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February 9, 2015 · 3:36 PM

Emotion Differentiation and the strengths of specificity

“I have learned now that while those who speak about one’s miseries usually hurt, those who keep silence hurt more.” – C.S. Lewis

The last post covered a metaphor to encourage people to embrace their emotions. More research is showing there is power in calling them by name.

lisafeldmanbarrett

Lisa Feldman Barrett, PhD, Distinguished Professor of Psychology at Northeastern University.

“Emotion differentiation” is the ability to say what one feels. It’s a central focus for emotional-intelligence researchers such as Lisa Feldman Barrett at Northeastern U. and Todd B. Kashdan at George Mason U. They’ve found that the people best able to regulate their feelings are the ones who can say they feel more regret than remorse, less guilt than shame or more miffed than peeved¹. Compared with those who only report feeling, “fine,” or “bad,” those with a fine-grained view of their emotions respond more resiliently to rejection². While they are more likely to employ many strategies to cope with unhappiness, they’re less likely to cope via alcohol abuse³ or violence⁴.

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Todd B. Kashdan, PhD, professor of clinical psychology at George Mason University.

Trouble with emotion differentiation seems to appear in different emotional health issues. Demiralp and Thompson⁵ found that people with depression had, “less-differentiated negative emotional experiences”; i.e., they could distinguish more specific positive feelings than negative ones. Kashdan and Farmer found similar findings for those with Social Phobia⁶.

Kashdan, Barrett and McKnight suggest knowing exactly what you’re feeling makes it easier to get those emotions’ message. That information connects us with other knowledge about what to expect and what to do. It also makes it easier to regulate the feelings, because they’re now classified either as motivation or as irrelevant. With less energy devoted to controlling one’s emotions, there’s more to put towards the things you want to achieve⁷.

Poor emotional differentiation in action.

Poor emotional differentiation in action.

They also point to evidence that emotion differentiation is a skill that can be taught⁷. This includes findings that emotionally-differentiating children behave and perform better in school⁹.One study found naming emotions helped arachnophobes tolerate exposure therapy better than distraction or cognitive reframing¹⁰.

For therapists working in community mental health, these findings can be a selling point. Live in a tough neighborhood? Need to keep up a strong front? You want to know what you feel so you can recover more quickly. If a client only values logic, emotion differentiation can be a way of getting them to look at their feelings; Ciarrochi,  Caputi and Mayer⁸ found that those who can identify specific emotions make decisions with less emotional bias.

howidealwithmyfeelings

Clients can get confused when we ask them to identify negative feelings. They come to us to feel better. Why are we asking them to feel worse?  The assumption that it is safest to suppress your emotions is a spin on the post hoc fallacy: “I feel vulnerable when I pay attention to my feelings, so  if I ignore them, I’ll be less vulnerable.” We may be able to tell our clients, “Emotions are only a vulnerability if you treat them that way. Treat them like information and they become a strength.”

All this gives us one more reason to pull out our emotion-word sheets and encourage clients  to name their feelings.  I’ve asked clients rate the intensity of their distress before and after identifying emotions. More often than not, they’re surprised to find their stress level has dropped.

Two examples to motivate clients to practice identifying feelings at home:

1. The tale of Rumplestiltskin. At the end of the story, the wicked little man had to give up his claim on the princess’ child. Why? Because she found out his name.

2. Tribal societies around the world, where members have a public name for common use, and a secret name kept private among family members. Why? Because knowing something’s name gives you power over it.

n.b.: Dr. Barrett responded to this post, and she suggested these for further reading:

Lindquist, K., & Barrett, L. F. (2008).  Emotional complexity. Chapter in M. Lewis, J. M. Haviland-Jones, and L.F. Barrett (Eds.), The handbook of emotion, 3rd Edition (p. 513-530). New York: Guilford.

