Art therapy is a specialized area of mental health that uses art materials and the creative process to explore emotions, reduce anxiety, increase self-esteem, and resolve other psychological conflicts. The American Art Therapy Association states that art therapy can be an effective mental health treatment for individuals who have experienced depression, trauma, medical illness, and social difficulties. Making art in therapy can be a way to achieve personal insight as well as healing.

There’s more to art therapy than simply “drawing your feelings.” Art therapists are trained to lead people through the creative process in a therapeutic way. Just as your doctor may prescribe a medication or behavioral change to aid your physical healing, your art therapist offers art-based therapy interventions that are tailored to your needs. As with every aspect of therapy, the choice to engage with specific types of materials will ultimately be up to you.

“Art washes from the soul the dust of everyday life.” —Pablo Picasso

In this article, we’ll take a look at some of the top questions people have about art therapy.

Q: Do I need art training or experience to participate in art therapy?

A: No art experience is necessary for you. Your art therapist is highly trained in visual art as well as psychology, and he or she will guide you in the process of creating art using specific types of materials. All you need is a willingness to experiment and explore.

Q: What kind of training should my art therapist have?

A: Art therapy is a profession that requires at least a master’s degree in a program with specific art therapy components.[fat_widget_right]While expressive arts therapists are trained in art therapy, there is also the designation of art therapist whereby the therapist studies only art therapy. There are also associations that offer certification as a supplement to your education, rather than a degree. Many art therapists have an art therapy credential called an ATR that indicates they are registered with the national art therapy credentials board.

Q: What kind of art will I make in art therapy?

A: It depends on your interests as well as the therapeutic benefits of certain types of art for your situation. Art therapy can include a wide range of art materials and processes. Your sessions could potentially include activities such as working with clay, painting, making a mask, creating a visual journal, and assembling a collage. Most often, the focus will be on the process rather than creating a finished art product.

Q: Do I get to keep the artwork that I make in art therapy? Will the art therapist show it to anyone else?

A: Your artwork is your creation and always belongs to you. Some people choose to keep the finished artwork, while others may decide to leave it in the care of the art therapist. Your art therapist will not show your artwork to anyone without your permission. The code of ethics followed by art therapists specifies that an art therapist must safeguard a client’s art creations the same way he/she would protect any other privileged information.

Q: Why are some art materials more appropriate for my situation than others? What does it mean to have an art therapist prescribe an art process for me?

A: Art materials have inherent healing qualities, but some are more appropriate for certain types of situations. For example, there is a therapeutic difference between using colored pencils, which are very dry and controlled, as opposed to watercolor paint, which is extremely wet and difficult to control. Your art therapist has specialized training in assessing which materials to suggest based on the issues you are facing, your frame of mind during the session, and other factors. Art therapists also have an extensive personal background in studio art, making them personally familiar with the use of specific types of art materials so that they can guide you through any difficulties that may arise in the creative process.

Q: Will the art therapist “interpret” my artwork?

A: Art therapists can use a variety of approaches, just as counselors or psychotherapists may utilize different approaches. It is not customary for a therapist to interpret your art. In a humanistic or transpersonal approach to art therapy, the focus will be on the personal meaning that you find within your own creative work, rather than an arbitrary meaning imposed by the therapist. You are the expert on your own artwork and creative process, and the art therapist’s role is to facilitate explorations of your work rather than to analyze or interpret it.

Reference:

Pablo Picasso Quotes—Art as Therapy. (2010, October 10). Retrieved May 6, 2013, from quotes: http://www.arttherapyblog.com/c/art-quotes/#ixzz2SYtZgGua

“Paradoxically, the ability to be alone is the condition for the ability to love.” – Eric Fromm, The Art of Loving

Self-Nurture through Self-Mirroring

Finding a way to emotionally take care of ourselves when we are alone is an individual process of self-discovery. One way to truthfully see ourselves is through collage therapy. Collage therapy is a simple form of art therapy that does not require drawing or painting. It can help you see your inner life in a fresh way. We all project personal meaning onto everything we see. If we are having trouble verbalizing what we are feeling, we can mirror our emotions through spontaneous collage.

Choosing imagery spontaneously, and then seeing what feelings and ideas arise, can incite new understanding about what you unconsciously believe about yourself and how you feel about your life. Whenever you feel strong feelings that you do not fully understand, take a few moments to spontaneously choose some imagery from an old magazine. Cut out and glue your pictures down without much thought. Then take a few minutes to contemplate what you have chosen.

