On this episode, Mike and Morgan return to take a thoughtful look at how emotional regulation plays such an important role in mental health and strategies to help with the flux in high and low emotional states. The conversation explores how trauma, anxiety, and personality disorders can affect the way people respond to stress and emotions. They also share helpful tools like breathing exercises, body awareness, and other healthy ways to manage overwhelming feelings.

Mentioned This Episode:

Article: Fundamental Questions in Emotional Regulation

Article: Emotional Regulation

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Welcome to A Psycho Delicious Conversation on mental health issues and trends from three local mental health professionals in the greater Lansing area. I'm Michael Stratton, LMSW. And I'm Morgan Bowen, PMHNP. And I'm Melissa Black, PMHNP. And we're here to provide you with a deep dive into the human experience of consciousness and beyond. Our aim is to be educational and entertaining, so just kick back and open your ears and your minds.

Hey, I'm Michael Stratton.

And I'm Morgan Bowen.

And..

Daedailian.

...is here...

Producer.

...producer. And we...

Hello.

...do not have Melissa today, but we have been talking about emotional regulation and Morgan did a great job.

In the first emotionally regulated.

He's on the struggle bus with emotional regulation, but, but he's introducing the topic and so Morgan, let's, let's open it up to treatment of emotional regulation. Yeah. Well, do you see it where when you see it, you see it as a problem?

Well, you know, so it's associated with, you know, several diagnoses. A lot of times people will come in and I'm thinking of a few people in particular.

Like a spouse has brought it up or it's caused issues and you know, know a marriage or a relationship, sometimes parents, oftentimes it's another person has pointed it out and you need therapy and the person is, you know, I don't accept appointments that are made by a family member, I guess, unless it's a child situation. But you know, diagnoses that I see it infrequently, trauma.

So oftentimes in a PTSD trauma situation, especially when somebody has not processed or has not done that work yet, and so they are reacting to things and they don't know why they're reacting and they're crying or getting really angry.

Especially I would say moms with kids angry at the kids and they love their kids and they're very distressed by that dissonance between their love, love for the child and then the anger with the child that I think I've seen that quite a bit. And they want to know what's going on, what the problem is. So after evaluation, sometimes it is so PTSD trauma based things is where I see it a lot.

Also personality disorders, I don't think we've talked too much about personality disorders specifically on our podcast yet. But borderline personality disorder I think is a classic diagnosis, that emotional regulation is actually one of the criteria of the disorder.

And so people are angry, then they're sad and oftentimes in the context of relationships, so you Know, a person is volatile, sometimes to the point of violence, sometimes to the point of self violence. Become, you know, they're very. They don't know what to do with this huge amount of emotion and feeling in their body and their.

And so they hurt themselves, they cut themselves, themselves. So that's a very adolescent thing, but it doesn't have to be. There's plenty of borderline personality disorder that persists into adulthood.

So those are the ones, I think, that come to mind. How about you?

Well, what I will see in terms of someone expressing an emotional state, usually it might have to do with a lot of anxiety. So people get. This is a terminology that gets used a lot these days as being triggered.

So there's something that happens that triggers them into an earlier emotional state. State of just like, I feel really threatened, I feel really scared. Their anxiety goes up. They might have a panic attack, for instance, in the room.

So one of the things that I do kind of by rote is when I notice that starting to happen, the first trick is to get in control of your body, and you do that with breathing. Now, I do a lot of emdr, eye movement desensitization and reprocessing, which works with trauma people.

But when they get into it and they start to remember a particular trauma in their mind, there'll be a kind of a reenactment of it almost, and their body will start to react as if it's happening right in the here and now. So the idea of, like, take some deep breaths, you know, just get back in touch with you. Because I'll notice people holding their breath.

Sometimes I'll just say, breathe, you know, just. And where are you noticing it in your body? And describe it in your body. Where is it? Where is it? How deep in your body?

As if I'm pointing at my chest right now. But if it's in your chest, try to figure out the diameter. Is it really deep? Is it close to the surface? Is it in your back? Is it in your front?