Barrett, L. F., Wilson-Mendenhall, C. D., & Barsalou, L. W.  (2015).  The conceptual act theory: A road map.  Chapter in L. F. Barrett and J. A. Russell (Eds.), The psychological construction of emotion(p. 83-110).  New York: Guilford. — this explains one theory for how to become more emotionally granular

Citations:

(1) LF Barrett, J Gross, TC Christensen, M Benvenuto.  “Knowing what you’re feeling and knowing what to do about it: Mapping the relation between emotion differentiation and emotion regulation” Cognition & Emotion 15 (6), 713-724

(2) Kashdan, T.B., *DeWall, C.N., Masten, C.L., Pond, R.S., Jr., Powell, C., Combs, D., Schurtz, D.R., & †Farmer, A.S. (2014). Who is most vulnerable to social rejection? The toxic combination of low self-esteem and lack of emotion differentiation on neural responses to rejection. PLoS ONE 9(3): e90651. doi:10.1371/journal.pone.0090651

(3) Kashdan, T.B., †Ferssizidis, P., Collins, R.L., & Muraven, M. (2010). Emotion differentiation as resilience against excessive alcohol use: An ecological momentary assessment in underage social drinkers. Psychological Science, 21, 1341-1347.

(4)  Pond, R.S., Kashdan, T.B., Dewall, C.N., †Savostyanova, A. A., Lambert, N.M., & Fincham, F.D. (2012). Emotion differentiation buffers aggressive behavior in angered people: A daily diary analysis.-7- Emotion, 12, 326-337.

(5) Demiralp E1, Thompson RJ, Mata J, Jaeggi SM, Buschkuehl M, Barrett LF, Ellsworth PC, Demiralp M, Hernandez-Garcia L, Deldin PJ, Gotlib IH, Jonides J. Feeling blue or turquoise? Emotional differentiation in major depressive disorder. Psychol Sci. 2012;23(11):1410-6. doi: 10.1177/0956797612444903. Epub 2012 Oct 15.

(6) Kashdan, T. B., & Farmer, A. S. (2014, February 10). Differentiating Emotions Across Contexts: Comparing Adults With and Without Social Anxiety Disorder Using Random, Social Interaction, and Daily Experience Sampling. Emotion. Advance online publication. http://dx.doi.org/10.1037/a0035796

(7) Kashdan, T.B., Barrett. L.F., & McKnight, P. E. (in press). Unpacking emotion differentiation: Transforming unpleasant experience by perceiving distinctions in negativity. Current Directions in Psychological Science.

(8) Ciarrochi, J., Caputi, P., Mayer, JD . The distinctiveness and utility of a measure of trait emotional awareness. Personality and Individual Differences 34 (8), 1477-1490

(9) Brackett, M. A., Rivers, S. E., Reyes, M. R., & Salovey, P. (2012). Enhancing academic performance and social and emotional competence with the RULER feeling words curriculum. Learning and Individual Differences, 22, 218-224. doi:10.1016/j.lindif.2010.10.002

(10) K. Kircanski, M. D. Lieberman, M. G. Craske. Feelings Into Words: Contributions of Language to Exposure Therapy. Psychological Science, 2012; DOI: 10.1177/0956797612443830

 @ 2015 Jonathan Miller All Rights Reserved

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May 8, 2014 · 8:59 PM

The Skunk in the Basement

“Never, for any reason on earth, could you wish for an increase in pain. Of pain you could wish only one thing: that it should stop.” – George Orwell, Nineteen Eighty-Four, Part Three, Chapter One.

Therapy can get stuck for the same reason our clients come in: their emotions are too upsetting to bear. It’s easy to vent on how unreasonably others  behave; addressing how it affected us is harder. To focus a client on their own thoughts and feelings can take sales-work. Some are satisfied with explanations of why catharsis is not therapy, how containment exercises can save them from being a wreck, or how mindfulness practice lets us both experience and contain our emotions. Others want an answer to a more basic question: why feel pain you could suppress?

Skunk, copyright 2006 by Torli

“Just stay present with that emotion. It’ll rise… peak… decline… and go trundling off through the grass.

