How to use emotional regulation coping skills

“The appearance of things change according to the emotions and thus we see magic and beauty in them, while the magic and beauty are really in ourselves.” – Kahlil Gibran

Emotion regulation is all about identifying, managing, and responding to emotions in a way that allows them to be useful and productive aspects of your internal experience. To “regulate” an emotion does not necessarily mean to make it disappear any more than it necessarily means to intensify the emotion. Depending upon the situation you are in and other contextual factors, it may be in your best interest to either calm an emotion or tap into an emotion more deeply.

Mindfulness enables you to become a more cognizant observer of your experience, allowing you to become more “tuned in” to what you are feeling inside. When emotions feel confusing, overwhelming, or paralyzing, they are not serving the healthy and productive function that those very same emotions are able to serve when used constructively.

It is important to understand that the emotion itself – be it anger, fear, sadness, or joy – is not the “enemy.” There is no such thing as a “bad emotion” anymore than there is a “good emotion.” Emotions can have theconsequence of making you feel good or bad, but it is often the interpretation of the emotion and the way that you respond to the emotion that creates this subjective experience.

For example, the emotion of anger can be experienced as “bad” when it results in lashing out inappropriately at other people or creating an internal state of feeling out of control. On the other hand, the same emotion of anger can be experienced as “good” when it is acting as a motivating force to urge you to stand up for yourself, protect yourself, or right a wrong.

Dialectical Behavior Therapy: Emotion Regulation

Consider integrating the following components of emotion regulation coping skills into your growing emotion regulation “toolkit:”

(1) Understand your emotions

Practice taking a step back from your emotional experiences and giving yourself the time and space to notice anddescribe what you are feeling. Choose not to immediately become swept away by your emotions, but rather mindfully take a pause and actually notice what you are experiencing. This might sound like a simple concept, but it is not easy. Reflect on the role that emotions have played in your life and make an honest self-appraisal of how well you have been able to truly understand your emotional experiences. Consider how your life might be changed for the better if you allowed yourself internal space to mindfully observe your emotions.

(2) Allow exposure to your feelings

The more that you choose (consciously or otherwise) to avoid your emotions, the more likely it may be that they will become persistent and simply wait around for you to acknowledge them and experience them. The idea is to carefully, mindfully, and gradually allow yourself to sit with uncomfortable feelings and truly experience them. When you create a story in your mind about your emotions being unacceptable or frightening, there is a natural tendency to avoid them at all costs. As you consider your willingness to experience your emotions, reflect on the following Robert Frost quote: “The best way out is always through.”

(3) Use counterconditioning procedures

The idea behind counterconditioning is that a response to a particular stimulus is replaced by a new response. This new response is intended to deter you from the stimulus. Systematic desensitization is one technique that falls under the counterconditioning umbrella. To use this technique, you basically learn to use relaxation and otherdistress tolerance techniques when faced with uncomfortable emotional experiences (e.g., fear, anxiety, sadness, anger, guilt, shame). Actively and deliberately practicing relaxation techniques directly in the face of distressing emotions allows you to reduce the sense of urgency that often accompanies painful emotions (i.e., urges to take immediate action).

(4) Increase positive experiences

Consider the saying “you are what you eat.” Try applying this same adage to your internal psychological experience: “you are what you think” or “you are what you do.” When your attention and conscious focus is consistently shifting toward negative, distressing, or unpleasant thoughts and behaviors, it is easy to see how your emotions might closely follow suit. Just as you are capable of creating an intense internal state of distress, you are equally capable of creating an internal state of peacefulness and calm. Actively direct your thought and deed toward positive and healthy endeavors. Choose to cultivate an attitude of gratitude and open your lived experience up to the light in the world, rather than the dark.

If you are struggling to consider how you might increase positive experiences, consider a few of the following suggestions:

  • Talk with a friend or loved one.
  • Take a walk or hike outside.
  • Take a bubble bath.
  • Listen to soothing or uplifting music.
  • Writing in your gratitude journal.

