Tag Archives: Dan Siegel

Emotional Regulation

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). Continue reading →

Discipline

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This is just a brief posting on a big subject that always seems disjointed to me when it is discussed out of context, but also a subject that parents and other caregivers have such headaches about that it deserves attention now and then.

There are two main points I want to make about discipline in this piece. The first is, discipline serves to maintain safety and to communicate values. The second is that discipline frequently gets mixed up with deep – both unconscious and nonconscious – reactions in the caregiver that influence the way the discipline is delivered. We all know both of these points. I am going to simply comment on examples of good discipline I have observed both at Deenabandhu and at Love and Hope and try to identify some of the features that make them effective. As for the deep reactions of the caregivers and how they influence the caregiver’s behavior, I will leave that for a later entry. Some insights for parents about this issue can be found in Parenting from the Inside Out (Siegel and Hartzell, 2003).

One observation I have made is that it is often easier in children’s homes than in single families to establish a consistent set of rules and consistent consequences for noncompliance with those rules. At Love and Hope these rules for behavior are listed in colorful posters on the walls of the dining hall. These rules also communicate the Christian values – such as generosity and compassion – that play such an important role in the life of the Home. Consistency takes some of the stress out of discipline from the point of view of the caregiver. That is very important, because those deep unwelcome reactions that cause caregivers to “blow up” at their children are in part stress reactions. In other words, the loss of perspective and even loss of control on the caregiver’s part is probably mostly generated by stress. If the caregiver can stay calm and reflect on the situation, he or she is more likely to respond to the child’s behavior appropriately (that is, in a way that fits his or her best values).

There are many ways to address the stress reactions that interfere with good discipline practices, and consistency in rules and consequences is only one of them. When caregivers can gain insight into the deep reactions, it is also useful. However, insight is a “top down” phenomenon, and often the stress reactions of the lower parts of the brain trump attempts to keep perspective with the thinking brain. When the caregiver can also use a “bottom up” response to stress, insight is even more effective. Bottom up strategies include ways of calming, or regulating, oneself.

One way of doing that is to disengage, that is, try to distance oneself from the intensity of the situation. That can be very helpful and is commonly called “time outs” either for the child or for the caregiver. Physical distance is often a critical part of this strategy. Another partial solution to this caregiver dilemma is the support of another caregiver, either in a partnership or in a group. When individuals develop supportive relationships with each other, they offer not only ideas, but also implicit patterns of mutual regulation that can be engaged when one caregiver is stressed, and that is calming. It is a cliché to speak of two parents working as a team in setting limits for their children. Yet, the stress generated by a noncompliant child can polarize caregiving teams, also. So, it is best to try to use all of these strategies when disciplining children.

Finally, there is the function of communicating values. This relates to Peter Fonagy’s “epistemic cues”. Values in a culture are transmitted by the way the caregiver communicates, not just what he or she communicates. If the caregiver, in the context of a trusting relationship, lets the child know that the child’s behavior is simply not acceptable – through calm but firm voice, facial expression, and gestures, indicating significance by emotional tone – the child will learn that behavior is unacceptable. This is key because cultural values fit the cultures they belong in, and they cannot be transposed from one culture to the next.

Let me give you an example of what seemed to me to be effective but also culturally specific discipline from Deenabandhu. At Deenabandhu, just as at Love and Hope, the expectations for behavior are clear, as are the consequences and usually involve taking away something small such as no television on one of the rare occasions when it is allowed. The little boys were throwing food in the courtyard. Prajna gave them a consequence. She explained to them and to me that food is given to them to eat by the benefactors of the ashram and produced by the efforts of the farmers, and that therefore wasting food is not acceptable. You can see that this reasoning would not work particularly well in most families in the U.S., but it works here. The values that are being communicated reflect the meaning of giving and serving that I mentioned in an earlier posting. Another time, Prajna gave the boys a similar consequence for running through the courtyard without restricting themselves to the lighted areas. It initially seemed to me a pity to stop them, because they were having so much fun and interacting so well as a group. However, Prajna explained that there might be snakes in the dark (sometimes cobras! One boy had recently been bitten by a non-poisonous snake.) And also trampling the plants was not acceptable. Then I understood.

