MemphisCounselor

Problems with emotional regulation are at the core of problems associated with complex post traumatic stress disorder (cPTSD).  This is the main symptom that differentiates these sufferers from those with PTSD.  The former have typically suffered long-lasting or multiple traumas.

Another cause of emotional dysregulation is the combination of a sensitive temperament combined with an invalidating environment during childhood.  The genetic part is just a predisposition. With caregivers that allow for the sensitivity of the child and who validate the child’s thoughts and feelings, emotional regulation will develop normally.  Without this healthy environment, emotional dysregulation (the inability to regulate ones own emotions) can occur.

Often this unhealthy environment produces a great amount of shame in the child.  Shame is defined as feeling bad about who we are, not what we have done (guilt).  Overwhelming shame is at the core of much distress and mental illness.

Part of the healing of shame is to understand its origins and to reconsider the shaming messages that were given to us at a young age.  This attacks the logical part, but is not nearly enough because the shame is a felt sense; an emotion that occurs well before conscious thought kicks in.  Typically, the person will avoid situations that are likely to trigger the shameful feelings.  At times, this may be a smart move, but a pattern of avoidance will result in the shame never healing and perhaps growing.  The avoidance of shame constrains the sufferer’s life and can lead to an overall sense of worthlessness.

Shame and avoidance of it also results in what is known as a shame spiral.  With alcoholics, the spiral starts with some trigger that causes the person to feel shame.  So they drink to feel better.  On sobering up, they feel ashamed for drinking again, and the spiral continues.  This same spiral can be seen with other avoidance behaviors including overeating, blaming, aggressive behavior, etc.

Shame plays a particularly insidious role in preventing its own healing in therapy.   Effective therapy involves confronting our painful past and our vulnerable present.  Doing so often triggers shameful feelings originating in our past.  To avoid these negative feelings, many people do not come to therapy and others drop out.  Because the shameful feeling is so painful, the person cannot begin to address it with their therapist.  If the person is courageous enough to come to therapy and stick it out, he will be asked to be willing to feel the shame, to explore it and learn that it is not as scary as it says it is.  To break it down into its component sensations.  To recognize its urge to action.  The thoughts that go with it will be recognized as just thoughts, not facts.  The client will often fall back on the defense (avoidant behavior) of choice, creating barriers to healing.  The result can be frustrating for the client and the therapist.   The therapist’s job is to continually bring the client back to having (vs. buying into) the thoughts and having the feelings (vs. buying into their scary message).   The client will be asked to be willing to have these thoughts and feelings in order to remove the constraints from her life and to move her life in valued directions.

Emotions are a natural and critical bridge between our brains and our bodies.  They begin their work before we are consciously aware of them, causing nerve signals and hormones to rapidly move through our body.  It is only the sensation of these bodily reactions that makes us aware of the emotion.  Emotions come with an action potential; to focus attention, to fight, to withdraw, to run, etc.  Without adding thought to emotion, we are impulsive.  By adding thought, we can use emotions and thought together to make wise decisions.

Sometimes, emotions are at the center of problems we have.  An emotion may be so strong that it cuts off our ability to think.  Our fight/flight response may be so sensitive that non-threatening things are sensed as threats.  We may get stuck in one emotion.

When this happens, our response is often to try to avoid or control the emotion that seems to be the problem.  This almost always makes the problem worse.  Avoidance of thoughts and feelings is central to what causes a bad event to become a trauma and to stay that way for years.  It is also central to many situations where we become stuck in an emotion.  For example, fear of public speaking does not go away by avoiding public speaking, and in fact may become worse.  By being willing to speak in public despite the fear; noticing the fear but not buying into it’s message, the person finds that the feared catastrophes do not occur and she may even get positive feedback.  In any case, the person is choosing to do what she values, despite uncomfortable feelings and thoughts that she has which would otherwise constrain her life.  Similar examples can be used to demonstrate that avoidance/control of thoughts and feelings prevents the healing of shame, grief, guilt, anxiety, phobias, etc.