(5) Increase mindfulness of your current experience

When you choose to make contact with the present moment, you are simultaneously letting go of your attachments to the past and future. Mindfulness enables you to fully step into this moment – right now. Quite often, worries about the past and future take us so fully away from the present moment that we can begin to feel disconnected from ourselves and our lives. Check back in with yourself and tap into this moment in time. Are you basically “okay” right now? No matter how intense or unpleasant emotions may be in the present moment, it is guaranteed that they will pass. Remember that emotional experiences are temporary. Allow yourself to become a mindful and curious observer of your experience and you will notice that it is possible to have a new relationship with your emotions. They have no magic power over you that you do not hand over to them.

(6) Increase competence in using coping skills

Learning to effectively regulate emotions is like learning any new skill… it takes practice. Remember that the ultimate outcome of feeling that you are the “captain of your own ship” is worth it. Your emotions don’t have to take over your life or interfere with your important relationships when you learn how to understand, manage, and respond to your emotions more effectively. Become mindful of your own personal tendencies and emotional triggers. Notice what situations tend to prompt emotional responses in you. When you increase self-knowledge in this way, you are better prepared to competently and confidently employ emotion regulation coping skills no matter what the situation.

When you make the decision that it is worth it to you to consistently and actively apply principles of emotion regulation skills to your daily life, your experience with your emotions with naturally evolve. Many parents don’t raise their children with an “emotional how-to” book that encourages them to teach their children how to effectively identify and manage their emotions. Often times, when these basic emotion regulation skills are not learned in childhood and adolescence, it can make for an adulthood rife with emotional confusion or distress. There is no time like the present to learn to use your emotions constructively, allowing them to work for you rather than against you.

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Marra, T. (2004). Depressed & anxious: The dialectical behavior therapy workbook for overcoming depression and anxiety. Oakland, CA: New Harbinger Publications, Inc.

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The Goals that guide us!

The Goals That Guide Us

Setting objectives can guide us to well-being and success. Having a road map for the future is a key element to success.

“Not all who wander are lost,” they say, but for the great majority of us, having a road map for the future is a key element to well-being and success, however we choose to define it. This means setting goals for ourselves, and finding ways to achieve them. If you’re a wanderer, it might be time to realize the boundless utility of setting goals.

It’s simply a fact: when people have goals to guide them, they are happier and achieve more than they would without having them. It’s a brain thing. Achieving a goal you’ve set produces dopamine, a neurotransmitter responsible for feelings of pleasure. Reciprocally, dopamine activates neural circuitry that makes you eager to pursue new challenges.

Goals provide focus. With no guiding vision or plan, people tend to drift. Goals provide a measuring stick for progress. Goals enhance productivity. They bolster self-esteem. And most of all, goals increase commitment, so you’re more likely to achieve whatever you set out to conquer.

While it’s not a good idea to try to change everything at once, you can set goals in virtually any domain of your life, from your wardrobe to your church to your workplace.

Of course, a thousand mile journey starts with the first small step. And whether we’re embarking on the long trek of a mid-life career switch or the walk to the bedroom to finally organize that closet, it can be hard to gather up the motivation to make that initial step. While setting goals is in itself motivating, sometimes it’s just not enough. Here are some tried-and-true ways you can begin to move toward achieving your goals, and maintain resolve when the going gets rough.

