Chapter 12:
Emotions are a fundamental aspect of human experience, vital for survival and for navigating daily life. Emotion-related disorders like anxiety and depression often lead to difficulties in relationships, work, school, and overall enjoyment of life. Emotions guide attention and influence behavioral decisions. Individuals begin developing emotion regulation skills in infancy, which form the basis for adult regulation. Occupational therapy practitioners (OTPs) assist in developing emotional awareness and skillful regulation strategies to enhance occupational performance and adaptive engagement in life.
Theories of Emotion
An emotion reflects a subjective thought process linked to expressive behaviors (facial expressions, words) and physiological/neurological changes (Gross, 1998).
Debate exists on: number of basic emotional categories (2 to 10 primary emotions), individual understanding and labeling of emotions, range of associated behaviors, and cultural universality.
Secondary emotions (e.g., jealousy, contentment) involve combinations of primary categories.
Emotional states are typically organized into two categories: positive and negative emotions.
Early theories viewed positive and negative emotions on opposite ends of a continuum.
Current theories recognize the independence of positive and negative affect; individuals can experience high or low rates of both simultaneously.
Distinctions:
Feelings: Purely conscious mental understanding of an emotional state; recognizing physiological, behavioral, and subjective thought processes as a specific emotion (e.g., excitement from a racing heart, smiling, and realizing a celebrity is present).
Mood states: More comprehensive emotional states (e.g., depression, cheerfulness) that persist longer, without a specific identifiable trigger.
Modal Model of Emotions (Gross, 1998): Describes emotions unfolding in four basic, recursive phases in the context of a specific goal:
Situation
Attention
Appraisal
Response
The response feeds back into the situation until the goal is achieved or modified.
Example: Child's toy taken (situation) $\rightarrow$ notices toy missing (attention) $\rightarrow$ goal of playing prevented (appraisal) $\rightarrow$ screams (response). Screaming (response) $\rightarrow$ teacher returns toy (modified situation), and child stops screaming to play.
Emotional Function in Daily Life: Emotion Regulation and Dysregulation
The Occupational Therapy Performance Framework, 4th Edition (OTPF-4) highlights:
Emotional expression, management, and regulation as skills for successful occupational performance.
"Expresses emotions" as a social interaction performance skill: "displays affect and emotions in a socially appropriate manner" (p. 48).
"Emotional performance" including "regulation and range of emotions, appropriateness of emotions, and lability of emotions" (p. 52) as a relevant person factor.
Social and emotional health promotion as part of health management occupations, emphasizing self-regulation intervention.
Emotion Regulation: An individual's ability to use strategies to manage emotional states (Gross, 1998).
Requires awareness of situations likely to elicit an emotional response.
Understood in the context of goal performance; emotion is not inherently negative, but how it impacts goal completion can be problematic (frequency, intensity, duration, onset speed, recovery ability).
Effectiveness of strategies varies by situation, individual experiences, and capabilities.
Process Model of Emotional Regulation (Gross, 1998): Identifies strategies to modulate emotional experience as it unfolds:
Situation Selection: Choosing situations to increase the likelihood of specific emotions (OTPs can use activity scheduling to increase positive situations).
Situation Modification: Modifying environmental and social factors as a situation unfolds (OTPs can identify and implement strategies given their activity analysis and environmental effects training).
Attentional Deployment: Directing attention to specific aspects of a situation that trigger emotional responses (e.g., ignoring negative body language; CBT helps redirect attention to positive features).
Cognitive Reappraisal: Deliberately challenging and reinterpreting automatic emotional responses (e.g., reframing being late due to an accident positively). This is a successful, evidence-based strategy.
Response Modulation: Occurs after emotion unfolds, typically involving suppression efforts.
Emotion suppression (e.g., neutral face, suppressing thoughts) can provide short-term goal completion but is associated with increased dysregulation long-term (Webb et al., 2012).
Cross-cultural differences exist: other-oriented cultures (China, Japan) use emotional suppression more frequently and it can be an adaptive strategy with fewer negative outcomes (Matsumoto et al., 2008).
Emotion Dysregulation: Emotional responses not adapted to the current situation (R. A. Thompson, 1994), typically when negative emotions hinder goal achievement due to unsuccessful strategy use.
Emotion Regulation Failures: Failing to engage in a helpful strategy (e.g., not using cognitive reappraisal to reduce anger).
