a guide for counselors to address a client’s rage at any ... · 1) understand the experience of...
TRANSCRIPT
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A Guide for Counselors to Address a Client’s Rage at Any Age: Emotional Intelligence and the Development of
Emotional Regulation
AACC World Conference
Pre-Conference Workshop
Nashville, TN
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Introductions
Anita Knight Kuhnley,
Ph.D.E. John Kuhnley, MD
Photo Credit: Brett Hartley Photo Credit: Olan Mills
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Laughter is the Best Medicine.
A boy smiling for the camera. Retrieved from https://unsplash.com/photos/sAmwQxM_3FI
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• Participants will:
1) Understand the experience of anger and rage of individuals in the world of
the child, adolescent, and adult, including psychiatric conditions that include
anger and rage.
2) Understand emotional intelligence including emotion-regulation, and the
counselor’s role in assisting clients in skill development.
3) Recognize the importance of a comprehensive life approach to helping
individuals develop self-awareness and emotion-regulation.
Objectives
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The reason we got started…
Starting with Why?
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• Sinek’s (2009) Golden Circle• What is our what?
• Identify and regulate emotions, specifically rage• What is our how?
• Skills associated with emotional intelligence, attachment system regulatory functions, research-based interventions, and medication when necessary
• What is our why?• Create a safer world for tomorrow’s generation by
helping children of all ages learn “feelings are mentionable, manageable” and modifiable
• Who?• Counselors and Clients
Silvey, Knight, & Sibcy (2019)
Why why?
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1) Understand the experience of anger and rage of individuals in the world of
the child, adolescent, and adult, including psychiatric conditions that include
anger and rage.
The Experience of Anger & Rage
(Kuhnley,2013)
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ANGER is………..
A normal emotion in reaction to perceived:–Threat of harm to self, others, property
•Incitement of the fight / flight / freeze response
–Being wronged, offended, challenged, shamed, or unfairly treated or
witnessing suchTypes of anger include:
–Situational / episodic
–Dispositional / characterological
–Purposeful / manipulative (Kuhnley, 2013)
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The Continuum
ANNOYANCE
DISTRACTION
DISAPPOINTMENT
FRUSTRATION
IRRITATION
AGITATION
ANGER
RAGE
FURY
https://pixabay.com/photos/young-woman-isolated-arms-crossed-3061646/
https://pixabay.com/photos/annoyed-woman-irate-angry-mad-3126442/
https://pixabay.com/photos/furious-upset-person-woman-angry-2514031/
https://pixabay.com/photos/young-woman-isolated-arms-crossed-3061646/https://pixabay.com/photos/annoyed-woman-irate-angry-mad-3126442/https://pixabay.com/photos/furious-upset-person-woman-angry-2514031/
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Causes of Irritability
•Normal Development Adjustments / Change
–Preschoolers and Adolescents
•Nutritional Deprivation/Inadequacy
•Psychosocial Circumstances/Interactions
•Traumatic Experiences/Abuse
•Sleep Deprivation
•Allergic Conditions
•Psychiatric Conditions
•Substance Use/withdrawal
•Medical Conditions
•Inflammation
•Medications
•Toxins
(Kuhnley)
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ANGER
•Anger may cause a loss in self-monitoring capacity and objective observability
•Anger may be internalized or externalized
•Anger may have physical correlates such as increases in
heart rate, blood pressure, and levels of adrenaline and
noradrenaline.
(Kuhnley)
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THE LIMBIC SYSTEM
Structures including:
❖ Amygdala,
❖ Hippocampus,
❖ Thalamus,
❖ Hypothalamus,
❖ Basal ganglia, Fornix
and Cingulate gyrus.The limbic system. Retrieved from
https://courses.lumenlearning.com/boundless-psychology/chapter/structure-
and-function-of-the-brain/
https://courses.lumenlearning.com/boundless-psychology/chapter/structure-and-function-of-the-brain/
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THE LIMBIC SYSTEM
Functions including:
❖ Emotion (Anger, fear)
❖ Behavior,
❖ Motivation
❖ Long term memory,
❖ Learning
The limbic system. Retrieved from https://courses.lumenlearning.com/boundless-
psychology/chapter/structure-and-function-of-the-brain/
https://courses.lumenlearning.com/boundless-psychology/chapter/structure-and-function-of-the-brain/
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The Brain
Frontal lobe controls cognitive skills: attention, reasoning, problem-solving, planning, organizing, language and communication, memory, judgment, impulse control, social and sexual behaviors, and personality
Temporal lobe is involved in processing sensory input or information.
Cerebellum is in the back of the brain. It provides for maintaining balance, coordinating eye movements, posture, and smooth body movement.
Basal ganglia include the globus pallidus, caudate nucleus, subthalamic nucleus, pallidum, putamen, and substantia nigra. Among the numerous functions, they serve to facilitate and coordinate movement and motor learning.
Function of Human Brain with Diagram. Retrieved from https://www.humanbrainfacts.org/human-brain-functions.php
https://www.humanbrainfacts.org/human-brain-functions.php
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The Frontal Cortex
The frontal cortex is important for the regulation of anger and the basic threat response. Different parts of the frontal lobe have been found to decrease amygdala activity which could have implications with emotional suppression.
(Kuhnley, 2013)
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Differential Diagnosis & Comorbidity
(Kuhnley, 2013)
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Aggression / Anger
•ODD = common; purposeful, not impulsive; fail to take responsibility
•ADHD = less common; impulsive, less purposeful; remorseful
•ANX = not common; fight or flight reaction to fear; impulsive or reactive
during episodes of anxiety; remorseful; more directed inward than outward
•MDD = not common; reactive during episodes of depression; remorseful;
more directed inward than outward
•BD = episodic and may be sustained during episode
•DMDD = non-episodic rages, i.e. not a change from baseline chronic irritability
(APA, 2013)
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Severe Mood Dysregulation
(Leibenluft, 2011)
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Amplification of Frustration
(Leibenluft, 2011)
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Ellen Liebenluft
The anterior cingulate cortex and medial frontal gyrus—both
hyperactivated in children with SMD (Severe Mood Dysregulation)
following negative feedback—were the same areas activated in
healthy control children following positive feedback.
“It makes you think about cognitive training or therapies that could
perhaps train children with SMD to pay greater attention to positive
feedback and less attention to negative feedback,” Leibenluft (2011)
said.
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Unpacking Emotional Intelligence & Emotion-Regulation
2) Understand emotional intelligence including emotion-
regulation, and the counselor’s role in assisting clients in skill
development.
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Demonstration
Step 1: Think of a situation that brought frustration or even anger
Sep 2: clench fists
Step 3….
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Circle of Security and Organizing Feelings
Photo Credit: Anita Kuhnley
Symbol used for secure base= open hands.
Nesting hands (Marvin & Seagroves, 2017)
Side Note: Linehan’s strategy of willing hands to diffuse anger.
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(Marvin & Seagroves, 2017)
(Graphic used with
permission from:
Hawkins, Knight,
Sibcy, Silvey &
Warren, 2019)
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Bob Marvin, to all counselors on the topic of Attachment
(Marvin & Seagrove, 2017)
(Wimmer & Brady, 2002)
Retrieved from:
https://www.gocomics.com/search/roseisrose?ut
f8=✓&terms=fully+charged+indicator+wiggle
https://www.gocomics.com/search/roseisrose?utf8=%E2%9C%93&terms=fully+charged+indicator+wiggle
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Links: Between EI, Attachment, & Anger
The attachment system serves a regulatory function (Coan, 2010)
Attachment, circle of security demonstrates part of the role of the attachment figure is to help one make sense of feelings
Emotional Intelligence, can involve organizing feelings through the process of identifying/labeling them, using them to inform thought, using them to provide a fuller understanding of life’s events. .
(Knight &
Sibcy, 2018
Redeeming
Attachment)
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EI Schools of Thought
Models of Emotional Intelligence
Popular
Research Based
Ability Model (Mayer, Caruso, & Salovey, 2016)
Self-report; Trait based Model (Petrides, 2010)
Daniel Goleman’s Model of EI (2006)
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Skills involved in EI
1) Identify emotions2) Use emotions to facilitate thoughts3) Understand emotional info4) Manage emotions
(Mayer, Caruso, & Salovey, 2007)
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Hierarchical Abilities
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(Sibcy & Knight, 2013; Modified from Salovey & Saluter , 1997)
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Using Emotions to facilitate Thought
Second branch of emotions-
Using emotions to facilitate thought
Ask the following questions:
- What is the emotion telling me?
- What do i need to learn from this?
- Why am I having this emotion?
-understanding of the brain
- cingulate gyrus the brain’s gear shifter (stuck on an emotion)
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Climbing the Tree
If we travel up the branches to get to a spot with a clear perspective:
1) Identify emotion
Ex: sadness
1) Emotion to facilitate thought
Ex: Sad mood, may influence my perspective
3) Understanding and Managing Emotions
*Interpret meaning emotions convey
For ex: Sadness often communicates loss of something of value. I feel sad when I miss my grandmother, since she died a few months ago.
4) Regulate- involves engaging or detaching based on utility
For ex: Tonight I need to complete paperwork, thinking on this will make it hard to focus, I may need to re-engage these feelings on the weekend and take time to cry, journal, look at pictures/create a photo album/memory books.
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(Mayor, Caruso, & Salovey, 2007)
What Emotion is Conveyed Here?
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I want to be creative
What emotion may promote creativity?
Thought Bubble. Retrieved from https://pixabay.com/photos/thought-idea-innovation-imagination-2123970/
https://pixabay.com/photos/thought-idea-innovation-imagination-2123970/
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Trait Based EI
We conducted research exploring the correlation between trait-based EI and Counselor Burnout (Harrichand, Captari, & Knight, 2017).
As EI increases, burnout decreases; we are developing EI trainings to help protect counselors from burnout
https://pixabay.com/vectors/shield-axe-sword-crest-armor-33957/
https://pixabay.com/vectors/shield-axe-sword-crest-armor-33957/
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Identifying Traits (Petrides, 2010)
Facets High Scorers perceive themselves as:
▰ Adaptability… flexible and willing to adapt to new conditions ▰ Assertiveness… forthright, frank and willing to stand up for their rights ▰ Emotion perception (self and others)… clear about their own and other people's feelings▰ Emotion expression… capable of communicating their feelings to others▰ Emotion management (others)… capable of influencing other people’s feelings ▰ Emotion regulation… capable of controlling their (own) emotions▰ Impulsiveness (low)… reflective and less likely to give in to their urges▰ Relationships…capable of having fulfilling personal relationships▰ Self-esteem… successful and self-confident▰ Self-motivation… driven and unlikely to give up in the face of adversity▰ Social awareness… accomplished networkers with excellent social skills▰ Stress management… capable of withstanding pressure and regulating stress▰ Trait empathy… capable of taking someone else’s perspective ▰ Trait happiness… cheerful and satisfied with their lives▰ Trait optimism… confident and likely to ‘look on the bright side of life’
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Other Benefits of Trait EI
Trait EI is positively linked to functional coping strategies:
• Problem-solving,
• Social support seeking,
• Reappraising,
And negatively linked to dysfunctional strategies:
• Inhibition of emotional expression,
• Substance abuse
(Mikolajczak, Petrides, & Hurry, 2009)
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Developing EI Traits
(Mikolajczak, Petrides, & Hurry, 2009)
“Also, one day workshops or seminars can be useful in raising
awareness of EI, but in themselves are unlikely to lead to the kind of
change that would be required for a person to successfully improve
their EI (Zeinder, Roberts, & Matthews, 2008). It may take several
weeks, with periods of relection between activities to effect longer
lasting change”
“A journey of a thousand miles begins with a single step”
- Chinese proverb, (Lao Tzu, nd.)
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(Petrides, 2009)
The Trait emotional intelligence questionnaire short form is
available for a donation. It is a very useful one page assessment.
Please see this website for more information:
http://psychometriclab.com/obtaining-the-teique/
An example of an item on the assessment is:
“Expressing my emotions with words is not a problem for me.”
Participants are asked to rank this on a likert scale.
Assessments like the MSCEIT and the TEIQUE-SF and TEIQUE
may be helpful for use with clients with difficulties with emotion
regulation, or who want to work on enhancing emotional
intelligence.
http://psychometriclab.com/obtaining-the-teique/http://psychometriclab.com/obtaining-the-teique/
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Attachment & EI
Attachment serves a regulatory function (Coan, 2010)
Research has revealed that caregiving experiences inform the development of both self-regulatory and neuro-regulatory processes over the course of the life span (Schore, 2016).
Emotion regulation is a branch of EI, or a trait of EI & develops rapidly during childhood
https://pixabay.com/illustrations/brain-heart-brain-
icon-3269655/
https://pixabay.com/illustrations/brain-heart-brain-icon-3269655/
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Attachment styles and Anger
Avoidant - dismissing; cold
Ambivalent- preoccupied; oscillations; frustrated
Secure- regulated
Disorganized- highly unregulated, changing from dismissing and cold, to pre-occupied/hot anger, to regulated, and a combination of all.
If disorganized lack a positive mental rep= strategies like Father’s love letter
Video retrieved from:
https://youtu.be/6TcxA_7_fi8
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Tools and Strategies for Regulation
Tools. Retrieved from https://pixabay.com/photos/tools-hammer-nail-nails-drill-nut-15539/
https://pixabay.com/photos/tools-hammer-nail-nails-drill-nut-15539/
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EAR DEMONSTRATION
EAR
Empathy
Assertiveness
Respect
From David Burns Essentials of Good Communication
(Burns, 2008, p. 71)
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Bio-Psycho-Social-Spiritual Model
3) Recognize the importance of a
comprehensive life approach to
helping individuals develop self-
awareness and self-regulation.
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Multimodal (Integrative) Treatment
(Kuhnley, 2013)
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The Neuroscience of Anger
● Biological considerations● What do we know about
the brain and anger?
https://pixabay.com/illustrations/brain-anatomy-human-science-health-512758/
https://pixabay.com/illustrations/brain-anatomy-human-science-health-512758/
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Neuroscience of Anger
Daniel Amen (2015, p. 4) Recommend clients read:“Change your brain change your life: The breakthrough guide to conquering anxiety, depression, obsessiveness, anger, and impulsiveness”
Temporal lobe is associated with emotional stability
(Amen, 1998)
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Enhancing the temporal lobe
Temporal lobe workouts can come in the form of:
- Learning a musical instrument- dancing/ moving in rhythmic ways - Creating an album of positive experiences to look back at - (Amen, 2015, p 264-268)
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Spiritual Interventions/Neuro-theology
● The right temporal lobe is associated with spiritual experiences● Wired into our brains for God to communicate with us● This part of the brain is active during prayer/meditation● Andrew Newberg, Professor and Researcher at an institute of
integrative health ● Conducted research on Franciscan nuns using SPECTS & found
increased PFC activity ● Amen described brains for those engaged in prayer and
meditation had fuller, healthier and less anxious
(Newberg, 2019)
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Social
Research examining the impact of suppression in emotions during transition to
college revealed three social costs associated with suppression of emotion:
● Lower social support
● Less closeness to others
● Less social satisfaction
(Srivastava, Tamir, McGonigal, John, & Gross, 2009; p. 883)
Demonstrates the importance of helping people organize their feelings
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Psychological
3 M’s
Mentionable
Manageable
Modifiable
Contrasted with the 3 F’s
Fight
Flight Freeze
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Anger in Children
Daniel tiger https://www.youtube.com/watch?v=ljWp8_5zvPM
https://www.youtube.com/watch?v=ljWp8_5zvPM
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Mister Rogers- Regulation in action
(Kuhnley, 2020)https://www.youtube.com/watch?v=fKy7ljRr0AA
https://www.youtube.com/watch?v=fKy7ljRr0AA
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Psychological Approach
● ANT’s
(Amen, 2010)
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DBT Emotion Regulation Skills, examples
STOP SKills:
What Is the STOP Skill?
The STOP skill consists of the following sequence of steps: Stop, Take a step back, Observe, and
Proceed mindfully.
*Treatment to avoid first impulse
Willing hands:
Doing the opposite of clenched fists (anger) to open hands
(Linehan, 2015)
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Why
The EI of anger- communicates something important to us regarding injustice, perceived threat, blocked.
Triggers Fight or Flight or Freeze
How to switch to 3 M’s
▻ Mentionable, mangeable, modifiable
MIndfulness*
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3 M’s
(McGuire, 1993; Rogers, 1969; Kuhnley, 2020)
Building upon the
work of Dr.
McFarland & Mister
Rogers
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Other considerations
If you sense something neurological is happening- Dr. Daniel Amen has shared a case where a cyst had to be removed because it was producing aberrant behavior and created higher risk for the client due to the location of the cyst
He reported 15 other cases associated with aggression that required a surgery to remove a cyst
Do not be afraid to refer clients to a neurologist to rule out a brain abnormality
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Recommended Resources
https://pixabay.com/photos/book-table-read-knowledge-wisdom-2592783/
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Recommended Resources/Readings by topic
▰ Attachment:
▰ Clinton, T., & Sibcy, G. (2009). Attachments: Why you love, feel, and act the way you do. Brentwood, TN: Integrity Publishers.
▰ Knight, A. M. & Sibcy, G. A. (2018). Redeeming Attachment: A Counselor’s guide to facilitating attachment to God and earned security. Dubuque, IA: Kendall Hunt Publishing. Free chapter available at: https://he.kendallhunt.com/product/redeeming-attachment-counselors-guide-facilitating-attachment-god-and-earned-security
▰ Hawkins, R., Knight, A., Sibcy, G., Silvey, J. & Warren, S. (2019). Research based counseling skills: The art and science of therapeutic empathy. Available at: https://he.kendallhunt.com/product/research-based-counseling-skills-art-and-science-therapeutic-empathy
https://he.kendallhunt.com/product/redeeming-attachment-counselors-guide-facilitating-attachment-god-and-earned-securityhttps://he.kendallhunt.com/product/research-based-counseling-skills-art-and-science-therapeutic-empathy
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Recommended Resources/Readings by topic
▰ Brain:
▰ Amen, D. G. (1998). Change your brain change your life: The breakthrough program for conquering anxiety, depression,
obsessiveness, lack of focus, anger, and memory problems. New York,
NY: Harmony Books.
▰ https://www.amazon.com/Change-Your-Brain-Revised-Expanded/dp/110190464X/ref=sr_1_3?keywords=amen+Change+your+brain+change+your+life&qid=1572468291&sr=8-3
▰
https://www.amazon.com/Change-Your-Brain-Revised-Expanded/dp/110190464X/ref=sr_1_3?keywords=amen+Change+your+brain+change+your+life&qid=1572468291&sr=8-3
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Recommended Resources/Readings by topic
▰ Interventions:
▰ Kuhnley, A. (2020 forthcoming). The Mister Rogers Effect: 7 secrets to brining out the best in yourself and others from America’s beloved neighbor. Ada, MI: Baker Books.
▰ Linehan, M. M. (2015). DBT skills training: Handouts and worksheets (2nd ed.). New York, NY: Guilford Publications. Retrieved from
https://projecticee.files.wordpress.com/2018/12/lin-c-dbt-handouts.pdf
▰ Emotion regulation resources for kids:
▰ Daniel Tigers’ Neighborhood PBS
▰ Mister Rogers’ Neighborhood PBS
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Recommended Resources/Readings by topic
▰ Parenting:
▰ Kuhnley, EJ. (1999). Program for Effective Parenting, Winchester, Virginia: PEP Publishing.
▰ Available directly from the author, email [email protected]
mailto:[email protected]
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References
Amen, D. G. (1998). Change your brain change your life: The breakthrough program for conquering anxiety, depression,
obsessiveness, lack of focus, anger, and memory problems. New York, NY: Harmony Books.
Amen, D. G. (2010). Automatic Negative Thoughts [web log post].
Amen, D. G. (2015). Change your brain change your life: The breakthrough program for conquering anxiety, depression,
obsessiveness, lack of focus, anger, and memory problems. New York, NY: Harmony Books.
APA (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.
Burns, D. D. (2008). Feeling Good Together: The Secret to Making Troubled Relationships Work. Harmony.
Cicchetti, D., & Toth, S. L. (1998). The development of depression in children and adolescents. American Psychologist, 53(2), 221–
241. doi:10.1037/0003-066X.53.2.221
Coan, J. A. (2010). Adult attachment and the brain. Journal of Social and Personal Relationships, 27(2), 210-217.
doi:10.1177/0265407509360900
Danieldeibler. (2015). May 1, 1969: Fred Rogers testifies before the senate subcommittee on communications [Video]. Retrieved
from https://www.youtube.com/watch?v=fKy7ljRr0AA
Daniel Tiger’s Neighborhood. (2018). Daniel Tiger when you feel so mad you want to roar song [Video]. Retrieved from
https://youtu.be/ljWp8_5zvPM
Eisenberg, N., Spinrad, T. L., & Eggum, N. D. (2010). Emotion-related self-regulation and its relation to children's maladjustment.
Annual review of clinical psychology, 6, 495–525. doi:10.1146/annurev.clinpsy.121208.131208
Goleman, D. (2006). Emotional Intelligence: Why it can matter more than IQ (the 10th anniversary ed.). New York, NY: Bantam
Dell.
Harrichand, J., Knight, A., & Captari, D. (2017). The Impact of Emotional Intelligence on Counselor Burnout. Virginia Counselors
Journal, 35, 40-46. Retrieved from
https://www.academia.edu/36714618/The_impact_of_emotional_intelligence_on_counselor_burnout_vca_journal_spring
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References Continued
Kuhnley, A. K. (Forthcoming: 2020) The Mister Rogers Effect: 7 Secrets to Bringing Out the Best in Yourself and Others from America’s
Beloved Neighbor. Ada, MI: Baker Publishing Group.
Hawkins, R., Knight, A., & Sibcy, G., Silvey, J., & Warren, S. (2019). Research-based counseling skills: The art and science of therapeutic
empathy. Dubuque, IA: Kendall Hunt.
Lao Tzu. (nd.). Tao Te Ching.
Leibenluft, E. (2011). Severe mood dysregulation, irritability, and the diagnostic boundaries of bipolar disorder in youths. American Journal of
Psychiatry, 168(2), 129–142. https://doi.org/10.1176/appi.ajp.2010.10050766
Linehan, M. M. (2015). DBT skills training: Handouts and worksheets (2nd ed.). New York, NY: Guilford Publications. Retrieved from
https://projecticee.files.wordpress.com/2018/12/lin-c-dbt-handouts.pdf
Marvin, B., & Seagroves, A. (2017). Attachment workshop. Liberty University Medical School. Lynchburg, VA. Retrieved from
http://theattachmentclinic.org/AboutUs/circle_of_security.html
Mayer, J. D., Caruso, D. R., & Salovey, P. (2007). Mayer-Salovey-Caruso emotional intelligence test (MSCEIT): Personal summary report.
North Tonawanda, NY: Multi-Health Systems. Retrieved from https://humancapitaltalent.co.za/wp-content/uploads/2018/11/MSCEIT-
Personal-Summary-Report.pdf
Mayer, J. D., Caruso, D. R., & Salovey, P. (2016). The ability model of emotional intelligence: Principles and updates. Emotion Review, 8(4),
290-300. doi:10.1177/1754073916639667
McGuire, P. A. (1993, May 14). Welcome to the neighborhood Mr. Rogers soft sell still smoothes the way. The Baltimore Sun. Retrieved from
https://www.baltimoresun.com/news/bs-xpm-1993-05-14-1993134131-story.html
Mikolajczak, M., Petrides, K. V., & Hurry, J. (2009). Adolescents choosing self-harm as an emotion regulation strategy: The protective role of
trait emotional intelligence. British Journal of Clinical Psychology, 48(2), 181-193. doi:10.1348/014466508X386027
Newberg, A. (2019). How do meditation and prayer change our brains. Retrieved from http://www.andrewnewberg.com/research
Petrides, K. V. (2009). Technical manual for the trait emotional intelligence questionnaires (TEIQue) (1st ed., 4th printing). London: London
Psychometric Laboratory. Retrieved from http://www.psychometriclab.com/adminsdata/files/TEIQue%20manual%20(4th%20printing%20-
%20contents)%20-%20KV%20Petrides.pdf
https://doi.org/10.1176/appi.ajp.2010.10050766
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Pool, L. D., & Qualter, P. (2012). Improving emotional intelligence and emotional self-efficacy through a teaching intervention for
university students. Learning and Individual Differences, 22(3). 306-312. Retrieved from https://doi.org/10.1016/j.lindif.2012.01.010
Rogers, F. (1969, May 1). Personal communications with U. S. Senate Commerce Committee [Video]. Retrieved from
https://www.youtube.com/watch?v=fKy7ljRr0AA
Salovey, P., & Sluyter, D. (1997). Emotional development and emotional intelligence: Educational Implication. Basic Books: New York:
NY.
Schore, A. N. (2016). Affect Regulation and the Origin of the Self: The neurobiology of emotional development (Psychology Press &
Routledge Classic Editions). New York, NY: Taylor and Francis.
Sibcy, G. A., & Kuhnley, J. (2013). Childhood rage: Diagnosis and treatment strategies for severe mood dysregulation part 2: Diagnosis and
treatment. Faculty Publications and Presentations, 70. http://digitalcommons.liberty.edu/ccfs_fac_pubs/70
Silvey, J., Knight, A., & Sibcy, G. (2019). The journey of becoming. In R. Hawkins, S. Warren, A. Knight, & G. Sibcy (Eds.), Research-
based counseling skills: The art and science of therapeutic empathy. Dubuque, IA: Kendall Hunt.
Sinek, S., & TEDxPuget Sound. (2009). How great leaders inspire action [Video]. Available from
https://www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action?utm_campaign=tedspread&utm_medium=referral&utm_source=
tedcomshare
Srivastava, S., Tamir, M., McGonigal, K. M., John, O. P., & Gross, J. J. (2009). The social costs of emotional suppression: a prospective
study of the transition to college. Journal of personality and social psychology, 96(4), 883–897. doi:10.1037/a0014755
Wimmer, D. & Brady, P. Rose is Rose. Fully Charged Indicator Wiggle. Retrieved from:
https://www.gocomics.com/search/roseisrose?utf8=%E2%9C%93&terms=fully+charged+indicator+wiggle
Zeidner, M., Roberts, R. D., & Matthews, G. (2008). The science of emotional intelligence: Current consensus and controversies. European
Psychologist, 13, 64-78. Retrieved from https://doi.org/10.1027/1016-9040.13.1.64
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Contact Info & Website
Anita Knight Kuhnley
https://dranitakuhnley.com/contact/
https://dranitakuhnley.com/contact/
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When Counseling is not Enough
Excerpt from Introduction to Counseling
- Vignette of medication leading to engagement in counseling
- (Hawkins, 2019)
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Additional reading bibliography (Composed by Rachel Birkeland)
Barnicot, K., & Crawford, M. (2018). Dialectical behavior therapy v. mentalization-based therapy for borderline personality disorder.
