© Youth Wellbeing Study€¦ · Insula an inner brain structure that receives physical signals...

Guidance Counsellor Professional Development day 16th September 2016Kealagh RobinsonKealagh.Robinson@vuw.ac.nzA/Prof Marc WilsonMarc.Wilson@vuw.ac.nzJessica GarischJessica.Garisch@vuw.ac.nz

© Youth Wellbeing Study

What is an emotion?

PHYSIOLOGY BEHAVIOUR

EMOTION

FEELING

Emotional

Response

EmotionRegulation

Gross & Thompson, 2007

From Nummenmaa, L., Glearan, E., Hari, R., & Hietanen, J.K. (2014). Bodily maps of emotions. Proceedings of the National Academy of Sciences, 111, 646-651.

Prefrontal Cortex

Amygdala responds to the presence of an emotionally important stimulus

Ventral Striatum a series of structures that respond strongly to rewarding stimuli

Insula an inner brain structure that receives physical signals from the body and is important for generating emotional feelings

Prefrontal Cortex a control centre that can alter brain function in other areas to regulate behaviour so we can achieve our goals

Why do we need to regulate our emotions?

Emotional

Response

EmotionRegulation

SituationSelection

SituationModification

AttentionalDeployment

Cognitive Reappraisal

EmotionalSuppression

Emotional Response

Process Model of Emotion Regulation

Gross, 2001

Reappraisal

Suppression

non-suicidal self-injury

Does emotion regulation matter?

13 yearsEmotion

Regulation

15 yearsEmotion

Regulation

14 yearsEmotion

Regulation

14 yearsLast year

NSSI

15 yearsLast year

NSSI

13 yearsNSSI History

Lower emotion regulation subsequently predicts NSSI

AND

Engaging in NSSI subsequently predicts poorer emotion regulation

Great emotion

regulation

Poor emotion

regulation

• Better emotion regulation

• Decreased NSSI severity

• Worse emotion regulation

• Increased NSSI severity

From Aldao, Nolen-Hoeksema, & Schweizer (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30, 217-237.

Strategy Relationship # Studies Specific Disorder

Avoidance Positive 37 Depression; Anxiety; ED

Rumination Positive 89 Depression; Anxiety; SU; ED

Suppression Positive 51 Depression; Anxiety; ED

Problem-solving

Negative 42 Depression; Anxiety, ED

Reappraisal Negative 15 Depression

Acceptance none 7

Emotion regulation strategies and psychological disorders

The neuroscience of emotion regulation

Limbic system matures at puberty

BUT

Prefrontal cortex matures in the 20s

Scientific American 312(6):32-37 · May 2015

DOI: 10.1038/scientificamerican0615-32

Scientific American 312(6):32-37 · May 2015

DOI: 10.1038/scientificamerican0615-32

Scientific American 312(6):32-37 · May 2015

DOI: 10.1038/scientificamerican0615-32

How can we influence our psychophysiology?

Breathing in increases heart rate

Breathing out slows heart rate

Marc Wilson, PhD, and Jessica Garisch, PhD

© Youth Wellbeing Study Team

Victoria University of Wellington

Adolescent wellbeing: Understanding anxiety and stress and the buffer of resilience

© Youth Wellbeing Study

© Youth Wellbeing Study

Fruit fly (Drosophila melanogaster, male), by Max Westby / Creative Commons BY-NC-SA

© Youth Wellbeing Study

SLEE

P

Daytime Mood,

Emotional Reactivity, and

Emotion Regulation

© Youth Wellbeing Study

SLEEPDaytime Mood,

Emotional Reactivity, and

Emotion Regulation

How much sleep The “Homeostatic” process

(Adenosine accumulation)

When sleep occurs The “circadian” process

(‘Entrainment’ to zeitgebers)

© Youth Wellbeing Study

© Youth Wellbeing Study

Emotion regulation means cognitive regulation

knowingneurons.files.wordpress.com; Creative Commons License

© Youth Wellbeing Study

knowingneurons.files.wordpress.com; Creative Commons License

Sleep loss impairs connectivity between PFC and Amygdala

© Youth Wellbeing Study

Sleep appears to ‘reset’ the brain for next-day emotional challenges

knowingneurons.files.wordpress.com; Creative Commons License

© Youth Wellbeing Study

D. Watson, Mood and Temperament, New York, Guilford Publications, 2000.

Mood instability arises when the circadian system receives conflicting timing cues from the ‘endogenous’ clock and the environment.