Control of thoughts and feelings doesn’t work for another reason.  In order to NOT think about something, we have to think about it, right?  For example, a man who has been bitten by a snake gets a rush of adrenaline every time he sees a coil of rope.  He can say, “I’m not going to think about the snake when I see the coil of rope.”  But then he just thought about the snake, strengthening the association between the coil of rope and the coiled up snake.  If, on the other hand, he goes to work in a rope factory it will not be long  till that association no longer exists.

Regulation of emotion, on the other hand, is the ability to increase or decrease our level of emotional arousal.  Emotions begin prior to our conscious recognition so cannot be stopped directly.  However, once we notice them, we can choose to alter the effect the emotion is having on our body.  The purpose of this is to allow the thinking part of our brain to work better so that our behavior is controlled by thought and emotion vs. just emotion (impulsivity).  For instance, if we find ourselves angry, we might use any of the following to lower our level of emotion:

1. Taking a few deep breaths
2. Monitoring our breathing to breathe fully but not hyperventilate.
3. Noticing our thoughts but only focusing on our present 5-senses experience.
4. Meditation
5. Soothing imagery
6. Progressive muscle relaxation
7. Looking upward at the ceiling, and/or moving our eyes back and forth between the corners of the ceiling and the walls.  The former reduces our brains access to emotion and the latter helps processing of emotion.

Similarly, if we feel numb, detached, or depressed, we might:

1. Make ourselves do something that we would ordinarily enjoy
2. Pay particular attention to our senses; notice five things we can hear, five things we can feel, five things we can see, etc.
3. Watch a funny television show or movie, even though we do not feel like doing so.
4. Listen to uplifting music.

Feeling numb, detached, or depressed is often an indication that emotion is being repressed (being kept from awareness by the unconscious).  This means that we are avoiding our emotions unconsciously,  so we need to get at those emotions and feel them.  Therapy can be helpful in this effort.

So what is the difference between distracting oneself by watching a movie (healthy) and avoiding emotions (unhealthy)?  The former is a conscious activity.  It also is a control of attention rather than trying to control the thought or emotion.  One chooses to distract oneself for a period of time and can come back to the troubling thought or feeling at a more opportune time.  Avoidance is often unconscious.  Some examples of avoidant behavior include substance use/abuse, aggressive behavior, passive behavior, withdrawal, denial, cutting off relationships, rationalization, saying “I don’t know” or “I don’t care”, blaming others, staying at home, not meeting new people, pulling other people into our dramas, overeating, compulsive shopping, . . . the list is endless.  Although we are conscious that we are doing these things, we are not conscious of why.

The key to healing of emotion-centered problems is being willing to move forward with life in spite of the uncomfortable thoughts and feelings; to notice and tolerate them and to not buy into their message.  The goal is to learn from ongoing experience rather than from fears generated by our minds.

I.  Consideration of suicide – the ultimate defense against feelings of worthlessness.

•     Humans are the only animals that kill themselves.
•     Suicide usually occurs in response to negative states of mind (guilt, anxiety, loss, worthlessness, inadequacy, or blame)
•     Animals change their behavior to avoid negative consequences and to have more positive consequences. They do this based on their PAST experience.
•     In the case of suicide, humans have never experienced whether the consequences of death are positive or negative.
•     Instead, suicide has a “verbal” purpose, “If I am dead, then X.” X may be anything from “no more pain”, “going to heaven”, “others being punished”, “insurance payments”, etc. It can be shown that all of this is a verbal formulation which animals are incapable of.
•     Therefore, suicide is rule-governed behavior, where the rules exist as a combination of our ability to be verbal and the verbal rules (beliefs) taught to us by our culture (p. 48).

II.  Having a belief “I am worthless” is the same as having a rule to that effect. However, normally, a rule can be compared to experience, and if the rule is not working for us, we can choose not to follow the rule. In this case, the truth of the rule is in the evaluations produced by the person with the rule; evaluations of events around them. Since they own the rule, it colors their evaluations, therefore artificially reinforcing the rule. This is called a strange loop.  For example, praise from others will be interpreted as having been manipulated, as the other person not being very smart, as having once again fooled other people, etc. (P. 33).

