Emotional Regulation: My Perspective

May 25, 2020

 

No one gets through adolescence without disruptions in worldview and shifts in perception. In addition, traumas seem to be ubiquitous in the human experience and play a huge role in behavior generation. These are aspects of individuals that healthcare seldom takes into account, so I wanted to provide some insight into how I think about it and address it in practice. 

Emotional dysregulation, to me, can be thought of as an integration of three parts: neuroanatomy, fundamental problems, and the therapy that can be employed to address the gaps. 

 

Neuroanatomy

            I like to break the areas involved into conscious and unconscious groups. Unconscious mediators include the classical limbic cortex – the amygdala, hippocampal formation, fornix, mammillary bodies, thalamus, entorhinal area, hypothalamus, tegmental nuclei, cingulate, and others. The duty of this circuitry is to adjust behavior based on past experience, somatosensory and visceral sensation, and external environmental cues. Once adjusted, behavior then manifests itself – which can be a display of anxiety, sadness, disgust, anger, jealousy, and other ‘sub-personalities’ which concomitantly initiate motor commands that carry the specific physical characteristics of the sub-personality. 

            Conscious mediators of emotional regulation involve the frontal cortex and its subsections like the dorsolateral and orbito-medial prefrontal cortices, as well as our voluntary motor responses. It may seem as though we are not in any control of the behavior that arises out of that mess reflexive circuitry mentioned above, but rather a victim of what our subconscious decides is the appropriate thing to do. This is partially true because of the effect that stress and sympathetic nervous system arousal has on the brain regions responsible for judgement and decision-making capability. The unconscious does not want your slow, rational, and volitional processing to have the reins when it believes there is a clear and present danger. Volitional effects seem to only happen once you “snap out of it” and are able to retrospectively assess the event – IF that retrospection is a normal process for an individual. On the other hand, there are times when a certain sub-personality may be desired, such as during a competitive event or dramatization, but it is a much more difficult task to call one forward instead of having one spontaneously emerge out of necessity for survival. 

 

Fundamental Problems

            Given the above description of anatomy, what is the fundamental nature of alterations in the functioning of the circuits? What is normal? What is abnormal? Are those categories absolute? Well, in an environment that is constantly changing, I would argue that there are no absolutes when it comes to behavior, as there are plenty of circumstances that would call for the worst parts of our instinctual machinery to surface and predominate. By and large it is cultural, social, and traditional influences that dictate what behaviors are appropriate, and by contrast what behaviors are pathological. There enters the first potential fundamental problem – a rapid dissociation of morality and traditional values from Judeo-Christian ethics. This is an idea I first heard from Dr. Jordan Peterson, a clinical psychologist who specializes in personality. The interesting point was that it is not a religious argument like it might imply, rather it was an argument that centered back on the consequences that Friedrich Neitzsche’s foretold of with the announcement of the death of God. Essentially, by ripping out the foundations for behavior and morality, people were left to their own devices to formulate personal value structures and something else to replace the archetypal “ideal” as well as something to deal with existential problems. In today’s society there are really no shortages of opinions, views, and beliefs that alter value structures to favor their own or their group ideologies, which, in part, aid in the dissolution of emotional and subconscious regulation. The tribalistic mentality shields members from outside perspectives while reinforcing their own. Whether that is a good thing, a neutral thing, or a bad thing is up to the fruit it bears.  

            The next fundamental problem I will address is autonomic balance, which is the seesawing, ebb and flow between signals of threat and safety that the nervous system endures throughout life. The autonomic nervous system consists of two branches – the sympathetic and the parasympathetic. The sympathetic branch facilitates responses and behavior that is indicative of a perceived threat, which can vary greatly between individuals and is commonly grouped with the alliteration ‘fight, flight, or freeze’. In contrast, the parasympathetic branch facilitates responses and behavior that indicative of environmental safety, and is commonly grouped with activities of exploration, rest, digestion, and recovery. The real question here is which side should people predominately be? Or should they be even? Well one possible answer is that it depends on how long you’d like to live, because living like something is always out to get you tends to burn the candle quite a bit faster – the profile of the typical American hustle, I’d say –  that old ‘sleep when you’re dead mentality’ that is likely a result of the evolution of socioeconomic and sociocultural value systems away from a more sustainable and, quite frankly, healthier Judeo-Christian framework. From the eight month of gestation humans have a relatively intact limbic system that can recognize faces (limited by visual resolution), pain, hunger, and stress, among other regulatory functions. This lays the groundwork for unconscious limbic wiring (i.e neuroplasticity) from before we are even born, which is why maternal stress has profound physiological effects on their passengers. Autonomics reflect how the unconscious is gauging the environment, which depends some degree on trait neuroticism, but regardless of how an individual would like to behave the unconscious will win unless the triggers are addressed. Some of the causes or reasons for dysautonomia are psychological trauma, physical trauma (particularly to the head), infection, autoimmune conditions, damaged mucosal integrity, heavy metal toxicity, prescribed and non-prescribed substances, and other circumstances where inflammation is sustained and chronic with poor or little resolution.