How high up does it go? How low does it go? If it has a color, what color is it? You know, how sharp is it? Is it dull?

Is it difficult for people to articulate that?

Take a breath? No, they do beautifully. They take a deep breath, and I say, now look at it again. Because one thing they realize is that it shifts.

It moves, it changes. And with breath, it changes too.

And I'm talking to them in a real soothing kind of way and helping them relax and helping them kind of get back in touch with their body. Because their body's warning them like it's fight, flight or freeze. And I'm in danger now.

And so I'm ready to leave the room one way or the other, dissociate or get up and walk out or explode or self implode or something like that. So if you can get a person more regulated in that moment through getting in touch with their body, that's one way that I would work with it.

That's a, a primary first way that I would work with it. And then we can move on to more emotional stuff and more. But emotions have a physical manifestation always.

So if you, if you go with the body first, that's the, that's the best way to do it.

You're very good at what you do, I would imagine. I've never worked with you, but I just, I know you. We're going to start. Yeah, your voice already is like, oh, it's just so.

But so on my end, medication management is what my piece of the puzzle is. And so there are times in which people are unable to get into the entry into trauma therapy.

And I was thinking actually while you were talking about substance use disorders, when somebody is in early sobriety, first becoming sober, they're all over the place, very difficult emotions and usually very minimal emotional regulation skills. Because the substance was the emotional regulation skill.

Yeah.

And, and so the person feels very chaotic, very, you know, very out of control and very scared and they want something to help them, you know, medication wise. And so there's working with somebody with where they're at.

It's hard to have somebody who's very dysregulated and chaotic to, you know, get into trauma theory. And oftentimes at the, at the root of substance use is some sort of trauma.

Let me ask you a question about this now.

So someone who has a substance problem, so say they're drinking too much or they're smoking a lot of pot or other substances as well, and they've stopped, they've decided to stop. They come to you for medication. They say, I'm having these really strong feelings.

And they want for instance, Xanax or something that'll suppress those emotional states versus an antidepressant. I mean, how do you make those distinctions? What do you do with that?

Well, so I work with a substance use rehabilitation residential program where the person is in, you know, in the, in the residence for 90 days. So three months. This is Dawn Farm.

And in that space there's limitations just on what we will use in terms of medications because of the guidelines of that particular program. And this is kind of a. I guess it's controversial in addiction medicine about how to work with somebody in early sobriety.

So in this case, I use non controlled substances.

So medications like clonidine and prazosin are, they're blood pressure medications, but they impact the adrenaline components of the, of the sympathetic nervous system.

So I've heard of Klonopin.

Klonopin is a frequent confusion, but Klonopin is a benzodiazepine. So that is a controlled substance. Okay, okay. But clonidine.

So that distinction between a controlled substance versus uncontrolled substance is what. How would you define that?

Well, it's already defined. So there's certain, there's certain medications that are, I mean, I don't know it by the. Controlled by the dea.

So the dea, the Drug Enforcement Agency, has determined that certain things such as Xanax are controlled substances based on the potential for, for physical and mental addiction to the substance. So something that is a level one drug is an illegal substance, such as cocaine or meth or whatnot. So those are not used in medicine.

Level 2 controlled substances are like Xanax. Adderall is a stimulant medication. Opiates are a level two controlled substance, and it goes down to level five.

And the, the higher the number, the less potentially addictive something is. So we don't, you know, we don't use.

But there's certainly a line of thinking in addiction medicine that like using methadone for, for withdrawal from heroin or from fentanyl. Methadone is a, is a level 2 controlled substance, but it's a replacement for the more dangerous. It's not used super often anymore.

But Suboxone, same thing has a controlled substance component to it. So there's a thought in stimulant use disorder.

So methamphetamines, which is a huge problem, that using a low dose of a prescription stimulant like Adderall or oftentimes Vyvanse can be helpful for the person. But, but again, these are clinician decisions based on the presentation of the person.

