602- Emotional Dysregulation in Adults: Managing Triggers & Co-Occurring Conditions  🔗 **Source:** [602- Emotional Dysregulation in Adults: Managing Triggers & Co-Occurring Conditions](https://share.snipd.com/episode/f8901369-bab8-4a4a-b4b4-1e4ea396b790) ## Highlights - **Reactive Emotional Snowball Explains Prolonged Distress** - Reactive responses to distress (worry, rumination, avoidance) initially reduce intensity but ultimately prolong suffering. - Doug Mennin compares this to a snowball rolling downhill that gathers dirt and hardens, making negative moods heavier and options less clear. Transcript: Doug Mennin This can happen when we hold our pain and struggles in our mind, repeatedly returning to them in too much reflection, and take unhelpful actions. Emotional dysregulation defines many conditions, as Annie mentioned, in adults, including ADHD, post-traumatic stress disorder, major depression, and generalized anxiety Disorder, and can also happen, as was noted, when we're feeling distress from economic uncertainty, medical illness, marginalization, and just relentlessly feeling intense emotions. Reactive responding is a type of emotion dysregulation when we want to fix or solve or make disappear our distressing emotions. They often prioritize distracting, avoiding, overfocusing, or withdrawing from the intensity of the emotional experience, even if it interferes with what is important to our happiness And obligations to our relationships, work, or school. To understand what's going on around us and within us, it's natural for us to focus our attention and rely on our senses to receive information about situations and personally relevant Goals. But one way we can respond reactively is with inflexible attention to different parts of a distressing experience. For example, our attention can become overly drawn to cues for safety or threat or loss, causing us to miss other important parts of our lives and our experience, like possibilities For reward, engagement, and opportunity. Another common way we can respond reactively in moments of distress is with spiraling thoughts. Distress leads us to talk to ourselves in ways that we hope might reduce the distress in the short term, but in actuality, it worsens and prolongs our suffering. And in particular, worrying often helps in the short term to create the illusion that one can control anxiety by reducing future uncertainty. Rumination can seem like a form of problem solving as we pour over possible solutions or responses to something that did not go well. And self-criticism is common in response to having become emotional in the first place, or perhaps in response to one's lack of assertiveness or dependency upon others. We also can try to dampen our emotional experiences to gain control and safety with our behaviors. For instance, we may ask confidants or loved ones for reassurance in troubling times when we feel unable to tolerate our emotions and hope that others will tell us that everything will Be okay. Distress can lead us to reduce contact, to isolate, to avoid people, places, or active activities when there appears to be no possible solution to an actual perceived problem. We might also withdraw to be unachievable or feel frozen and unable to take action at all. Conversely, we can try to stimulate our experience to release or gain excitement through our behaviors. For instance, we may drink to feel pleasure or more relaxed after a long day at work. React responding occur rapidly in moments of distress. To illustrate this, let's imagine a snowball at the top of a hill. At first, it's clean and pure, like our initial emotional response. As it rolls down the hill, it gathers dirt, twigs, and ice, much like we intentionally distract over a focus and worry and ruminate or self-criticize in attempts to control or reduce Emotional intensity. Over time, these reactive patterns become rigid and limiting. We feel stuck in prolonged negative moods, and new possibilities seem out of reach. By the time the snowball reaches the bottom, it's heavy, dirty, and hardened. ([Time 0:05:17](https://share.snipd.com/snip/c085536c-942b-47c5-b84b-c021057694fb)) - **Catch Emotional Triggers Early With ERT Skills** - Train emotion regulation by noticing emotions early and using skills to disrupt the cascade before it escalates. - Mennin describes Emotion Regulation Therapy (ERT) taught in trials to catch the 'snowball' near the top of the hill. Transcript: Doug Mennin Noticing our emotions is the first skill, to understand the message they're trying to relay. Then finding the ability to shift and sustain our attention on all parts of our experience, as well as increasing our ability to view our experiences from different perspectives, And subsequently taking action from a clearer mind. Using these skills will help us catch our as they roll. Eventually, we even catch a snowball at the top of the hill before it begins to roll in the first place. I just want to say that the training I'm going to talk about is based on our ERT therapy that we have tested in over 10 clinical trials, including three randomized control trials shown Here, with many populations of individuals suffering from different conditions, struggling with different contexts, and we've offered it in different lengths and modalities. ([Time 0:10:57](https://share.snipd.com/snip/2c9fd7ea-0075-4aff-a7d1-36a20c1e5c83)) - **Emotions Are Motivational Signals Not Problems To Erase** - Emotions function as motivational signals that pull toward safety or reward rather than mere feelings to