Siegel, D. & Hartzell, M. (2003). Parenting from the Inside Out: How a Deeper Self-Understanding Can Help You Raise Children Who Thrive, New York, Penguin Group.

photograph by Ginger Gregory

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The School

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Ginger went to observe in the school with a group of other visitors the first day. When she returned, she had many positive things to say about the school and the teaching. Every classroom they visited had active engagement of almost all the children. The teachers were tolerant of children having conversations with each other while working on projects. There were no desks. The students moved freely from place to place during the classes, while still staying engaged in their work. The teachers maintained a calm, contained environment.

The teachers managed lack of participation and disruption – potential or actual – in an unusually skillful way. In one class on Social Studies, the students made paper lanterns and discussed a topic about profit and loss in an animated and involved way; the students who had trouble actively participating in the discussion, had something not disruptive to do with their hands in a self-regulating way, allowing them to listen and follow along. A little boy in the upper kindergarten who wanted to be part of a puzzle activity during a free choice time had difficulty collaborating with the puzzle doers. The teacher came up and put a hand on his shoulders and to calm him and support his efforts, and when that was not successful, guided him to another activity that had a more sensory basis, sorting seeds. He never sorted the seeds the way everybody else did but sat next to another child and kept scooping up the seeds and letting them fall through his fingers, his way of participating. He tried to take seeds from a little girl, but she set a clear boundary and he stopped.

The teachers consistently displayed a calm and receptive manner, quietly acknowledging individual children’s successes. In the upper kindergarten classroom, each child had to bring the teacher his or her journal when finished with each lesson, so that she could mark it. In that way no child was allowed to fall behind or drop out. The kids seemed to expect it to be a good day. Even at the end of the day, the children did not seem eager to leave.

After the school day was over, Ginger and I gathered in the Resource Room and gave a presentation about helping children learn. In addition to showing some videos of El Salvador that offered an example of adults facilitating learning in an infant, we concentrated on teaching about early developmental problems that can interfere with learning, introducing Dan Siegel’s model of the brain (Siegel, 2012) and Bruce Perry’s Neurosequential Model, and also offered some interventions designed for the “bottom up” healing of developmental problems that affect learning, such as breathing exercises, regulatory breaks of various types, and meditation (which is culturally syntonic here). The teachers were receptive and and stayed late to listen. At the end, Prajna suggested that we continue the next afternoon, so we did that.

After school, Prajna brought over tea and biscuits, and she reflected on how the school had changed over the years that she had known it. She discussed the project-based learning curriculum, a change from the original lecture-based curriculum. They eventually moved to what they called an activity-based instruction method in which they added structure to a project-based model. In that way they “grew” their own curriculum, adding structure to allow for more helpful classroom control. She explained that the teachers remain with their classes through the lower grades, providing a continuity of the caregiving role of the teacher. Prajna also mentioned her belief in the value of practice and structure in learning.

Then I did a little work of my own and later followed her to the dining room where the older children (“standards” 5-8) were doing homework. It was now 7:00, and the children would not eat until 9:00. There were thirty kids, both boys and girls, sitting in two circles on the floor, and Prajna was the only adult in the room besides me. Prajna was leading a lesson on English grammar, and of the twenty children sitting with her, all of them were actively engaged for more than 40 minutes, eagerly offering answers to her prompts. From time to time, a child from the other circle, where the children were working together in small informal groups doing math, would come to ask Prajna to review their work. She always interrupted to do this, and she gave a non-effusive but affirming response to each child. One thing I noticed is that Prajna immediately responded to each child who made a bid for her attention, even if it were for a few seconds; I remember being impressed with Rachel’s habit of doing this at Love and Hope.

Siegel, D. (2012) The Developing Mind: How Relationships and the Brain Interact to Shape Who We Are (Second Edition). Guilford Press.

photograph by Ginger Gregory

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The Workshop: Magic Moments

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Day II: The Workshop

A good group gathered for the workshop, including representatives of four orphanages. I began the workshop with a description of brain development. I used Dan Siegel’s ingenious model of the brain in which the thumb represents the brain stem and midbrain, and the fingers curled around this core represent the cortex. The thumb, the evolutionarily primitive brain maintains essential functions such as heart and respiratory rate, sleep, appetite, and reaction to threat of danger (objective or subjective), but also reward, regulation, and mood (Bruce Perry). The fingers are the “thinking brain”. The thumb develops first in life, and the fingers don’t “come online” until around 1-year old. You can see where I am going with this, because M entered the home at age 1, and therefore he moved into an enriched environment after most of this development took place. The circumstances of his earlier life were known to be depriving and neglectful. I also reminded the participants that development was unpredictable and that boys were generally more vulnerable than girls. It has been observed that in the home the girls tend to do better than the boys, both from the point of behavior and also achievement.

