion gets you closer to your short term goals, like making the pain stop. And true pain is unpleasant. However, in the big scheme of things, 15 minutes from now, three hours from now, is that getting you closer to the goals that you really want to achieve or was it just a stopgap? Expressing your emotions will influence others in ways that will help you. So if you want to influence others in ways that are positive and will help you, then emotions can be very. Can be very helpful. Emotions are sending you an important message, and we already talked about that now. So I'm thinking the devil's advocate in me goes, well, I can think of a client that goes, yeah, rage is a great emotion to express. Is it in my best interest? Yeah, get people to leave me the heck alone. Does it get me closer to my ultimate goals? Yeah, it reduces my stress by getting people to leave me the heck alone. Will it influence others in ways that will help you? Yeah, it makes them go away. And are these emotions sending you an important message? Yeah, rage is telling me that these people, like everybody, is a threat to me. So in the short term, when you look at it that way, it can be tricky to see. But we want to help people get outside of this immediate threat and say, where do you want to be? What does happiness look like to you? Or however you want to define that ultimate goal. Then once you get into distress tolerance, which is Thursday, talk about how do you endure unpleasant emotions so you don't take the stopgap route. Now on to our favorite HPA axis. The hypothalamic pituitary adrenal axis is our central stress response system. And don't get too caught up in all the psychobiology of this. I think it's good to be cognizant of, but obviously we're not prescribing. The hypothalamus place in the brain releases a compound called corticotropin releasing factor, or crf, which triggers the release of adrenocorticotropic hormone from the pituitary gland, which triggers the adrenal glands to release stress hormones, particularly cortisol and adrenaline. Now, your adrenal glands are actually on your kidneys. And why is that important? What I want you to see or understand is there's a lot of systems involved, There's a lot of hormones involved, There's a lot of stuff involved that's not just thoughts. You're releasing a bunch of chemicals in your body that are altering the neurochemicals and the other hormones to prepare you for fight or fleet. The adrenals control chemical reactions over large parts of your body, including the fight or flight response, and produce even more hormones than the pituitary gland. So you've got these adrenals. This is kind of your stress area, if you will. It produces steroid hormones like cortisol, which is a glutocorticoid which means it makes your body release glucose. What do we know? That glucose, blood sugar, energy. All right, so it increases the availability of glucose and fat for the long term fight or flight reaction. It also produces sex hormones like DHEA and estrogen. Okay, why is that important? Because we know that when estrogen goes up, serotonin availability goes up. So if there's. The adrenals are busy doing something else, it may cause other hormonal imbalances. And it also produces stress hormones like adrenaline that are going to ramp you up, they're going to increase your respiration, increase your heart rate, all that kind of stuff. So once you have that whole reaction we talked about and the perceived threat passes, cortisol levels return to normal. Great. This is what happens in the ideal situation. But what if the threat never passes? What if we're working with a client who is constantly fearing rejection and isolation? They need external validation because they don't feel good enough as they are. They don't have social supports because their emotional reactivity has kind of pushed everybody away. So they're constantly feeling this threat of rejection, isolation, failure, loss of control, and the unknown. They're holding on just like you were holding on to the steering wheel after you ran off the road and you got back on. You know, you kept chugging because you wanted to get to your destination, but you were scared witless. Okay, so you're chugging along. What's going on? What's going on in that body? The amygdala and the hippocampus are intertwined with the stress response. The amygdala modulates anger and fear or fight or flight. And the hippocampus helps to develop and store memories. When you're under stress and think about a time when you were under a lot of stress, were you effective at learning and paying attention to the good things and the bad things, or were you just trying to make the pain stop, make the threat go away? The brain of the child or adolescent is particularly vulnerable because of its high state of plasticity, which is why we see people who tend to have personality disorders. Much of their trauma and stuff really started early in their development, which is why it's pervasive in every area or many areas of their life. Bad things are learned. Emotional upset prevents learning new positive things to counterbalance it. If you're in a bad mood, if you're scared, if you're threatened, you know, if you're hungry, homeless, put whatever stuff is there. Are you really paying attention to the bluebirds that Are flying around and singing pretty songs or are you really paying attention to the fact that you got an A on a test? Maybe not. So we need to understand this. People who live in a chronically stressful environment may