Psychological Medicine, 49, 2060-2068. doi:https://doi.org/10.1017/S0033291718002878
Through comparing the effectiveness of Dialectal Behavior Therapy (DBT) and Mentalization-Based Therapy (MBT) on 90 patients with
Borderline Personality Disorder (BPD) over a year, it was noted that DBT was significantly more effective than MBT. Patients had a more
evident decrease in self-destructive behaviors and emotional dysregulation in the DBT group, which indicates that DBT is a more effective
treatment in regards to enhancing emotional regulation.
Christou-Champi, S., Farrow, T. F. D., & Webb, T. L. (2015). Automatic control of negative emotions: Evidence that structured practice
increases the efficiency of emotion regulation. Cognition and Emotion, 29(2), 319-331, doi:10.1080/02699931.2014.901213
This article proposed that structured practice can enhance emotional regulation (ER). The aim for this study is to help clients gain a sense of
automatic emotional regulation, and to help clients improve their natural and immediate ability to control their negative emotions. The study
was done through a one-week training, with the introduction of pictures and short videos that would induce negative emotions in 27
participants. After the training, it was reported that participants are able to take less time to enhance their ER and decrease their negative
emotions. The participants were also reported to have a sense of automatic control of their ER
Derella, O. J., Johnston, O. G., Loeber, R., & Burke, J. D. (2019). CBT-enhanced emotion regulation as a mechanism of improvement for
childhood irritability. Journal of Clinical Child & Adolescent Psychology, 48(1), 146-154. doi:10.1080/15374416.2016.1270832
A cognitive behavioral approach to helping oppositional defiant teens in healthy emotional regulation is found in the intervention course
SNAP, which stands for Stop Now and Plan. SNAP is used to treat clients in their anger management, touchiness, and temper control. When
comparing SNAP with regular behavioral treatment, the authors noted that when the targeted teens were given tools to better regulate their
mood, they also had a significant improvement in their frustration tolerance level, resulting in having less negative emotions. This study also
noted that one’s ability for emotional regulation has a positive correlation with one’s level of irritability.
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Additional reading bibliography
Finlay-Jones, A. L. (2017). The relevance of self-compassion as an intervention target in mood and anxiety disorders: A narrative
review based on an emotion regulation framework. Clinical Psychologist, 21, 90-103. doi:10.1111/cp.12131
Finlay-Jones desired to find therapeutic and research implications from the relationship that has been exhibited from the
relationship between emotional regulation and mood and anxiety disorders, as self-compassion was used as a therapeutic
method within Cognitive Based Interventions. It is noted that self-compassion has a positive influence on emotional awareness,
emotional regulation, secure attachment, self-acceptance, stress response, and more.
Ford, J. D., & Blaustein, M. E. (2013). Systemic self-regulation: A framework for trauma-informed services in residential juvenile
justice programs. Journal of Family Violence, 28, 665-677. doi:10.1007/s10896-013-9538-5
The authors promoted self-regulation as a emotional regulation intervention for delinquent children, they noted that the benefits
of self-regulation allows one to have focused attention, awareness on interpersonal and environmental cues, here and now adapt
through past memories, and a better sense of emotional control that enhances one’s long term well-being. Systemic Self-
Regulation interventions come in many forms in the juvenile justice programs, such as: Attachment, Self-Regulation, and
Competency (ARC); Sanctuary; Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS); Trauma
Affect Regulation: Guide for Education and Therapy (TARGET); and Trauma Systems Therapy (TST). The authors concluded
that the Systemic Self-Regulation is structured, theory based, and are trauma-informed tools for youth who can have a second
chance. Such treatment will be beneficial for clients and staff members as clients gain healthier emotional regulation from their
reactions to trauma and find a better projection on their future.
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Additional reading bibliography
Lemberger-Truelove, M. E., Carbonneau, K. J., Atencio, D. J., Zieher, A. K., & Palacios, A. F. (2017). Self-regulatory growth effects for
young children participating in a combined social and emotional learning and mindfulness-based intervention. Journal of Counseling and
Development, 96, 289-302. doi:10.1002/jcad.12203
A small group of preschool-aged students from lower economic status families were provided with treatment that integrates Social and
Emotional Learning (SEL) and Mindfulness-Based Interventions (MBIs) for eight weeks. Significant results were found in this study,
and children who enrolled in treatment showed greater signs of self-regulation in task work and in experiential activities, children were
also noted to be more cordial in speech and in behavior during the treatment phase. The authors noted that a combination of SEL and
MBI will be beneficial to young children.