            The final fundamental problem that I’d like to address is hemispheristic synchrony between the right and left brain. When it comes to the responsibilities of the hemispheres it can generally be said that the right brain is in control of organizing the external and internal environments through an appraisal process that unconsciously establishes positive, negative, emotional, and relative importance to the stimuli that are in those environments. What’s really important here is that it’s an unconscious process that occurs through amygdalar and limbic memory systems and that the physical manifestation of this process is revealed through affect, facial expression, body language, emotion, and attitude. Contrast all this with the general responsibility of the left brain, which is to take that appraisal process and integrate it with other somatosensory, visual, auditory, and visceral information. That information is filtered through Wernicke’s and other association areas and organize it into meaningful information that can be comprehended and interpreted through goal-oriented language, thought, and attention. When there is a disconnect in these areas what you end up seeing is a trapped mind that doesn’t know how to orient their perception with the external and internal worlds. In other words, you get a person that doesn’t understand how to talk about how they feel. Perhaps they are unable to explain, even within their own reference frame, complex or abstract concepts. The lack of these abilities indicates a system that has suppressed, hidden, or lost the fundamental ability to reflect on what they feel, followed by verbalizing and representing those feelings cognitively. Is it to protect their fragile psyche? Is it a coping mechanism? Did they not develop the abilities? The answer is, who the hell knows?

            It’s important to note that the fundamental problems I’ve laid out are not exclusive or independent of each other, but instead represent somewhat of a mesh of possible, low resolution pictures of what can be further dug into and explored after first acknowledging them. This short list is also not comprehensive, and I do not claim that what I’ve compiled is completely scientific, that is to say, completely empirical and free of subjectivity, but rather an attempt to understand clinical experience and philosophy in light of neurophysiological and neuropsychological knowns. In addition, my value preposition on Judeo-Christian ethics is not without the acknowledgment of its shortcomings - I'm well aware. 

 

Therapy

            So what is there to do about emotional dysregulation? How can we deal with the fundamental problems that give rise to it? I think the number one tool that people have is introspection and the ability to articulate the chaos into order – out of the domain of thought and into an action. If someone is unable to reflect internally and organize their thoughts and feelings enough to be able to have a conversation about it, than that is where the practice must begin - exercises like looking at pictures or videos of faces that depict certain emotions or sub-personalities is a good start. Talking is an amazingly simple solution to very complex issues – If someone will listen. Determine what is pathological, reality test, expose, understand values, motivation, and highlight personal responsibility. 

            Another way of training the top-down control of the unconscious is getting in an uncomfortable situation – not too uncomfortable but something that has a decent stimulus, like stretching, enduring light pain, exploring temperature extremes, etc. all while modulating the facial expression to be opposite of what the unconscious is telling it to do – smile in the face of discomfort. Additionally, modulating posture to signal that there is no threat or danger will also volitionally override unconscious posturing, as well as feed better proprioceptive input into the brain so it is a two-for-one. It is also important to visualize or focus on something else that will serve not only as a distraction for the person, but the act will be telling the brain that the discomfort must not be as severe as its current evaluation is suggesting. These types of situations can also be trained under exposure-like circumstances by pairing triggers with sensory stimuli that override the stress response, like deep breathing, olfaction, and gustation. 

            Finally, to directly address the skewed autonomic balance, activities that directly stimulate the parasympathetic nervous system can be helpful. Since the parasympathetic nervous system is mainly represented by the vagus nerve, using the different end organs innervated by the vagus will activate it and engage the parasympathetic branch while concomitantly reducing sympathetic branch activity. If you are physically cleared and able to do so, examples include gargling, performing the Valsalva maneuver, eliciting the oculo-cardiac and carotid reflexes, and diaphragmatic breathing. For added measures, stimulating other brainstem regions that modulate autonomic activity can helpful, such as ocular, vestibular, and hypoglossal complexes. One final note in regard to neurological therapy is this – oxygenation and appropriate fuel are absolutely vital for long term potentiation and neuroplasticity to occur with rehabilitative efforts. Combining hyperbaric oxygen and targeted nutritional therapy geared toward mitochondrial health are just as important as finding and rehabbing the pathology, as both may nevertheless be involved in the pathogenesis. 

 

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