The Loneliness of Individuation

As we learn to express ourselves more authentically, our particularity asserts itself into our life, and we may begin to feel misunderstood by those around us. Many years ago, I put together a spontaneous collage about loneliness when I was discovering my true life path. At the time, I was discovering new strengths and gifts inside of myself and I excitedly tried to share my newly discovered authenticity with the people in my life. But few at the time seemed to understand what I was going through. I was mistakenly looking outside of myself to be mirrored for my inner truths.

I was not yet devoted to mirroring myself to myself. I was still looking for validation from the outside. I was still looking for other people to help me feel good about myself. Sitting alone with ourselves is not always easy. Difficult emotions that we do not want to feel tend to come into our awareness when we are quiet and alone. We can mistake these uncomfortable feelings as loneliness instead of seeing the emotional awareness that is trying to rise. It is during such times of emotional discomfort that is becomes easy to fall into unhealthy distractions. Thinking we are lonely, we may want to spend time with people in ways that are not healthy or meaningful to divert our attention away from what feels emotionally uncomfortable inside.

Instead of spending time in ways that are merely distracting us from what we feel, we could turn towards our inner strength and creativity during our alone time instead. Being alone is a fruitful time to tend to our emotions in order to understand how we feel on a more truthful level. When we start to see our deeper thoughts and feelings more carefully—in the outer projection of our collage—we realize that we have a distinctiveness that wants to reveal itself. We consider that we may never be able to rely on other people to know the total depths of who we are, but we can choose to know ourselves profoundly. When we realize that we need to do our own inner work, without insisting on validation from others, we may begin to feel lonely.

Strength in Loneliness

As we become more authentically expressive and self-examining of all our feelings, we might find that some of the relationships we have been hiding in no longer support our fullest self-expression. Some people do not leave unhealthy relationships because they fear loneliness more that they fear abuse. If we have felt abandoned, shunned, or ignored for expressing our true feelings as children, the loneliness of true self-expression can be a primal place of fear. The genuine loneliness of authenticity can feel piercing to the core when we have received little validation for how we felt in the past.

Our authentic self-expression can feel like it is the exact place where we have not been loved in the past, yet it is this very place where we need to learn how to love ourselves. As we progressively delve into our uniqueness, however, we grow to understand that we can find self-love and emotional strength in the aloneness of our unique personhood. As we become more honest about expressing the truth of our feelings, the fear of not being loved and accepted can intensify at first. But it is in our most alone places, when we are willing to stay in supportive witness to our arising truths, that we can find the love we crave.

Emotional Self-Connection Heals Loneliness

It is our own emotional self-connection that heals loneliness. We can be surrounded by people, but if we are not authentically expressing who we are, we will feel lonely. When we feel authentically connected to ourselves, we feel connected with others. When we begin to know who we truly are, we can reach out for help in ways that are healing instead of hindering to our emotional growth. We can start to build a support system that can help us further develop into our unique strengths in the world.

We can extend ourselves in healthy ways towards genuine friendships with people on similar life paths. When we are in touch with our deeper truths we will start to gravitate towards people who nurture their own unique personhood and who respect our individuality. As we come to know how to soothe our painful feelings without demanding that other people do it for us, we deepen into a self-nurturance that is kind and mature. We can choose to become deeply present to our emotional life. As we tend to our own emotional needs, we discover the warmth and abiding friendship of the true self.

Premature termination with people in therapy happens with both seasoned and newly licensed therapists. In a study that talked about the therapeutic relationship and psychotherapy outcome, it shows that 20 to 57 percent of people in therapy do not return after the initial session (Lambert). Another 37 to 45 percent only attend therapy a total of two times (Schwartz). Sometimes these people leave without warning, but sometimes they do give some signs they won’t be returning, even if they do not directly explain them. Some will contact the therapists by email, will leave phone messages, or simply will not show up for their appointments. These people may come back much later, or not all. Many will also find a new therapist when they want to resume their therapy work.

There can be many reasons for this. I have had some people and personal contacts share some of their reasons with me. Here are some common reasons I’ve heard:

The ‘Can of Worms’

People realize therapy opened a bigger “can of worms” than they were prepared to handle. They say hindsight vision is 20/20. I wrote in my previous article, Helpful Tips to Make Therapy Most Effective for You, that one of the things to keep in mind during therapy is what you want to achieve or gain in therapy. Sometimes we don’t always know, even when we are posed that question. We can identify that we are struggling in some area of our life, or we are in some pain either emotionally or mentally, and we want some relief. We find the therapist we have a good connection with, make the appointment, and go in for our sessions.

