Transcription
Slowing down and saying, "What am I feeling?" sounds like an obvious statement for a psychologist. Most people don't go around the world saying, "What am I feeling right now? How do I know what I'm feeling? What do I do when I'm feeling a little out of my range?" Most people pay attention to how they're feeling when they're out of range already.
For all humans, when we get in high states of emotion, your prefrontal cortex shuts down. Which is the part of your brain that is about sort of identifying, planning, organization. So, if I asked anybody to evaluate their state of being in a high state of emotion, it would be near to impossible for anybody to do that. If you're more vulnerable, so what I mean by that is if you're somebody who's just born with emotional vulnerability towards high sensitivity, high reactivity, to ask you to identify your emotion would, in my opinion, be almost cruel and unusual punishment.
Karyn is here to talk to us today partly about a book she has written and the associated toolkit. And the intention of that is to really help parents not have messed up kids.
How would you define the book?
Like my hope is that it's a tool for parents to talk about feelings, to get comfortable um communicating with their kids, and to provide some really basic interventions that we know are related to empirically supported treatments, and we can distill it for children in very simple, direct ways that can be fun, engaging, and um aside from the psychoeducation and the evidence that we know will sort of back these interventions can be seen as sort of like toys that otherwise kids might be drawn to psychoeducation aside. So, um that's my hope. The idea behind this was can we introduce um feelings into every household? How do you talk about them? What do kids experience in their body when emotions get too big? Are there some basic things we can help kids and parents do to um understand what's going on and to kind of regulate themselves and learn from a really early age so that when big problems, you know, little kids little problems, when problems become bigger kids already have these sort of skills integrated in their mind and under their belt.
And the reason that you are qualified to put this forth is really your history and what you do. So, Karen treats people with pretty severe personality disorders in a residential milieu setting. So, one of the things that you do is you teach people how to understand their internal life. And one of the first things that comes up in your feelings toolkit is teaching children to identify how they feel. So, who cares? Why why why does that matter?
When I think about emotions, it's a bell curve. Everyone has emotions. All of us are born with innate emotions across cultures. They're all the same across cultures. When you think about emotional experiences at a just a typical level, it's are you in tune with what's going on inside of you? We all have anxiety. Do you know when you're anxious? Do you know what causes that anxiety? What do you feel in your body? What do you do when you're anxious? When you talk about people that I may treat, those are the people who are on the upper end of the bell curve. They have a lot of emotion. It feels really intense, and it's very hard to regulate. So, those are the people who, for all sorts of reasons, end up more quickly in therapy because those emotional experiences have created obstacles in their life. And they want to address those. Either they want to address them, or somebody that loves them dearly would like them to address those experiences. So, in thinking about this book, it was not intended for necessarily the upper end of folks who experience emotions really intensely. It was really meant for the average child. To just understand what is it that I feel so that as you grow up later on in life, and you notice, "Oh, this is anxiety. That's different than excitement, although the same physiology may be activated." How do I know that that's going on with me? And then, how can I easily respond so that the emotions don't move to a more extreme level in a way that it feels overwhelming to people?
If I'm feeling mild anxiety, or if a kid is feeling mild anxiety, and then it shoots through the roof, so they have what we'll call like a meltdown of some kind. Like a crazy thing with hair going everywhere, right? You can't Um what's happened in that instance that's made it so hard to parse out what they're feeling?
For all humans, when we get in high states of emotion, your prefrontal cortex shuts down. Which is the part of your brain that is about sort of identifying, planning, organization. So, if I asked anybody to evaluate their state of being in a high state of emotion, it would be near to impossible for anybody to do that. If you're more vulnerable, so what I mean by that is if you're somebody who's just born with emotional vulnerability towards high sensitivity, high reactivity, to ask you to identify your emotion would, in my opinion, be almost cruel and unusual punishment. So, when you can teach somebody to know those signs early on, what is my body feeling physiologically, to understand those experiences, they can get in in there themselves before it escalates to say a 10 out of 10. So, it is an important muscle to begin to not only identify but build early on.