Any examples?

© Youth Wellbeing Study

Are you a ‘morning’ or ‘evening’ person?

© Youth Wellbeing Study

Tucker et al., 2012

© Youth Wellbeing Study

Are you a ‘morning’ or ‘evening’ person?

“eveningness” associated with… adolescent and adult emotion dysregulation.

(but it might be that extremes are the problem)

© Youth Wellbeing Study

From the YWS…

Regular sleep/wake times were associated with:

Less self-injury and suicidal ideation, depression and anxiety.

More emotion regulation (and emotional reapprasial), self-esteem, and positive perfectionism

© Youth Wellbeing Study

Eating good, and emotionality

Ironically, this cartoon predates

the actual tiger attack on Roy

Horn in 2003

Why don’t people eat good?

Why should we eat good?

From: http://theconversation.com/health-check-the-science-of-hangry-or-why-some-people-get-grumpy-when-theyre-hungry-37229

Why should we eat good?

http://www.wired.com/2014/07/everything-you-need-to-know-about-the-10-brain-myth-explained-in-60-seconds/

Why does your brain

need energy?

Why should we eat good?

http://www.wired.com/2014/07/everything-you-need-to-know-about-the-10-brain-myth-explained-in-60-seconds/

2-3% of your body

weight…

25% of circulating

glucose…

A note on willpower…

“Hangry?”

http://www.wsj.com/articles/how-the-brain-

uses-glucose-to-fuel-self-control-

1417618996

“Hangry?”

Remember stress?

(Google “PsycBlog what the hell”)

Sooo…

If you shouldn’t have too much sugary drinks, Red Bull, alcohol, fatty foods, etc, what should you eat?

• Don’t try to be perfect, try to be good… Remember willpower? “What the hell…”

• Acquisitional, rather than inhibitional, goals…• Involve others and plan ahead…• Set a timer!

Emotion Regulation: Considerations in clinical practice

Presented at the Guidance Counsellor Professional Development day 16th September 2016

Marc WilsonKealagh RobinsonJessica Garisch

Youth Wellbeing Study School of Psychology Victoria University of Wellington

© Youth Wellbeing Study

Outline• Development of emotion regulation across the lifespan

• Consideration of personality

• Application of ideas into clinical practice

• Sensory modulation

• Mindfulness

Image source: flickr.com/photos/wiseacre/380593827/

Emotion Regulation across the lifespanInfancy as the period for developing attachments, which lay the ground work for the development of connections with others, and the self.

Messages we get from a young age set the stage for our attributions, perspectives, and emotional response.

The development of emotion regulation

Beginning in early infancy children learn to:

• Label emotions

• Understand emotional experience

• Interpret emotional experience

• Communicate emotion

• Modulate their arousal (internally and externally)

• Tolerate distress

This occurs though:

1. what is modelled within primary attachment relationships

2. progressive exposure to emotionally challenging situations

The development of secure attachment

Attachment literature is vast and complex but all theories agree that:

Effective parent–child interaction are the foundation for development

Attachment is dynamic and multidirectional.

Developmental tasks or stages How these tasks are achieved

Secure attachment Begins from birth. Impacted on by factors such as caregiver sensitivity to a child’s emotional and physical needs. (Therapeutic relationship)

Affect regulation Validation, expression, and mirroring of (Emotion regulation, mindfulness)

Identity formation Gaining a sense of what’s important, strengths, self-efficacy, self-esteem. (Values work/valued activity)

Categorical thinking – dimensional thinking

Moving from seeing the world as categorical (good-bad; me-you) and developing psychological flexibility(Integrating dialectics, mindfulness)

Social Perspective taking Developing capacity for perspective taking; development of theory of mind; understanding social cues.(Mentalisation)

Managing Impulsivity Ability to make decisions regarding behaviour, and act in accordance with future goals rather than react in the moment to impulsive drives/urges.(Distress tolerance, mindfulness)

Adapted from slides created by Regional Personality Disorder Service, ccdhb

‘Big Five’ in personality research

Dimension High scorers are ... Low scorers are ...

Openness Creative, imaginative, eccentric, adventurous, curious and open to new experiences.

Practical, conventional, sceptical and rational. You like to stick to the rules.

Conscientiousness Organised, self-directed, dependable, disciplined and successful, but controlling.

Spontaneous, careless, can be prone to addiction.

Extroversion Outgoing, chatty, enthusiastic, active.You seek novelty and excitement.