It's always important for the person to learn emotional regulation, but it's a steep hill to climb when somebody is first sober and usually, at least when I'm seeing them. There's legal trouble, divorce, family situations, custody issues, lots and lots of housing issues.

There's a of lot, lot to deal with, and it can be overwhelming.

It's one of the dilemmas of substance use.

When someone gets into recovery of some Kind or another, their brain starts to get back online and they're starting to have all their emotional states again that were so uncomfortable to begin with that they were using to cover those up or to deal with those. And they've got the consequences of usually years of use.

So often there is financial damages, relational damages, could be legal, could be medical, could be any number of things. You know, so they've got to find a way to kind of navigate through all of that while they are not.

Using their coping well. And so the therapists, they're social workers at Dahn Farm, but there's do a wonderful job at pretty much modeling.

I mean, so if somebody's having a custody issue, then it's sitting down, allowing the person to have a pretty volatile reaction to whatever the situation may be, as long as it's within reason. I mean, you know, somebody is throwing chairs around or getting violent, and that's a problem.

But yelling, you know, scream, whatever it may be, then coming down from that, because as you were talking about with trauma, when somebody's so emotional, there's so many chemicals that are flooding and they're flooded. And so there's really not an ability to do rational problem solving when you're at a level 8 or 9.

So you need to come down to a level 4 or 5 or whatever it may be to be able to start to do, you know, the problem solving and in this case, the logistical stuff about contacting your lawyer or, you know, contacting the court to understand what is needed from you.

And so it's helpful to have like the other model is a peer recovery coach who can kind of help to facilitate or kind of walk beside when somebody is beginning to do that type of thing and somebody who understands and has been there as far as the difficulty that happens with processing those things because people get overwhelmed and then they drop out of treatment, they're like f this and they go out and use.

Yeah, that's why relapse rates are so high in those first. It sounds ridiculous, but it's true. The longer you can stay sober, the more likely you are to remain sober.

But that if you can get through those first, you know, that first month, those first three months, that first year, your odds, each segment you get through, it just gets better and better and easier and easier.

The other kind of work that we look at is to do, you know, what age were you when you started using and finding out really what's going on to help somebody find that spot and do the parts work.

Then, you know that I started Using at this point because I didn't have any friends, or I started using it at this point because I was really scared or I was. This helped me connect with people, or I was so sad all the time. And then I started drinking and I was happy, you know, whatever that was.

That emotional state that seems so intolerable. To be able to understand that part and to bring that in and to understand that, normalize it, like, yeah, I think you're right.

I think at that point it was intolerable. And now it's 10 years later, it's 20 years later, it's 30 years later. Maybe that same condition doesn't exist.

And maybe it's okay to have some of those feelings because we have other resources for you now. There's other ways to deal with this.

And to give a shout out to the idea of kind of primary prevention. I mean, working with somebody who is having difficulty managing emotion as an adolescent or really anybody.

But before, because alcohol and drugs become very attractive to somebody who is feeling very internally chaotic because it's gonna be helpful when the person first starts the drink or the drug can be helpful and is for a person who's feeling very. And this is most frequently, I would say, in adolescence.

So if we as clinicians can really help support the development of emotional regulation, of dealing with difficult emotions, providing, facilitating, developing the skill sets to be able to do that. The possibility of preventing years and years of just chaos and damage from the use.

I mentioned earlier, or maybe it was in the previous segment of this that I've been attending this symposium. And this morning there was a keynote address that was by the Surgeon General of California.

And in a previous episode, we talked about ACEs, Adverse Childhood Experiences. And the higher your score is, the more likely you are to develop all kinds of different issues.

Medical issues, psychological issues, emotional issues, relationship issues.

She's implemented a way to do screening with kids as early as early childhood to see how many aces they have and to provide with them for them this resiliency package of wraparound services that works with the child and with the caretaker so that the child has a firm connection with that caretaker.

So cool.

It's amazing. And she's starting to export this. She said Utah, Tennessee, there were two or three other states that are working on trying to get the same.