Sometimes, we never know what to expect. Some have really good results; others have light-bulb moments with increased insight. Some, however, are taken aback by the depth of therapy, and they realized they didn’t want to go further at that time. One particularly candid response I heard from someone in this position was, “it was just too hard and painful at the time, and I just didn’t want to see what else was there.”

Subconscious Resistance

I don’t often hear people in therapy say, “I don’t think I’m ready to continue with this issue.” Sometimes other reasons come up, which is known as resistance. Therapy can provide wonderful possibilities, benefits, and outcomes, but occasionally we still resist the experience. This may be because of fear of success, failure, feeling overwhelmed by truth, fear of the unknown, or simply overwhelming emotions.

Therapeutic Breach

Misunderstandings, miscommunications, and impasses can often happen between therapists and people in therapy during the treatment duration. In the study mentioned earlier, the top reason people dropped out of therapy after the initial session was dissatisfaction with the therapist, or the feeling that the therapist didn’t really “get” them. There can be both competent and unprofessional behaviors found in all professions, and this is holds true in the therapy world. Further, even with the best training and the heart to serve people, the best therapists are not omnipotent, nor will they be perfect in their approach.

Many interventions are chosen according to what the person in therapy presents. Some will make unintentional mistakes or misunderstand what people meant. Therapy is not like getting a medical exam. There is no therapeutic equivalent to getting blood drawn, waiting for it to be studied, then receiving a detailed evaluation and report. The journey of healing through therapy must be a collaborative effort to be effective. If or when a therapeutic breach happens, a person may choose to drop out prematurely, or avoid the elephant in the room—the elephant being that there’s something hindering your therapeutic growth; you can feel it’s there but you are not able to talk about it. Alternatively, the person in treatment and therapist could have a dialogue, which can offer the most constructive growth for both parties. Often, however, it’s difficult to initiate that dialogue.

Giving Feedback

Healing in therapy is not just about getting results and meeting goals; it is also about the process of the therapeutic relationship. It is about how things unfold as you are exploring issues with your therapist. Therefore, sometimes constructive feedback is needed from people in therapy to minimize impasses and misunderstandings. This proactive approach can itself be a reflection of significant growth. For example, let’s say this person has relational difficulties, such as discussing vulnerable feelings. This is a wonderful opportunity to practice giving constructive feedback, which the person can then apply to other relationships. A competent therapist will often be very receptive to constructive feedback at any time during the sessions.

Readiness for therapy often comes at a point where people experience greater pain and discomfort by remaining personally stagnant than by initiating small adjustments in life to feel better in the long run. While there is no exact time frame for those lasting changes to occur, that readiness provides that platform for real growth to occur. The key is consistency. Premature termination sometimes cuts that opportunity short, despite improvements thus far in therapy sessions. Therapy, no matter the duration, is not a pass-or-fail experience, but rather an opportunity for positive growth with the right therapist.

References:

1. Lambert, M., J. & Barley, D., E. (2001). Research Summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy, 38, 4, 357-361.
2. Schwartz, Bernard, PhD and Flowers, John, PhD. (2010). How therapists fail: Why too many clients drop out of therapy prematurely. Impact Publishers.

Most people have experienced trauma at some point in time. The nature of traumatic experiences varies by severity and frequency and also differs with respect to the effect they have on survivors. Some people who have experienced violence, abuse, or disaster develop significant psychological problems and posttraumatic stress (PTSD) as a result of the trauma, while others appear to be more resilient and rebound with very few psychological problems.

Predisposition to mental health issues and stress sensitivity are two factors that have been theorized to affect risk for PTSD in trauma victims. But another factor that is less understood in relation to PTSD is intelligence. Intelligence quotient (IQ) can impact emotional regulation and reactivity and, therefore, it could be assumed that people with higher IQs may be more resilient to trauma.

To test this theory, Naomi Breslau of the Department of Epidemiology and Biostatistics at the College of Human Medicine at Michigan State University recently led a study involving 713 17-year olds. The participants were assessed for trauma history, type of trauma classified as assaultive trauma (sexual trauma, rape, life threatening trauma), or general trauma (accident, illness, disaster) and IQ taken at age 6. Breslau used this information to see how these factors affected PTSD at age 17.