Aloof, quiet and independent. You are cautious and enjoy time alone or prefer small groups.

Agreeableness Trusting, empathetic, compassionate, helpful and compliant. You are slow to anger.

Guarded, slow to warm and wary of others. More self-referential

Neuroticism Sensitive to stress, worry and emotionality. Sensitive to uncertainty.

Emotionally stable but can take unnecessary risks.

Source: slides created by Regional Personality Disorder Service, ccdhb

Trait Change Comment

Negative affectivity Decreases Decreases most from adolescence until age 30, then more gradually during adult and older years

Positive affectivity/ Extraversion

Increases to 20sStable to 50sDecreases after 50s

Shows greatest degree of change in adolescents/early adulthood

Antagonism Decreases

Disinhibition Decreases Decreases with maturation throughout the lifespan.

Detachment Stable to 50’s, increases later

May increase as attachment figures become fewer in late life and do not get replaced

Population trends in absolute (mean level) personality trait domains.

Source slides created by Regional Personality Disorder Service, ccdhb

Importance of ValidationTo acknowledge and accept a person’s feelings, thoughts, behaviours and internal experience as valid and understandable

‘The essence of validation is this. The therapist communicates to the client that her response make sense and are understandable within her current life context and situation. The therapist actively accepts the client and communicates this acceptance to the client. The therapist takes the client’s responses seriously and does not discount or trivialise them. Validation strategies require the therapist to search for, recognise and reflect to the client the validity inherent in her responses to events. With unruly children parents have to catch them while they’re good in order to reinforce their behaviour, similarly, the therapist has to uncover the validity within the client’s response, sometimes amplify it, and then reinforce it’ (Linehan, 1993, 222 – 223).

Importance of Validation Facilitates emotion regulation

Strengthens persistence through hard times by communicating an understanding of the distress (feel heard)

Recognises the kernel of truth in all perspectives. By recognising someone’s perspective you lessen resistance.

Enhances the relationship

Enhances identity

Levels of validationLevel 1: Being present

Level 2: Accurate Reflection

Level 3: Guessing about unstated feelings

Level 4: Validate in terms of past history

Level 5: Validate in terms of present events and the way most people would react (Normalising)

Level 6: Radical genuineness

Skills required for validationActive listening

Mindfulness

Dialectical thinking

Letting go of any set rules

Compassion

Celebrating difference

Making Emotion Regulation part of (ongoing) assessmentFormal measures

◦ Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004).

Informal ◦ Diary of emotional experience

◦ Naïve inquirer◦ Socratic questioning

◦ What is that (emotion) like for you?

◦ Provides information on

◦ Emotion language

◦ Intensity of emotion

◦ Non-verbal (is this congruent?)

◦ Ease of talking about emotion

◦ Associated regulation strategies

Emotion (Regulation) record form

Situation Emotion Thoughts Body Sensations

What you did?

Use of strategies*

*rate perceived effectivenessAdditional columns : Outcome of strategy; emotion after use of strategy

What (un)helpful strategies are they using already? • What is the perceived effectiveness? (“has that been working for you..?”)• Motivation to change current strategies? Add to repertoire?

Using resources to cultivate awarenessAssessing body sensations associated with different emotions

Emotion words – cultivating language for expression of emotions

Emotion games – e.g. matching different experiences with an emotion

What do you use?

What aspect of insight is the most challenging to cultivate?

Developing insightHow is emotion talked about at home?

◦ What are the messages they get regarding emotions

◦ Are there good and bad emotions?

◦ Is it okay to show distress?

◦ What do others’ emotions evoke in them?

◦ What would it mean to let people know you’re distressed?

◦ Is it helpful to “buy” these thoughts/beliefs

◦ Experiment with what it feels like to give enough space for alternative beliefs/assumptions

◦ Creating room to consider doing things differently….

Developing agencyHaving young people view themselves as agents of change

Our emotion = our reality?

Psychoeducation◦ Emotions are fleeting unless reactivated

◦ Our emotional response can be strongly influenced by our attributions and past experience

◦ We can reduce/increase our physiological arousal voluntarily (e.g. biofeedback)

Responding to resistanceMotivational interview techniques

Acknowledging the pros/appeal of current strategies

Cultivating ambivalence

Responding to resistant beliefs through gentle inquiryOpen ended questions:

What is the belief regarding emotions?

What purpose does the belief serve? Is it aimed at being protective? Achieving something? e.g. acceptance from others

Represent these beliefs and assumptions pictorially:

Where do others sit on the level they represent this belief/enact this in their daily life?