eliminate. - Mennin frames emotions as action urges: fear signals avoidant safety pulls, interest signals reward and approach. Transcript: Doug Mennin Even difficult emotions help us survive, navigate the challenges of life, and understand what matters most. While it's natural to wish we could eliminate painful emotions, they also guide our relationships, decisions, and goals. Without emotions like joy, love, anger, or sadness, much of what gives our lives meaning would be lost. Emotions are often accompanied by a desire to do something, which we call an action urge. For example, sadness may create an urge to withdraw, to protect ourselves from further loss. Importantly, an action urge does not force behavior, but pulls us in a certain direction to act. It's informative. In this way, emotions signal our motivations. Emotions are signals to act which reflect our momentary motivations or pulls to survive and protect ourselves when necessary and to thrive and advance ourselves when possible. Let's explore the purpose of some of the most often reported emotions. Remember, we can think of emotions as a motivational message signaling us to act in ways that can benefit our survival, but also help us prosper in our environment. For example, can help us prevent future harm or danger. Sadness signals an important loss or unreachable goal, allowing for disengagement and conservation of energy. And interest signals increased attention to potential reward. ([Time 0:13:51](https://share.snipd.com/snip/bb745895-f169-4668-8c2c-764b9c8be3ec)) - **Observe First Then Allow To Broaden Attention** - Use mindful attention skills to shift and broaden focus when distressed: observe then allow before acting. - Mennin teaches anchoring attention (breath or tactile object) to notice body sensations, sounds, and environment to avoid tunnel threat focus. Transcript: Doug Mennin This involves noticing our emotions, considering the information they convey, and determining the most effective course of action in important moments without relying on reactive Responding. To help us gain this clarity to take counteraction, we can learn mindful regulation skills, which we will explore now. All of the mindful regulation skills in ERT integrate principles of emotion regulation with mindfulness meditation practices. Mindfulness is defined as paying attention in a particular way, on purpose, in the present moment, non-judgmentally. ERT involves mindful regulation techniques that begin with two mindful attention skills followed by two mindful perspective-taking skills. These skills help us respond counteractively instead of reactively through noticing our emotions and motivations and responding to them more intentionally in times of distress. Let's more deeply explore intervening on our attention. And to make effective choices in daily life, we rely on focused attention in our senses to gather information about a situation, and this helps us weigh potential rewards and opportunities Against risks and effort when deciding how to act. However, during distress, emotions and urges can become intense and confusing, making it harder to determine the best course of action. In these moments, our attention may become overly focused on cues for safety, threat, or loss, causing us to overlook other important cues for reward, engagement, or opportunity. Mindful intention is the ability to bring focused and flexible attention to the most relevant parts of our experience, including moments when we feel pulled towards safety, reward, Or both. It allows us to place our attention where it is most useful and shift it when new information appears. Strengthening mindful attention helps us notice emotions as they arise without adding more mental activity. The first mindful attending skill is observing. Observing refers to the ability to shift and broaden our attention. At times, a narrow focus is helpful, especially when we need to determine whether a threat is present. However, broadening our attention allows us to notice more information in our environment and within ourselves. Effective observing involves focusing on relevant parts of our experience while remaining flexible enough to shift our attention when new information appears. This allows us to intentionally place and maintain our attention and gently bring it back when it wanders. The observing skill is based on mindfulness meditation practices that train us to anchor our attention on breath, move it to different areas of the body and environment, and gently Return it to the breath when the mind wanders. Although simple, the skill strengthens with practice and becomes easier to use during stressful moments. In the moment observing uses the breath as an anchor to increase flexible awareness of your body and surroundings. By shifting and broadening your attention, you can take in more information from your environment and respond more effectively in the moment. With practice, this skill can become more automatic, like riding a bike. ([Time 0:20:30](https://share.snipd.com/snip/6601271a-38d3-4978-a18c-dc3fa61b7467)) - **Allow Painful Feelings Using A Pause Cue** - Practice allowing by sustaining attention on uncomfortable sensations instead of escaping them; use a cue word like 'pause' to anchor. - Mennin emphasizes allowing as action: stay present with unpleasant pulls without endorsing harsh self-judgment. Transcript: Doug Mennin Allowing is the second mindful attention skill that builds off of observing. Allowing represents the ability to sustain our attention on all parts of our