  • Put your goals in writing.The act of writing down what you are going to do is a strong motivator. Writing down goals prevents you from leaving your goals vague. Be specific. Use action verbs. Let your goals have measurable outcomes. Specify completion dates. Also record what your reward will be for achieving the goal. Make a contract with yourself, then read it each morning and night. This will help you to be more committed your goal as each day passes. And while you’ve got the pen in your hand…
  • Make a list of obstacles.Think of everything that might stand in your way. Then decide what you can do about each obstacle. Design a plan to reduce the influence of each obstacle and increase the chances that you will be successful in reaching your goal.
  • List the benefits of achieving your goal.Knowing exactly what you will gain from reaching your goal is a strong motivator. Keeping my checkbook balanced will give me more spending money on the weekends. Walking a mile every morning will help me stay focused at work.
  • Identify subgoals.Break down complicated plans into manageable chunks. Be specific about what has to be accomplished. Decide what you are going to do, and when. Make sure each step is challenging but achievable, and that you have a complete plan of action. Then write it on your calendar and review it regularly.
  • Learn what you need to learn.If information or skill is keeping you from achieving your goals, determine ways to fill in the gaps, and build this into your action plan. Be willing to study and work hard to reach your goals. Think about how much time and effort will be required, and ask yourself whether you are really willing and able to do what is necessary. It is better to adjust your goals or your timetable than to proceed with a plan that is unrealistic.
  • Enlist the help of others.Find someone, a coworker or friend, with whom you share a common goal. Get someone to go to the gym with you, or to quit smoking with you, or to share healthy meals with you. A partner can help you stay committed and motivated. Look for role models, people who have already achieved the goals you seek to reach. Ask them for advice and suggestions. Find how they got where they are, and incorporate what you learn into your plan.
  • Visualize yourself having achieved each of your goals.The more real you can make your visualization, the better. Find a quiet place, visualize, write down your experiences afterward. Go through magazines and cut out pictures that represent your goal, then put them around the house. Provide constant reminders to yourself about what you’re working towards. Describe your ideal life in the future. Write a few paragraphs describing what you have accomplished, and how your life is better as a result. Use the present tense as if it is happening right here, right now. This is another way of making your vision real.
  • Get organized.When you are prepared and organized, you will feel better about your ability to reach your goals. Having information scattered in too many places makes you feel out of control and undermines motivation. Set up a filing system, set aside your workout clothes.
  • Reward yourself each step of the way.Let yourself feel good about progress you’ve made. Treat yourself to rewards that will give you a lift as you accomplish each subgoal on your road to success.
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Diagnosis: The Signs And Symptoms Of Obsessive-Compulsive Disorder (OCD)

As the name implies, the obsessive-compulsive disorder (OCD) is the kingpin of the entire category of disorders called obsessive-compulsive and related disorders. Obsessions are repetitive and distressing thoughts, urges, or imagery that are experienced as uncontrollable. Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to obsessions. These obsessions and compulsions are at times consuming (an hour or more per day). They create significant distress and/or interfere with a person’s functioning.

Ordinarily, obsessional thoughts, images, or impulses are not about typical, everyday things. Common obsessional themes are:

  • extreme and unrealistic concerns about contamination, and/or need for cleanliness;
  • repeated and excessive doubts, such as wondering if a door was left unlocked, or if a coffee pot was turned off;
  • the need to have things in a precise and particular order or arrangement (with intense distress or distractions if this order or arrangement is disturbed);
  • aggressive or horrific impulses, such as a desire to harm one’s child; and
  • disturbing sexual imagery, such as intrusive pornographic imagery.

These are the most common types of obsessions. However, any distressing, repetitive, uncontrollable, and unwanted thought can form an obsession.

Obsessions are not the same as hallucinations, which are a hallmark symptom of several other, rather severe, mental disorders (psychotic disorders). When someone is experiencing a hallucination, they are unaware that what they are experiencing is not real and a creation of their own mind. In contrast, people who experience obsessions recognize that the obsessions are generated by their own mind. This is true, even for people with limited insight.

People with OCD try to ignore or neutralize these intrusive thoughts, images, or impulses. In other words, they attempt to counteract or block these distressing and repetitive thoughts. One way people try to block or neutralize obsessions is with compulsions. Compulsions are recurring behaviors (such as repeatedly checking appliances or repeatedly washing hands) or repetitive mental acts (such as counting or praying) that an individual feels they must do in response to an obsession.

Compulsions serve to avoid or reduce distress. In some cases, a person may believe they must perform compulsive acts in order to prevent something terrible from happening. For example, a person may touch things only after they have all been bleached. They believe they must perform this act in order to prevent disease.

