Why Emotional Regulation is the Most Important Skill to Teach Anyone Who is Suffering from Mental Health Challenges (Guest Post)
Neuropain Health Coach and Strategy Director Julia Mirer, MD reviews why emotional regulation is the single most important tool to learn as adults (or to teach children) in order to address/prevent mental health challenges and improve one's quality of life.
This article is reposted with her permission from her substack, which I highly encourage subscribing to!
Author: Julia Mirer, MD
If you and I have spoken in the last couple of months, you probably heard the words “emotional regulation” come out of my mouth in one context or another. Let me take you on the path that led me to believe that emotional regulation is the single most important tool to learn as adults (or to teach children) in order to address/prevent mental health challenges and improve one's quality of life.
TLDR; At the core of every mental health diagnosis is emotional dysregulation.
Exercise: Take this 2-minute online quiz to see your level of emotional regulation.
Extra credit: Take a hit/sip of your vice of choice every time you see the words emotional regulation to get a nice buzz by the end of this piece.
Emotional regulation is the ability to manage and respond to one's emotions in a healthy and constructive way. It involves the ability to:
Recognize and identify: understand what emotions are being felt
Accept: acknowledge emotions without judgment
Express: communicate emotions in a respectful and constructive way
I began to see a pattern when I thought about the diagnosis of Borderline Personality Disorder. Are these people inherently bad? I don’t think so. But are these people who have developed poor coping skills that were reinforced over time? 100% (maybe 99%, to leave room for changing my mind with new information). In fact, when you look at diagnoses like borderline or bipolar in women—and superimpose the symptoms onto the timeline of the female hormone cycle—you start to see a pattern that suggests emotional dysregulation is the culprit. Are these women’s symptoms worthy of a mental health diagnosis, or are these symptoms evidence of insecure attachments (big emotions) and poor coping skills that are revealed during vulnerable times in a fluctuating hormonal cycle? If it is the latter, then medication alone is not the answer: insight and behavioral modifications are.
For context: I wasn’t just thinking about emotional regulation for fun. At 36 years old, I discovered the power of emotional regulation firsthand. If you have ever struggled to not react to situations or to not have your day be derailed by a negative experience, developing the ability to regulate your emotions in the moment feels like a tectonic shift in your soul. It is now my goal to bring this practice to as many people as I can in this lifetime.
The Role of Caregivers
Here’s the thing: Children are not born with a mental health diagnosis. Children are, however, born with all the emotions of an adult and with zero tools to navigate them. They look to their primary caregivers to teach them how to manage their emotions. This is a tall order for parents with their own mental health challenges, substance use habits, demanding work schedules, and/or general lack of emotional intelligence. I mean… could you picture your parents, or your parents' parents, being equipped to handle this kind of task? Most of us can’t.
The reason I believe that emotional dysregulation is at the core of mental health problems is because at some point you were a child trying to navigate your emotions. Without proper guidance from your (even well-intentioned) caregiver, you were left to your own devices. Over time, whatever way you learned to cope with emotions becomes a pattern (tantrums). Later on, this pattern becomes your personality (angsty teen). And if the maladaptive coping mechanism continues, you develop a diagnosis (anxiety disorder). Once people have a diagnosis, they often end up medicated. Many people start identifying with their diagnosis (“I am an anxious person”), and they find themselves in a loop of victim mindset and failed interventions—undermining their confidence and perpetuating their inability to cope.
A Transdiagnostic Approach
I don’t like viewing people through the lens of diagnostic criteria because it doesn't really tell me what to do for them. The reason I like this transdiagnostic lens of how well one is able to emotionally regulate is because it provides an actionable first step. I am not saying that mental health diagnoses need not be taken seriously, or even medicated at times. I am simply suggesting that whether you have been diagnosed with ADHD, Borderline, Bipolar Disorder, OCD, PTSD, Depression, Anxiety, or even Autism, at least some portion of your symptoms can be improved through developing an ability to regulate your emotions*.
