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How to Help a Loved One with Emotion Dysregulation

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How to Help a Loved One with Emotion Dysregulation

This handout offers some guidelines for communicating effectively with individuals who are experiencing intense emotions, or for those who are emotionally sensitive, emotionally dysregulated or have a history of intense emotional outbursts. The tools outlined in this handout are based on Dialectical Behavioral Therapy (DBT), the “gold standard” treatment for people who experience extreme emotion dysregulation (impulsivity, suicidality, self harm, extreme emotional outbursts, etc). DBT is heavily researched and proven to be effective in treating a wide range of emotional experiences including disorders such as depression, anxiety/panic, post-traumatic stress disorder (PTSD), anger management, mood disorders and borderline personality disorder. In truth, we ALL experience emotions and when faced with an intensely traumatic experience, none of us are immune to intense emotional reactions. The tips and tricks listed below are all basic acceptance and

communication skills that can be used to improve ANY relationship. GOOD LUCK!

LISTEN:

Keep in mind that an individual who feels emotions more intensely than the average person has most likely been dismissed or shut down quite frequently throughout their lives. When anyone is repeatedly shut down, dismissed or invalidated, they begin to believe that nobody is interested or willing to hear what they have to say. In other words, they may not believe you are taking them seriously, no matter how sincere you are. It’s important that you continue to show you are listening, regardless of their reaction. It may not feel like you are making headway in the moment, but by consistently showing your friend or family member that you are really listening to them, you are interfering with any deep set belief that nobody cares. Slowly planting small seeds of doubt can add up over time.

When any of us take the risk to express our feelings to another person (i.e., let ourselves be vulnerable), our hope is that we will be heard and accepted. Learning and applying Active Listening Skills can be one of the most effective ways to make a person feel like they are being heard and it’s the fastest way to de-escalate an extreme emotional reaction.

Google, “Active Listening,” and you will find a plethora of information on the topic, but in a nutshell, Active Listening means that you actually SHOW the person that you have heard them by using the following skills:

• Paraphrasing or repeating back what you have heard: “So your mother hasn’t called you in over a week…”

• Asking clarifying, open-ended questions to make sure you understand what you have heard: “Do you have an idea of why she isn’t calling you back?”

• Noticing and giving feedback regarding a person’s behavior, tone, facial expression and body

language:

“I notice that you’re not talking as much as you usually do and you look really sad right now.” • Making an attempt to identify the deeper meaning behind the words (i.e., what isn’t being said):

“It must feel like she doesn’t want to talk to you…”

VALIDATE:

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Validation does NOT mean you are agreeing with a person’s behavior or choices. NEVER VALIDATE THE INVALID! Instead, validation is about making an attempt to find any kernel of truth in another person's

perspective, rather than debating whether their interpretation of the situation is accurate or not. For instance, if my sister’s car is repossessed, I can validate that it is going to be hard to get to work without a car, rather than debating whether she made her payments on time or deserves the consequences.

Validation also means that we accept the fact that we each view the world through our own emotional lens, that the truth is often subjective and that every person has the right to feel the way they do. To do this we may have to reach deep into our own psyche and remember a time when we felt something very intensely. We should then remind ourselves that our loved one is feeling that same level of intensity in this moment. Here are some ideas on what you can validate:

• THE FACTS: What you know to be true about a situation. Ex: “Your car was gone when you got home.”

• A person's experiences, feelings/emotions, beliefs, opinions, or thoughts about something (even if

you don’t agree, or wouldn’t feel the same way in the same situation, you can show your loved one that you are making an attempt to understand their point of view, at least in that moment).

Ex: “You don’t think this is fair,” or “You were shocked that this happened so fast,” or, “You’re angry with your loan company.”

• A person’s suffering and struggles.

Ex: “You don’t know how you are going to get to work now,” or, “You must be devastated.”

DON’T TRY TO SOLVE THE PROBLEM:

Making any attempt to solve the problem, minimize the problem, or come up with reasons the person should not feel the way they do, is invalidating (this goes for ALL people, not just those who experience intense emotions). Though our intentions may be positive: to reduce the pain and help our loved one feel better, trying to stop someone from feeling a certain way actually has the opposite effect. When we are told or given the impression that we “shouldn’t” feel the way we do, we not only feel bad, we also feel bad about

ourselves for feeling bad in the first place.

