Have you ever thought you might experience feelings too strongly? Or wondered why you couldn’t just be happier or less anxious? Check out the stories of clients I’ve had who have felt the same way. You may be surprised to discover what they learned in therapy about emotion regulation!
This past week I submitted a scientific article summarizing the current research on the role of emotions and emotion regulation in binge eating disorder (BED). The super short version of the article is that individuals with BED frequently experience unpleasant emotions, and binge eating appears to serve as a means to regulate these emotions because these individuals likely don’t have other strategies at their disposal for coping with these difficult feelings.
While difficulties with emotion regulation are often seen in people with eating disorders, addiction, and those engaging in self-harm, it can also be present in individuals who are exhibiting less severe behaviors. I really enjoy working with these clients because they usually don’t come to me saying ¨I have a problem with emotion regulation,¨ so it can be incredibly empowering for them to start connecting the dots through the work we do together and realize how changing the way they relate to their emotions could help them in many areas of their lives.
Some of the clients I’ve worked with who struggled with emotion regulation difficulties came to therapy with the following concerns (note: these are composite patients, all details and identifying information has been changed to protect patient confidentiality)–
Rose is a 35-year-old entrepreneur who has begun to experience panic attacks at work.
Daniel is a 46-year-old business executive who is struggling in his personal and professional relationships and is considering quitting his job and leaving his wife.
Sabrina is a 35-year-old high school teacher and mother who is often unable to attend personal and professional obligations because she becomes overwhelmed with emotions and can’t explain WHY she feels the way she does.
Jennifer is a 26-year old English teacher who drinks more than she’d like every weekend and can’t figure out how to get herself to stop.
James is a 28-year-old translator who recently broke up with his boyfriend and feels incredible guilt at the fact that he can’t just ¨get over it.¨
Stephanie is a 33-year-old aspiring writer struggling with procrastination and sees herself as being ¨lazy” and ¨pathetic.”
While these stories are very different, each one of these individuals struggled with identifying their feelings, tended to avoid or judge their emotions, and lacked healthy skills to regulate, or cope, with these feelings. Dialectical Behavioral Therapy (DBT) and Acceptance and Commitment Therapy (ACT), which are both mindfulness-based interventions, offer incredibly helpful techniques for people who struggle with emotion regulation (which most of us do to some extent).
When I suspect a client may struggle with emotion regulation, I work through the following steps:
1. Assess how they think about and respond to their feelings
Here I ask questions like: ¨do you think there are good and bad emotions?¨ ¨do you ever feel scared of your feelings?¨
2. Evaluate their current emotion regulation strategies
What do they do when they experience difficult feelings? One of my main goals with therapy is to help clients build their own ¨coping skills toolbox,¨ and this is the first step towards identifying what things could be in that toolbox.
3. Identify what contributes to their difficulties with emotion regulation
Were they ever told they were ¨too sensitive” when they were growing up? How did their parents respond when they cried, became anxious or angry? What messages do they get from society about how they’re ¨supposed” to feel?
4. Provide them with information about emotion regulation
This includes information such as why all emotions are important, an explanation of primary and secondary emotions, and an explanation of how resisting or judging uncomfortable emotions can strengthen these emotions in the long term.
5. Practice, practice, practice
This phase is very individualized depending on the client, but may include emotion diaries, teaching mindfulness skills, learning distress tolerance techniques, etc.
Here’s a look at how emotion regulation interventions worked with the clients I mentioned above:
Rose realized that she viewed anxiety as weak and shameful and this only served to increase her anxiety when she noticed some of the first symptoms of a panic attack. She began slowly giving herself permission to feel some anxiety and stopped avoiding situations that she knew would increase her anxiety. She found it helpful to imagine her anxiety as an ¨anxiety monster” that sometimes appeared, but who was much less scary when she just gave it permission to hang around.
Daniel discovered that his desire to leave these situations was related to a lack of assertiveness, or not being able to express how he was feeling in situations. He realized that this was related to being taught that men are not supposed to express their emotions. He began to practice some mindfulness of emotion techniques he learned in sessions. This helped him to start telling his coworkers when he was disappointed in them, and his wife when he was feeling overwhelmed.
Sabrina realized that she’d been criticized for being ¨too emotional” since she was a little girl. We worked to help her identify what emotion she was feeling, and to what intensity, so that she could begin to practice allowing herself to see them as ¨just emotions” that sometimes didn’t have an explanation. Instead of getting wrapped up in analyzing her emotions she could devote her energy to practicing not allowing her emotions to dictate the decisions she made.
Jennifer found that her drinking was related to her wanting to always be happy, despite the fact that she often felt anxious or sad. This pressure to feel a certain way overwhelmed her and her drinking was a way to escape these emotions that she didn’t know how to cope with. Giving herself permission to feel anxious and sad allowed her to process these feelings in therapy, tell her friends what she was going through and develop other ways to cope with difficult feelings.
James was initially resistant to the possibility that he struggled with emotion regulation, but after a few sessions he realized that he was very resistant to letting himself experience the natural feelings of grief that can come with the end to a romantic relationship. Allowing himself to feel these emotions and also identifying things that helped him to regulate them (crying, playing his guitar, taking walks) helped him to work through this difficult moment and even approach other behavior changes that he’d previously not felt capable of taking on.
Stephanie was surprised to realize that there was a connection between emotion regulation difficulties and her procrastination tendencies. It seemed counterintuitive to her to be more accepting and kind towards the fear and doubt that arose when she sat down to write because her usual reaction was to be critical of herself. She discovered that accepting her emotions allowed her to work on her writing even though these emotions were present, instead of waiting for them to disappear.
One of the first things I tell clients when we start working on emotion regulation strategies is that these are skills that pretty much anyone would benefit from. Unfortunately, the majority of us did not learn healthy ways to identify, relate to and cope with our feelings when we were growing up. The good news is that just like learning any other new skill (cooking, a language, a new sport), with patience and dedication there´s no reason why you can´t learn these skills as well.
Since writing this post, I’ve transitioned from providing to therapy to coaching. However, I still help my coaching clients work on developing emotional intelligence and shifting their relationship with hard emotions, such as fear and sadness, so that they don’t hold them back from doing what’s important to them.
Would you like to learn more about my coaching services for expats and global nomads? I offer a free 30-minute consultation for potential clients so that you can see if my coaching services are a good fit for you: