© youth wellbeing study€¦ · insula an inner brain structure that receives physical signals...
TRANSCRIPT
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Guidance Counsellor Professional Development day 16th September 2016Kealagh [email protected]/Prof Marc [email protected] [email protected]
© Youth Wellbeing Study
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What is an emotion?
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PHYSIOLOGY BEHAVIOUR
EMOTION
FEELING
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Emotional
Response
EmotionRegulation
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Gross & Thompson, 2007
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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.
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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
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Why do we need to regulate our emotions?
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Emotional
Response
EmotionRegulation
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SituationSelection
SituationModification
AttentionalDeployment
Cognitive Reappraisal
EmotionalSuppression
Emotional Response
Process Model of Emotion Regulation
Gross, 2001
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Reappraisal
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Suppression
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non-suicidal self-injury
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Does emotion regulation matter?
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13 yearsEmotion
Regulation
15 yearsEmotion
Regulation
14 yearsEmotion
Regulation
14 yearsLast year
NSSI
15 yearsLast year
NSSI
13 yearsNSSI History
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Lower emotion regulation subsequently predicts NSSI
AND
Engaging in NSSI subsequently predicts poorer emotion regulation
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Great emotion
regulation
Poor emotion
regulation
• Better emotion regulation
• Decreased NSSI severity
• Worse emotion regulation
• Increased NSSI severity
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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
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The neuroscience of emotion regulation
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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
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Scientific American 312(6):32-37 · May 2015
DOI: 10.1038/scientificamerican0615-32
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Scientific American 312(6):32-37 · May 2015
DOI: 10.1038/scientificamerican0615-32
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How can we influence our psychophysiology?
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Breathing in increases heart rate
Breathing out slows heart rate
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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
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© Youth Wellbeing Study
Fruit fly (Drosophila melanogaster, male), by Max Westby / Creative Commons BY-NC-SA
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© Youth Wellbeing Study
SLEE
P
Daytime Mood,
Emotional Reactivity, and
Emotion Regulation
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© Youth Wellbeing Study
SLEEPDaytime Mood,
Emotional Reactivity, and
Emotion Regulation
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How much sleep The “Homeostatic” process
(Adenosine accumulation)
When sleep occurs The “circadian” process
(‘Entrainment’ to zeitgebers)
© Youth Wellbeing Study
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© Youth Wellbeing Study
Emotion regulation means cognitive regulation
knowingneurons.files.wordpress.com; Creative Commons License
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© Youth Wellbeing Study
knowingneurons.files.wordpress.com; Creative Commons License
Sleep loss impairs connectivity between PFC and Amygdala
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© Youth Wellbeing Study
Sleep appears to ‘reset’ the brain for next-day emotional challenges
knowingneurons.files.wordpress.com; Creative Commons License
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© Youth Wellbeing Study
D. Watson, Mood and Temperament, New York, Guilford Publications, 2000.
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Mood instability arises when the circadian system receives conflicting timing cues from the ‘endogenous’ clock and the environment.
Any examples?
© Youth Wellbeing Study
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Are you a ‘morning’ or ‘evening’ person?
© Youth Wellbeing Study
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Tucker et al., 2012
© Youth Wellbeing Study
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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
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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
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Eating good, and emotionality
Ironically, this cartoon predates
the actual tiger attack on Roy
Horn in 2003
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Why don’t people eat good?
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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
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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?
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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…
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A note on willpower…
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“Hangry?”
http://www.wsj.com/articles/how-the-brain-
uses-glucose-to-fuel-self-control-
1417618996
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“Hangry?”
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Remember stress?
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(Google “PsycBlog what the hell”)
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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!
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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
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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/
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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.
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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
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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.
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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
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‘Big Five’ in personality research
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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
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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
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Importance of ValidationTo acknowledge and accept a person’s feelings, thoughts, behaviours and internal experience as valid and understandable
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‘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).
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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
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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
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Skills required for validationActive listening
Mindfulness
Dialectical thinking
Letting go of any set rules
Compassion
Celebrating difference
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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
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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?
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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?
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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….
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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)
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Responding to resistanceMotivational interview techniques
Acknowledging the pros/appeal of current strategies
Cultivating ambivalence
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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?
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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
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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
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0% show distress 100% show distress
Always rejected
Never rejected
Underlying assumption
would indicate all
the data points exist
here
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0% show distress 100% show distress
Always rejected
Never rejected
In reality…
…Opportunity to create ambivalence…
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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.)
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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.
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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.
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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
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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
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Mindfulness“What” Skills (POD)
◦ Participate
◦ Observe
◦ Describe
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Mindfulness“How” Skills (NOD)
◦ Non-judgemental stance
◦ One-mindfully
◦ Do what works (Be Effective)
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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
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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)
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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.
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Thank you for listening!
Thank you to Linda Eastman for organising this PD session
Thanks to the Health Research Council for funding our research