Emotional Misregulation: Using a strategy poorly matched to the situation (e.g., suppressing frustration with a boss, leading to an argument with a spouse).
Alexithymia: Difficulties with emotional awareness; trouble identifying, describing, differentiating emotions, recognizing physical sensations, and focusing on external facts over internal experiences (Bagby et al., 1994). Common in literature on emotional processing in children and adults with physical/neurological conditions.
Neuroscience of Emotion Regulation
Emotions involve a cluster of physiological, behavioral, and cognitive responses.
Individual differences in physiological response strength to emotional events.
Hypothalamic-pituitary axis (HPA): Key component of the autonomic nervous system response, variability in its responsiveness to stress influences mental illness development, especially with childhood adversities (Koss & Gunnar, 2018).
Childhood adversity leads to abnormally heightened short-term stress response, evolving into chronic underresponsiveness.
Abnormal HPA responses are seen in externalizing (conduct disorder, substance abuse) and internalizing (depression, anxiety) conditions.
Occupation-based sensory processing interventions can modify physiological symptoms of over- and underarousal.
Emotions are represented as a distributed brain network, not discrete categories (Aldao et al., 2016).
Subcortical areas: Amygdala, insula, ventral striatum, hippocampus – involved in emotional event awareness.
Higher cortical areas: Prefrontal cortex, orbitofrontal cortex, anterior cingulate cortex (ACC) – activated when strategies are used to modify emotional experience/expression.
Dysfunctions in brain activation/balance are documented in depression, anxiety, PTSD, bipolar disorder, substance abuse, ADHD.
Subcortical Structures:
Amygdala: Primary area for identifying social and environmental emotional cues. Active in both negative (fear) and positive (pleasure, reward) emotions.
Insula: Responds to visceral sensations (e.g., hollow stomach for fear, physical recoil for disgust) associated with emotions.
Ventral Striatum: Involved in learning cues that predict rewarding outcomes (social or tangible).
Hippocampus: Key for long-term memory storage/retrieval; events with strong emotional responses are more likely stored. Responsible for feelings associated with specific places/situations (e.g., calm at a loved one's home, anxiety in a classroom after failing).
Higher Order Cortical Brain Areas: Associated with executive functions (problem-solving, planning, attention, impulse control).
Prefrontal Cortex: Modulates subcortical structures (amygdala, ventral striatum). Tracks positive/negative aspects of situations goal-dependently. Active during cognitive reappraisal, not emotional suppression.
Orbitofrontal Cortex (OFC): Inhibits impulsive behaviors. Integrates internal feelings with external context to guide behavior. Damage leads to impaired emotion regulation, poor decision-making, risk-taking, difficulty delaying rewards. Plays a crucial role in regulating anger/aggression, with deficits linked to aggressive responses in conflict (seen in intermittent explosive disorder, conduct disorder, antisocial personality disorder).
Anterior Cingulate Cortex (ACC): Manages cognitive conflict. Associated with sadness and depression; in depression, it becomes hypersensitized to negative cues. Damage leads to significant emotional lability, suggesting a role in controlling daily emotional variations.
Development of Emotion Regulation Across the Life Span
Temperament: Innate predisposition to react to environment and self-regulate responses (easygoing, slow-to-warm, active, fussy). Predicts success/struggles and is a precursor to emotion regulation, representing genetic vulnerability.
Emotion regulation abilities develop over time, with negative and positive emotion management developing along separate timelines.
Prefrontal cortex develops slower than subcortical structures, reaching full maturation in early adulthood, potentially contributing to heightened emotional reactivity in children and adolescents.
Control of negative emotions is poor in adolescence; experiencing/regulating positive emotions is a strength.
Environmental Influences:
Adverse Childhood Experiences (ACEs): Traumatic events (violence, family mental illness/substance abuse) lead to worse adult physical/mental health outcomes (Rudenstine et al., 2019).
Chronic stressors (e.g., community violence) lead to hypervigilance, interfering with stress management and emotion regulation.
Impact is cumulative: $\ge 4$ ACEs linked to worse adult functioning. Emotion regulation mediates ACE impact; children with difficulties experience greater psychological distress as adults.
Interventions to develop emotion regulation skills can reduce negative impacts of trauma.
Supportive Caregivers: Affect development through modeling, overall emotional climate, and explicit techniques.
