Understand definitions and theories regarding emotion regulation.
Develop awareness of the transdiagnostic approach to youth mental health.
Explore the clinical associations of emotional dysregulation.
Identify management options for emotional and behavioral dysregulation.
Explore these concepts using a case study.
Definitions
Emotion: A complex psychological state involving physiological, behavioral, and cognitive changes.
Responses to events or situations.
Can significantly impact thoughts, feelings, and behaviors.
Affect: A broader term referring to any feeling or experience with a subjective quality.
Understood in terms of valence (positive, negative, or neutral) and arousal.
Cognition: Mental processes such as attention, perception, memory, thinking, and reasoning.
Circumplex Model of Affect
Horizontal axis: Valence dimension.
Vertical axis: Arousal dimension.
Key Differences
Emotions
Definition: Intense, short-lived reactions to specific stimuli, encompassing a range of responses such as joy, anger, fear, surprise, and more.
Characteristics: Brief and intense, triggered by internal or external events, and accompanied by physiological changes.
Example: Feeling elated after a success or experiencing fear during a thrilling movie.
Feelings
Definition: Subjective experiences that arise from emotions, influenced by personal interpretations, beliefs, and experiences.
Characteristics: Individual and subjective, shaped by personal perceptions, and can be more prolonged than emotions.
Example: Feeling warmth and affection toward a loved one or experiencing embarrassment after a mistake.
Moods
Definition: Sustained emotional states less intense than emotions, coloring our overall disposition over a more extended period.
Characteristics: More long-lasting, influencing our outlook and behavior, and influenced by various factors such as environment, health, and circumstances.
Example: Waking up feeling cheerful and optimistic, leading to a day filled with enthusiasm, or feeling persistently low and melancholic without a clear cause.
Emotions
Not fixed, pre-determined states.
Constructed by our mind, based on cognitive, physiological, and social factors.
Shaped by our interpretations, beliefs, past experiences, and early life.
Emotion is your brain helping to make meaning of your world.
Importance of Emotions
Communication: Emotions tell us things about the world and our place in it.
Function to communicate to others and influence others.
Similar to physical sensations (pain) communicating what your body is experiencing, emotions communicate what your brain/mind is experiencing.
Motivate behavior: Emotions cause us to respond; they motivate action.
Example: ANGER
Anger communicates about something important being threatened.
Motivates us to act (e.g., political rallies).
Influences others to respond to our needs.
Communicates that our expectations or needs are not being met.
Anger can be problematic:
When it is expressed in a non-adaptive way (e.g., violence, abuse, aggression).
When it is based on misinterpretations of others’ intent.
Transdiagnostic Approach to Youth Mental Health
Emotion dysregulation is a core transdiagnostic feature.
Clinical stages:
Stage 0: Asymptomatic
Stage 1a: Distress disorder
Stage 1b: Distress disorder and subthreshold specificity
Stage 2: First treated episode
Stage 3: Recurrence or persistence
Stage 4: Treatment resistance
Emotions
Emotions can be intolerably painful.
For some people, emotions feel incredibly problematic.
These people might wish to avoid emotional experiences altogether.
Clinical focus on understanding and regulating (managing) emotions.
Reminder that humans experience emotions for a reason.
Often, emotions are useful biological and instinctual responses.
Can lead to maladaptive, problem behavior.
Understanding Emotions
Identifying Emotions.
Factors Making Emotion Regulation Difficult
Genetics/Biological predisposition.
Lack of skill.
Reinforced emotional behavior.
Emotional overload.
Vulnerabilities (tired, hungry, trauma triggers).
Hand Model of the Brain
Prefrontal Cortex
Limbic System (Thumb)
Flip the Lid
Limbic System
Developmental Theories of Emotion Regulation
Genetics
Early life trauma
Mentalization: 'the ability to infer the mental states of others'
Increasing capacity to identify affect
Increased influence of peers
Co-regulation with caregiver (<3 yrs)
Stressors
Social deprivation
Parental mental illness, loss
Attachment theory
Erikson stages
Emotion Regulation in Young People
Self-Regulation:
The idea that we can manage our emotions and behavior even in changing situations.
This is difficult, even for adults, and it is something that people have to learn and practice as they grow and develop.
Expecting young children to always be able to "act right" when their brains are still developing is not reasonable – the emotional adult brain doesn’t develop until ~24 years old.
Co-Regulation:
The process where we are influenced by the feelings and actions of those around us.
Adults can support the development of self-regulation by modeling healthy self-regulation and meeting the child with warmth, responsive attention, structure, and practice.
Theory of Emotion Regulation
Identification
Selection
Implementation
Identification of the emotion
Requires capacity to reflect or mentalize / theory of mind
Alexithymia
Selection of strategy
e.g.: distraction, check the facts, opposition to emotion action
Implementation of an emotion regulation strategy
Distraction
Helpful, especially in situations of high emotional distress.
Problematic if over-utilized.
Check the Facts: Thoughts Aren’t Facts (DBT)
Something happens.
You have thoughts about what has just happened.
You experience emotions based on your thoughts.
You respond to your thoughts and feelings with behaviors.
Alter the cognitions in order to change feelings and behavior.
Opposite to Emotion Action (DBT)
EMOTION -> BEHAVIOURAL URGE -> Engage in OPPOSITE ACTION
Anger -> Defend; Attack; Approach; Mobilizes you to get moving
Gently avoid the person rather than attack
Do something nice for that person
Imagine sympathy or empathy for the other person, rather than blame
Fear -> Run away; Escape; Avoid
Approach the situation
Stay in the situation
Do what you are afraid of, over and over…
Impacts of Emotion Dysregulation
Significant psychosocial, interpersonal, and functional impact.
May indicate a mental health disorder.
Risk factor for adult mental illness (and treatment resistance).
Increased rate of adverse outcomes → BEHAVIOUR
Risk-taking
Suicidal behavior
Substance use
Transdiagnostic Approach to Youth Mental Health
Emotion dysregulation is a core transdiagnostic feature
Case Study: Olivia, 14 yo
Referred from ED for follow up after episode of suicidal ideation. Her friend called an ambulance after Olivia told her friend about suicidal ideation via text.
In ED, reports very low mood, no energy, no appetite, no enjoyment in things, feels hopeless, not sleeping.
She still has suicidal ideation but agreed to safety plan to go home with parents.
Prior to your review, you see Olivia looking bright and reactive, on her phone talking to friends, laughing in the waiting room.
Olivia reports her friend overreacted as the reason for ED visit. SI fluctuates. There are no triggers or reasons for suicidal ideation.
Diagnosis of BPAD, ‘medications not working’
Uses lots of diagnostic terms, thinks she has ADHD, DID, OCD. Wants a new medication.
Collateral History
Parents report Olivia as ‘up and down’. Since hospital has been happy, seeing friends, but on her phone all night, goes to sleep late
Olivia was always a happy child, no issues until last summer holidays.
Had some conflict with friend, parents don’t know details. Very upset after that, but now has new friend group.
Intermittent episodes of extreme lows, anger, frustration, crying, expressing SI. Usually better in a few hours. Sometimes misses school.
Mum initially thought it was ‘just teen moodiness’. But then became worried it could be BPAD. Family Hx of BPAD in maternal grandfather.
Worried its biological, genetic.
Saw psychiatrist, tried different medications, didn’t work. Parents says that talking therapy doesn’t work for bipolar because it’s biological.
Management Approach
Assessment
Holistic, multidisciplinary, thorough, and longitudinal
Understand social, family context
Identify co-morbidities e.g. ADHD, ASD, anxiety
Neuropsychology, OT/ functional assessments
Identify sensory sensitivities, recommend strategies to reduce arousal
Therapy interventions
Psychological, OT, social worker
E.g. DBT-based approaches (primarily for emotional dysregulation)
Mood stabilizers, anti-psychotics, anti-depressants may all be used, off-label
Follow up and monitoring to identify progress/transition
Management Approaches
Reducing family stressors & addressing social adversity
Early identification and intervention
Family support
Collaborative care with school, service providers
Family + individual approaches
Summary
Emotions help to communicate information and motivate behavior.
Emotion Regulation is not innate but develops throughout childhood, adolescence (and adulthood!).
Emotion dysregulation is associated with negative outcomes including increased risk-taking, suicidal ideation, substance use, interpersonal difficulties, and psychiatric illness.
Psychological management is key: various approaches based on age, including DBT (evidenced based in adolescence and adults).