experience, even when some aspects feel like they're in conflict. And when focusing on some of those parts might be emotional, we feel the urge to disengage. All of us encounter situations in daily life that bring up powerful emotions, such as worrying about an exam, financial insecurity, or rejection. The desire to escape painful emotions is deeply human. Allowing does not mean that we have to like or want our emotions. Instead, allowing means attending to and embracing our emotions and sensations, even when they feel intense or uncomfortable. We think of allowing as an action rather than simply as an attitude. When we practice allowing, we sustain our attention on what is happening right now, even if it is unpleasant, so we can stay in contact with the full range of our emotional experience. Allowing practice helps us to sustain attention on the full complexity of our emotional experience. Like the orchestra metaphor introduced earlier, allowing helps us focus our attention so we can hear all the instruments, whether they are loud or soft, pleasant or unpleasant. This allows us to broaden our attention rather than narrowing our focus and missing important parts of the experience. In the moment, allowing involves sustaining attention on all aspects of that emotional experience. And once again, we would start with the observing skill, breathing and noticing, taking the breath, noticing the body, noticing our environment close and far, coming back to the breath, Then noticing our mind, noticing where the intensity of your mind are of our emotions and how they might be in conflict with each other. ([Time 0:24:22](https://share.snipd.com/snip/c1d3c934-910e-4c44-9163-83de9e23b838)) - **Create Mental Distance With Imagery Techniques** - Use distancing imagery to create mental space from dominant thoughts or emotions before choosing action. - Examples: imagine yourself as a rooted tree, place emotions on branches, take thoughts for a car ride, or assign colors on a palette. Transcript: Doug Mennin Mindful perspective-taking skills involve using our imagination and inner dialogue to relate differently to our experiences. They ask us to pause and intentionally use images or words to make sense of what we're feeling. And self-criticism also involve this kind of mental effort. They are forms of repetitive thinking that can create a temporary sense of control or predictability when emotions feel intense. That's often why they become our default response. However, over time, these patterns tend to backfire, increasing distress rather than reducing it. And it can interfere with the useful information emotions are trying to provide, such as signaling what matters most to us or what action may be needed. When we get stuck in these reactive loops, it becomes harder to see clearly and choose our next steps wisely. Hence, learning mindful perspective taking can give us an alternative. Distancing helps us see the bigger picture. In moments of distress, one emotion or one thought can dominate our attention, as if it's the only instrument playing in an orchestra. Distancing reminds us that there are other instruments playing as well besides that tuba. When we see the broader context, you're better able to focus on what truly matters rather than being pulled entirely by the emotion of the moment. One approach is invoking the tree. This means calling up an image of yourself as a steady, rooted tree that is grounded when emotions feel intense. You might imagine placing your emotions and motivational urges on the branches of the tree. You can also picture self-critical, ruminative, or worried thoughts as existing outside the tree. The goal is to clearly separate your core motivations from your active thought patterns. To gain distance in time, you might imagine emotional crisis as passing storms in a forest. Practice in-the distancing is to imagine aspects of your emotional experience and take them on a car ride. Take a moment to ask yourself if you were driving the car or if one of your motivational poles is behind the wheel or seeing how reactive responses are serving as backseat drivers dictating The commands. You could also try grabbing the jumble of thoughts of things you're having in your mind and throwing them against the wall like splattered paint. This imaginal act of decluttering your mind might help you gain some physical distance from thoughts and emotions and spread them out to help you to observe them all at once. Lastly, you could try placing aspects of your emotional experience on your key ring or as items in your bag or wallet. Another example would be for someone working as an artist who might choose to assign different colors in a palette to their emotions, motivational pulls, and thoughts. This could help the person observe their emotional experience without letting it get in the way at work. You can try any of these in-the versions of distancing or even create your own. It helps you gain perspective on your emotional experience. As with prior skills, distancing builds on observing and then allowing, all for the purpose of gaining clarity in a moment to take effective counteraction. ([Time 0:26:37](https://share.snipd.com/snip/38b1a424-06d7-439e-9b22-c8814609a023)) - **Use Small Genuine Reframes Not Forced Positivity** - Reframe using courageous, compassionate, or curious self-statements with partial buy-in (about 51%) rather than forced positivity. - Mennin suggests bringing supportive reframes on a business card or keys to prompt real-feeling shifts. Transcript: Doug Mennin