also have an overactive HPA axis. So they're already. They've already already got some adrenaline and cortisol going on. They live kind of in this state of hyper vigilance and then something happens and they're just like through the roof, Kind of like when you scare a cat. What happens to the brain when there's a chronic threat to safety and a constant underlay of anxiety? This constant undercurrent, as it learns your brain forges synaptic connections from experience and prunes away connections that aren't utilized. People who feel a lack of control over their environment are particularly vulnerable to excessive stimulation of the stress response. Now, it's not just children. Abused and neglected children pop right up there, but abused and neglected adults. Think about a client that you've worked with who's been in an abusive relationship for years. Does she have all the happy connections? Or is she pretty much terrified, exhausted and stressed out most of the time? Adults with anxiety or depressive disorders, it doesn't even have to be an abusive or neglectful situation. If you have someone that forever, whatever reason, has clinical anxiety or depressive symptoms, they are in this state of constant threat and constant upheaval, if you will. So they're not seeing, they're not able to learn and take in as much of the good stuff. So there's more bad stuff coming in. They're paying attention to more of the bad stuff or unpleasant stuff. The synaptic connections that form the foundation of people's schema of themselves in the world become skewed towards the traumatic event at the expense of a synaptic network based on positive experiences and healthy relationships. So we have this client here, and these are her negative experiences. She has a lot of them and she's got these going through her head a lot. And it's not. They don't just go away. Whenever she meets somebody and she's like, well, they're going to leave me. Whenever something happens, she feels isolated and alone she may fear. So she's got really strong connections to those past memories and past experiences. And when you're in the midst of all this, there's not a lot of happy stuff. And even when she appears happy, a lot of times she's faking it. She's not seeing and remembering all the happy stuff. She just wants to avoid the pain. Another example I could give you is think about a city planner. Now, a city planner only has a certain budget, just like we only have a certain amount of energy. The city planner looks and says, what roads, what connections between cities get the most traffic? And let's devote our resources and strengthen those connections, because we know we've got all kinds of traffic going over there. And those roads that really aren't traveled, those back roads, we don't need to pay much attention to them right now because we need to make sure that those roads that are used the most are strong. That's the best analogy I can give without putting out strings and everything else, but. So the hypervigilant state activated by the stress response disrupts our ability to focus and learn. You know, we're just trying to not die. We're trying to not be consumed by pain. It impairs the ability to form new memories and recall information due to the physiologic changes in the hippocampus. It's not time to learn and process and do all that kind of stuff. Have you ever tried to study for a test when you had 16 other things going on that you were stressed about? How well did you remember this stuff over here? Sometimes people relate things to prior experience. Well, most of the time. So maybe they've had a lot of dysfunctional relationships and they start to get in a relationship, which side is going to be triggered, the negative memories or the positive memories? And then you have somebody who maybe has had some positive relationships, they start to get into a relationship, they remember some of the positive because there have been some really good relationships. But, you know, they may remember the negative too, but most likely they're going to remember more strongly the positive. So what's their reaction going to be? If we're trying to help our clients develop a healthy support system, we need to help them address some of those highways that are going towards the negative memories. Emotion regulation is transdiagnostic or useful with many disorders. It helps people increase their present focused emotion awareness. It says, right now, right here, right now, what are your feelings? What are your physical sensations? What are your thoughts, and what are your urges? It helps people increase cognitive flexibility because it helps them kind of step back and take a look and say, okay, what are my options? Let me step back from being intertwined with this feeling and go, okay, I feel angry. Got it. What are my options here? What do I usually do? What do I want to do when I'm on autopilot? But what are some other Options I could do that might help me move toward where I want to go. Identifying and preventing patterns of emotion avoidance and emotion driven behaviors. We don't want to get in the situation of constantly trying to avoid unpleasant emotions by lashing out, by hurting ourselves, or by doing things reactively. When I feel this way, I must smoke a cigarette, I must cut myself, I must fill in the blank. We want to help people find alternate ways and be able to step back and say, that is an option. Is it the option I want to choose today? Increasing awareness and tolerance of emotion related physical