Foundation of Adaptive Functioning: Improving Emotion Regulation Capacities

Transcription

1 Foundation of Adaptive Functioning: Improving Emotion Regulation Capacities Julie F. Brown, PhD Justice Resource Institute Disclosure: I receive royalties from the sale of the Skills System books and compensation for providing Skills System Training/ consultation to agencies through Justice Resource Institute.

2 Youth with Intellectual Disabilities Experience Increased Vulnerability Higher prevalence of co-occurring mental health problems Higher rates of trauma/victimization Higher rates of social stigmatization Higher rates of behavioral dysregulation (challenging behaviors) Higher rates of polypharmacy (side effects linked to increasing challenging behaviors) Environmental interventions are prevalent (Environmental factors linked to increased rates of challenging behavior) Few psychologically-based treatments and providers with experience treating this population Heterogeneous Population with Complex Clinical Needs

3

4

5

6 What is Emotion Regulation? The individual engages in processes to up- or down- regulate emotions depending on his/her goal. These processes can impact the intensity and duration of the emotional experience. (James Gross, 2007) The Process Model of Emotion Generation (Gross & Thompson, 2007, 2014) Emotions Have Multiple Processes Situation happens Situation has meaning to the person & he/she brings attention to it The person assesses the situation using cognitive processing Emotions create experiential, behavioral, physical, and neurobiological changes

7 Emotion Regulation is Challenging (Situation Selection & Modification) (Attentional Deployment) (Cognitive Change) (Response Modulation) Verbal comprehension Working memory Learning from experience Academic learning Abstract thinking Quantitative learning Perceptual learning Problem solving Priority setting Planning Strategizing Cognitive flexibility Judgment Cognitive Deficits outlined in the DSM-5 Diagnosis for ID

8 Skills SYSTEM: Elaboration & Scaffolding for Coping Behaviors ELABORATION OF SKILLS SCAFFOLDING FOR HIGHER-ORDER THINKING CP: Mindful awareness OTT: Appraisal, Reappraisal & planning OTA- Effective behaviors (selfdetermined) Skills SYSTEM (Structure & Teaching Strategies): Provide FUNCTIONAL VALIDATION Related to Enhanced Needs External Validation Promotes SELF-VALIDATION

9 SKILLS SYSTEM HANDOUT 1 The Skills List 1. Clear Picture 2. On-Track Thinking 3. On-Track Action 4. Safety Plan 5. New-Me Activities 6. Problem Solving 7. Expressing Myself 8. Getting It Right 9. Relationship Care Copyright 2016 Julie F. Brown. Published by The Guilford Press. The publisher grants purchasers of this book permission to photocopy and/or download additional copies of this material (see the box at the end of the table of contents).

10 I use the Feelings Rating Scale is a scale to rate how strong my feelings are. The Feelings Rating Scale helps me know what skills and how many skills I need to use in a situation. There are two Categories of Skills: All-the-Time skills and Calm Only skills. I can use All-the-Time skills at any level of emotion: I can only use Calm Only skills when I am between a 0 and level 3 emotion. The Recipe for Skills helps me know how many skills I need to use in a situation. The Recipe tells me to add 1 skill to my level of emotion. So, if I am at a #3 sad, I need to use 4 skills.

11 Level 4 = Fuzzy Thinking; Unable to Talk, Listen & Have a 2-Way Street Relationship Level 5= Off-Track Thinking; Hurting Self, Other, or Property Levels 0-3 = Clear Thinking; Able to Talk, Listen & Have a 2-Way Street Relationship

12 CATEGORIES OF SkIllS handout 1 Once I know my level of emotion ( ), I know what Category of Skills I can use: The Skills List 1. Clear Picture 2. On-Track Thinking 3. On-Track Action 4. Safety Plan 5. New-Me Activities All-the-Time skills 0 5 emotions 6. Problem Solving 7. Expressing Myself 8. Getting It Right 9. Relationship Care Calm-Only skills Only 0 3 emotions! Copyright 2016 Julie F. Brown. Published by The Guilford Press. The publisher grants purchasers of this book permission to photocopy and/or download additional copies of this material (see the box at the end of the table of contents).

13

14 Assembling Adaptive Chains of Behavior Dysregulated Emotion- Higher & Longer Execute enough effective behaviors in the second Make effective plans when cognitively regulated Be present in situations earlier

15 Maximizing Teachable Moments Teaching Strategies Implicit/Conceptual Explicit/SS Terms Implicit & Explicit Teaching Formats Standard A La Carte Standard & A La Carte Teaching Opportunities In-the-Moment In-Vivo (in context with others) 1:1 Sessions Skills Groups Coaching & Teaching: Juggling in Beginner s Mind

16 Standard & A La Carte Skills Training Common Chain for Level 4 Angry Shaping the Chaining Process: A La Carte Adjusted Chain for Level 4 Angry- Higher Reliance on Extrinsic Supports Safety Plan (SP) SP - Clear Picture (CP) CP - On-Track Thinking (OTT) -SP CP CP - OTT -SP CP CP - OTT SP - NMA CP-CP-CP-OTT-SP-NMA

17 1. CLEAR PICTURE HANDOUT 1 Focus 100% on the Clear Picture Do s 1. Notice my breath 2. Check my surroundings 3. Body check 4. Label and rate my feelings 5. Notice my thoughts 6. Notice my urges Copyright 2016 Julie F. Brown. Published by The Guilford Press. The publisher grants purchasers of this book permission to photocopy and/or download additional copies of this material (see the box at the end of the table of contents).