Reframing involves deliberately changing how we interpret our emotional experience. When we shift how we view a situation, our emotional responses often shift as well. Reframing serves an antidote to reactive habits like worry, rumination, and self-criticism. Rather than automatically accepting our first interpretation, we can pause and reconsider it. When strong safety pills show up or when we're already in the middle of reacting, that's usually the moment we most need to remind ourselves of our own strength and soften the fearful And self-critical thoughts. Reframing allows us to take a courageous, compassionate, or curious perspective towards ourselves in moments of distress. For example, a courageous perspective might sound like saying to yourself, I am capable of getting through this moment or I can take this action. As for how to get a compassionate perspective, you might think back to a time when a friend or loved one reminded you of your strengths, kindness, and understanding when you felt discouraged Or defeated. Interestingly, many of us are much better at offering that compassion and courage to others than to ourselves. Think about a time when someone in your life was feeling stuck or down on themselves. You likely said something encouraging and validating, or something that helped them feel less alone. If reframing feels difficult, start there. Ask yourself, how would I speak to someone I care about in this situation? And then try offering that same tone to yourself. Also, see if you can be curious. Imagine what would be new or possible in taking an action towards a desired goal. The in-the reframing skill involves speaking back to our worries, rumination, and self-criticism. When you encounter an emotional moment, these courageous, compassionate, or curious reframes may offer potential ideas for in-the reframing. Further, these statements can be added to the in-the distancing skill. For example, you might imagine a courageous or compassionate person speaking to the branches of your tree. You also could throw on the wall courageous and compassionate reframes alongside the worried and self-critical voices. Alternatively, you may choose to bring a reframe with you on your keys or write a reframing statement on a business card to carry it with you throughout the day, tapping on it to remind You of its meaning. ([Time 0:29:32](https://share.snipd.com/snip/40bc9e8a-7ba7-4079-bf1e-8c1c921397fe)) - **Follow The Observe Allow Distance Reframe Sequence** - Apply the four in-the skills in order: observe, allow, distance, reframe, then take counteraction aligned with values. - Mennin stresses practicing these steps so action follows clarity rather than reactive urges. Transcript: Doug Mennin So step one, observe or breathe and notice. To implement the observing skill, we can just breathe and notice our bodily sensations, sights and sounds, near and far, and then bring attention back to our breath. Step two, allow or pause. Should observing not be sufficient or if we find it difficult to remain in contact with the distressing experience, allowing can help us to face pain rather than trying to fight it. To implement the allowing skill, we can say the word pause or allow. Step three, distance to gain perspective. The next step involves gaining distance in time and space. This could include invoking the tree, traveling the car, or bringing it with you, or any other metaphor that is helpful to you that gets at this idea of distancing. Step four, refrain. Speak back. If it is difficult to keep a distance perspective, we can bring to mind a reframing statement to remind ourselves of our strength and to soften our self-judgments to shift the way we Feel about the situation or our experience. And finally, we can take counteraction. The in-the skills are meant to help us gain emotional clarity and make the best decisions about action from a perspective where you can clearly hear the motivational message. You can then decide which action you want to take. ([Time 0:32:01](https://share.snipd.com/snip/71bc6099-3f8a-45c3-b3f6-9d568cab21a2)) - **Use Body Signals And Safety/Reward Pulls To Identify Emotion** - If you can't name an emotion in the moment, track bodily and behavioral signals (tight chest, wanting to leave) and ask whether safety or reward pulls dominate. - Mennin recommends using images (magic wand/time machine) to imagine shifting pulls and decide an action. Transcript: Doug Mennin It's more about signaling in context. So one thing we can do is find cues and triggers in our environment and ourselves. It's kind of common things that plug us in. And like, for instance, we might not know, but we might feel a sense of tension in our hand. Like we might feel like we're squeezing our hand, or maybe we feel like we get a little drop in our stomach, or maybe we just notice a little bit of neck tension, or maybe we notice ourselves Kind of wanting to get out of a conversation or walk away as we heard some withdrawal kinds of feelings. So any of those can be signals to this being an emotional moment. We might feel sort of arising in ourselves. We don't have to really identify what the emotion is. I think we have this feeling that we need to know the story of our emotions. But discrete emotions are really constructions that we can come up with to make sense of things. But in the moment, it might be more helpful just to know the ways you're feeling pulled. And I mentioned these two systems of safety and reward, and all emotions break down to those two systems, but it's not an either or. So you