sensations. Sometimes these physical sensations are just so powerful and so overwhelming. And sometimes the rush of adrenaline and that foggy, wibbly, wobbly feeling you get in your head when you have just adrenaline coursing through your veins is so overwhelming that people don't know what to do with it and they're afraid it won't stop. So let's help them increase their awareness and tolerance of this, Help them understand that it passes and use emotion focused exposure procedures when they get upset. Help them think about things in group, in session that get them a little bit revved up. You know, we don't want to precipitate a full scale crisis or talk about something that happened last week that got them upset. And let's apply these procedures. Emotional behavior is functional. To change the behavior, it's necessary to identify the functions and reinforcers of the behavior. So when they did it, you know, let's talk about cutting because you know, that is one of those behaviors that we see, or self injury. It's what is the function of that behavior. Cutting or self injury is a way of inflicting physical pain where the person has control and they focus on that and they feel a sense of mastery. When the stuff going on in their head feels completely uncontrollable and intolerable, it diverts their attention and it also is something that they can control how much pain they're in. So that's how it's functioning now. Is that the best response we want? No. But we can see why somebody might engage in that behavior. What reinforces that behavior? Well, when they do that, not only do they get a reprieve from this emotional turmoil that they don't feel like they can touch or control or do anything with, but the body also releases endorphins. It releases natural painkillers to kill that physical pain, which makes them feel a little bit better. So they've got kind of a double whammy on reinforcers there. So we understand that now. We need to find something else that they can do and help them figure out how to tolerate the turmoil. Emotions function to communicate to others and influence and control their behaviors and serve as an alert or an alarm to motivate one's own behaviors. So let's talk about the first one. Communicate to others. So I'm communicating to around me, the people around me through my emotions. What's going on? If I'm angry, I'm lashing out, I'm going to influence people's behavior and they're probably going to back off. If I am sad or crying, scared, that might bring them closer and in a more supportive sort of thing, you know, Again, you've got to look at some of the behaviors. Self injury can elicit a caretaking response. But these emotions, before somebody actually starts acting out the behaviors, the emotions serve as a cue that, okay, Sally is getting ready to go into free fall so they can start reacting sooner. And it serves as an alert or an alarm to the person to motivate their own behaviors. If you know you're on the precipice, if you know you're right on the edge of being vulnerable, being cranky, being real irritable that day, it can motivate your own behaviors to figure out how to reduce some of your vulnerabilities. Identifying obstacles to changing emotions. Now we can't just say, just be happy and all of a sudden somebody's like, oh, I don't know why I didn't think of that. I'm just gonna go ahead and be happy. That's just not how it works. So we want to look at organic factors. Do they have an organic, long standing chemical imbalance of some sort? And it may not be neurochemical, it may be hormonal, they may have too much estrogen, too much testosterone, too little estrogen, too little testosterone, whatever. Let's figure out, you know, have them go see their doctor and figure out if there's something, thyroid, hormones, whatever, that might be affecting their mood. Okay. Once we identify anything that we can tweak there, we can't measure neurotransmitters, we're out of luck there because they're found in so many places in the body that there's no way to isolate how much serotonin is actually in the brain. Can't do it yet. We want to look at other factors that are biological imbalances, neurochemical imbalances that are caused by chronic stress, that are caused by addiction, sleep deprivation, and nutritional problems. So what sort of chemical imbalances Are we precipitating by keeping the stress going and keeping the adrenaline going, keeping your body revved up all the time? We want to look at obstacles. Well, let me stay with biological factors here real quick. The organic things, if we can refer to the physician and we can figure out ways to address those, that gives the person one step forward so they're not feeling as depressed or they're not feeling as reactive. People with hyperthyroid, you know, when their thyroid is overactive, may have some anxiety issues or some other mood issues that can be addressed with medication. Then we look at the situationally caused things. Are there ways we can help them reduce their chronic stress? Sometimes there are some easy right now sort of solutions. Other times the chronic stress comes from issues that are so long standing, it's going to take a while. It's not that we can't do it, but it's going to be a process. So we move on and we say, okay, addiction. We know that when people use stimulants, it revs them up and then they crash and it makes them more that emotional yo yo caused by the substances or the addictive behaviors also makes them more vulnerable to emotional reactivity. Sleep