Negative emotions are uncomfortable, for sure, but they are also part of being human. They’re instinctual – a signal from the most primitive part of our brain. Even if we really, really, really don’t want to feel the way we do, we still feel that way. Emotions are like a wave that washes over us. The most effective way to help

someone through a difficult emotional experience is to show them we are willing to help them THROUGH that experience. Even the most intense emotional reactions end, eventually, unless we try to stop them. That wave of emotional energy doesn’t just stop. It continues to push forward, building in pressure until we can no longer hold it back. What started as a wave can quickly turn into a tsunami if we do not allow the emotion to happen. Here are some commonly used phrases that are meant to help, but often backfire:

• Just give it some time, or, Time heals all wounds (true, but dismissive of the current experience) • Calm down

• You shouldn’t feel that way

• Why do you feel that way? (the word, “why” gives the impression that you don’t understand or don’t believe that they should feel that way)

• Don’t be sad (angry, afraid, etc.) • Here’s what you should do… • Have you tried…?

• Everything happens for a reason, or, It’s probably meant to be

• I understand how you feel (Even if you DO understand, you’re not currently feeling it)

REMEMBER THE DIALECTIC:

A dialectic occurs when two opposing ideas are both true at the same time. For example, I can both, 1) Understand that you didn’t mean to hurt my feelings, and, 2) Have hurt feelings anyway. As you can imagine, this often causes internal dissonance. The “D” in DBT stands for “dialectical”.

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Here are some common dialectics that we need to keep in mind:

• I can feel sad and still understand that I have a lot to be grateful for • I can want to change and still have a need to be accepted as I am • I can be in crisis and avoiding my emotions at the same time • I can feel helpless and still keep a tight control over my situation

• I can know the solution to my problems and still feel intensely emotional

TOLERATE THE DISCOMFORT OF YOUR OWN EMOTIONS:

I’m not going to lie; it’s uncomfortable to be around someone who is having an intense negative reaction. It’s even more uncomfortable when they tell us that WE are the reason they are feeling that way. Though it’s easy to understand the desire to make another person feel better; it’s much harder to acknowledge that what we really want is to make OURSELVES feel better. Both of these things are usually true (a dialectic!).

Learning to acknowledge and tolerate our own uncomfortable emotions is beneficial for a variety of reasons. Naming our own emotions and allowing ourselves to feel them will reduce the intensity of the emotion, for one thing. It also gives us the opportunity to model the behavior we want to see in our loved one. Most importantly, tolerating our own discomfort will allow us to better understand the pain our loved one is experiencing. Allowing both ourselves and our loved one to feel at the same time can be a scary prospect for sure, but letting ourselves be vulnerable makes it safe for them to do the same. In the long run, naming and tolerating emotions helps all of us make better decisions that fit our values. It gets us closer to a place of self-acceptance and improves our overall sense of self. Getting in touch with our own uncomfortable emotions will also improve our ability to empathize in general. Our feelings, though sometimes painful, foster connection with others and the benefits are likely to outweigh the risks in the end.

DON’T ENGAGE IN DEBATES:

This is probably one of the most difficult skills to master, especially if your loved one threatens suicide, but try not to fall into the trap of engaging in a debate. It distracts from emotions and just ends up in a never-ending back and forth. For example, if a person says, “I’m ugly and nobody is every going to love me,” and your response is, “No, you’re not,” the instinctual reaction for all of us is to defend our position. Here’s what that sounds like:

“Yes I am.” “No you’re not.” “Yes I am.” “No you’re not.” ….

The words may change but the gist is the same. When a person is defending a belief, their brain is actively searching through all of their past experiences for evidence to justify the belief and that’s the last thing their brain should be doing during an emotional crisis.

The most difficult trap not to fall into is when your loved one says, “I should just kill myself.” Here’s what that one sounds like:

“No you shouldn’t.” “Yes I should.” “No you shouldn’t” “Yes I should.” ….

Again, the words may be different but the gist is the same and this time their brain is actively searching for evidence that they should end their lives.