MacIntosh, H. B., Cloitre, M., Kortis, K., Peck, A., & Weiss, B. J. (2018). Implementation and evaluation of the skills training in affective
and interpersonal regulation (STAIR) in a community setting in the context of childhood sexual abuse. Research on Social Work
Practice, 28(5), 595-602. doi:10.1177/1049731516656803
The evidence based group therapy Skills Training in Affective and Interpersonal Regulation (STAIR) is presented in this study was
analyzed in this article after it was put into practice for two years, implementing 10 week intensive training treatment for 85 adult
patients who have experienced childhood trauma (23 male, 62 female), with a mean age of 43, SD = 11. It is noted that STAIR is
beneficial to individuals who have experienced childhood trauma or abuse, and are participating in group therapy. The tools used for
STAIR are the Life Event Checklist (LEC), the Difficulties in Emotion Regulation Scale (DERS), the Dissociative Experiences Scale
(DES), the Inventory of Interpersonal Problems (IIP), and the International Classification of Diseases Trauma Questionnaire (ICD:
PTSD). Authors found a significant lowering of scores on the DERS t(84) = 4.31, p < .001; DES t(84) = 1.98, p < .05, IIP t(84) = 3.18, p
< .002, and ICD:PTSD t(84) = 2.99, p < .004 posttreatment. These significant lowering of scores indicate a significant benefit to one’s
ability regulate emotions, handle interpersonal issues, as well as his ability to cope with trauma symptoms. The therapists who trained
clients in this study also provided positive feedback on STAIR as it was concrete, relevant, tangible and experiential for their clients.
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Additional reading bibliography
Pena-Sarrionandia, A., Mikolajczak, M., & Gross, J. J. (2015). Integrating emotion regulation and emotional intelligence traditions: A meta-analysis.
Frontiers in Psychology, 6, 1-27. doi:10.3389/fpsyg.2015.00160
Through a meta-analysis of 90 studies with a total of 23,174 participants, the authors noted that emotional regulation (ER) and emotional intelligence
(EI) comes hand in hand. EI is an important ingredient to one’s ability for ER and that a bidirectional benefit will emerge through the integration of EI
and ER. The authors grouped EI attributes into five ER categories: Situation selection, situation modification, attention deployment, cognitive change,
and response modulation. It is noted that in order to be more emotionally regulated, an individual with high EI would work around his presenting
situations and promote actions and behaviors that help him cope better. Healthy ER is related to better stress management, better ability to manage
emotions in stressful situations, and less of a tendency for harmful behaviors. It is also noted that individuals who are higher in EI also have lower
relational or substance dependencies.
Rothenberg, W. A., Weinstein, A., Dandes, E. A., & Jent, J. F. (2018). Improving child emotion regulation: Effects of parent-child interaction-therapy
and emotion socialization strategies. Journal of Child and Family Studies, 28(3), 720-731. doi:https://doi.org/10.1007/s10826-018-1302-2
82 young children took part in this Parent-Child Interaction Therapy (PCIT) study, which was tested to be a viable intervention for
children to better regulate their emotions. The PCIT pre- and posttest sought to find correlations to a child’s emotional regulation in the
child’s behavior improvement, positive parenting skills, and positive parent emotion socialization strategies use for emotional connection.
The authors noted that children showed better improvement in their behavior when they had relatively better behavior during the pre-
treatment phase, as well as when parents had positive emotional socialization strategies with their kids. It was also tested that PCIT as an
intervention successfully and significantly enhanced a child’s behavior and increased a child’s ability to have healthy emotional
regulation.
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Additional reading bibliography
Smyth, J. M., & Arigo, D. (2009). Recent evidence supports emotion-regulation interventions for improving health in at-risk and
clinical populations. Current Opinion in Psychiatry, 22, 205-210. doi:10.1097/YCO.0b013e3283252d6d
The authors studied the effectiveness that aerobic exercise have on emotional regulation in an 8-week intervention on 61
participants that were spilt into a waitlist group and a study group. It was noted that there is a positive correlation between
emotional regulation, aerobic fitness, and mindfulness. Moreover, the authors noted that such positive correlation results from
changes in the prefrontal and parietal cortices through exercise, the same brain regions also regulate one’s emotions.
Zhang, Y., Fu, R. F., Sun, L., Gong, Y. J., & Tang, D. H. (2019). How does exercise improve implicit emotion regulation ability:
Preliminary evidence of mind-body exercise intervention combined with aerobic jogging and mindfulness-based yoga.
Frontiers in Psychology, 10, 1-9. doi:10.3389/fpsyg.2019.01888
The authors studied the effectiveness that aerobic exercise have on emotional regulation in an 8-week intervention on 61
participants that were spilt into a waitlist group and a study group. It was noted that there is a positive correlation between
emotional regulation, aerobic fitness, and mindfulness. Moreover, the authors noted that such positive correlation results from
changes in the prefrontal and parietal cortices through exercise, the same brain regions also regulate one’s emotions.