A few thoughts on regulating intense emotions

Simone Hoermann, Ph.D. Updated: May 28th 2009

illustration of four emoticons indicating embarrassment, anger, confusion and fear

People with Borderline Personality Disorder (BPD) tend to have difficulty in regulating emotions, meaning that emotions can become very intense and often overwhelming. It can be hard to put this experience into words, and sometimes it is difficult to tease apart what exact emotions are coming up, thus making it hard for a person to label the emotions they are experiencing. Often, the emotions are so overwhelming or painful that they lead to self-destructive behaviors such as substance use or self-injury. In this context, the self-destructive behaviors can be interpreted as attempts at coping with some difficult feelings. At first, these behaviors may appear to bring temporary relief, but they are also extremely destructive and dangerous. What's important is that these self-destructive behaviors lead to physical harm as well as emotional harm, and often there are intense feelings of shame and guilt in the aftermath.

Marsha Linehan, the person who developed Dialectical Behavior Therapy (DBT), has observed that people with BPD are particularly vulnerable to experiencing emotions intensely, and that it takes them longer than other people to calm down. Generally, our emotions are connected with an impulse to do something, for instance, when we feel anxious, the impulse is usually to run away or avoid; when we feel angry, the impulse is usually to attack. These processes tend to happen extremely quickly for us, so that it can be difficult not to act upon the impulse, and they also happen so quickly that it can be difficult to separate out the actual emotion from the impulse for action.

The research group around Drs. Ulrich Ebner-Priemer, Marsha M. Linehan, and Martin Bohus published a paper in 2008 in The Journal of Nervous and Mental Disease which investigated the relation between the experience of psychological distress and the regulation of emotions by following 50 women with BPD and 50 women without BPD in both the United States and Germany.

Each participant carried a portable physiological recorder system which continuously assessed physical activity and electrocardiogram (ECG) over a 24-hour period in order to assess levels of physiological arousal. During that same time-period, they also carried a palmtop computer which beeped every 10 to 20 minutes. Participants were then asked to record what emotion they felt and how intensely they felt it right before the beep.

After looking at statistical analyses of the data they had collected, the authors concluded that amongst the women with BPD, there was an association between the inability to label emotions and psychological distress, in other words, people who were less able to name their current emotion experienced more psychological distress. In addition, people who felt negative as well as positive emotions at the same time also showed more signs of psychological distress. It is important to note that the direction of the relation remains unclear. This means that based on these findings, we are not able to tell whether the inability to label emotions causes distress, or whether experiencing high states of distress makes it harder for a person to label one’s emotions.

What these findings do appear to underline, though, is the importance of being able to name- or label- one’s emotion. This ability is stressed in the emotion regulation module in DBT, which teaches skills for dealing with emotions. There is also some similarity to Mentalization Based Treatment, which focuses on trying to understand one’s own internal state. The main idea here is that the more we can be aware of our feelings, the better we might be able to deal with our emotions – and this might also include our ability to tolerate and “sit with” contradictory emotions.

Simone Hoermann, Ph.D., is a Psychologist in private practice in New York City. She specializes in providing psychotherapy for Personality Disorders, Anxiety, and Depression. She is a faculty member of Columbia University, and facilitates psychotherapy and skills training groups at the Columbia East 60th Street Day Treatment Program.

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