Suppressed emotions are like a skunk in the basement. Our clients weren’t raised with wildlife-management skills, so down in the basement it went. Even though the animal can’t be seen, the house stinks from the foundation up. To experience an emotion means to let the skunk out. If we tolerate the disgusting sight and smell of Mephitis mephitis parading through our home, it can walk out the door and leave.

Most people believe little comes from painful emotions but pain. There can also be relief and increased tolerance for one’s feelings. Why accept sadness, fear or embarrassment? For the same reason we exercise, floss, save money, give birth, and eat habanero peppers. The pain fades. It’s replaced with relief, and sometimes joy.

@ 2014 Jonathan Miller All Rights Reserved

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April 13, 2014 · 7:08 PM

Stress Management Blogging #6

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March 22, 2014 · 11:43 AM

Wim Wenders on Psychotherapy

An opposing view from the director of Wings of Desire and Pina:

"My advice is don't spend your money on therapy. Spend it in a record store." Wim Wenders

 

 

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February 19, 2014 · 9:03 PM

New Warning Signs of Suicide

Doctors worry they might kill their patients. Therapists have to worry their clients will kill themselves. Lethality assessment shouldn’t be a nerve-wracking process of guesswork and intuition, but clients can’t always think clearly enough in crisis to give us straightforward answers. Three recent studies identify newly-substantiated risk factors for us to consider.

Trauma and suicide are clearly linked. In a 2009 article [i] for the Journal of Traumatic Stress, Jakupcak, Cook, et al found that veterans who meet criteria for post-traumatic stress disorder are four times more likely to consider suicide than those who don’t. Researchers at the University of Manitoba [ii] have identified key post-traumatic symptoms that indicate higher risk. After talking to 2,322 subjects and controlling for other mental health issues, they found that physical reactions to reminders of the trauma, being unable to recall some part of the trauma, and having a sense of foreshortened future were all strongly associated with suicide attempts. If you felt wrenched with every reminder of something you couldn’t remember properly, how long could you tolerate a persistent sense of doom?

Client’s families can also give clues to the risk of suicide.  Anju Mathew and Anil Prabhakaran of the Government Medical College, Thiruvanathapuram, Kerala, India, tracked “expressed emotion,” a measure of how much criticism, hostility, or emotional over-involvement family members show. Per their findings [iii], the more clients felt criticized after a suicide attempt, the more likely they were to try it again. We wish all of our clients returned from the hospital to supportive, understanding families. Unfortunately, it’s too rare that people with such serious issues have families that respond in a caring, validating way.  Prabhakaran and Mathew suggest therapists involve the family members in sessions after a suicide attempt. They suggest families will be less critical if they have the chance to work through their thoughts and feelings, and better understand their loved one’s needs. At the very least, we should ask such clients, “How did your family take this?”

If you’ve ever told clients, “Everyone thinks about suicide now and then,” stop.  A 1999 review of nine western countries [iv] found the highest percentage that had considered suicide at some point during their lives was only 18.51%.  (This was in New Zealand – apparently a hobbit-ridden archipelago of despair.) Ideation is highly correlated with attempts. Simon, Rutter, et al [v] reviewed Patient Health Questionnaire (PHQ-9) Depression Screens  completed between 2007 and 2011 by 84,418 primary-care patients; 704 of whom would attempt suicide and forty-six of whom would die from it. The PHQ-9 asks, “Over the past two weeks, how often have you been bothered by the following problems?” Those who reported, “Thoughts that you would be better off dead, or of hurting yourself,” had bothered them nearly every day were ten times more likely to attempt suicide over the next year than those who answered, “Not at all.” They were ten times more likely to succeed. If the actual percentages are relatively small,  (from 0.4% to 4% for an attempt, and 0.03% to 0.3% for successful suicide), the factor of ten makes it worth our time to ask how often clients think about ending their lives.

Marsha Linehan’s UWRAP and UWRAMP protocols are helpful checklists to use when assessing suicidal clients. They don’t tell us which clients are more likely to reach a suicidal crisis. These studies give us three more questions to ask when considering how carefully to watch a client: “How did your family respond when you attempted suicide?” “Have you been having physical reactions to reminders something you can’t remember, but left you feeling jinxed?” and, most simply, “How often does suicide cross your mind?”