Warm, supportive families with secure child-caregiver relationships and clear rules facilitate development.
Caregivers model emotional socialization (young children: redirect attention, comfort) and emotional coaching (adolescents: problem-solving, labeling).
Cross-cultural differences: Western parents use facial expressions for positive emotions, verbal for emotional coaching. Eastern parents use verbal expressions to guide understanding; less correlation between parental coaching and child well-being (Yang & Wang, 2019).
Adolescence: Heightened risk for emotion regulation disorders.
Increased frequency/intensity of negative emotions.
Complex developmental demands: parent conflict, school independence, peer/romantic relationships.
Bidirectional development: emotional skills influence relationship quality, and successful relationships foster skill development. Key time for interventions supporting emotional skill development.
Early and Middle Adulthood: Skills solidify; individuals modify approaches for different emotional states.
Emotion regulation supports personal/life goals.
Adults use social support (peers, friends, romantic partners) more effectively to manage negative emotions than adolescents.
Greater skills lead to better quality of life, well-being, and success in work/relationships.
Older Adulthood: Emotions tend to become more positive with age.
Adults in their 60s/70s report more positive, less negative affect than younger adults (Isaacowitz et al., 2017).
Reflects changes in life goals (e.g., maintaining social networks, life review) and social networks.
Less intensity, greater predictability in daily emotions leading to less fear/anger and more calmness.
Better able to regulate emotions via situation selection, supporting goals of social cohesion/enjoyment.
Changes are not universal and are impacted by health/social history.
Cross-cultural differences: Eastern societies may not show the same reduction in negative emotions; older adults still show positive emotions in unpleasant situations.
OTPs working with older adults should avoid assumptions of age-related decline linked to heightened negative emotions; careful evaluation based on life history and goals is warranted.
Emotion Dysregulation and Mental Illness
Emotion regulation is a core impairment in many psychological disorders, categorized along an internal/external dimension.
Internalizing disorders: Activate behavioral inhibitory system, involve negative emotions (e.g., depression, anxiety).
Externalizing disorders: Impulsive behaviors (e.g., substance abuse, disordered eating, risk-taking) causing high positive affect.
Depression:
High negative affect, low positive affect.
Rumination: Repetitively dwelling on past mistakes, regrets, shortcomings.
Anhedonia: Reduced ability to experience pleasure; uniquely tied to clinical depression.
Low positive affect leads to difficulties with goal-directed behavior, responding to positive cues, and shifting to positive emotional states.
Biases toward negative events (attention, memory) and away from positive events, leading to withdrawal and hopelessness.
Biological model: Amygdala overresponding to neutral/mildly negative cues, ventral striatum underresponding to positive cues, prefrontal cortex underactivation during negative emotion regulation (Davidson et al., 2002).
Treatment: Behavioral activation (increasing pleasant activities) is effective; OTPs can use occupations to increase positive affect.
Anxiety:
Excessive negative affect, particularly fear.
Fear response is often disproportionate in timing/intensity to the situation and persists long after.
Physiological hyperarousal (increased heart rate) and hypervigilance to threat cues.
Situations seen as threatening vary (phobias, generalized anxiety).
Frequent use of suppression, which paradoxically increases psychological distress.
Avoidance strategies stem from viewing fear as intolerable.
Treatment: Mindfulness and acceptance-oriented therapies (Dialectical Behavior Therapy [DBT], Acceptance and Commitment Therapy [ACT]) effective by focusing on observation and radical acceptance of negative emotions.
Bipolar Disorder:
Experience depression and at least one episode of mania (extreme positive affect or irritability).
Biological model: Dysregulation in the behavioral approach system (BAS), with increased orientation toward rewards and goals (Katz et al., 2021).
Greater magnitude of BAS activation/deactivation during daily rewards/losses.
Results in impulsivity (engaging in behaviors with high reinforcement potential without considering risks).
Emotion regulation difficulties in managing BAS changes, leading to failure to avoid highly positive states (mania) and manage negative states (depression).
BAS dysregulation also linked to substance abuse and eating disorders.
Substance Use Disorder:
Inability to reduce use despite negative consequences, loss of control over cravings.
Higher rates of negative mood, emotion dysregulation, impulsivity (Kober, 2014).
Substance use is a coping mechanism for negative mood states, inducing positive affect/euphoria; withdrawal leads to intense negative mood, reinforcing substance use.