In order to get out of the debate trap, try acknowledging the feelings and thoughts behind their statements by saying, “It sounds like you’re really sad,” or asking open-ended questions such as, “Can you tell me what happened to make you feel this way?” If you find yourself in the middle of a debate, that’s okay, it happens to the best of us. Just stop as soon as you notice it and bring the conversation back to feelings. If your loved one responds with silence, that’s okay too. Try to sit with the silence and allow the person to process how they feel. Silence is much better than a debate.

TREAT THEM AS YOUR EQUAL:

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intelligence and reason they had before the emotion took over is still in there somewhere. Treating them as if they have the ability to be reasonable is not only a sign of respect, it can actually help them access that side of their brain.

Treating ANY person as fragile or incompetent (even if you believe they are) is condescending and

disrespectful. Unsolicited advice or offering to do things for your loved one that they are capable of doing for themselves can reinforce a feeling of helplessness. Treating a person as your equal empowers them to use their rational brain to solve the problem for themselves. Try to remember the best possible version of your loved one and treat them as if they are presenting with that version of themselves in that moment.

Ways to treat others as your equal:

• Remind them of their strength, intelligence or other positive traits:

EX: “You’ve always been resilient,” or, “I can see that you are motivated to fix this.” • Assume they will be able to do the right thing and/or solve the problem themselves:

EX: “What have you come up with so far?” or, “I know you can figure this out.” • Remind them of times in the past when they were reasonable or competent:

EX: “The last time this happened, you handled it really well.” • Ask them their opinion:

EX: “What are you going to do?” or “What is your plan?”

On the same vein, treating others as your equal means that you don’t put YOURSELF in a lower position by overly apologizing or invalidating your own emotions. Try to view the situation as if you are two reasonable people who both have the ability to get through this because, well, you probably do.

DON’T MAKE ASSUMPTIONS, ASK:

If you really want to do the right thing for your loved one, the BEST approach is to ask them what that right thing is. Making assumptions about what a person needs, even if it is coming from a genuine and helpful place, can come across as dismissive or disrespectful. We have to remember that we are not in the same head space as the person experiencing the emotional crisis. If we are going to assume anything about the people we love, we should assume that our assumptions are wrong, first. Asking how you can help shows your loved one that you really want to listen to what they have to say. Not knowing what to do is human. Expressing that you don’t know, is a way to model vulnerability which can help your loved one feel safe to express their needs. It opens the door to connection on your loved one’s terms, rather than your own.

On the other hand, if you are 100% sure you already know the best thing to do, maybe because it worked in the past or it’s something that has always helped them, you should definitely STILL ASK THEM! You can empower your loved one by letting them determine what they need for themselves. Telling them what they need, even if they agree, reinforces the idea that they are helpless. Of course, if they ask YOU what they should do, you should answer them honestly.

BE HONEST:

If you are unsure how to react or afraid that you are going to say the wrong thing, tell them that too: “I want to help but I’m not sure what to do,” or, “I don’t know what to say right now.” If you feel stuck, it’s much better to say, “I feel stuck,” than to pretend you have all the answers.

Intense emotions can make us push people away or turn down offers of help. They may tell you that they don’t need anything or that they want you to get the hell out. They may also tell you that they want you to listen or just sit with them. Respect their wishes either way. Unless their request is impossible, puts you or them at risk, or is unreasonable, doing your best to follow through will show them that you are not only listening, but you also respect their ability to solve the problem.

JUST AS IMPORTANT: Don’t ask them what they need from you if you don’t think you will be able, or you are unwilling to follow through. It’s perfectly acceptable and it can also be a sign of respect to say, “No,” if the request is unreasonable. It’s important to set and KEEP boundaries with loved ones, even when they are in crisis. The most important thing is to be sincere. Try offering to call someone else that may be willing to help, like their therapist, a crisis line or a friend/family member.

TREAT THEM THE SAME WHEN THEY ARE IN CRISIS AS WHEN THEY’RE NOT:

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inadvertently conditioning them to act out in order to get the behavior they desire from us. The same thing goes for asking the person what they need. If you are only offering help when they are in crisis, you may be conditioning them that they need to be in crisis in order to get your help.