@ 2014 Jonathan Miller All Rights Reserved

Citations:

[i] Jakupcak M, Cook J, Imel Z, Fontana A, Rosenheck R, McFall M. Posttraumatic stress disorder as a risk factor for suicidal ideation in Iraq and Afghanistan War veterans. J Trauma Stress. 2009 Aug;22(4):303-6. doi: 10.1002/jts.20423.

[ii] 2. Zeynep M.H. Selamana, Hayley K. Chartrandb,  James M. Boltona, Jitender Sareena, Which symptoms of post-traumatic stress disorder are associated with suicide attempts? http://dx.doi.org/10.1016/j.janxdis.2013.12.005

[iii] Mathew A, Prabhakaran, A. Perceived Expressed Emotion as a Risk Factor for Attempted Suicide – A Case Control Study International Journal of Recent Trends in Science and Technology, Volume 9, Issue 2, December 2013 pp 299-302

[iv] Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Joyce PR, Karam EG, Lee CK, Lellouch J, Lepine JP, Newman SC, Rubio-Stipec M, Wells JE, Wickramaratne PJ, Wittchen HU, Yeh EK. Prevalence of suicide ideation and suicide attempts in nine countries. Psychological Medicine, Volume: 29  Issue: 1  Pages: 9-17, DOI: 10.1017/S0033291798007867

 [v] Simon GE, Rutter CM, Peterson D, Oliver M, Whiteside U, Operskalski B, Ludman EJ. Does response on the PHQ-9 Depression Questionnaire predict subsequent suicide attempt or suicide death? Psychiatric Services 2013; doi: 10.1176/appi.ps.201200587

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April 9, 2013 · 10:22 PM

Invalidation at the Multiplex

... and invalidation won't actually toughen up your kid.

… and invalidation won’t actually toughen up your kid.

This week, I spotted ads for the upcoming After Earth at the local movie theater. Between the tensed faces of Will and Jaden Smith, the poster blurbs, “Danger is Real. Fear is a Choice.”

Oh, Hollywood. So much sex. So much violence. So little psychological accuracy. Any $275-per-hour L.A. psychologist could have told you: emotions aren’t a rational choice, any more than logic is an emotional impulse. To tell people otherwise is invalidating.

Invalidation happens any time clients get the message their emotions or beliefs are flawed, wrong or unimportant. It is more than just negativity: “You failed the test,” states a fact. “Don’t tell me you studied when you bring home an F,” invalidates all of the student’s effort.

Everyone can handle a little. What kid has never heard, “You can’t be hungry, you just ate”? Repeated invalidation leaves people in doubt about their emotions and themselves. It’s associated with poor social skills in children,  self-harm in teen-agers, psychological distress in adulthood and worsened rheumatoid arthritis in sufferers of all ages.  In cognitive-behavioral therapy, it takes a delicate touch to challenge clients’ beliefs without invalidating them as people. When people hear enough repetitions of, “You put the pressure on yourself,” “Let’s hold a pity party,” or “Stop being so dramatic,” they’ll start invalidating themselves.

New, hesitant clients often say, “Maybe I should just get over it.”  They’ve absorbed the idea they can fix their emotional issues by choosing not to have them. The trouble is, emotions are like pets and children. We’re each responsible for our own, but we control them indirectly at best.  If you start by believing anxiety means you are weak and self-indulgent, you can wind up certain you are a failure when it doesn’t go away.

C’mon, Tinseltown! How about a tag line like,

“Danger is real.

Fear is a normal, healthy emotion everyone experiences.

You can manage it effectively with  mindful acceptance and self-validation.”

That would be much more accurate, and only cut ticket sales by half.

n.b.: . Steve Hein, of EQI.org has a .pdf on invalidation for parents of teen-agers here. Worth a read.