III.  A large part of our brain is made up of association networks, explaining why we remember parts of names, incidents, etc. and then manage to recall the whole thing by piecing together a few associations. Once something goes into the associational network, it does not come out. It may be harder to access, but it is still there. Subsequently, other things get associated to it and serve as reminders or triggers of that memory. For example, telling someone to remember the number 867 and then asking them to not think about it or forget it is giving them an impossible task. In order to not think about it, they have to think about it. Based on this, one can see how negative messages given to us by others stick in our minds, and get triggered by seemingly unrelated events. If we have been given the message that we have no worth (and that message is given to children in a myriad of ways) that sense of being worthless can be triggered by events many years later where the connection is no longer apparent. The trick is to understand that the message “I am worthless” is not different from the remembered number 867; it has no inherent meaning (P. 128).

IV.  The idea that we call “self” in everyday language is really “self-concept”; all the ideas we have about ourselves and the labels we and others have put on ourselves. Our core self is not that conceptualized self. It is instead a core that is indescribable and ineffable; one could say in the same sense that God is indescribable and ineffable. There is no good or bad to it. The self simply IS. When we idenitfy ourselves with these labels, which can be positive or negative, we are mixing up who we are with a lot of language that has been used to explain our actions  by others and ourselves. When these come from others, they are often in the service of getting us to continue or discontinue a behavior. They may or may not be true about our overall patterns of behavior, which were learned. Most of the time they are gross generalizations of how we behave. We often internalize these labels as being true, especially when they were given to us by powerful people (parents, older kids, teachers, etc.) when we were young.  

In any case, they do not describe our SELF, but the describer’s perception or concept of who we are. Therefore, even our own evaluations are stories or concepts about who we are. They do not describe our SELF because that is indescribable. We can CHOOSE the stories we tell about ourselves, even to ourselves. We can examine the evidence to tell the most accurate and helpful story possible. But even then, we are giving a healthier conception of our self. It is like looking at a map. The map is a description of the territory and is accurate to a greater or lesser degree. But it is NOT the territory. And our self-concept is not our self. Regardless of our self-concept, our self IS what it IS. Worth is a concept that does not apply to it, just as the concept of smell does not apply to a symphony (P. 150)

This is the sense in which Buddhism refers to our life as “an illusion”. So much of what we believe as true is like this; learned rules, descriptions, evaluations, judgements that are not accurate and certainly not helpful. The Buddhist answer to this is awareness of the illusion, and letting go of these as we notice them. Even positive illusions are still illusions, and can melt away in the blink of an eye.

V.  The story of the bad cup – If I have a ceramic cup and I think it is beautiful but you think it is ugly, and we are the only two people in the world, what is it really? What if I drop dead? What if you drop dead? What if we both do?

The cup is ceramic, no matter what. But it is beautiful only in my mind. Beauty is an attribute of my evaluation, not of the cup (P. 169).

VI.  Values are beliefs that are strongly held by a person and that act as principles in helping them make decisions across a variety of settings. Values are choices, pure and simple. Another person may not agree with your values, but there is no argument that will stand against your values, because they are purely choices. No reasons are required. They are foundational and therefore they are flawless because they are raw material – your pure choices.

It can be helpful to identify your values and to see them as a positive, flawless part of your self-concept. If you find a flaw in your values, and only you can, you will automatically adapt your values, because your real value helped you find the flaw. Our understanding of our values may not completely match our true values until we do significant work. For example, I may choose a value because it is prized in society, but my behavior may not reflect that value. To be rigorously honest, I need to reassess that value and possibly replace it in my value list with one that is more accurately depicted by my actions. Regardless of that, we all have a solid bedrock of chosen values that we can look at as a positive foundation for our self-concept (P. 222).

VII.  We analyze ourselves and find ourselves wanting. So we try harder, and then feel like that is not good enough. The cycle continues without end because we see the problem as behavior when it is really thinking and an internalized “felt sense” that was taught to us..

What if our acceptability is more like a choice, with no reasons given. Not a product of analysis. That you can choose to be OK without having to earn it. Then that critic inside our head talking about our worth is just that; not a fact, because the fact of our OK’ness has been decided by choice. What will you choose? (P. 263).