Emotional Regulation

IMG_1566

EMOTIONAL REGULATION (ER) –

I have a wonderful new mothers’ group, and when I asked them what topics they would like to discuss – and for me to research for them – this is the first one they picked.

Working Definition: “The automatic or intentional modification of a person’s emotional state that promotes adaptive or goal-directed behavior” (Mazefsky et al, 679).

The study of ER has recently gained more attention, in part because of developments in brain science and imaging techniques. The idea of emotional regulation was earlier considered as an aspect of temperament, which is a more inclusive concept and stresses biologically based individual differences of many kinds. (I often refer to children in my practice as having “artistic temperament”.) One of the pioneers of temperament research is Jerome Kagan, who identified high reactive infants in the womb and showed that their “temperamental” characteristics, while not necessarily hindering them in their future lives, did become part of their enduring personalities.

Why do we have emotions anyway? We would all agree that emotions contribute much of what we experience of the richness in life. They also serve the more primitive function of alerting us to danger and helping us size up situations rapidly (both from inside our bodies and from the environment). Your sudden recoil when you see a darting motion on the ground near your feet is an emotion-triggered response, that from the point of evolution probably allowed humans to avoid snakes. A similar reaction is the anxiety one experiences when one has an internal proprioceptive response to losing one’s balance. These emotions allow one to prepare subsequent action to the perceived threat, in order to maintain wellbeing.

However, each individual evaluates a stimulus differently from an emotional point of view in terms of strength – ie. intensity and speed – and this will affect the characteristic emotional response the individual has. This is referred to as “emotional reactivity”. Emotional response includes components of behavior, subjective experience, and physiology.

Many treatment modalities have been used to treat emotional dysregulation. They include psychodynamic and behavioral therapies, such as CBT (cognitive behavioral therapy) and DBT (dialectical behavioral therapy). Before I get into a discussion of the therapies, I would like to give you a sense of what is going on in the brain.

YOUR BRAIN
My favorite discussions of the brain, how it develops, and how its relationship to stress and emotion are given by Dan Siegel (Siegel, 2007, 2012) and Bruce Perry (Perry & Hambrick, 2008).

1. Brain is organized hierarchically in terms of function.
2. The “lower” parts of the brain – brain stem – mediate “simple” functions that keep the body alive such as respiration, heart rate, and body temperature. The brain stem processes sensory information such as sound, light, temperature. The drive to modulate sensory input to comfortable level in individuals with heightened sensitivity to environmental influences (sensory sensitivity, resistance to change) may also influence ER.
3. The mid brain, diencephalon, mediates among other things emotion (the famous amygdala).
4. The higher cortical parts mediate language and abstract thinking.
5. Neuronal networks communicate between and among the various parts of the brain. The prefrontal cortex (PFC) is a part of the brain governing judgment; PFC is important in perspective taking. PFC/amygdala connectivity deals with gaining perspective on emotional experiences.
6. Perspective – when focus or attention is diminished by anxiety or other means, result is interruption of access to important information that may decrease arousal, so a vicious cycle can result in distorted judgment of the environment, misattribution of negative intentions to others (“they are disapproving of me” can lead to anger, shame, which can cause further misattribution of negative intentions.
7. Classical lesion studies in rodent model systems have implicated the medial pre-optic area of the hypothalamus, the ventral part of the bed nucleus of the stria terminalis, and the lateral septum as regions pivotal for regulating pup-directed maternal behavior via a limited number of key genes and hormones – estrogen, prolactin, and oxytocin   . Maternal responsiveness necessarily includes hypothalamic control of both approaching distressed offspring and inhibiting competing stress responses that would interfere with providing help. Approach motivation is increased via the nucleus accumbens-ventral pallidum circuit, and avoidance is reduced by interrupting threat signals from the amygdala to the peri-aqueductal grey. Both motivations are intimately tied to the regulation of the sympathetic response system (Swain et al, pp. 116-117).

Back to Techniques for Emotional Regulation: Most of them focus on your thinking brain: Most of the techniques recommended for ER focus on emotion but involve higher brain function. However, while not explicitly articulated, most therapies also include techniques to decrease arousal.

1. CBT, DBT, and psychodynamic techniques
a. Accept the fact that feelings are neither bad nor good (all three therapies).
b. Identification of specific emotion (all three).
c. Identify the “primary” and “secondary” emotions (primary might be anger, secondary might be shame or guilt) (all three).
d. Identify patterns that lead to overwhelming emotion (all three).
e. Put aside or “let go” the negative thoughts – mindfulness (DBT).
f. Monitor your moods (DBT and CBT).
g. Keep journal of your moods and associated events (DBT and CBT).
h. Challenge unrealistic expectations; don’t try to be perfect (all three).
i. Break down the crisis – reflect on it afterwards and consider it step by step (all three).
j. Appreciate how your interpretation of event can perpetuate the bad feeling (all three).
k. Increase positive emotional experience (also “power of positive thinking”) (DBT).
l. Taking the opposite action (effort to disrupt problem patterns?) (DBT).
m. Importance of the relationship: Talk to someone about it. (only psychodynamic therapies).

Other important techniques focus directly on your stress response system: This involves mid and lower brain levels and the neural circuits connecting them. These techniques are not so culturally familiar to us and are harder to implement in our multitasking society. For example, the mindfulness meditation, which has been proven to actually change the brain in positive ways, is hard for people to do, even though it requires only about 20 min per day! Nevertheless, it is something to consider – introducing repetitive rhythmic motor activities such as physical exercises and dancing to music – into the home and school of preschoolers. These organizing behaviors grow the stress regulating system of the brain.

1. “Self Care” – (DBT term) treat physical illness, eat healthily, avoid mood altering drugs, sleep, exercise.
2. Meditation, mindfulness. Studies on brain structural plasticity have found that compassion-based mindfulness meditation increased cortical thickness and grey matter of the anterior insula (the key brain region underlying compassion) of long-term mindfulness practitioners versus matched controls.
3. Patterned neural activation – music, movement, yoga, drumming, therapeutic massage (Perry, p. 42).
4. These physical techniques of emotional regulation are very important. They are not as popular in western society because they do not fit with the multi-tasking culture in which constant alertness and concern about performance and competition are given such importance. Yet, they require little time – mindfulness meditation requires only about 20 min per day – and have robust evidence of their effectiveness in growing the brain.

References:

Field T (2003). Infant Massage: Power of Touch, DVD, National Health Education Media Network.

Mazefsky CA, Herrington J, Siegel M, Scarpa A, Maddox B, Scarhill L, White S (2013).The role of emotional regulation in autism spectrum disorder, J Amer Acad Child and Adol Psychiatry, 52(7):679-687.

Perry B, Hambrick E (2008). The Neurosequential model of therapeutics, www.reclaiming.com, 17:3, pp38-43.

Swain JE, Konrath S, Brown SL, Finegood ED, Akce LB, Dayton CJ, Ho (2013). Parenting, science and practice, Winthrop University Hospital, Hollis Health Sciences Library, dmauro@winthrop.org.

Siegel D (2012). The Developing Mind, New York: The Guilford Press.

Siegel D (2007). The Mindful Brain, New York: WW Norton Press.

 

 

 

Leave a Reply

Your email address will not be published. Required fields are marked *