Can you, if you're a parent of a child, is there a way to identify early on, say, four, five, six, if your kid is going to be one of these people that's going to be hypersensitive?
Yeah. So, I'm going to rely a rely a little bit on the forefathers of borderline, because one of the things about BPD is that it really is um a problem of emotion dysregulation, behavioral dyscontrol, cognitive sort of distortions, black and white thinking. You have the whole constellation. So, when somebody is diagnosed with BPD later on in life, that's more of a um severe personality problem, but very treatable. I just want to make sure that that's importantly put out there. Um John Gunderson, who was my mentor, and I've mentioned that many times, I think, in these interviews, um would often say that some kids who eventually develop BPD are just more emotionally challenging growing up. So, parents can sort of see it early on. They're harder to soothe. Things trigger them more easily. They may be more sensitive to not just different interpersonal dynamics, changes, different situations. They may have sensory issues and be more sensitive to say the way one puts on their socks. Right? So, those kinds of things. Even if you look to Marsha Linehan and her theory of the development of BPD, it's a psychosocial theory of the development of the disorder. And part of that is based on these biological vulnerabilities. These emotion vulnerabilities, high sensitivity, high reactivity, slow return to baseline. So, sometimes you see these young children who get more reactive, who are harder to self-soothe, harder to soothe as a parent, um and are really sensitive to different things in their environment or very sensitive interpersonally. So, those may be the kids who are more obviously struggling and may eventually go on to struggle with more significant things. However, that's not always the case. You may have a child who looks kind of a managing their emotions okay, not so reactive, but over time you see the evolution of more difficulty with their emotion regulation capacities and their sensitivities. Those are the kids who if they learn some strategies early on, may be able to say to themselves, "Oh, I know that what I'm feeling. I can access things to sort of keep it within a range that's more manageable for me."
Right. And I mean, you may end up in a situation where your kid sort of stays on the developmental course and doesn't get waylaid by problems that result when you can't regulate your feelings.
Exactly. Exactly. And again, there are some basic things that most parents don't even know about and often teachers don't. Unfortunately, there's some disconnection between what psychologists may know, how that's translated to educators, and then to parents. So, an easy example is something called an ice dive. And I talk about this with people all of the time because an ice dive is really an empirically supported intervention that instructs people to submerge this sort of section of their face where they're um where often a mask is for scuba divers, and you submerge that part of your face in cold water to immediately activate your parasympathetic nervous system. That's your system that activates your rest and digest system, and it's pretty quick. Most parents and educators don't realize that could be a very useful intervention for a young child who's feeling overwhelmed. It doesn't have to be submerging your face in ice water, by the way. You can put a ice pack over your eyes or frozen peas. In the toolbox, I have So, these little beads that that are patches that like boo-boo bunnies that parents have used for boo-boos, but intended for this very purpose of activating your parasympathetic nervous system by putting something that's really kind of cold over this area of your face. And if you look at people's heart rate, respiration, everything slows down once that parasympathetic nervous system is activated. Very effective response. Most people have never heard of it. They just don't know.
Right. Has your observation been that the more these kind of regulatory skills get applied over time, are they less required because the overall climate, not just the temperature, shifts?
You hope that as if I'm working with somebody that as I'm working with them, their their self-awareness increases over time. So, their awareness of what's going on internally. We often don't pay attention to that part. Slowing down and saying, "What am I feeling?" sounds like an obvious statement for psychologist. Most people don't go around the world saying, "What am I feeling right now? How do I know what I'm feeling? What do I What do I do when I'm feeling a little out of my range?" Most people pay attention to how they're feeling when they're out of range already. So, through therapy, one hope I have for people is they become more attuned with what's going on inside. So, as you feel an emotion climbing, you can more easily and automatically intervene without a lot of thought. So, DBT is a great example and it's one of the reasons it's been really effective in treating not just BPD, but lots of things. Over time, what you see people do through this sort of structured self-awareness of diary cards, all sorts of other things that people do when they really go through a formal DBT process, is they become much more aware of what's going on inside and there's more of an automatic response of integrating distress tolerance, emotion regulation skills. So, you don't see these upswings and downswings. You see a far more over time what I would say regulated person who automatically responds to different cues that indicate that they're reaching one end of an emotional spectrum.