Then I reminded the participants of the notion of “magic moments”, those moments in the interaction between caregiver and child when the pair confronts a choice between (1) taking the risk of trying something new (and more energy-demanding in the short run) or (2) slipping down the slippery slope into a problem pattern such as a struggle, and instead of following the old problem pattern they find their way to a better path. I showed them two clips of children at the home that demonstrated magic moments, pointing out that these magic moments prepared the way, or increased the probability, for future magic moments; in other words, the more of these you practice, the easier it is to slip into a good path in the future. Both clips illustrated child and adult working side by side. In one, a boy was grating carrots with an adult, and in another a girl was being helped to cut cucumbers with a big knife. In both, the side-by-side aspect of the activity was emphasized. My message (despite the fact that some cynics in the group thought that some of the behavior was influenced by the presence of a camera) was that when children practice tasks at the side of an approving adult, the task becomes more doable by the child independently in the future.

Then I began the Presentation of “M”:

M entered the home at age 1-year old. I invited the participants, now that they knew about brain development in the first year of life, to consider what neurodevelopmental vulnerabilities M might have brought with him into the home. In fact, early on, Rachel identified him as having delayed speech. He was described as sweet, warmly attached to familiar adults, but unusually timid and fearful, crying a lot. Still, many foundational skills seemed in place – in one observation Sarah Measures did when he was 2-years old, he was able to engage in reciprocal play and had gestural language, his motor sequencing seemed OK, his language comprehension was good, his reading of social cues seemed fine, and he showed no signs of extreme sensory sensitivities. He was observed hanging around the other boys, on the edge of the rough and tumble play. Still, he eventually joined in and remained engaged for 30 minutes.

I showed a video clip of M at 1-year old. He was a sweet-looking boy in a high chair, with a pleasant expression, playing with a toy on the tray of the high chair. When he dropped it, he patiently waited for the caregiver to replace it, which she did. He did not, however, give her a direct gaze, nor did he initiate a gesture to recover the toy himself. Yet, he was clearly interested in the child sitting next to him and to what was going on with her.

In kindergarten, M’s teacher complained that he fell asleep in school. Sarah and I observed him, and he did have his head on the desk most of the time. His teachers seemed to not know what to do with this behavior. At this time, Rachel also had concerns about his not eating and having stomachaches, though the doctor could find nothing wrong. He continued to have crying spells and to spend more time sitting alone than the other children, sitting on the steps eating mangos. At other times, though, he would join in the fun. I reminded the group of the physiological regulation problems that can be associated with problems in neurodevelopment in the first year of life.

M Today: Video of M’s Noncompliance: Rupture and Repair

Step 1. I described the interactions I captured on film the day before. The first step was M’s refusal to change out of his school uniform, an expectation at the home. Tia (“Auntie”, caregiver) Ani and Jessica (the psychologist) tried to help him comply. Instead, he lay on the floor. Gentle persuasion got nowhere. In the clip, M’s foot is seen on the floor of the bedroom, where he is lying and talking in a whimpering, defiant voice. Ani’s voice is soft, and she leaves pauses that seem to say, “You can take over if you want.” She does not escalate the emotion. Later Ani explained that she was asking M what was wrong, and at first he said, “Everything is wrong!” He later explained that he spilled his yoghurt at school, and then further explained that the boys made fun of him for doing that. This information emerged bit by bit, allowed by Ani’s empathic approach. Still, M could not respond to the demand to change his uniform. In the clip he tentatively kicks the door in rebellion, but he is not “too far gone” yet.