Michigan, Michigan, not Michigan.

Yet she didn't mention Michigan. I'd love to see it here. But basically that it is something that they're doing longitudinal studies now and they're seeing these kids flourish.

These are kids that would have developed into real problems in the culture, in the society of all sorts of things. And to have them as really productive members of society who are happy.

Yeah, which is important. And that's the reason that the research is important, the program development is important, the funding that goes into that type of thing.

Because this stuff costs money. I mean, it definitely costs money.

But the prevention of the treatment centers, the jails, the prisons, the amount of crime and of generational repetition of trauma that happens, I mean, the amount that. That costs us as, you know, as a species, as a society is enormous.

She quoted the number of $14 trillion is what it's cost us to have people with.

And invariably it's people with really high ACE scores who didn't have access to any kind of treatment, any kind of way to deal with what's going on with them. So it's. Yeah, the cost of addiction, crime.

Yeah, this is such an interesting direction that we've taken. But, you know, so when you.

When you speak with people, and I haven't done a lot of forensic work, meaning working with somebody who's committed a crime, and the crime, you know, may or may not or is being evaluated whether or not there was a mental health issue involved.

But, you know, when you work with folks who have done some really terrible things, they're oftentimes very like, nor, you know, very normal in the interaction. Very nice, even very like, pleasant.

It's really, you know, at the times in which they have become so dysregulated that, you know, for whatever reason, whether it be drugs or anger or that the. That the crime happens, that the violence or the, you know, the.

And that this is by no means meant to excuse that, but it does provide a sense that the treatment or the development of emotional regulation skills is the way to manage difficult emotions. And in those states, people make very rash and impulsive and bad decisions that cause harm to people.

Yeah, yeah. You can see people have that sense of an emotional state kind of taking over the rest of their. All the rest of their executive functioning.

And all of a sudden there's a crazy person driving the bus, basically.

I would say another really big issue that may be more prevalent in our listening base of people that they know kids is self harm. So lots of teens, tweens, I would say probably 11, 10, 11, 20, 12, 13. And I wonder what the statistics are now.

I mean, at a certain point it was just all over. There was so much of it that. That seemed to be sweeping the nation. And that is distressing.

Certainly for parents, it's distressing for the, for the child and repetitive self harm, you know, once it starts and it kind of takes hold can be much more difficult to treat or to. And by treating it it really is trying to facilitate the regulation of very difficult emotion and not self harming in that.

And that can be much harder to treat if it's gone on for a certain amount of time.

It used to be seen as someone's cutting themselves. They want attention. And what the truth is is they're trying to avoid another emotional state by doing the cutting.

They're trying to allow themselves to feel something so they don't feel something else. Sometimes that's dissociation like they feel. And all of us dissociate a little bit.

Some of that is completely normal where you're driving down the street and you realize you've been in your head and all of a sudden you've driven 10 miles and like did I pass my exit? I have no idea. You know, I've just been. So some dissociation is. Is completely normal.

But to dissociate to the point where you feel like I don't feel real anymore or this doesn't feel real anymore, those kind of states, sometimes people will cut to try to break that sense to bring themselves into the here and now, bring themselves into their body.

So one way of dealing with that is encourage people to hold an ice cube in their hand because it does a similar thing, but it doesn't leave a scar.

So here we go.

A Psycho Delicious Conversation is meant for educational and entertainment purposes only. It is no substitute for therapy and should not be treated as such. If you feel a need for real therapy, you should consult your local provider, Google “therapy” or “therapists” in your area. Check with community mental health or a suicide hotline if you are feeling suicidal. Mike, Morgan and Melissa welcome your questions, feedback or dilemmas. Feel free to send your emails to psych.deelish@gmail.com that's P S Y C H dot D E E L I S H at Gmail dot com. The views expressed on this podcast are solely the opinions of Mike Stratton, Morgan Bowen and Melissa Black and do not reflect the views or opinions of any site broadcasting this podcast. Replication of this podcast without written permission is strictly prohibited.