deprivation gets all kinds of hormones out of whack, tends to make people more irritable. That's one most everybody can look at addressing right now and nutritional problems. If they're not eating well, not eating at all, encouraging them to see a nutritionist in order to make sure they're getting something balanced that they will actually adhere to, not something that they look at and go, yeah, that looks great, but no way I'm eating that. Skills factors, what can we help them with? We can identify cognitive responses that are obstacles, which is basically, I can't do that, I won't do that. Resistance in some way. My response to that obstacle is to look at it and weigh the positives and the negatives. Do a decisional balance exercise to address the cognitive responses and figure out why is the dysfunctional or unhelpful reaction more rewarding? Why is it more rewarding to be angry or scared than to look at doing things and thinking things that will help you feel happier? What's the disconnect? And generally it comes back to prior failures, fear of failure, because they've been down that road before and it's such a letdown when they're feeling really good for like three weeks and then they crash. Behavioral responses that are obstacles to changing emotions. If somebody lashes out when they get upset and they lash out and they throw things and then they feel guilty. So this behavioral response may lead to having more difficulty changing emotions, because we've got to help them figure out how to pause before the behavioral response so they don't compound the situation with more negative emotions and environmental factors. People, places and things. Being in environments where you're surrounded by people who either egg on negativity or who bring out, you know, they're with you, they're talking about conspiracy theories. They're just negative about everything, but. Or they're critical of you or remind you of situations where you've been criticized before. So first, we want to help people identify and label emotions. A lot of our clients are relatively alexthymic. You know, they have a small repertoire, if any, of noting their emotions. They just generally go from situation to reaction, and labeling what they felt is kind of a mystery. So we want to help them. And doing it retrospectively is fine at first because that's probably all you're going to be able to get. The event prompting the emotion. What were your thoughts, your physical sensations and your urges? Help me describe this in enough detail that if we were going to give it to an actor or an actress, they could recreate the situation. What expressive behaviors were associated with that emotion? Did you cry? Did you throw things? Did you hit the wall? What were your interpretations of that event in the moment, not retrospectively, but in the moment? What were your interpretations of what was going on? What history prior to the event increased your vulnerability to emotional dysregulation? Lots of big words. What happened prior to that that already stressed you out or had you on edge? And, you know, we go through a whole bunch of different things, and this is, you know, behavior chaining. We're looking at kind of what led up to the event, what made you more vulnerable, and what were you feeling at that time? And then what were the after effects of the emotion or the reaction on your other types of functioning? So after this event and you went on free fall and you got angry and you lashed out and you screamed and you threw things, how did that affect your work? How did that affect your relationships with your family? How did that affect your mood and just generally your sense of being in yourself for the rest of the day? Changing unwanted emotions. Okay, so we've started labeling them. We figure out what we're feeling. We figure out that, yeah, when we feel that way, we. We act in ways that make us feel worse afterwards. What do we do about it? Let's change them. All right? We already talked about the obstacles, and we're trying to address those. But in the moment, check for facts. Ask yourself what are the facts for and against my belief? If you believe that someone did something to be antagonistic towards you, okay, what was their motivation? What are the facts for and against that? Also ask yourself, is this emotional or factual reasoning? Am I making a decision based on how I felt? I felt attacked, therefore I must have been being attacked. Or facts, you know, I felt attacked, yes, but that was because this person said ABCDE and all of those were very attacking and I felt like I needed to defend myself. So those are two check the facts sort of steps or and you can go with problem solving. So let's change the situation that's causing the unpleasant emotion. Like I said, with spiders in the moment, you may not have enough information to not feel scared, but maybe your spouse really loves hiking and camping and you want to go, but you're afraid of those darn spiders. So how can you change the situation so spiders don't trigger that same reaction? Increased knowledge, increase exposure. There's a lot of different ways. But problem solving says, okay, what can I do? So my reaction, my correct reaction is not one of threat or anger, but it is one of at least mild acceptance. Prevent vulnerabilities, which helps reduce reactivity. If you are 100%, you know, you get up and you're like, this is going to be a good day today. Things that come your way are probably going to roll more like water off a duck's back then