Which let's talk about like adversity. Um I'm curious what you think about letting a kid sit in their feelings and not intervening. I think often about that when I'm dealing with my kid and she's having a lot of intense feelings and when to intervene and when to just let her have them. But can you advise parents on intervening in intense emotional experiences for children and how it might be helpful to think about that?
Yeah. So we've talked a lot about intervention and bringing the intensity of emotion down and I would say that's really important across the board for children to learn how to do. I'm feeling at a 10 out of 10. What skills, what tools do I have in my toolbox to help bring that emotion down? I mentioned the prefrontal cortex. I kind of say to get my mind back online so I can think. As we know, we all have emotions and sometimes it's hard to bring them down and even when we do, they're still upsetting. And that's because we're human. We're just human beings with feelings. So to present somebody with the idea that here's a set of skills, use these things and you'll learn how to regulate everything will be wonderful is a message I would not want to send. In fact, I would rather send a message here's a set of tools that when you're in these more intense moments, you know how to bring the emotion down and at the same time learning how to tolerate your internal experience is critical. And that you can survive it and you will be okay. So I I referring to DBT. It's just helpful language. In DBT, it's called riding the wave. If you look very early on to infancy, Ferberizing was a thing when I had children. And Ferberizing is about teaching your child to sleep through the night. And what Ferber describes is when your child reaches a certain time in their development when they can take in enough food, really, they're large enough to get through Get through the night is relative depending on how long your child sleeps, but to try and get them through the night. Ferber talks about how do you help your child regulate? And there's a whole system when your child cries. You Sometimes they're not hungry. They don't need a diaper change. They just want to be held. Which is completely understandable. They want to be soothed. So, parents learning how to help a child self-soothe even at that young age becomes sort of the foundation of what you're describing. So, a parent may go in, say to the child, "I'm here. You're okay." Pat your child on the back. And then how Ferber organizes his system is by going in so your child knows you're there and leaving and extending that interval a little bit each time. But not going in to pick your child up to soothe them. Rather trying to teach your child in those moments how to soothe themselves so they can get back to sleep. And it's a whole process. That foundation is similar to sort of what you're describing of how do you bring your intensity down? And then how do you tolerate riding the wave? Being in the emotional experience without making it worse by either creating a crisis through your behavioral responses or by having a perception that you cannot manage this emotional experience. It's just too much for you.
So that as a parent, you sort of need to attune to your kids to determine when you need to step in and soothe and when let them let them and depending on their age, like let them at it alone.
Exactly. So being attuned, once you know your you've done this with your child, for example, you see them really upset at the checkout counter of this grocery store and they want a candy bar. And you've gone through this process with them and maybe you've even taught them some of these tools that we're describing earlier. Over time, conveying that message you know, I know you can do this. You've been here before. And depending on where your child is in their own process of emotional regulation um you want to sort of teach them a little bit how to do this and then gradually back off. Maybe even reminding your child I know you this is really tough and I I know you have this.
If you're in a situation where let's say your toolbox goes into schools, right? And some level of implementation is happening at schools. And I do notice schools are now more aware of emotion regulation and emotional awareness and teaching kids how to identify their feelings. But let's say you have a really messed up home. Let's say the home is a really messed up home. How much of a shot does someone have?
If all the systems are aligned it may not even produce the optimal outcome but the message is being reinforced. And what I would say let me liken this to what happens in actual therapy. Say if I was with an adult person in therapy and I teach them all these various things that might help with emotional regulation. And their parent or partner is on board, maybe they've had psychoeducation themselves, maybe they're in family therapy that can reinforce what we're doing in individual sessions. They may be more easily able to generalize those very responses um more effectively. Because they're getting it from everywhere. Everyone's in the know. It's being supported by lots of different people in their life. And that's called generalization. If you're seeing somebody and you're doing a lot of work and they are still in an environment that may not support all of these changes, can that person still change? Absolutely. It's just harder. It's just harder. Because they're not getting that support and reinforcement from other loved ones or other very active present people in their life. So, yes, they can change. It's just an obstacle.