UNDERSTAND THE DIFFERENCE BETWEEN SUICIDAL AND SELF HARMING BEHAVIORS:

Many people with severe emotion dysregulation engage in self-harm (cutting, scratching, burning, etc.). Self-harming behaviors are completely different from suicidal behaviors (though they can sometimes look similar in the moment). Self-harm often functions to bring down, relieve or distract from painful emotions, but it can also serve to jolt a person back into reality when they are dissociating (feeling numb). Though self-harm can sometimes serve as a form of self-punishment, this is not the typical goal. What self-harm is NOT is an attempt to end one’s life.

Self-harming behaviors should be taken seriously, but it’s important to remember that, barring infection or other anomalies (like accidents), self-harm is rarely life-threatening. Many people who self-harm have never experienced a suicidal thought in their lives and though it is impossible to measure, self-harm is much more common than you think. You probably know or work with a person who has self-harmed in the past or is presently self-harming.

Suicidal behavior, on the other hand, including thoughts, threats and attempts, should always be taken seriously as they are literally life threatening. Though there are many people who threaten suicide and do not follow through, most people who do end their lives have threatened or attempted suicide at least once in the past. Though there are people who experience suicidal ideation daily and never act on it, every person who ends their life has experienced some form of ideation first. Statistically, the highest risk factor for suicide is having a previous suicide attempt and according to the American Federation for Suicide Prevention, 50-75% of people who attempt suicide tell someone about their intention.

People with emotion dysregulation may have suicidal behaviors only, self-harming behaviors only, a combination of both or none at all.

HOW DO I KNOW IF MY LOVED ONE IS SUICIDAL?

ASK THEM! Chances are that the thought of suicide is either already there or it isn’t – it’s unlikely that asking about suicide is going to give them a brand new idea. Keep in mind that there is a difference between wanting “everything to end” and actually having a plan to end one’s life and it’s okay to clarify vague answers to get to an actual, “yes” or “no.” If the person expresses an actual plan, the risk is obviously higher.

If you suspect that your loved one is suicidal and you do not feel comfortable asking them, get some support by calling a professional: your loved one’s therapist, your local suicide hotline or the national suicide hotline (1-800-273-8255).

IF THE ANSWER IS NO:

If your loved one tells you that they are not suicidal, it’s important to accept that answer as the truth and continue to be supportive using the tools listed above.

It IS true that some people will deny that they are suicidal to avoid going to the hospital or getting the police involved, especially if they have had a negative experience in the past. If this is the case, imagine that they are saying, “Yes, I am suicidal but I do not want you to call the police and I do not want to go to the hospital,” and respond accordingly.

IF THE ANSWER IS YES:

Remember, it’s impossible to predict whether a person will follow through with a threat of suicide, so always take direct threats seriously. This doesn’t necessarily mean that you should jump into action by calling the police (sometimes, getting the police involved can actually escalate the situation, especially if the person asks you NOT to call them). However, if the person is in imminent danger or you do not feel comfortable or competent enough to offer support on your own, it’s always better to err on the side of caution.

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the emergency room for a professional evaluation. Or, if you are comfortable with it, you can use the skills listed in this handout to help them express their painful emotions until the threat is over.

ADDITIONAL RECOMMENDATIONS FOR RESPONSING TO SUICIDAL THREATS:

Regardless of what you choose to do, here are some additional recommendations for responding to someone who has threatened suicide:

• It’s important to tell the person that you do not want them to end their life. Remember, don’t get into a debate as to whether they should or not; simply express, in your own words, that you do not want them to follow through with it. Avoid making general statements about the value of life or any other statements that may trigger a debate.

• Stay with them until help arrives or until the threat has ended.

• Unless the person is in imminent danger, the key word here is ASK before you act. Remember: treat them like an equal.

• If the person has access to lethal means (i.e., pills, knives, guns, etc), you can ask them to move to a different room, ask them if you can put the items away or ask them to help you remove the items. • Encourage them to get professional help. If they have an established therapist, you can help them call

or schedule an appointment. If they do not have a therapist you can help them find one. If they refuse professional help, try not to get into a debate about it while they are in crisis. You can come back to this later when they are calmer and in a better position to hear you.

• Allow them to talk about their thoughts and feelings and show them that you are listening by using the active listening skills listed above

• VALIDATE the facts of the situation and their right to feel the way they do Don’t minimize or try to solve the problem

Treat them like an equal by being honest with them and respecting their wishes

Tolerate your own uncomfortable emotions

References

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