She found that surprisingly, individuals of assaultive trauma were not more likely to develop PTSD than those of general trauma. However, Breslau did find a link between IQ and PTSD. “A drop of one standard deviation in IQ score measured at age 6 increased the relative risk ratio of PTSD resulting from either trauma type by approximately 50%,” she said.

This result can be interpreted in several ways. First, individuals with a lower IQ may be less able to regulate emotional reactions and thus be more vulnerable to PTSD. Second, making meaning of trauma and assigning context to a traumatic event may be easier for people with high intelligence. This can protect people from negative emotional responses and triggers, and decrease their vulnerability to negative mental health outcomes like PTSD. Although these findings clearly demonstrate a link between IQ and resiliency/vulnerability, more work should be done to determine how this link impacts younger and older individuals.

Reference:
Breslau, N., Chen, Q., Luo, Z. (2013). The role of intelligence in posttraumatic stress disorder: Does it vary by trauma severity? PLoS ONE 8(6): e65391. doi:10.1371/journal.pone.0065391

Avoidance is a behavior that can be seen as both adaptive and maladaptive. In psychological research, people with anxious personalities tend to avoid social situations and use avoidance as a way to circumvent threatening environments. People with depression also engage in avoidance behaviors.

In contradiction to these theories, attentional bias toward certain stimuli is also common in certain psychological conditions. Although avoidance is not always a bad practice, people who avoid emotional stimuli may internalize feelings and increase their risk for further symptoms of depression and/or anxiety. Existing research on emotional bias and avoidance focuses mostly on children, adolescents, young adults, and middle-aged adults. But few studies have looked at how emotional avoidance and processing changes with advanced age.

To address this, Ineke Demeyer of the Department of Experimental Clinical and Health Psychology at Ghent University in Belgium recently led a study that compared 25 middle-aged adult emotional bias to attentional and emotional bias in a group of 37 older adults between the ages of 75 and 88. Demeyer also looked at how the presence of depression or anxiety affected attention bias.

The results revealed that the older participants engaged in avoidant behaviors to all of the stimuli, regardless of whether the cues were neutral, sad, or happy. The middle-aged participants did not demonstrate any attentional bias. When Demeyer looked further, it was revealed that the older adults showed avoidant behavior toward the sad and happy cues more than the neutral ones. Demeyer added, “When taking a closer look into the role of mood and affective symptoms, we found that older adults who experienced more anxiety symptoms showed more avoidance of negative stimuli.”

Demeyer believes that these findings can be interpreted in several ways. First, older individuals may have higher levels of emotional regulation, which causes them to temper their emotional responses more than younger adults. Second, because older individuals are aware of their limited life span, they may choose to avoid any negative stimuli in particular, as they would rather only expend energy on positive things. Finally, their limited energy resources may cause them to have a blunted emotional response to all stimuli in general.

In conclusion, these findings show that there are differences in how older and middle-aged adults respond to emotional stimuli. Future work should explore these variances and their overall impact on well-being in more depth.

Reference:
Demeyer, I., De Raedt, R. (2013). Attentional bias for emotional information in older adults: The role of emotion and future time perspective. PLoS ONE 8(6): e65429. doi:10.1371/journal.pone.0065429

Studies on depression have shown that negative affect is a strong risk factor for depressive symptoms. Rumination, the process of thinking about negative events and distressing situations, can increase negative affect and make people more vulnerable to depressive episodes.

Neil P. Jones of the Western Psychiatric Institute and Clinic at the University of Pittsburgh in Pennsylvania wanted to add to the existing research on depression and rumination by looking at how goal failure, an event that can lead to negative emotions, influences affect. In his study, Jones examined the emotional reactions of 93 college students after they completed an exercise that required they write about their past failures related to prevention and promotion goals.

Promotion goals are hopes, dreams, and desires while prevention goals are classified as more obligatory and necessary goals pertaining to safety and security. Jones theorized that chronic failure to achieve the goals would lead to higher levels of rumination and increased depression and even anxiety in the participants. The results provided partial support for Jones’ theory.

First, the participants who wrote about chronic promotion goal failure reported higher levels of dejection. Surprisingly, even though they did not perceive themselves failing chronically at prevention goals, they still felt dejected when they wrote about any prevention goals they did not achieve. In other words, negative associations with promotion goals created an overall sense of dejection which led directly to increased rumination.

