When emotions get in the way: DBT, Emotion Regulation, Adolescents, and Self-harm

1. When emotions get in the way: DBT, Emotion Regulation, Adolescents, and Self-harm Renee Hoekstra, Psy.D. Author of The Emotional Extremist’s Guide to Handling Cartoon Elephants www.cartoonelephantbook.com

2. Overview • DBT and the theory behind emotion • Emotionally sensitive people and how emotions work • Functions of self-harm in adolescents • An overview of DBT skills

3. An Emotional Thermometer As emotion rises, several things happen: • Attention is kidnapped (person becomes focused on the threat- fight or flight) • Less “rational”- when you are focused on escaping pain it is hard to see the facts or get a clear picture of reality • Physiological changes- sympathetic nervous system is kicking in

4. What is emotional vulnerability? • Emotional sensitivity • Emotional reactivity • Slow return to baseline • The interaction between an emotionally sensitive person and an invalidating environment is thought to cause problems with emotion dysregulation

5. Theoretical overview: Dialectical Behavior Therapy • Extreme emotions get in the way of relationships, thinking, behaviors, and self-experience • Emotion dysregulation (rapid onset, intensely experienced, rapid changes of emotion, “out of control” emotional experience, long lasting emotions- when being “emotional” is more typical than being at resting awareness)

6. Extreme emotions get in the way of interpersonal functioning: • Interpersonal dysregulation (need to communicate or explain emotional behavior, interactions are driven by emotions, persons end up interacting in ways that are prickly, snappish, or mean; people avoid interactions or conflict; fluctuating emotions make interactions confusing by giving mixed messages or making them hard to read, relationships are more difficult to keep when you are constantly “emotional”)

7. Extreme emotions get in the way of organizing action • Behavioral dysregulation (in order to control, diminish, or reduce unwanted or painful emotions, people engage in extreme behaviors to “numb out”, avoid, or manage emotional intensity; alternately intensity seeking helps people to feel “real” or “alive”) • Cognitive dysregulation (extreme thinking, decision making is driven by emotions/ emotional behavior, inability to look at facts/ be aware, see things from multiple perspectives)

8. Extreme emotions get in the way of oneself: • Self dysfunction (a person who can’t control emotion doesn’t feel in control of him or herself, a person who can’t control emotion has difficulty predicting and controlling one’s own behavior, and may experience him/ herself as inconsistent over time and across situations and contexts).

9. What good are emotions • Emotions give us important information about ourselves and our environment • The let us know that something is “wrong”, is not “sitting right”, is uncomfortable, distasteful, unwarranted or unwanted, lost • They let us know what we want, what is meaningful, what or who we want to be close to, what we want to pursue/ value

10. What good are emotions • Emotions get us active and moving • Emotions help us organize behavior, prevent harm, prevent insult and injury, reduce threat, pursue and persist on getting things, make our lives easier and better, avoid hurt, get us motivated and challenged, and work hard.

11. What good are emotions • Emotions communicate • Nonverbal actions speak louder than words (reading someone’s facial expression vs. what they are saying) • Emotions let others know what is safe, threatening, harmful, unwarranted, etc. • Emotions might “leak” or communicate in ways we don’t intend • People read and interpret emotional behavior

12. Dysfunctional behavior is functional • Self harm may function to communicate (escalate intensity to get point across, feel heard/ understood) • Self harm may function to self-validate (feel “real”, connected, alive; like one matters) • Self harm may be a way to manage or reduce emotional intensity • Self harm may inhibit or block painful emotions (take it out oneself vs. feel regret or shame)

13. Self harm may serve different purposes • Sometimes students are puzzled and confused by the behavior • Students may not be ready to problem solve (“It has nothing to do with…”); it may be too personal and be too closely tied with identity • The behavior can be frightening and overwhelming; it can also be misinterpreted for suicidal intent

14. What are the DBT skills? Distress tolerance: If you can’t solve a problem right now, don’t make it worse -Ice and the parasympathetic nervous system -Breathing and counting -Creating space for what you feel -Distracting -Self-soothing

15. What are the DBT skills? Emotion Regulation • Observing and describing emotions (know oneself, know what you feel, get accurate) • Identifying function of emotions • Opposite action to emotion skills • Is your fear working for you? If not… • Is your anger working for you? If not…

16. What are the DBT skills? Interpersonal Effectiveness • Objectives: Getting what you want and saying no to what you don’t want • Relationship effectiveness- How will this impact the relationship? • Self- respect effectiveness- How do you want to feel about yourself after the interaction? If you have to approach an unwanted situation, how will you handle yourself so you don’t “lose it” or regret how you acted later?

17. The Core DBT skill: Mindfulness • Exercises to quiet the mind, focus attention, and regroup • Settle into the moment and into your breath • Everyone has their own wisdom: Consider your own inner wisdom, intuition, and what your gut says without ignoring reality or the facts • “Pause” the moment and see what other information is there for you

18. www.reneehoekstra.com • Adolescent girls groups: Mindfulness, psychodrama, DBT skills, cohesion building, wise mind decision making, perspective taking, and treatment for social anxiety • Location: Stoneham, MA • Girls are selected into the groups from different high schools to ensure privacy and confidentiality