(*If someone was not able to voice their needs as a young child because it angered their caregiver or because nobody was there to tend to them—they may have disconnected from their own emotions so as not to upset the primary caregiver whom they are dependent on for survival. Picture an animal caught in a trap; they will gnaw off their foot in order to survive. In this example, that foot is a person's emotions. This tends to manifest as people-pleasing in adulthood. These clients often have to start with connecting to, and validating, their own emotions before learning how to regulate them.)
I am oversimplifying here, but consider these examples:
Depression: Shutting down in response to big emotions.
ADHD: Struggling to slow thoughts or wait your turn to speak during big positive emotions.
Borderline Personality Disorder: Lashing out at a partner when fear of abandonment is triggered.
OCD: Performing compulsive behaviors in response to intrusive thoughts, such as a fear of a family member dying.
Even the diagnosis of Bipolar Disorder, which usually comes after someone is medicated for depression and has a manic swing, points to emotional dysregulation. If a person is taught to regulate their emotions alongside the antidepressant, could we maybe see a decline in Bipolar diagnoses? If a teenager is taught emotional regulation, could we maybe see a decline in Borderline diagnoses?
Now, I am not saying any of this to minimize the felt experience of someone with a diagnosis. I am saying this to provide a beacon of hope that can inspire someone to dig deeper than childhood trauma or diagnostic criteria to the part of themselves that IS modifiable. If the goal becomes emotional regulation and not the daunting task of “curing depression,” then the game is changed. Coaching is all about small actionable steps that are repeated consistently. I promise you, when you begin to connect to your emotions, you will recognize how often an opportunity to regulate your emotions actually shows up. (Fun fact: Did you know that having a judgmental thought about someone or assuming you know someone’s intentions is a subtle internal cue that you are triggered? Notice how often that comes up in your day-to-day life to better understand the value of learning how to regulate emotions.)
Psychedelics and Emotional Regulation
When it comes to psychedelic medicine, I think teaching emotional regulation alongside treatment is of utmost importance. As a non-specific amplifier, these medicines can actually make you more aware of the emotions you have (or the ones you have suppressed) —if you are not taught how to navigate them, we are doing you a disservice.
A Huberman Lab podcast episode points out that no neuroplasticity happens during an event (in this case, let’s take the event to be a ketamine dose), but it happens in the period of time afterward, including during sleep and non-sleep deep rest. Neuroplasticity (the ability of the brain to form and reorganize synaptic connections) requires the neuromodulators acetylcholine (to highlight the new pathways for remembering) and epinephrine (for attention), which together often create the emotions of agitation and discomfort. If you are unable to regulate your emotions, this agitation is a sure way to make you stop doing something new. And since behavior change requires an ability to tolerate distress, you can see how emotional regulation even plays a key role in any effort to address challenges across the mental health spectrum.
This idea that neuroplasticity happens through effortful top-down processes is why I tell clients that a ketamine treatment will likely provide them with 7–10 days of relief from the burden of their symptoms, but what they do (read: what behavior changes they make) in that period will be what determines their long-term outcomes. All too often, I hear people tell me that they felt good for a while after ketamine (or other psychedelics), but then the effects wore off. I reassure them that the effects were never meant to stay—they were meant to remind them what good feels like and to make behavior change a little easier to jumpstart their journey to well-being.
Emotional regulation is diagnosis-agnostic and also does not require a diagnosis to be beneficial. It helps us not burn out after a conference, it helps us prevent making unnecessary impulse buys, it helps us understand why someone's words hurt us deeply, and it helps us soften our internal dialogue. It is an incredibly valuable skill to have as a colleague or as a leader, an incredibly powerful tool to use as a parent, and is one of the most attractive things you can do as a partner. Emotional regulation creates internal balance, and from a place of balance, the whole world opens up.
Julia is available to work with you (with or without ketamine) as one of NeuroPain Health’s coaches. If you’d like to schedule to speak with her today, contact us.