Environmental/situational cues trigger cravings (amygdala, ventral striatum involvement), with prefrontal cortex regulating craving-related behavior.
Treatment: Emotion regulation skills training to manage cravings; CBT, mindfulness-based therapies, developing new social relationships, identifying non-substance activities.
Eating Disorders (Anorexia Nervosa [AN], Bulimia Nervosa [BN]):
AN: Restricted calorie intake, low weight. BN: Binge eating, compensatory behaviors, normal weight.
High rates of co-occurring mood and anxiety disorders.
Underlying emotion regulation deficits are similar, with varied behavioral manifestations.
High negative emotionality, alexithymia, trouble with emotional awareness.
Significant distress tolerance difficulties: nonacceptance of negative emotions, strong belief that they must be avoided.
Heightened punishment sensitivity leading to strong avoidance of negative situations.
Food consumption (including binge/restrictive eating) as a maladaptive strategy for intense negative emotions, involving BAS activation.
Resistant to treatment due to eating being necessary and increasing negative affect, while also being an emotion regulation means.
Borderline Personality Disorder (BPD):
Most associated with emotion dysregulation; diagnostic criteria include mood reactivity, inappropriate/intense anger, difficulty controlling anger.
Difficulties in five areas: emotion sensitivity, greater intensity of negative emotions, greater lability of negative emotions, lack of appropriate regulation strategies, excess of maladaptive regulation strategies (Carpenter & Trull, 2013).
Linehan’s biosocial theory: Predisposed sensitivity to emotions in infancy, high rates of negative emotions over time, leading to difficulties developing appropriate regulation strategies. Highlights role of traumatic/invaliding environments and abuse.
Emotional instability, rapid increase of anger/hostility.
Difficulty with emotional awareness and accurate labeling, hindering adaptive coping (situation modification, cognitive reappraisal).
Extreme maladaptive regulation strategies: suicidal and self-injurious behaviors (SISI) to manage negative emotions.
Frequent impulsive behaviors: disordered eating, substance abuse, impulsive buying, risk-taking.
Treatment: Dialectical Behavior Therapy (DBT) specifically developed for BPD to address emotion dysregulation and behavioral impulsivity.
Posttraumatic Stress Disorder (PTSD):
Involves a traumatic situation leading to abnormal emotional, physical, psychosocial responding.
Intense, prolonged startle response to threats, flashbacks, re-experiencing.
Two subtypes based on emotional responding:
Hyperresponsive to threat situations.
Emotional numbing and alexithymia in the face of intense emotions (Lanius et al., 2011).
Type of trauma, age at experience, cumulative nature, and ability to avoid cues all affect emotional response.
Both subtypes involve an imbalance in prefrontal-cortex control of the amygdala.
Effective treatments vary by emotion dysregulation type.
Attention Deficit-Hyperactivity Disorder (ADHD):
Primary impairments are cognitive: attention difficulties (inattentive subtype), behavioral control (hyperactive-impulsive subtype).
Prominent role for emotion dysregulation (Shaw et al., 2014).
Children with ADHD struggle regulating irritability; often diagnosed with oppositional defiance disorder, conduct disorder.
Display difficult temperament in infancy with frequent, intense negative emotional displays (Southam-Gerow & Kendall, 2002).
Hyperactivity in amygdala, underactivity in ventral striatum contribute to temperament.
Mood lability with rapid changes (positive to negative), especially aggression, common in childhood.
Emotional control difficulties impact well-being more than inattentive/hyperactive symptoms.
Psychostimulants (for cognitive symptoms) can reduce emotional lability and irritability.
Autism:
Core symptoms (language/communication difficulties, theory of mind, sensory processing deficits) contribute to emotion dysregulation and co-occurring psychiatric disorders.
Alexithymia: Identified in $\approx 50\%$ of autistic individuals (Poquerusse et al., 2018), including difficulties interpreting/regulating own emotions and others'.
Emotion interpretation difficulties may stem from interoception impairments: inability to correctly identify/describe physiological processes (e.g., discomfort in stomach is hunger vs. anxiety).
Insula: Brain integration center for bodily sensations and feelings. Atypical function/connectivity in autistic individuals (Nomi et al., 2019).
Sensory interventions identifying/understanding sensory processes and interoception can improve emotion regulation.
