In every session, I speak about Emotion Regulation (ER). For many with eating disorders, their symptoms modulate unwanted emotions by numbing or comforting them. Unfortunately, individuals who have had their disordered eating patterns for a while often have difficulty managing difficult emotions without the support of their eating disorder. This makes eliminating their symptoms difficult.
I'm sure to anyone who has not already learned about it, ER sounds like a cold and clinical term describing how to feel good. However, that's not the case. ER is not always about feeling good but managing your feelings to work for you.
I hesitated a bit with this topic because it is so basic and boring (let's be honest). Still, I wanted to ensure that readers had available foundational ER knowledge. So be prepared; this is a long one.
I could go through a 10-week edition of blog posts and teach every skill about ER, but ER boils down to four basic themes.
Self-Monitoring
Most treatments informed by cognitive-behavioral approaches start with monitoring. For example, DBT uses Diary Logs, CBT uses thought logs, and other third-wave cognitive-behavioral therapies use different methods.
The idea is that the more people know themselves, the better they will handle emotions. Learning what situations trigger anxiety versus the situations that trigger anger or what intensity of fear arises when encountering a new situation is just the start.
Self-monitoring also includes education on emotions and how people experience them. So let's start that education here.
Every day our senses are constantly picking up stimuli. People pick up all sights, sounds, sensations, tastes, and smells, and that information is processed. So some information gets our attention, and other information doesn't.
This is attentional bias, and prior experiences (as well as other factors) influence it. I like the analogy that the human mind is like a filing cabinet. All that information is sorted into file folders that make sense to us. For example, some of us have files such as "People aren't safe" or "I am a terrible person." Other folders might not be so severe and are labeled things like "Stuff I find boring." Essentially, these file folders are your brain's neural pathways. The more information stored, the bigger the file becomes and the stronger the neural pathway.
If a person happens to have a lot of past experiences, such as people criticizing their weight, their brain in future situations, will jump to the file folder that relates to that. For example, that might be the tone a person uses that sounds like a bully from their past. Perhaps the words used, even if meant more nicely, are the same as in the past. Maybe a new doctor's office looks the same as one where a person was weight shamed. But, again, this is attentional bias.
Attention is drawn to stimuli, and our brain and body go through a process of processing that information. First, the primal part of our brain takes that information. Then, it carries out automatic biological changes such as heart rate quickening, blood being directed to your limbs (and away from non-essential organs like your stomach), and increased blood flow leads to more oxygen and quicker breathing. Keep in mind this process described would be for more energizing emotions such as fear or anger. Emotions that deplete energy, like sadness, go through different biological changes.
At the same time that you may notice these biological changes, the frontal part of the brain has now received the message from the primal part of the brain. The frontal part of the brain is more equipped to do something with that information, like associate it with other situations and identify how to respond to the environment. At this point, the body expresses emotion. These expressions may be verbal, behavioral, or facial and bodily expressions. You may hold your arms tightly if you sense a threat. Maybe your face begins to scowl. You may say something like, "Oh h*!# no" to watching a scary movie. Your brain still hasn't labeled an emotion yet...just signaled you to do something. However, shortly after this is when we may say, "I'm too scared to watch scary movies."
Although this process is just a few seconds, a lot happens before we put words to an emotion. For those who get flooded easily, the physical changes may be too much to tolerate, and we have a hard time focusing on our feelings. This is where self-monitoring comes in.
The more I check in with myself, the more I notice connections between my internal experience and my external experiences.
What are things to notice when self-monitoring?
Your Triggers
Your Urges
Your physical sensations
Your expressions
Your vulnerabilities (I'll get to this next)
Situations or patterns that feel good
General self-care (e.g., taking medications, getting enough sleep, etc.)
Speaking of vulnerabilities and general self-care, let's discuss how taking care of yourself is the second theme of ER.
Taking Care of Yourself
Our bodies are constantly striving to stay in a state of homeostasis. Sometimes it is automatic such as walking into a cold room and your internal temperature adjusting. Sometimes it is a bit more impulsive such as having a draining day and binging to feel comfort and energy.
We can also work to keep our bodies in this state of balance through purposeful behaviors. We are less susceptible to being emotional or cranky when in good health. When we do not take of ourselves, we may have a more challenging time handling stressful situations because we are already in an emotional place.
Let's take a deep dive into seven different subcategories. You can also download the My Self-Care Plan worksheet to figure out how best to reduce your vulnerabilities.
The average adult needs approximately 6-9 hours of sleep each night to feel their most optimal. Throughout our lifespan, these amounts shift a bit. For example, teenagers are going through a boom of development (e.g., bone, physical, brain, and sexual development all at once) and typically need a bit more. We also have a natural rise and fall of energy and normally do better with more relaxing activities in the evening and energizing (i.e., mentally or physically) activities in the morning. Check out this post to learn more. Picture a recent morning when you woke up feeling relaxed and restored. Some of you may have difficulty conjuring a time, and that's okay. What factors played into feeling this way?
Many individuals have physical ailments that they maintain or take care of regularly. Those with diabetes take medications. Individuals with chronic pain may require regular massages. What physical symptoms do you deal with, and what have physicians recommended? These recommendations are part of your self-care plan, not just a physician's babbling.
