The Hero’s Journey: Understanding the Impact of Poor Emotion Regulation in Children and Adolescents

How does emotion dysregulation impact children and adolescents?

This blog article focuses on recognizing the importance of helping children to regulate their strong emotions, understanding the concept of windows of tolerance, and using the therapeutic powers of play to help them learn skills for regulating their emotions. As mental health professionals working with children, youth, and families – how many of you are working with kids and teens in your office or program who struggle with regulating their emotions? The answer is probably 100% of you. Emotion dysregulation is one of the most common presenting concerns for parents seeking counseling for their child.

First, what do we mean when we refer to windows of tolerance as it relates to emotion regulation? This is a key concept to understand when working with emotion dysregulation because the goal is to help our young clients regulate their emotions and to do that we need to understand their windows of tolerance for emotional distress.

Each of us has the ability to tolerate emotional distress in varying degrees depending on a variety of neurobiologically-based factors. Our ability to integrate the emotion-processing centers (limbic system) of our brain with the higher-level cognitive functioning areas of our brain (pre-frontal cortex) depends on a lot of biological and experiential information stored away and processed in our minds. Siegel (2011) states: “in general, our windows of tolerance determine how comfortable we feel with specific memories, issues, emotions, and bodily sensations” (p. 137). This will vary from individual to individual. What I might be able to tolerate pretty well, another person may not be able to tolerate as well. And I might be better at tolerating some things better than other things. Our window of tolerance is the range of emotional distress we’re able to tolerate to remain as emotionally regulated as possible and maintain homeostasis. The wider our window of tolerance, the more we’re able to tolerate our distress and remain fairly well regulated for homeostasis. “Within our window of tolerance we remain receptive; outside our window of it we become reactive” (Siegel, 2011, p. 137).

When we’re stressed and overwhelmed, our brain registers a heightened state of alertness to potential threats as if our mind is saying – “Hey, pay attention here!” All of us get stressed and overwhelmed at times, and our ability to manage our distress will be dependent upon the width of our window of tolerance for emotional distress. Another way to think about it is the range of my ability to tolerate emotional distress. According to Siegel (2011), our windows of tolerance will vary depending on what we are more sensitive to than other things, and our experiences will influence our ability to tolerate circumstances and situations. For example, if a child is raised in a home in which a parent is highly anxious and hyperalert to possible danger, then the child learns to register danger more frequently and can become hyperalert to potential danger easily. Whereas, someone who was not raised in a home with an overanxious parent will likely not be overly sensitive to stressful events and will likely be able to remain within their window of tolerance under normal life circumstances.

The window of tolerance for emotional distress in someone who is usually hyperalert to potential danger will be narrower and their distress may quickly move them outside of their ability to cope with the situation in a calm manner. Their distress will move them outside their window of tolerance. According to Siegel (2011), we tend to have several windows of tolerance that are typically specific to situations and emotional states. When someone is moved outside of their window of tolerance for emotional distress, what does this low distress tolerance “look like?” Siegel (2011) refers to the flow of energy and information in an integrated and coherent manner to help us maintain homeostasis. This homeostasis is what supports physical and emotional well-being. When our homeostasis is disrupted, our body alerts us to potential threats. If our window of tolerance is narrow, then we manifest symptoms of distress more often and sometimes with more intensity depending on the individual. Some people are more prone to be easily emotionally triggered and may have a propensity to go from “zero to 100” with their emotional intensity. These are the children we usually see in our clinical practice because they struggle with regulating their strong emotions that “come hard and fast,” and then they have a long, slow recuperation period after an emotional outburst. It takes their mind and body time to get emotionally regulated and calm again.