@ 2013 Jonathan Miller All Rights Reserved

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March 25, 2013 · 8:07 PM

Hearts, Darkness and Chinua Achebe

The Nigerian novelist, Chinua Achebe,  died last week. Besides being, “one of the greatest writers of the 20th century,”  he was also a publisher, professor, deputy vice-president of a Nigerian political party and a stalwart champion for third-world writers. I studied under Achebe in undergrad.  In one class, he taught something invaluable for therapy practice.

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RIP Chinua Achebe: November 16, 1930 – March 21, 2013

This day, we asked Professor Achebe about his famous critique of Joseph Conrad’s Heart of Darkness. First, we took deep breaths. The professor always spoke with quiet, measured dignity; so much so, it took courage once to tell him he was teaching next week’s book. Pulses calmed, we asked: was it fair to call Conrad’s masterwork racist? Didn’t  Kurtz’s character show it was Europeans who disgusted the author?

Gently, he explained we had missed his point entirely.

heartofdarknessAchebe told us about childhood in a Nigeria that was part of the British empire; where his schoolbooks taught the story of, “we Britons,” and the few Africans in storybooks were savages.  To him, it wasn’t the spears or loincloths that made these fictional natives sub-human.  He himself wrote a book in which tribesmen kill and eat a man, chatting casually over their meal. His point was speech. The only natives who speak aloud in Heart of Darkness, he said, are those under the ‘civilizing influence’ Conrad viewed with irony and despair.  The professor, a master of many languages, opined Conrad dehumanizes his natives because he limits them to animalistic shrieks and war whoops. At least Achebe let his cannibals talk.

In our first counseling class, we’re taught we should speak 30% of the time and listen 70%.  In session, we fight the urge to interrupt our clients and tell them how to fix their problems. A psychology professor told me in his years as a therapist, the lesson he’d re-learned the most was, “Shut up and listen.” Professor Achebe would have appreciated his effort. Clients often come to us because no one else will hear. Letting people talk can give back their humanity.

@ 2013 Jonathan Miller All Rights Reserved

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January 7, 2013 · 8:29 PM

“Six Harsh Truths” and depression

David Wong‘s Six Harsh Truths That Will Make You a Better Person is a New Year’s essay for those who lack resolution – one that applies directly to treating depression.

If you want to know why society seems to shun you, or why you seem to get no respect, it’s because society is full of people who need things … the moment you came into the world, you became part of a system designed purely to see to people’s needs.

 Either you will go about the task of seeing to those needs by learning a unique set of skills, or the world will reject you, no matter how kind, giving and polite you are. You will be poor, you will be alone, you will be left out in the cold.

 Does that seem mean, or crass, or materialistic? What about love and kindness — don’t those things matter? Of course. As long as they result in you doing things for people that they can’t get elsewhere.

He’s talking to those paralyzed by the dissatisfaction they feel with their lives, and that includes those with Major Depressive Disorder. As  Marsha Linehan pointed out, the best medicine for unpleasant emotions is often the opposite of what the emotion makes us want to do.  “Opposite action” is Wong’s prescription for those who are disgruntled but inert: do something. Anything. Anything  more than what you do now, that would also be useful to others. He stands with  Roy F. Baumeister, whose research shows we don’t achieve because we have good self-esteem. Per the Florida State University researcher, if there’s a relationship between the two variables,  it’s much more likely we have good self-esteem because we achieve.

It’s a shame Wong builds his argument on Alec Baldwin’s role in Glengarry Glen Ross as a manager who shames and threatens his sales force.  Who gets motivated from abuse? Those galvanized by anxiety – the sort of highly-motivated go-getters who rarely need our help. Wong doesn’t scorn his readers for freezing in fear of rejection and failure. His point is simpler: the world values you for what you do. You can be valued more highly by doing more.

In cognitive-behavioral therapy, the most effective reframes for thoughts of, “I’m worthless,” are usually about accomplishments – grades the client earned, projects they completed, people they have helped. Once I’ve helped a client identify all of the reasons they aren’t garbage, I’m going to ask, “Now that we’ve settled that, what do you want to do that would make you even more worthwhile?”