smack you upside the face like a mud pie. So we want to prevent vulnerabilities, turn down the stress response. Because when you're not, when you're not up here already, then you know, you can fluctuate a little bit more. And they help the person be aware of and able to learn and remember positive experiences. So if you turn down that vulnerability and somebody's in a good place or a better place than they were, at least they're going to be able to notice. And we're going to want to encourage them to notice the positive experiences. You know, instead of thinking that all people are threatening, all people are going to hurt me, all people are going to leave, they might notice that. You know, there's Sally over here who's worked here for the 15 years with me. And you know, she's there, she sometimes calls in sick, but then she comes back, she's generally in a good mood. You know, she's actually not such a bad person. You start noticing some of the things that are not self fulfilling prophecies. Building mastery through Activities that build self efficacy, self control and competence. Small goals. We don't want to say you don't. You don't want to set a goal where somebody needs to go an entire week without having an emotionally reactive response. Let's say go four hours or maybe even a whole day. That would be wonderful. But first we've got to talk about how to reduce those vulnerabilities. So we set the person up for success. What things can you do? And we're going to get down here in a minute. What can you do if you wake up and you're feeling vulnerable? You know, the creepy cruds are going around. They actually canceled school for the entire week for the school, the county school system. The kids are off for an entire week because of illness right now. But you wake up in the morning and you've got a fever and a sore throat, and you're like, I really don't want to go to work and get out of bed today. What can you do to prevent being grumpy and being overly reactive throughout the day? Mental rehearsal. And this can go for. If you're getting ready to do something scary or threatening, seeing yourself do that and do it successfully. And this can even be during the day, just envisioning yourself getting up, eating your breakfast, driving to work, going through your day, seeing that one person at the office that always has some sort of snarky comment to say or whatever irritates you, laughing at it or dealing with it just fine. Going through everything in your day as you would like to see it happen, Envision it, see, see what you can do. Rehearse it. Rehearse how to handle negativity. You know, if you know you're gonna have to go in for your annual evaluation with your boss. Okay? So mentally rehearse how it's gonna go, how are you gonna react, what's gonna happen? So you're prepared for it. You have your responses, and it takes some of the unknown out of the situation. Physical body Mind care, Pain and illness treatment. And the acronym for this is please. And I changed one of them to laughter. It used to be physical illness, and that was both P and L, but I like laughter. Anyway, we'll get there. When you're in pain or when you're sick, you're vulnerable to being a little bit cranky. You know, that's just your body's already saying you are weak. You know, back in the day when you had to defend yourself against predators, the sick ones and the ones that were in pain were the ones that Usually got taken out first. There's a part of our brain that still remembers that for whatever reason. So when we're in pain or when we're sick, our body keeps that cortisol, keeps our cortisol levels higher and the stress response a little bit higher. So we want to deal with those things, but know if we wake up and we're in that situation at the moment, that we're a little bit more vulnerable. So we need to handle with care. Laughter. You can't be miserable and happy at the same time. Laughter releases endorphins. Laughter helps people feel a little bit better. Find something to laugh at and have. On my phone I keep comedy skits. Every once in a while I'll just pop one in. Even if I'm not having a bad day. Pop it in because I like to laugh. Eat. To support mental and physical health, avoid addictive or mood altering drugs or behaviors that are going to put you on that up and down roller coaster that goes up and it goes even further down than you were when you started. Get adequate quality sleep and exercise. Exercise also helps increase serotonin and release endorphins, which helps people be in a better mood. Mindfulness is nonjudgmental observation and description of the current emotions. And we're not going to really go deep into this right now. There's another class on mindfulness and you can also Google it. Remembering that primary emotions are often adaptive and appropriate. I know, I've said that like six times. Much emotional distress is a result of your secondary responses. Shame over having it, I shouldn't feel this way. Anxiety about being wrong, you know, maybe, maybe this is the wrong way to respond. Or you know what, if I'm wrong about this or rage due to feeling judged for feeling that way, I feel this way and you're telling me I shouldn't. How dare you. So mindfulness is kind of an exposure technique because it helps people identify that yes, I feel that way, but it helps them learn to step back and figure out how to not judge that and just go, okay, I feel that way. Better, worse, whatever. That's how I feel. Exposure to intense emotions without negative