Children’s OCD symptoms are similar to adults. However, children may not ask for help. Therefore, it becomes their caregivers’ responsibility to identify these symptoms and seek treatment. While an adult may be able to tell you their rationale for the compulsive act (“I’m washing my hands so I don’t contract HIV”), a child may not be able to articulate this. Even though children may be unable explain the reason for their compulsive behavior, they may still try to minimize their compulsions in front of others.

The diagnosis of OCD includes an insight specifier to further refine the diagnosis. While it is true that obsessions and compulsions are based on inaccurate or irrational beliefs, people differ in terms of whether they recognize this fact. In other words, some people readily recognize and accept that obsessions and are not sensible. Nonetheless, this insight is insufficient to prevent the obsessions and compulsions. Other people lack this insight. They firmly cling to their distorted beliefs, despite evidence that refutes the validity of such beliefs. This lack of insight is important with respect to treatment. In general, people with poor or absent insight have a poorer prognosis for a full and complete recovery. However, the degree of insight can be quite variable. In one moment, a person may be well aware their beliefs are irrational. Later, when directly faced with a fearful situation, this insight may vanish completely.

There are three insight specifiers: 1) good/fair, 2) poor, or 3) absent/delusional. An insight specifier rates a person’s degree of insight about their disorder-related beliefs. For instance, some people realize that checking the locks, dozens of times throughout the day, is unlikely to affect whether or not a burglary occurs. This indicates good/fair insight. Someone else may believe that without this degree of vigilance a burglary is nearly certain to occur. This indicates poor insight. A small minority of people are absolutely convinced a burglary is certain to occur without rigorous checking of locks. These people demonstrate absent/delusional insight.

The presence of absent/delusional insight requires very careful diagnostic evaluation. Delusional thoughts are also a symptom of another category of rather severe disorders, called psychotic disorders. Therefore, is very important that the absent/delusional insight in an OCRD is not misdiagnosed as psychotic disorder merely because of delusional beliefs. Proper diagnosis is essential to receiving the right treatment. For example, the medications used to treat psychotic disorders are very different than for OCRDs. If the symptoms of OCRDs are misdiagnosed as a psychotic disorder, a person might receive the wrong kind of medication.

About 30% of people with OCD will also have a tic disorder at some point in their lives. For this reason, OCD has a tic specifier. This diagnostic distinction is made because people with tic disorder have different presentations of OCD than those who never had a tic disorder. Tic disorder is more common in males with childhood onset OCD (APA, 2013).

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What are Obsessive Compulsive Disorders?

Obsessive-compulsive disorders are a group of psychiatric disorders characterized by some combination of repetitive thoughts, distressing emotions, and compulsive behaviors. The specific types of thoughts, emotions, and behaviors vary according to each disorder within this group.

The idea of a spectrum of disorders with obsessive-compulsive features is nothing new. Indeed, evidence spanning over a 20-year period has continued to accumulate. This research supports the theoretical and clinical utility of grouping these disorders together. As research continues, the types of disorders included in this group may change. Moreover, our understanding of this obsessive-compulsive spectrum will continue to be refined.

The Diagnostic and Statistical Manual of Mental Disorders- Edition 5 (DSM-5; APA, 2013) places these disorders into a category called obsessive-compulsive and related disorders (OCRDs). The DSM-5 is a manual used by mental health professionals to diagnosis mental disorders. The primary purpose of theDSM-5 is to help clinicians reliably identify and diagnose various mental disorders.

Each disorder in the DSM-5 includes a list of symptoms associated with that disorder. The manual also includes additional features of the disorder (e.g., age of onset, family history, etc.). It further provides criteria for distinguishing the disorders from each other. This is particularly important as many mental disorders share similar symptoms. Accurate diagnosis aids clinicians to identify which people may benefit from treatment. Perhaps more importantly, it helps clinicians select the most effective treatment approach. Just as there are many cancers with different methods of effective treatments, so too are there many mental disorders with different forms of effective treatments.