Assessment
OTPs use various assessments to examine emotional experiences, regulation skills, and related coping/self-regulation.
Emotional Experiences in Activities of Daily Living Scale (EEADLs):
Purpose: Measures frequency of 5 emotions in 25 daily occupations (self-care, simple IADLs, complex IADLs).
Method: Paper-based questionnaire, self-rated for occupations completed weekly.
Measures: Frequency of positive/negative emotional experiences in daily occupations.
Benefits: Identifies activities causing positive or negative affect. OTPs can reduce negative activities or modify them, and use behavioral activation to increase positive engagement.
Emotion Regulation Scale for Adolescents:
Purpose: Identifies how adolescents use occupations as coping mechanisms for specific emotions (e.g., anger).
Method: 39-item self-report questionnaire.
Measures: Strategy use in 5 categories: comfort and sharing, antisocial behavior, creative activities, physical activities, eating.
Difficulties in Emotion Regulation Scale (DERS):
Purpose: Self-report measure for adolescents and adults.
Method: 36-item paper-based questionnaire.
Measures: Emotion regulation capacity and skill use across 6 domains: acceptance of negative emotions, goal-directed behavior engagement, impulsive behavior control, strategy use, emotional awareness, emotional clarity. Higher scores indicate greater difficulty.
Emotion Regulation Skills Questionnaire (ERSQ):
Purpose: Self-report measure for adults and adolescents on frequency of skill use.
Method: 27-item paper-based questionnaire, for previous week.
Measures: Use of 9 adaptive emotion regulation skills (e.g., awareness, acceptance, tolerance, modifying emotions, self-support).
Profile of Emotional Competence (PEC):
Purpose: Self-report measure for adults on competency in regulating emotions in daily life.
Method: 50-item scale.
Measures: 5 competency skills (identification, understanding, expression, regulation, use) applied to own emotions (intrapersonal) and others' emotions (interpersonal).
Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA):
Purpose: Brief self-report measure of cognitive reappraisal and emotional suppression frequency.
Method: 10-item paper questionnaire, simplified from adult ERQ.
Toronto Alexithymia Scale (TAS-20):
Purpose: Assesses specific difficulties with emotional awareness in adults.
Method: 20-item paper questionnaire.
Measures: Ability to identify, describe feelings, and externally oriented thinking.
Five Facet Mindfulness Questionnaire (FFMQ):
Purpose: Self-report measure for adults on mindfulness knowledge and skills.
Method: 39-item survey.
Measures: 5 facets: observing, describing, acting with awareness, nonjudging inner experience, nonreactivity to inner experience.
Preschool Self-Regulation Assessment (PSRA):
Purpose: Measures self-regulation in emotion, attention, and behavior for preschool children.
Method: Direct observation of child's skills in simple situations (e.g., waiting for a snack), clinician reports on social competence, externalizing/internalizing behaviors.
Role of OTPs in Assessment: Assessment results guide targeted OT-based interventions (e.g., sensory processing, interoception awareness, self-regulation, mindfulness strategies).
Intervention
Interventions address two main areas: managing intense negative emotions and introducing positive situations/emotions.
Interventions That Regulate Negative Emotions
Dialectical Behavior Therapy (DBT):
Mindfulness-based approach with individual psychotherapy and psychosocial skills training (Linehan, 1993, 2020).
Original purpose: Suicidal and parasuicidal behaviors in BPD; now used for emotion dysregulation and impulsive behavior in various externalizing conditions.
Modified CBT, incorporates skills training and behavioral analysis.
Dialectic: Balance between accepting severe negative emotions and strategies to change them.
Skills training: Group format for new strategies (effective as stand-alone for depression, ADHD, substance abuse, forensic populations).
OTPs, with group dynamics and psychoeducation background, often lead DBT skills training groups.
Four Modules:
Mindfulness: Directing attention to the present moment, observant, nonjudgmental.
Interpersonal Effectiveness: Improving problem-solving, assertiveness, social skills to navigate intense emotional social situations.
Emotional Modulation: Increasing ability to identify/label emotions, recognize obstacles to change, reduce vulnerability to strong emotions.
Distress Tolerance: Experiencing negative emotional states without immediate change. Involves engaging in occupations for distraction, self-soothe, improving current feelings. Uniquely relies on activity engagement rather than just psychological/cognitive processes.