It's just they're fighting a further uphill battle. So, if our kid is sort of getting or if you have one parent that is effective and another one that is disruptive to that kind of development, which I am imagining a fair degree of people who are in two-parent households experience. Do you have any advice to people who are in contentious households?
So, accessing again the people that are really aligned and invested will be very helpful. Um part of what comes to my mind as you're asking me this question is how old is the child that we're talking about. I see adult children all of the time. We have one parent who sees the problem that may align very well with the treatment team and another parent who may see things very differently. Um and providing as much psychoeducation as we can, where what we can do is say, this is what I'm seeing actively in my own observation. And um hearkening back to how this resonates with what that parent may also have experienced with that person. So their lens may shift or grow. Um integrating what these professionals are seeing, which may actually provide a different lens for that parent. So it's providing psychoeducation. It's including family members as much as you possibly can. Sharing your own observations. If you really understand the person in front of you, you might understand why this parent may see things very differently. And then talking to that parent from that lens um broadens the scope of understanding. So change may happen. You might not see it in that moment. But there are many times where you're planting the seeds that then 5 years later I might hear from families or a patient, "Hey, that thing that we talked about during that session sat with me. And it really impacted the way I have evolved and see my loved one now over time. So just because you don't see the changes immediately doesn't mean they're not going to take hold over time. Even the parent who might completely disagree with you.
Right. I mean, I think what's hard is when you have a younger child who is really like developing at breakneck speed. In other words, who this kid was at age five is not who the kid was at age four. It always is concerning because they're like building into the structure of their selfness these two dichotomous pieces. And so I think that's why I asked because the stakes feel so high and the development is so quick. That the fear of them absorbing messy ineffective ways of living feels very real. And dire.
You know, one of the biggest things you can look at is does that person that you're actually seeing when they take in what you're offering and make use of it, do they feel differently? And if they're starting to feel more empowered, more capable, more regulated, that reinforcer is very powerful. So, it's not only in what those around them are supporting, it's their own experience. Wow, I didn't realize if I did nice dive, I can regulate myself much more effectively and efficiently. Regardless of what anyone else is, you know, agreeing to or not. So, there's the data.
So, what you're saying is if the kid has some of the those capacities, it protects against some of the external forces that might be disrupting development or heading them down a path that will be no fun to crawl out of. And you may not crawl out.
What it does is give them real-life examples and evidence of feeling better. And that's a really powerful thing. Everyone wants to feel competent. And feeling competent in regulating yourself is very powerful. So, when somebody can feel pretty good about their capacity to regulate high emotion, it's incredibly rewarding. Wow.
Which moves to sort of one of the final modules of your toolkit, which is integration and sort of celebrating, recognizing those regulatory upskills, and sort of celebrating them for them.
It's a big deal. Yeah, and reinforces it and actually maybe further allows them to keep on the path.
So, reinforcement is one of these basic behavioral um concepts that psycho behavioral psychologists have goes way back to Skinner, for example. Reinforcement can come in all different form shapes and sizes. Um reinforcement can be celebrating. It could be paying attention to something that causes that behavior to increase over time. So, when you when you start as a child, for example, feeling really good about um recognizing your emotions, integrating these different tools or skills, feeling good about yourself and competent that you can respond to these more intense moments and feel a bit empowered, that you have agency, it's it is um incredibly reinforcing. And we know reinforcers actually are very helpful, again, I'm speaking as a behaviorist, in shaping behavior. It means that if this thing happens and makes me feel good, I'll do more of it over time. So, so the end of this the Feelings Toolbox, what you're referring to is this curriculum that I've developed for schools integrating what you've learned throughout the 12-week process and bringing it home. Bringing it home to parents, celebrating with parents, celebrating with teachers, celebrating with your peers, acknowledging all the tools you've gained, this capacity that you've now developed, and that in and of itself is a reinforcer. Yeah. Let's hope it pays it forward. Yes.