consequences. That non judgmental acceptance, just going alright, it is what it is. Extinguishes the secondary emotional responses of feeling guilty about it or feeling ashamed or angry at yourself for being angry. So think of it this way and if you can't see this one, it was the best Bruce Lee picture I could come up with. Scenario one is an unpleasant experience. The person has an unpleasant emotion, then Feels guilt, shame, or anger for feeling that emotion. So instead of having to deal with one emotion one on one, now you're having to fight four different unpleasant emotions and you start acting to try to stop the avalanche of negativity in the absence of adequate skills. Now, Bruce Lee, he was able to take out four or five at a time. But most of us, you know, we would be beaten because all of these adversaries would be coming at us and we would be building on them in scenario two. And this is where we want people to get. They have an unpleasant experience which is part of life. They identify the unpleasant emotion. Again, part of life, sucky, but part. But they have the ability to deal with one emotion. They're like, okay, I'm angry, what do I do about it? Instead, if I'm angry, what do I do about it? And I'm guilty. And you see how, you know, she's got this, she can take that one emotion. So what we're helping people do is uncomplicate, if you will. Emotional dysregulation is common to many disorders. People with dysregulated emotions have a stronger and longer lasting response to stimuli. You know, they're already kind of stressed out, they're already hyper vigilant. If you want to say they're already wound up a little bit and then something happens and it amps them up. Now we have a scale of one to five. If they're already on a four and it amps them up two points, they've fallen off the scale, they're in free fall. So we need to understand that what we perceive as an excessive emotional reaction or they may not have been starting from the same place that we were, we're starting from a one. If they're starting from a four, you know, then their reaction to the same thing may seem pretty reasonable. Emotional dysregulation is often punished or invalidated and increases hopelessness and isolation. Emotional regulation means we help people use mindfulness to be aware of and reduce their vulnerabilities. So we help them take it. So they're not at a four, they may be at a two. You know, they're in therapy for a reason. We're going to help them work on the other stuff and get them down to a one. But right now, let's help them figure out ways they can take down their stress response, take down their just underlying anxiety and stuff, identify the function and reinforcers for current emotions when they happen. Let's understand where they came from because they're functional. Do that Chaining worksheet. Check for facts. Okay, now that I know how I feel, I know what my reactions are, I know what my thoughts are, I know what my urges are. Let's check for the facts in the situation, for and against. That forces people to kind of step back, which lets the urge sail out some and then problem solve. What can I do right now to improve the situation and what can I do in the future so I don't necessarily experience this exact same situation Again, how can I break that mold? Okay, so emotion regulation doesn't provide us with a whole lot of distress tolerance skills. Emotion regulation is really about preventing vulnerabilities and helping people figure out, okay, here's where I'm at. How do I pause? So then I can choose from my distress tolerance, problem solving, or interpersonal effectiveness skills. But it's a big step. How awesome would it be if you could eliminate some of your vulnerabilities and think about it just for a minute or two, what vulnerabilities you've got going on in you right now and how many of those, you know, could you potentially over the next week or two kind of address sleeping, eating, maybe you have 16 things going on and you could pare it down to eight. There are a lot of different things that you might be able to kind of pull out of the rabbit hat, if you will. And what kind of a difference would it make? If you're talking about your staff, look around at your organizational environment. What vulnerabilities are there? Environmental vulnerabilities, physical vulnerabilities? My best friend's working somewhere right now where pretty much everybody is required to work doubles because they are so short staffed. They're going to start getting vulnerable pretty soon. So look around. What can you do to moderate that? So they can model effective emotional regulation, but they can also not be emotionally dysregulated by a client who has emotional dysregulation issues. Alrighty, so that concludes our discussion today. If you have any questions, I would love to hear them. If you want to discuss, that's awesome. If you want to get on to your next client, you know, I totally understand that. I want to wish everybody a happy Valentine's Day. For me, I don't particularly pay a lot of attention to Valentine's Day, but it is the eve before half price chocolate and that is my kind of my kind of day. All. Right, it. Sam, If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing@allce.com Counselor Toolbox this episode has been brought to you in part by allce.com providing 24.7 multimedia continuing education and pre certification training to counselors, therapists and nurses since 2006. Use coupon code counselortoolbox to get a 20% discount off your order this month.