Here’s what others may see in these clients with emotion dysregulation difficulties:

Children with high anxiety may struggle with emotional “meltdowns” due to irrational fears shutting down rational thinking
Children may struggle with insecurities that leave them feeling stuck and unable to move past their fearfulness about how other people view them or their ability to overcome challenges, such as saying things like, “I can’t …” and/or “My teacher hates me so why try?
Children on the autism spectrum tend to get “stuck” emotionally and then get emotionally overwhelmed due to their rigid thinking and difficulty thinking about things from another perspective for problem-solving.
Children with sensory processing problems that overwhelm their sensory systems will likely experience emotion dysregulation because their body and mind are overloaded by the sensory information that overwhelms their ability to tolerate it.
Some children may struggle with intense emotions due to underlying neurological “roots” like ADHD, developmental delays, or possible exposure to toxic substances in utero that negatively impact their neurological circuitry.
Children who have experienced trauma will likely become dysregulated by their trauma triggers.
Children experiencing depression, feelings of hopelessness, and feelings of worthlessness may activate irritability and anger outbursts or cause them to withdraw and become isolated.

How does emotion dysregulation negatively impact children? Children with emotion dysregulation problems are at an increased risk of negative self-concept because they may view themselves as a “bad” kid, “defective,” and/or “unlovable.” They have an increased risk for poor attachment relationships with parents, caregivers, teachers because they may not be able to use the adults in their lives to help them co-regulate and use coping/calming skills when needed. Children with emotion dysregulation problems have an increased risk for poor social competence because of their emotional outbursts, rigid behavior, difficulty taking turns, cheating at games, controlling behavior. These children are often referred to by other children and adults as the “bad kids” or tend to be on the peripheral of the social circles. They may be considered the outcasts and “trouble makers.”

Play therapy can help children struggling with emotion dysregulation learn skills to regulate their emotions and widen their windows of tolerance for emotional distress. Using play therapy with mindful presence and attunement can help them improve self-esteem and teach them coping/calming skills. Mental health professionals can use play therapy to facilitate cognitive restructuring and help with exposure therapy for anxiety-producing stimuli. It can help children and their parents improve their attachment relationships, and help children use their parents for co-regulation. When children are connected with their parents they are more willing to allow their parents to help them use coping skills when they’re struggling emotionally.

The key for mental health professionals working with these children and their parents is to establish a sense of safety and security in the session to invite the child to feel “felt” and “heard,” and understood, which in and of itself is healing. This is where we tap into our resonance circuits as described by Siegel (2011) to become psychobiologically attuned to our clients and mirror to them our sense of calm and empathy. Siegel (2011) states:

“Here’s the key about relationships: The resonance circuitry not only allows ups to ‘feel felt’ and to connect with one another, but it also helps to regulate our internal state. (It is the middle prefrontal area at the top of the resonance circuitry that shapes our subcortical states)” (p. 138).

The Be 5 Framework is helpful for creating a clinical framework for play therapy and expressive arts interventions. It describes how to create a safe therapeutic space with your young clients using intention and mindful presence within a clinical framework.

Once the therapeutic relationship is established then therapists can introduce the change process and invite parents into the change process to help their child regulate their emotions as needed. When using an integrated approach to play therapy with directive play therapy techniques, it’s usually helpful to start the treatment process by teaching children a language vocabulary and then help them recognize how those emotions are experienced in their bodies and what triggers those emotions. This mind-body connection builds the foundation for learning how to regulate their emotions. Using the therapeutic powers of play is the bridge to help children learn and use coping/calming skills because it is developmentally aligned with their clinical needs.

Recap:

Children with narrow windows of emotional distress tolerance struggle with emotion dysregulation on a regular basis.
Children with emotion dysregulation struggle with a negative self-concept, strained attachment relationships, and poor social relationships.
Using the therapeutic powers of play to help children regulate their emotions requires a therapeutic framework that facilitates safety and clinical decision-making and helps them understand the mind-body connections for emotions.

If you’re a mental health professional working with children, youth, and families and you’d like a free copy of the “Be” 5 Framework, click here.

Reference:

Siegle, D. J. (2011). Mindsight: The new science of personal transformation. New York, NK: Bantam Books.

Categories: : Neuroscience of attachment