don't have to ask yourself, am I feeling, do I want safety? How much do I feel in any moment? Like I want protection, like I want to pull something away. How much do I want to feel a sense of reward? And we can just imagine those even as images coming close to us or farther away. Then we can try to create placement for it. Almost if we had a magic wand, if we waved a magic wand, what would we be thinking in doing this moment? Or if we had a time machine or go into another dimension, like what, how, you know, if we could be where we want to be, if we could pull that safety away further and the reward closer, a little Closer, what would our thoughts and actions be like? So then we can, what about if we just did those thoughts and actions without actually being there? And that's a context for change. ([Time 0:38:02](https://share.snipd.com/snip/c582ef59-d871-4bac-9ac4-52d9f87c7c36)) - **Regulate Yourself First Then Teach With Characters** - Caregivers should regulate themselves first (put on your oxygen mask) before coaching others and use simplified characters or objects to teach kids the skills. - Mennin suggests using Inside Out characters, pets, or tactile anchors as relatable cues for children. Transcript: Doug Mennin That's a great question. And so some of the trials that I mentioned, we work with caregivers, particularly of those with cancer, so family members of someone with cancer. But this is true for any type of caregiver, whether you're caring for a child particularly or as much older or a partner. And, you know, I think it starts with the metaphor of like, you know, the oxygen mask coming down. Right. You have to put your oxygen mask on first before your child. So the first step in helping someone with their emotion regulation is, is, is managing your own. So how do you ground yourself? And so, and that doesn't have to look exactly the same as your child or the other, but you have to start with yourself and, and understand where you need to be. And then absolutely helping a child in this way, you can use simplified. The example I gave came from helping an adolescent was having trouble before a sporting game. And so by using like a sense of something felt, it was easier. But also in the more elaborative, those perspective skills, you know, often we can call up, you know, characters and, you know, we, people may be familiar with the, the, the movies inside Out. Right. So we, we should, we all have a sense of like internalized characters. They're not exactly what an emotion is, but there are a representation of emotions. There are ways that we understand emotions and they become like, like objects or characters in our mind. And that's very common for us all to do, even as adults. But children might respond well to making that the character, like their favorite cartoon character can talk to them about ways to take steps towards more courage. Or they could talk to them about, and even things like their dog or their cat that they love. Like, what do they have to say to them? And so there are ways that you can draw things in that don't have to be as elaborative, that can be more in their own experience. ([Time 0:42:29](https://share.snipd.com/snip/4f1a0b7f-52a6-42a9-98c8-101dbbdf8608)) - **Perseveration Survives Because It Feels Controlling** - Perseverative loops like worry and self-criticism persist because they provide a false sense of control and predictability. - Mennin argues you can't eliminate them fully; instead add alternative skills to modulate and reduce their reinforcement. Transcript: Doug Mennin It's like a fly on the wall. And we wouldn't have all this. We wouldn't be talking through a little video machine, like some futuristic thing 30 years ago, right? If it wasn't for those abilities. But those same abilities make us go into the future and try to make sure something bad doesn't happen or reach into the past and try to figure out what the bad thing did happen and make sure It doesn't happen again. Or to see ourselves in perspective and be like a tough coach and tell us to do better. Those are really natural responses, but it's really important to realize that all those perseverative responses, ways we get caught in our thinking and beliefs are all motorized By those feelings. They're all meant, they're all, they all come up online and get reinforced because in a weird way, they give us a sense of control and predictability, even though I don't feel good. And that's where the cycle is. The cycle is a negative feedback loop. The more that we think, same way that we might have like a, you know, a charm or something that makes us feel like we're going to do well, or we, you know, there's certain thing we do when We fly a plane, if we're nervous, that makes us feel less anxious when the plane doesn't crash. We think that it worked, not cognitively, but we have this implicit association. And that's the same thing that happens with worry, rumination, self-crecisism, and other types of beliefs about ourself is that these get reinforced by a certain kind of function With emotions. And we go back to them and we go back to them. So it's hard to break the habit. But I think the key is you're not trying to undo that. You're trying to add some of these skills and shift your happiness. And when you do that, you will feel less of those other things. It's a bit of a rub, but when you try not to feel those things, they come back up very readily. So it's more about trying something different. ([Time 0:49:56](https://share.snipd.com/snip/6ab38fc8-8b87-4d6c-9ee2-c26ef944d354))