@ 2013 Jonathan Miller All Rights Reserved

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November 25, 2012 · 2:37 PM

Successful Branding: Don’t Be a Therapist

Interesting New York Times article here about a rookie therapist who sought branding experts’ help in building her private practice. It seems the key to success is to choose a hyper-specific niche, tweet banalities, study pop culture, make borderline-inappropriate self-disclosures,  be available 24/7, treat clients via text message, reassure them they don’t need to make changes and downplay the fact you’re a therapist.

On that note, I’m going back to bed.

@ 2012 Jonathan Miller All Rights Reserved

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November 22, 2012 · 1:44 PM

On Resentment

Photo copyright 2012 by Jenny Rollo“Resentment is the most precious flower of poverty” – Carson McCullers

On the third Thursday of each November, we Americans bow our heads and meditate on all we are thankful for. For those of us who like our turkey tartened with cranberry sauce, here are a few thoughts on gratitude’s opposite.

What is Resentment?

The word begins with the prefix re (as in repeat) and adds from the Latin sentire – to feel. Ordinary anger flares up and is quenched. Resentment is felt over and over. Vengefulness takes action. Hostility and rage lash out.  Resentment is passive and slow-fermenting. One can be bitter at life in general, but we are resentful towards people. We feel prejudice because of who others are, but we are resentful over what others have done.  Or not done. No one begrudges basement inventors their new-found wealth, but blue-collar teens are often resentful towards rich kids who did nothing to deserve designer clothes or private-school education.

Philosopher Robert C. Solomon pointed out resentment involves inferiority; we resent our siblings for taking up more of our parents’ time and attention. Like all anger, resentment involves the perception of victimization. If our younger brother gets more maternal love, we get less. Resentment is often misplaced; Li’l Brother didn’t ask to be Mom’s favorite, after all.

Photo copyright 2012 by Kavitha ShivanThere’s even a special type of resentment when it affects our perceptions of the world: ressentiment. Per thinkers such as Kierkegaard and Nietzsche, ressentiment means you’ve invented a morality-based explanation of your inferior position. Your children won’t talk to you? Those selfish ingrates should thank you for raising them with discipline. When you believe you have lost because you are the better person, ressentiment protects your self-esteem but blinds you to your role in the problem.

Why feel resentful?

Resentment is painful and corrosive. Most resentment advice minimizes to two words: “Stop it.” What use could such a toxic feeling serve? It could enforce social norms by punishing those who act haughty and superior. It also could be protective. In the 1980s, political scientist Robert Axelrod wrote computer programs to test strategies for “Prisoner’s Dilemma” games, where success depends on smart choices on whether to cooperate with another. The most successful strategy was to cooperate with those who cooperated in earlier rounds and to thwart those who didn’t. Resentment reminds us who didn’t cooperate. When you pick at a scab, the wound will never heal, but you’ll never lose your reminder of how you were hurt.

Photo copyright 2012 by Emiliano SpadaHow can we work through it?

The Big Book Bunch  encourages those in recovery to write out a four-column summary of their resentments, and to examine the role they may have played in the problem. Taking responsibility can ease resentment, as long as that responsibility is present. A middle child who resents the youngest for taking up her parents’ attention can’t take responsibility for being born between siblings, for the younger child’s greater needs for parental attention, or for the parents’ limited supply of time and energy. Rational-Emotive Behavioral Therapy provides a less-invalidating approach: examine our beliefs about the situation, so we can shift our feelings from paralyzing resentment to healthier negative emotions, such as sorrow, disappointment or grief.

Discussion of healthier emotions (that is, those that lead us to more constructive, motivated thinking) raises the Thanksgiving Day question: If we’re trying to move back to healthier emotions, shouldn’t we try to shift to gratitude? Possibly not. As Ronnie de Sousa points out in a review of one of Solomon’s books, to be grateful to someone is to be in their debt. And to be in their debt is to place yourself in a position of subservience to them. And positions of subservience can lead straight back to … resentment.

 

@ 2012 Jonathan Miller All Rights Reserved

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