Shrinks In Sneakers

Tag: emotions

  • Family Ties That Bind: When High Expressed Emotion Worsens Schizophrenia

    Family Ties That Bind: When High Expressed Emotion Worsens Schizophrenia

    In psychiatry we are always asking patients about social support. The presence or absence of social support can have a major impact on treatment response and ability to remain well once someone leaves the hospital. This usually includes support from family members and friends. 

    In 1956 the Medical Research Council Social Psychiatry (MRCSP) London conducted a study regarding the readmission of schizophrenic patients. The research revealed that patients who were stabilized symptomatically and functionally inpatient and subsequently discharged to live with their parents or wives were frequently readmitted for relapse of symptoms compared to those who were discharged to a sibling, or non-family environment. While family involvement is generally a protective factor that helps prevent things like suicide, there are some situations where the over involvement of family can complicate matters and even create worse outcomes.

    This usually occurs when a family has high expressed emotion. 

    Expressed emotion (EE) has consistently been shown to predict relapse in schizophrenia as well as other psychiatric disorders. Expressed emotion is a measure of the family environment that is based on how the relatives of a psychiatric patient spontaneously talk about the patient. 

    It measures 3 aspects of the family environment associated with high expressed emotion:

    1. Hostility (outward anger and frustration towards the patient because the family believes they are choosing to not get better) 
    2. Emotional over-involvement (This is where the family tries to solve all the problems for the patient taking away their ability to be self-reliant). 
    3. Critical comments (where the family views the mentally ill patient as lazy or selfish, not appreciating the difficulty of living with mental illness). 

    However, research has shown the following as indications of an environment with low expressed emotion: 

    1.    Positivity: (statements that express appreciation or support for the patient’s behavior and gives verbal and nonverbal reinforcement). 

    2.    Warmth: (kindness, concern and empathy expressed by the caregiver).

    There is such a thing as too much involvement on the part of the families which can lead to complicating family dynamics and exacerbation of an individual’s symptoms of mental illness. Interventions for improving outcomes include reducing contact with high EE caregivers and providing psychoeducation about EE to care givers. Bringing awareness to this behavior may help family members change. 

  • Affective Dysregulation: Understanding and Managing Emotional Sensitivity

    Affective Dysregulation: Understanding and Managing Emotional Sensitivity

    When we think about patients who have trouble regulating strong emotions, it often begins with a genetic predisposition toward higher emotional sensitivity. These individuals experience emotions more intensely than the average person. Their feelings are easily triggered by seemingly minor stressors, and it takes them a long time to return to baseline after experiencing these emotions.

    These patients frequently encounter more stressors than the average person, creating a cycle where they experience strong emotions, face excessive stressors, and struggle to re-regulate. This combination makes life particularly challenging for these individuals, who typically lack the tools to cope with their intense emotions effectively.

    To exacerbate the situation, these patients often live in invalidating environments. They are surrounded by people who don’t understand how distressing it can be to live this way, leading to the development of maladaptive coping strategies. Family and friends may perceive them as “overly emotional or irrational,” dismissing the severity of their emotional states. As a result, behaviors such as self-injury, drug use, eating disorders, and suicidal tendencies can emerge.

    Support from family and friends is often only provided once these maladaptive behaviors have escalated, inadvertently reinforcing these behaviors as useful coping mechanisms. By understanding the underlying genetic and environmental factors contributing to affective dysregulation, we can better support these patients and help them develop healthier ways to manage their emotions.

  • Coping Strategies for Dealing with Intense Emotions

    Coping Strategies for Dealing with Intense Emotions

    In the fast-paced world of modern healthcare, it’s not uncommon to encounter individuals who don’t fit neatly into specific psychiatric diagnoses. Recently, I’ve noticed a significant number of patients who, despite not having bipolar disorder or depression, still experience considerable distress. Many of these individuals have endured severe trauma, including sexual abuse, and have a history of self-injurious behavior. I refer to these patients as affectively dysregulated, a term that, while not perfect, attempts to capture their unique experiences.

    Treating these individuals is particularly challenging because their core symptoms and experiences often can’t be effectively managed with pharmaceutical drugs. Instead, they require intense psychotherapy, which is typically difficult to find and expensive. This situation often leaves affectively dysregulated patients with few options, leading them to engage in self-harm and seek admission to inpatient hospitals. Unfortunately, this creates a vicious and dangerous cycle, as inpatient units are usually focused on acute stabilization rather than providing the long-term care these patients need.

    When evaluating these patients, I try to emphasize the limited efficacy of medications in treating affective dysregulation and instead focus on coping strategies, especially during periods of intense distress. Here are some strategies that can be helpful:

    1. Deep Breathing Exercises: Practicing deep, slow breathing can help calm the nervous system and reduce feelings of panic and anxiety.
    2. Grounding Techniques: Grounding involves using the five senses to reconnect with the present moment. This can include focusing on the feeling of your feet on the ground, listening to ambient sounds, or touching a familiar object.
    3. Mindfulness and Meditation: Mindfulness practices encourage staying present and accepting one’s emotions without judgment. Meditation can also help in cultivating a sense of inner peace and stability.
    4. Physical Activity: Engaging in physical exercise, whether it’s a walk, yoga, or a more intense workout, can help release built-up tension and improve mood.
    5. Creative Outlets: Activities like drawing, painting, writing, or playing music can provide an emotional release and a way to express feelings that might be difficult to articulate otherwise.
    6. Social Support: Talking to friends, family, or support groups can provide comfort and perspective. It’s essential to feel understood and not alone in your struggles.
    7. Professional Help: Seeking therapy from a qualified mental health professional can provide structured support and coping mechanisms tailored to individual needs.
    8. Healthy Distractions: Engaging in hobbies or activities that you enjoy can provide a temporary respite from overwhelming emotions.
    9. Self-Compassion: Practicing kindness towards oneself, especially during tough times, can reduce self-criticism and foster a sense of resilience.
    10. Safety Planning: Having a safety plan in place, which includes identifying triggers, safe people to contact, and safe places to go, can be crucial during times of crisis.

    It’s crucial to remember that coping strategies are highly individual, and what works for one person might not work for another. Encouraging patients to explore and find what resonates with them is key. By focusing on these strategies, we can provide affectively dysregulated patients with the tools they need to manage their distress and break the cycle of self-harm and hospital admissions.