Emotional Regulation in Mood Disorders
Can be Improved !!
Ketamine Treatment and Psychotherapy
“Cassie..?”
“Yes, Mom?”
“Sam called … says he can’t come over because he has to go to the mall with his mom …”
“WHAAAAATT??? That CREEP!!”
The freshly opened Coke can in Cassie’s hand flew at the door like a bullet and exploded into a hole just above the door facing … carbonation spewing everywhere.
“Cassie…. it was his mother’s decision…” But before her mom got the words out, Cassie had crashed through the front door and was gone.
Ever reacted to disappointment the way Cassie did? Know anyone who has?
Adapting or Stressing Out?
There’s a whole cascade of adaptations or maladaptations that occur in a moment of disappointment or frustration … or hurt. The things that go through your mind, the decisions you make in the split second after the moment and beyond, determine how an event will affect your life.
If you choose healthy ways to look at the event, and to respond, your mood will reflect that you have the skills to adapt, and roll with the punches. Learning emotional regulation skills can make the difference.
When you choose maladaptive thoughts that are self-destructive and create more conflict, you lay another brick in the foundation within yourself for an eventual diagnosis of depression.
In many psychiatric disorders, impaired emotional regulation (or emotional dysregulation) is a common characteristic. For most of us, it’s not that hard to see that some people with certain disorders — like, say, bipolar disorder — may have a hard time regulating and controlling their emotions.
There are other disorders where this may happen, too. Like PTSD, panic disorder, and depression.
A child affected by a disorder like depression or bipolar disorder often has 
difficulty developing his emotion-managing skills. Add to that certain conditions that also interfere, like alexithymia, for instance … and it’s all that much harder.
Emotion Regulation and Alexithymia
Alexithymia is a term coined in 1972 by Peter Sifneos, introducing to psychiatry the condition of a person who can’t identify or describe their emotions. Since emotion is felt physically … if you can’t feel it… it must be awfully hard to articulate.
In your case, maybe you don’t feel emotions or find it hard to put them in words … or maybe you do feel them.
If so, your condition can be just as difficult for you as it is for someone who experiences alexithymia, because both can put you in awkward, even embarrassing, situations.
Society Maintains Certain Expectations of Us All
Emotion self-regulation is the ability to respond to whatever is going on at the moment in a way that’s socially “tolerable” … but also 
flexible to fit the circumstances. For instance, so you can either react spontaneously or … if the situation requires it … delay your response til a more appropriate time and manner.
The ability to self-regulate your emotions is a complex stack of dominoes. A thousand different things stimulate in you a potential response or reaction…every single day.
If you don’t develop the ability to manage your reactions — in other words, if you don’t find out how to respond to a given situation in an appropriate way — your inappropriate reactions can isolate you from jobs, relationships, and fulfillment. People may see you as someone who doesn’t fit in.
The Behavior Police
Society imposes pressure on everyone to adapt to behaviors it considers in line with a civilized community. And people can be cruel as they police the boundaries to ensure everyone “behaves.”
If you’re able to develop an intuitive understanding of those boundaries as you grow through childhood, and if you can implement the “acceptable” behaviors in various situations, it will help you in every situation as you grow through adulthood.
However, as we mentioned before, some people are unable to do this adapting. And you may find yourself reacting forcefully and loudly in situations where you feel strong emotion.
Learning Emotional Regulation Skills Can Be Difficult
On the one hand, this difficulty regulating and adapting emotions to 
the situation is important, but what can you do if you just can’t? Furthermore, what happens if you never learn how…? Or never get better enough to learn…?
So here’s the thing.
It’s tough to learn how to redirect and adapt your responses to situations you’ve found upsetting in the past…especially when you’re in the heat of it. So treating the disorder and minimizing the pressure you feel to react is a solid first step.
It’s Easier to Learn Emotional Regulation Skills Without Symptoms
With medications that drastically reduce symptoms, you’re in a better position to actually use therapy that can help you develop skills to respond differently to circumstances that you’ve reacted to in the past.
Therapy that helps you learn to problem solve rather than erupt, and handle circumstances instead of brooding or avoiding those situations altogether can be far more effective if your emotions aren’t in overdrive.
Because, according to studies, when you can’t modulate your emotions, it does seem to set you up for relapse of your disorder. To stay healthy, you need to learn to think healthy. This underpins that infrastructure within you to sustain mental and emotional health.
Poor Emotional Regulation Leads to Relapse
Researchers in Norway published a meta-analysis of studies on 
emotional modulation in May of this year in Frontiers in Psychology. The report analyzed 72 studies involving 3371 participants with major depression or those in remission from depression, and 5094 healthy controls.
Huge numbers.
They studied the way the participants managed their emotions through difficult and stressful experiences.
Then, they found that when they compared the way the healthy people (who’d never been depressed) responded the way those with major depression and those in remission responded, the healthy people had constructive, self-loving ways of responding and those with depression had more self-destructive ways of responding.
These researchers also found that the more “maladaptive” a person’s response to difficulty or conflict, the more likely that person will become depressed.
Conversely, the more healthy and constructive a person is in adapting to stressful situations, the less likely he will be depressed.
So poor ability to respond to difficulty and conflict correlates to likelihood of depression. And learning emotional regulation skills can prevent depression relapse.
And there’s more…
3 Factors Influence Emotion Regulation in Depression Remission
They found there are factors that influence how well someone with depression in remission can regulate his or her emotions:
- Age when the illness began
- Anxiety disorder that accompanies the depression
- How long the disorder has been in remission
Clearly more study is needed. We need to understand healthy adaptive means of emotion regulation. And we need to learn how to help depressed patients even when their disorder is in remission. We want to help them develop healthier responses. And by doing that, prevent relapse.
How many times do people stop psychotherapy — or stop their meds — as soon as they feel better? How many times have you?
Also, they urged more study of alexithymia in patients with remission so that they can understand how it impacts their ability to learn healthier responses.
How Ketamine Treatment Can Help
And keep in mind, if you’ve been treated for these disorders and you have not achieved remission, you may be a candidate for ketamine treatment. No other treatment has been as effective in as many treatment-resistant cases.
As we said before, it’s not easy to unlearn old habits and learn new 
ones in the way you think about and respond to painful or frustrating situations. If you’re in pain yourself, and the structures in your brain are broken and worn down from the stress of a mood disorder, this is especially true.
Remission can empower you to build a healthier inner thought life that sustains remission when you do achieve it.
At Innovative Psychiatry, we see people achieve remission through ketamine treatment every week. We’d love to work with you to help you build a healthier, more rewarding life.
Give yourself the chance to be well.
If you’ve suffered with a mood disorder and other medicines and treatments haven’t helped much or at all, call us at 860.648.9755. Let us help you achieve remission and a more meaningful life.
To the development of your best self,
Lori Calabrese, MD