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.