Mindfulness-Based Therapies (MBTs):
Mindfulness: State of mind achieved by present-moment awareness, observing/accepting feelings, thoughts, bodily sensations (Kabat-Zinn, 1990).
Jon Kabat-Zinn introduced Mindfulness-Based Stress Reduction (MBSR) for chronic pain.
Integrated into treatments like Mindfulness-Based Cognitive Therapy (MBCT) and Acceptance and Commitment Therapy (ACT).
Emotion regulation is a primary target of MBIs.
Mindfulness-Based Occupational Therapy (MBOT): Integrates mindful approaches into OT practice, highlighting value of occupational engagement for mindful awareness and flow states.
OTPs can integrate sensory processing and mindfulness (individuals with poor sensory awareness and mind wandering benefit from interventions in interoception, sensory awareness, and mindfulness).
Emotional Awareness Training in Neurological Rehabilitation:
For individuals in neurorehabilitation (traumatic brain injury, stroke, MS, Parkinson's) with difficulties processing emotions, often leading to anxiety, depression, alexithymia, dysregulation.
Interventions teach psychoeducational skills: identifying/describing emotions, building emotional vocabularies, differentiating emotions, identifying physical changes (Neumann et al., 2017).
Focus on TBI due to impact on community integration. Learning new emotional skills is possible despite cognitive impairments.
Pilot work supports group-based CBT and stress management for MS to improve emotion regulation.
Evidence-Based Practice: Emotion Regulation Interventions in the Classroom
OTPs adapt programs for classrooms as preventive measures for high-risk children.
Alert Program (Williams & Shellenberger, 1996): Self-regulation intervention using cognitive learning and sensory activities to change alertness, increase classroom participation. Adapted for children with emotional disturbances, improving sensory processing and self-regulation over 8 weeks (Barnes et al., 2008).
Interoception Curriculum (Mahler et al., 2022): Designed by an OT for autistic children with interoception and alexithymia. 25-week program teaching body mindfulness strategies (noticing body signals, associating emotions, exploring comfort activities). Improvements in interoception, emotional, cognitive, and behavioral regulation seen.
Interventions That Increase Positive Emotions
Behavioral Activation and Occupational Engagement:
Effective treatment for depression and other conditions with high negative emotions (Cuijpers et al., 2007).
Uses activity scheduling to identify and increase pleasant activities.
Differs from other CBT by direct approach to quickly increase positive emotions, rather than modifying negative thoughts.
Well-suited for OTPs due to reliance on activity analysis, time management, and activity modification principles.
Creative Therapies in Mental Health Practice:
Drawing, painting, pottery, craftwork, music, drama have long been used by OTPs.
Artful kits helped individuals manage emotions by creating self-soothing kits (music, journaling, painting, etc.) alongside mindfulness (Sokmen & Watters, 2016). Improved emotional awareness, reduced suppression, increased mood.
Positive Psychology Interventions in Chronic Health Conditions:
Techniques to increase happiness and positive emotions, addressing Gross's Process Model stages (Quoidbach et al., 2015).
Includes well-being therapy, quality of life therapy, solution-focused coping, mindfulness-based techniques to cultivate positive emotions.
Short-term increases through attentional deployment, cognitive change, response modulation.
Long-term improvements from skills training in situation selection and attentional deployment (before, during, after events).
OTPs' activity analysis and modification skills are valuable for these interventions.
Peer Groups and Community-Based Interventions:
Utilize peer coaching to effect change in emotional performance, crucial for social relationships and mental health.
Community-based peer mentoring for individuals with severe mental illness improves self-regulation and quality of life (Cabassa et al., 2017).
School-based programs address self-regulation through group activities (efficacy varies).
Core component: frequent engagement in positive social interactions with identified peers.
OTPs can develop peer-based programming to increase positive emotional experiences across the life span.
Here’s the Point
Emotions are regulated by strategies applied before and during occupations and social situations.
Emotion regulation skills have a neurological basis, develop across the life span, and are significantly influenced by social situations and environments.
Emotion dysregulation is a core impairment in diverse psychological disorders, including depression, anxiety, BPD, substance abuse, eating disorders, ADHD, and autism.
OTPs use both occupation-specific and broader psychological assessments to identify emotion dysregulation.
Interventions like mindfulness-based practice, DBT, and awareness training, alongside strategies to increase positive daily experiences, help individuals develop regulation skills.