I also want to point out that medications are a unique aspect of maintaining health. Some individuals may regularly forget their medications or take them at odd times. This dysregulation can also lead to a more significant emotional state. Other individuals, especially those taking psychotropics, may find that their medications are working for them and think that they are no longer needed. Therefore, I caution against stopping a medication without talking to the prescribing doctor first.
Too much of a substance in our system has harmful effects, but even certain more negligible levels may impact your day-to-day health. For example, too much caffeine may make a person feel jittery and on edge all day, disrupting sleep. Too much alcohol can dehydrate, leading to headaches, inflammation, and gastric issues. Knowing your levels is significant, but these guidelines may help.
Typically, the average adult male should not exceed more than two drinks per day, and females should not exceed one drink per day. The FDA recommends a maximum of 400 mg of caffeine per day, but most people are likely to feel optimal around 200 mg, the equivalent of 2 cups of coffee or one espresso drink. Medical professionals also recommend not consuming caffeine later in the day, typically past 4 o'clock. Marijuana is a substance that is legal in most states (to some degree) nowadays, but recommended dosages do not exist. Most professionals would likely agree that periodic to abstinent use for adults. Most other substances are not recommended at any dose.
People keep homeostasis by balancing energizing activities with relaxing activities and balancing responsibilities. I won't go too into depth with this one, as I cover this in more detail in this post.
Maintaining balanced movement and dietary needs is a unique topic that may take its own post. I want to start by first cautioning folks about the wealth of misguided information available. I would also warn that if professionals who do not have training around nutrition are providing specific recommendations, you should seek information from a professional (i.e., a registered dietitian). One last disclaimer - many people, have basic nutrition knowledge but have not had formalized education, internships, or experience in dietetics. These individuals typically go by the term nutritionist, while the latter generally is called a registered dietitian.
Again, seek specific from a registered dietitian, but here are some generalized guidelines that most clinicians in the eating disorder field subscribe to.
Dietary
Eat smaller meals and snacks throughout the day, typically three meals and 2-3 snacks.
Meals should include all food groups (e.g., protein, starches, produce, fats and dairy).
Meals should not be skipped regardless if the previous meal/snack was bigger than desired.
Meal times should occur at consistent times day-to-day and not exceed more than 4 hours between a meal and snack.
Meals and snacks are best when consumed through food rather than supplements, but follow the guidance of your healthcare professionals.
All foods should be considered safe. When we restrict our diet, we crave those items more.
Movement
Movement can include any activity that moves your body, such as lawn mowing.
Generally, healthcare professionals recommend about an hour of moderate movement. (Again, seek a recommendation from a dietitian.)
Movement should put stress on your muscles but not be overly uncomfortable.
Some movements may need to be modified based on your individual needs. If healthcare providers have made a recommendation to restrict movement, follow the guidance.
If you are underweight or have had a recent rapid weight loss (i.e., 10% body mass in 3 months or less), you likely should refrain from movement altogether or follow. If you have a physician and dietitian making recommendations, follow their guidelines around activity.
Okay, let's now discuss what to do with feelings when they come up.
Dealing with Feelings
Crazy to think that this post is at the halfway point before even discussing what to do with emotions. Most people believe that this is the only part of ER.
There are two things a person should understand in this section. One - it is better to allow yourself to experience a feeling, even if uncomfortable to tolerate. This doesn't mean that you need to sit with the emotion forever. Two - there are questions you should ask yourself when an unwanted feeling comes up.
Does this emotion match what is going on?
Is this emotion helpful?
If you answer "No" to either question or both, practice a skill called Opposite Action.
If you answer "Yes" to both questions, problem solve through how to manage the emotion.
All of this is true for moderate-intensity levels of emotion, but if a feeling gets too intense, keep
reading.
Okay, let's discuss Opposite Action. Almost everyone who hears about Opposite Action for the first time thinks, "Oh, fake it until you make it." That is somewhat true; however, Opposite Action also involves changing your physical symptoms to a new emotion.
Let's use sadness as an example. Every emotion has an urge tendency that is universal for all people. The urge for sadness is to withdraw. Most individuals do not want to be around others or do activities. Sadness tells us not to engage. The opposite of this tendency is getting up, moving, being around others, and engaging in situations. There is a physical change that occurs when you act in a way that is opposite to sadness. Act opposite in your behaviors, thinking, and words, but also act opposite in your facial expressions, body language, posture, and paralanguage.
Dealing with Strong Emotions
When they struggle with ER, most people lean entirely on Distress Tolerance skills. However, use Distress Tolerance skills sparingly only when the intensity of an emotion is too strong to think through regulating the emotion.
There are several skills I could discuss there, but most of the skills focus on regulating your physical symptoms of the emotion, reducing them so that other skills can be used. Changing your breathing, your temperature, and your muscle tension can all have a powerful effect on lessening the intensity of your emotion. Skills like deep breathing, progressive muscle relaxation, and self-soothing fall into this category.
You might be taking a step back from this article and letting your brain relax, which is understandable. There is a lot here! I would suggest that those experiencing impairment in their life because of how they manage their emotions should seek the support of a mental health professional. For anyone who reads through the "Taking Care of Yourself" section and feels like you need more help to maintain those things or figure them out, you guessed it, seek a mental health professional. I currently have availability for anyone who resides in Iowa, Nebraska, and Ohio, and you can contact me for a consultation to learn more about therapy.
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