18 2. ON-TRACK THINKING HANDOUT 1 Does the urge help me reach my goal? Helpful or Not Helpful? Turn It Up to On-Track Thinking Cheerleading Cheerleading thoughts coach me to Do What Works to get me to my goal. I don t want to go off-track. I want to reach my goal. I will make the best of it. I can handle this. Check It Make a Skills Plan Can I use Calm-Only Skills? How many skills do I need? What skills will I link together to help me reach my goal? Take an On-Track Action Copyright 2016 Julie F. Brown. Published by The Guilford Press. The publisher grants purchasers of this book permission to photocopy and/or download additional copies of this material (see the box at the end of the table of contents).

19

20

21

22 6. PROBLEM SOLVING HANDOUT 1 Problem Solving is a Calm-Only skill. I have to be at a 0 3 emotion to do Problem Solving. I have to be focused, so that I can think things through to reach my goals. Problem Solving: Problem Solving Clear Picture of the Problem What s my goal and what s in my way? Size of the problem: small, medium, and large helpful hints: Check All Options Fast forward each option. Check the pros and cons. Make Plans A, B, and C Plan A is the best option. Plan B is a back-up or second favorite option. Plan C is the option if A and B don t work. Fix Problems in Wise Mind. I want to see small problems as small problems, so I don t overreact and drive my feelings to higher levels. I also want to see big problems as big problems, so I do enough to fix them. Ignoring problems can make problems bigger and feelings stronger. Copyright 2016 Julie F. Brown. Published by The Guilford Press. The publisher grants purchasers of this book permission to photocopy and/or download additional copies of this material (see the box at the end of the table of contents).

23 WHAT S WRONG: WHAT DO I WANT? WHAT S IN MY WAY? PROBLEM to FIX: Size of the Problem: SMALL MEDIUM LARGE CHECK MY OPTIONS to Fix the Problem: 1. Pros: Cons: 2. Pros: Cons: 3. Pros: Cons: 4. Pros: Cons: What option is the best fit: PLAN A: PLAN B: PLAN C:

24 7. EXPRESSING MYSELF HANDOUT 1 What Is Expressing Myself? When I Express Myself, I share things that are On My Mind and In My heart: Thoughts Concerns Needs Feelings Likes & dislikes Hopes & dreams I Express Myself through: Talking/Signing (in person, phone, video) Writing (letter, , texting) Pictures Body language I Express Myself when I do New-Me Activities like: Singing Dancing Playing music Drawing Acting Copyright 2016 Julie F. Brown. Published by The Guilford Press. The publisher grants purchasers of this book permission to photocopy and/or download additional copies of this material (see the box at the end of the table of contents).

25

26 Relationship Care is a Calm Only skill. This means that I can only use Relationship Care when I and the other person are at 0-3 level of emotion. When either person is over a 3, they may not be thinking clearly enough to manage relationships well. I use Clear Picture and On-Track Thinking to build, balance, and change my relationships.

27 9. RELATIONSHIP CARE HANDOUT 3 A. Building On-Track Relationships Different Types of Relationships Coworkers Dating Housemates Friends Professionals Family Me Can you think of others? Copyright 2016 Julie F. Brown. Published by The Guilford Press. The publisher grants purchasers of this book permission to photocopy and/or download additional copies of this material (see the box at the end of the table of contents).

28

29 9. RELATIONSHIP CARE HANDOUT 7 Finding Middle Ground I use all of my Calm-Only skills to change off-track relationships: Problem Solving What is the relationship Expressing Myself I decide how I will Getting It Right I choose the Right Time, Find Middle Ground I see both sides and problem? What are my options? If my best option is to try to work it out helpful hints: Communicate - In person? - Phone? - ? - Letter? - Body language? If I want things to change Place, Tone, and Words: Sugar Explain the problem Ask for change Listen Seal the Deal Talk out a win win solution Know when to use a Safety Plan. If feelings go over a level 3, a Safety Plan may be a good option. End Off-Track relationships. If I have tried to find middle ground and the relationship problems are not better, I may have to end the relationship. I should not be in a situation that is off-track for me. Copyright 2016 Julie F. Brown. Published by The Guilford Press. The publisher grants purchasers of this book permission to photocopy and/or download additional copies of this material (see the box at the end of the table of contents).

30 9. RELATIONSHIP CARE HANDOUT 8 C. Changing Off-Track Relationships with Myself and with Others Steps of Responsibility I made a mistake I said or did something that hurt a relationship that is important to me. Helpful Hints: Admit the problem I use Expressing Myself to explain what I did and why it was a problem. Apologize I apologize for what I feel sorry for doing. Commit to change If I want to get the other person s trust back, I explain how I will be different in the future. Take an On-Track Action. I take On- Track Actions in the relationship Taking responsibility can increase feelings. Relationships can be confusing. I sometimes don t even know when I have hurt another person. Finding out about my mistakes can make me feel guilty, ashamed, and even angry. I use Clear Picture and lots of On-Track Thinking to be sure that Relationship Care is an On-Track Action at that time. I want to help the relationship rather than make things worse! I do a Safety Plan and stop doing the steps, if I go over a level 3. Copyright 2016 Julie F. Brown. Published by The Guilford Press. The publisher grants purchasers of this book permission to photocopy and/or download additional copies of this material (see the box at the end of the table of contents).