Where do they sit on the level they exemplify/have achieved the aim underlying this belief?

Where do the people you know sit on this continuum when it comes to showing their distress?Where would you place yourself?

An exampleBelief: I cannot show my distress to othersAssumption underlying belief: I will avoid rejection

0% show distress 100% show distress

Where do the (same) people you know sit on this continuum when it comes to experiencing rejection?Where would you place yourself?

An exampleBelief: I cannot show my distress to othersAssumption underlying belief: I will avoid rejection

Never Rejected Always rejected

0% show distress 100% show distress

Always rejected

Never rejected

Underlying assumption

would indicate all

the data points exist

here

0% show distress 100% show distress

Always rejected

Never rejected

In reality…

…Opportunity to create ambivalence…

Sensory modulationOur central nervous system’s ability to respond to incoming sensory information from our surroundings and body.

Helps us:

- Regulate arousal levels

- Adapt to changes in the environment

- Maintain concentration and attention

- Take on new information

- Filter out irrelevant information (noise, touch, etc.)

Sensory dysfunctionWhen sensory integration is out of sync.

Leads to low arousal or high arousal

Low arousal: A lot of stimulation feels like a little; typically passive, hard to engage.

High arousal: A little stimulation feels like a lot; typically distracted or defensive to light, sounds and touch; can be fussy eaters.

Sensory seeking behavioursBoth high and low arousal can evoke sensory seeking behaviour.

Examples of sensory seeking behaviour:

Fidgeting in seat

Oral stimulation (e.g. chewing, biting)

Overly tactile

Behaviours may be subconscious; a way to stabilize the nervous system and create equilibrium – the ‘just right’ level of stimulation.

Calming and alerting: examplesCalming Alerting

HearingRhythmic, predictable soundsWhite noiseHeadphones or ear putty to give the brain a rest if feeling overwhelmed

HearingShort, sharp, loud and novel soundsSudden loud noisesRock music, pop music, busy street

VisionDim lightingMuted coloursPlain wallsDark sunglasses

VisionBright lightingLots of colour, varietyMirror ball; bubble lampBright marketPrint homework on coloured paper

TasteFoods that are warm, smooth, sweetWorking the jaw and check muscles – gum or a mintiePencil toppers or chewy jewellery

TasteTwirling lollipops (have a battery that makes them spin)Cold, sour/tart, spicy, minty, crunch foodsCrunch ice, sip a smoothie through a straw, bite a lemon or frozen orange

MindfulnessAttending to moment-to-moment experience as it occurs.

Vehicle for developing emotional insight & competence

Slow down and attend ◦ Requires practice

◦ May be uncomfortable to ‘sit’ and attend – ensure that experience is tolerable to sit with (start small)

Provides space to make an adaptive response when experiencing intense emotion

Mindfulness“What” Skills (POD)

◦ Participate

◦ Observe

◦ Describe

Mindfulness“How” Skills (NOD)

◦ Non-judgemental stance

◦ One-mindfully

◦ Do what works (Be Effective)

Wise mindEmotions tell us important information

◦ Values◦ What’s important to us

◦ When our needs are/aren’t met

◦ When rules have been transgressed

◦ It’s important to attend to them & the facts

Other strategies for regulationTechnique Literature/evidence to cultivate buy-in

(Diaphragmatic) Breathing Reduces physiological arousal

Regular eatingPaying attention to what we are eating

After c. 3 hours body goes into starvationmode. Become ‘hangry’

Some foods are conducive to help manage mood, anxiety, sleep…

Sleep hygiene Importance of early morning sunshine Turning off electronicsRegular sleep patterns

Creating (and repeating) alternative ways of thinking (cognitive reappraisal)

Neural pathway re-wiring requires repeated use to become the ‘go-to’

‘Allowing’ emotion Emotions are fleeting – will pass unless reactivated

Social support Hand holding reduces distress when in stressful situations (see research by James Coan)

ReferencesHarris, R. (2008). The Happiness Trap: How to Stop Struggling and Start Living: A guide to ACT. Trumpeter Publishing.

Kabat-Zinn, J (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. Hyperion Books.

Linehan, M. (1993). Cognitive-Behavioural Treatment of Borderline Personality Disorder. Guilford Press

Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping People Change, 3rd

Edition. The Guilford Press, New York.

Thank you for listening!

Thank you to Linda Eastman for organising this PD session

Thanks to the Health Research Council for funding our research