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Attention to patient affect—emotions—is of the utmost importance and invariably informs the clinician in confirming an appropriate diagnosis. In fact, affect dysregulation is a major component of associated features supporting diagnosis in most of the severe mental illnesses listed in the DSM-V. There are various ways of understanding affect. Many contemporary researchers conceptualize universally understood emotions as a core set consisting of sadness, anger, fear, disgust, happiness and surprise; emotions are considered physiological responses that communicate how each individual is feeling, which then advises how one might behave in an attempt to regulate neurobiological states.
Daniel Hill (2015) synthesizes contemporary research (such as classical attachment theory) and neurobiology in his recent book. Hill explicates affect regulation through the lens of internal working models that John Bowlby observed and interpreted in his original observations of children. With a firmer understanding of affect’s neurobiological and psychosocial foundations, there has been a surge in literature regarding ways in which this new research-based information can inform treatments for emotional dysregulation. Mindfulness-based treatments and practices have become more widely accepted, as well as cognitive-behavioral based therapies.
Before considering the various treatments, it is important to become familiar with the neurobiological structures that support emotional control. The combined complex operations of the limbic system, the Autonomic Nervous System (ANS), and the HPA (hypothalamus/pituitary/adrenal glands) axis are key biological components that contribute to affect regulation. The ANS is part of the overall nervous system and a functional part of the nervous system, not a structural division like the central nervous system and the peripheral nervous system. The two big subsystems are the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system serves to accelerate the body during moments of fight-or-flight. The parasympathetic nervous system serves to slow down the acceleration activated by the sympathetic. The HPA axis is a major part of the endocrine system that releases hormones and neurotransmitters needed to induce physiological changes. Hormones such as epinephrine, norepinephrine and cortisol are secreted, and neurotransmitters such as dopamine are released. When the brain and the body are able to self-regulate successfully and provide optimal neurobiological functioning, there is proper integration and flexibility in emotional expression and control.
Purves (2013) briefly discusses cognitive-behavioral interventions aimed at developing skills that could provide new and more adaptive responses to emotional triggers by reappraising one’s thoughts or changing one’s behavior thereby preventing an emotional response. In engaging in cognitive reappraisals, individuals actively attempt to interpret what one is thinking, quite specifically to elicit a different emotional response.
An example of cognitive reappraisal might be the way in which an individual reacts emotionally to the picture of an empty chair in front of a window in a small room. Initially, the individual might automatically have a negative response as part of a life-long pattern and express thoughts of solitude at looking out of the window, evoking feelings of sadness and loneliness. Using cognitive reappraisal strategies—a reframing—the individual could be helped to reinterpret what they see. It could be suggested that the individual imagine that the chair has been placed there so they will always have the best view of their loved ones as they return. This practice would give the client an opportunity to develop the ability to experience life with more complexity. Purves also discusses a behavioral approach that can help regulate emotion called situation selection. Essentially, one would avoid situations that provoke emotional distress; one might take the train across the country instead of flying to avoid extreme anxiety or fear.
Whatever the therapeutic technique or framework, the goal in therapy regarding affect regulation is to develop the ability to modulate intense emotions. Vago & Silberweig (2012) illustrate the complexities of mindfulness and how practicing mindfulness has been proven to mitigate difficulties in emotional dysregulation and promote healthy social relationships. This theoretical framework integrates self-awareness, self-regulation, and self-transcendence and is abbreviated as (S-ART). Developing a more integrative model for affect regulation appears to make sense, especially when one considers that each client or patient is unique and experiences their inner world and their external environment differently. With an increased awareness of physical reactions to emotional states and with an increased awareness of how emotions trigger biological responses, effective emotion regulation can be developed.
Inthava Bounpraseuth is a longstanding contributor to Painted Brain News