Step 2. The next clip is of Tio Luis, who comes to help Ani. His style is to use affectionate physical support, holding M around the waist (M is standing now) and bending his body gently in the same arc as M’s. Still, M shows he is not ready to respond; he grabs hold of the gate to resist Luis’ pull. He may still escalate. I suggest taking a break (who knows if this was the “right” thing to do?) and Luis backs off gracefully. M retreated to the bedroom and lay on his bed, covering himself with a blanket. I went into the bedroom with him and sat quietly on another bed.

Step 3. There was music in the adjoining room, where Kirsten was playing the guitar with three littler boys. M got up and moved into that room, sitting on a chair on the outskirts of the action, watching. I moved to a position behind him; he turned once to look at me and then looked back. Kirsten made no fuss about his joining, nor did she make an explicit invitation for him to come closer. I was glad, because I thought M needed low-key responses.

Step 4. M got out of his chair and lay on the floor next to the other children, with his cheek on the floor and his bum in the air, in a caterpillar position. There was a potential conflict with an assertive little boy when they both reached for the same object, but it did not escalate.

Step 5. Kirsten gave the guitar to M to take a turn. M sat up and took the guitar and began to strum. She gave gentle instruction to M about how to do it and reminded the littler boy to get his hands off the guitar while M took his turn. Slowly, M stood up and strummed the guitar. After a while, he stood taller and assumed a little of a rock star posture. I thought, “This is how self esteem is redeemed.”

Steps 6 and 7. Later in the afternoon, I saw that M had changed the shirt of his uniform, leaving on the pants. Later still, before the birthday celebration, I saw that he had changed his pants as well. His twin brothers were celebrating their birthday, and he sat close to one of them, watching everything.

Because the evaluations from last time included the desire to hear more voices, I had decided to at this point divide into small groups for discussion. Here are some of the results of the discussion from these groups.

Discussion from the Small Groups-:

-Tia Ani did not raise her voice to M in the bedroom because we have raised our voices before, and it doesn’t work. When the child is stuck in a rut, raising your voice doesn’t work.

– It was a good idea for Luis to step in when he did, because collaboration between two caregivers is often helpful and can avoid a struggle.

– There was a discussion about “teaching a child to manipulate” and what is the message to the other children if the understood consequence for “bad” behavior is delayed or not applied. I suggested that there must be communication among the caregivers (CG) so that there is no “splitting” (the child playing one CG off the other) and so that if one person gets confused and is tending to bend the rules, the second person can set him straight. These actions work against manipulation.

– We also talked about how it is good to be flexible sometimes. Yet, “being flexible” can also be seen as a reflection on the CG’s job performance. In that case, it is good for the CG to explain her reasoning to her supervisor.

– We discussed the timing of giving consequences. If the child is in a highly reactive state, reminding him of the consequence for his “bad” behavior is likely to escalate his aggressive behavior. Certainly he will not be able to “learn” from a lecture in that state, when his cortex (thinking brain) is “offline”. It is a challenge to assess the “state” of the child and then to make a decision about the timing of the consequence. All CG’s struggle with this challenge. We all thought that M should get a consequence later, when he could handle it. In this case, after M had calmed down and Ani had responded to him empathically in a gentle, slow paced way, he received his consequence easily.

– All groups also thought that it was important to talk to M about what happened later. One participant suggested that if the child is unable or chooses not to talk, he may draw or write about what happened. I added that children may communicate “what happened” either in reality or in his unconscious fantasy in the form of symbolic play.

– What were the “magic moments” in this scenario? (1) The first may be Ani’s choice to empathically question M about his day instead of immediately setting the limit about changing his uniform. (2) The second may be Luis’ joining Ani so that she would not be alone and vulnerable to being drawn into an old struggle pattern. (3) The third may be Luis’ “letting go” and allowing M to withdraw in order to “get himself together”. (4) The fourth may be Kirsten’s low key and implicit welcome of M into the group without stressing him. (5) The fifth may have been Kirsten’s allowing M to “take the stage” and in that way reclaiming his self-esteem. (6) Finally, the staff’s allowing M to pace himself in his eventual compliance with the rule, even though he had to accept the consequence of refusing to comply when he was asked.

If you can imagine the child’s mind, you do not expect more than he can accomplish. You can empathize with his experience and help him feel less alone. You can in that way maximize the probability of his success.

In the next posting I will briefly address the issue of working with families and then talk about the adolescents.

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