The following disorders are included in the DSM-5 category called obsessive-compulsive and related disorders category (OCRDs):

  • obsessive compulsive disorder (OCD);
  • body dysmorphic disorder (BDD);
  • hoarding disorder;
  • trichotillomania (hair pulling); and,
  • excoriation (skin picking) disorder.

In addition, several other “lower order” disorders are included in this category:

  • substance/medication-induced obsessive-compulsive related disorder;
  • obsessive-compulsive and related disorder due to another medical condition;
  • other specified obsessive and compulsive and related disorders; and,
  • unspecified obsessive-compulsive and related disorders (such as body-focused repetitive behavior disorder and obsessional jealousy).

Decisions about which disorders are grouped together in the DSM-5 are based on whether there is some underlying relationship between two or more disorders. In other words, do these disorders have something in common with each other? With respect to mental disorders, there are several things that suggest a similarity between disorders. Some examples are: symptom similarity; frequency of co-occurrence (called comorbidity); the onset and usual pattern of the disorder; genetic risk factors; environmental risk factors; neural substrates, biological markers; and treatment response. To date, the strongest evidence for similarities among the OCRDs comes from symptom similarity, as well as the high degree of co-occurrence (comorbidity) among the disorders.

It is interesting to note the rationale used to organize the entire DSM-5 manual is similar to the rationale used for grouping the obsessive-compulsive and related disorders (OCRDs) together. For example, the chapter on anxiety disorders precedes the chapter on OCRDS. The purpose behind this placement is to inform clinicians there is a similarity between anxiety disorders and OCRDs. While anxiety is a key feature in OCRDs, there are enough unique differences between anxiety disorders (e.g., panic disorder, social phobia) and OCRDs to justify a separate category.

To recap, the hallmark features of OCRDs are repetitive thoughts, distressing emotions, and compulsive behaviors. Although there is symptom similarity and overlap, each disorder has its own unique features. These differences affect treatment decisions in several ways: 1) the choice of treatment type; 2) the ordering, and pacing of therapeutic interventions; and, 3) setting realistic goals and expectations for clinicians, patients, and family members about treatment progress. These differences are discussed in the treatment section.

 

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What is Obsessive Compulsive Disorder

What is an Obsessive-Compulsive Disorder?

Obsessive-compulsive spectrum disorders are a group of similar psychiatric disorders characterized by repetitive thoughts, distressing emotions, and compulsive behaviors. The specific types of thoughts, emotions, and behaviors vary according to each disorder.

What is an Obsessive-Compulsive Disorder?

Research indicates that substance use disorders and OCD frequently occur together. Prevalence has been highlighted for alcohol, meth and cocaine.

Research IconFor more information:

Some examples of these disorders include:

1. Obsessive-compulsive disorder (OCD).
2. Body dysmorphic disorder (BDD).
3. Hoarding disorder.
4. Hair-pulling disorder (trichotillomania).
5. Skin-picking disorder (excoriation).

What are Obsessions?

Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted. Common obsessional themes include:

  • Concerns about contamination.
  • Harm happening to oneself or others.
  • Intrusive sexual thoughts.
  • Religious preoccupation and rituals.
  • Repeated and excessive doubts about safety and security.
  • The need for symmetry and order.
  • Perfectionism.

Because obsessions are unwanted, they create anxiety and distress when they occur. To reduce this discomfort people perform compulsions.

What are Compulsions?

Compulsions are behaviors or mental acts that a person feels “driven” to perform in response to an obsession. Common compulsions include:

  • Excessive hand-washing.
  • Re-ordering objects in a specific way.
  • Checking on safety and security (a door lock, an electric appliance).
  • Counting (aloud or silently).
  • The ritualistic repetition of prayers in one’s mind.

Obsessive-compulsive spectrum disorders share many similar features. However, there are also important differences. The following example illustrates the importance of these differences.

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