Jones found no association between goal failure and rumination, except when dejection was present. This was particularly interesting and suggests that there may be a protective mechanism at play, allowing some individuals who are exposed to goal failure to regulate their emotional reactions to the exposure so that they do not feel dejected and engage in negative rumination.

Jones believes these results extend existing research on the relationship between goal failure, affect and depressive symptoms. “Our findings are also consistent with our previous work demonstrating that dispositional tendencies to ruminate combined with chronic perceived promotion goal failure are associated with increased depressive symptoms,” added Jones.

Reference:
Jones, Neil P., et al. (2013). Cognitive Processes in Response to Goal Failure: A Study of Ruminative Thought and its Affective Consequences. Journal of Social and Clinical Psychology 32.5 (2013): 482-503. ProQuest. Web.

There is a growing body of research that suggests that mood influences our ability to learn. Specifically, the theory behind this research supports the idea that being in a sad mood creates a narrower focus of attention, thus providing an individual with an enhanced ability to implicitly acquire and retain information. Implicit learning is unintended and is required to function. For instance, people must learn how to disseminate various sensory cues such as smells and sights and how to identify pertinent embedded information. The latter example was the focus of a recent study designed to test this theory.

Julie Bertels of the Centre for Research in Cognition and Neurosciences at the Free University of Brussels in Belgium chose to assess how well 128 college students were able to acquire and retain information on a statistical learning (SL) task and how their mood affected this ability. SL is similar to implicit learning and involves being able to identify numbers or letters embedded in other cues. The participants were required to complete the task while they listened to a sad or neutral story. They were assessed before and after the experiment. Some were put into a delayed group and assessed 20 minutes after completion to ensure mood states had returned to baseline levels. These delayed participants, along with the other participants, were asked to consciously retrieve the information they learned during the experiment. In total, three check-in points were used to assess SL skills and mood: immediately after the experiment, 20 minutes later (for delayed group), and 20 minutes further (for same delayed group).

The results revealed that mood definitely impacted the ability to consciously retrieve information. Even though Bertels found that the neutral and sad groups both performed equally during the tasks and immediately after, the confidence they reported pertaining to their performance was quite different. In fact, the sad group reported more confidence and indeed was better able to consciously retrieve the statistical information they acquired during the experiment. Regardless of whether sad/neutral participants were also part of the delayed group, the results remained the same. These findings demonstrate that although negative mood states can impair some cognitive capacities, the narrowing of focus appears to enhance statistical and implicit learning. Bertels added, “Further studies should systematically investigate the possibility that negative words induce an analytic processing style promoting conscious processing and, consequently, higher levels of performance in recall.”

Reference:
Bertels J, Demoulin C, Franco A, Destrebecqz A. (2013). Side effects of being blue: Influence of sad mood on visual statistical learning. PLoS ONE 8(3): e59832. doi:10.1371/journal.pone.0059832

According to the results of a recent study, not all aggression is bad. Konrad Bresin of the Psychology Department at the University of Illinois Urbana-Champaign recently conducted two separate studies examining the cathartic effect of aggression. Bresin wanted to counter the existing body of research on aggression, which suggests that for the most part, aggression is maladaptive and has only negative consequences, such as violence. Bresin based his research on the catharsis theory that implies there is a healing and anger-reducing affect that occurs through aggression. It is important that a distinction be made between aggression and violence, as the two behaviors are not mutually exclusive. Aggression, in this study, was the act of participants verbally retaliating against negative feedback. In one study, the participants were instructed to aggress toward the person who gave the feedback or a neutral individual. Measures of anger were assessed prior to and after the feedback was delivered. In the second study, Bresin wanted to see if participants who had reductions in anger in the first study would be more likely to aggress at a future time.

Overall, the results of both studies supported Bresin’s predictions and the catharsis theory. In the first study, the participants who aggressed against the source of the negative feedback had sharp decreases in anger when compared to the participants who aggressed against nonsource neutral controls. In the second study, Bresin found that these same individuals who had anger reductions were more likely to aggress in another experiment. These findings demonstrate that aggressing toward a source of frustration can have a very cathartic effect. Anger and hostility that may increase during a tense situation can be easily moderated with aggression. Although some forms of aggression are maladaptive, such as abuse, physical violence, and verbal abuse, adaptive forms of aggression appear to not only create a calming effect, but also empower participants with the tools necessary to regulate anger emotions in the future. This is especially important for people prone to violence. Because anger, aggression, and violence are quite different, being angry does not always cause someone to become violent. Bresin believes that this study shows how adaptive aggression can potentially reduce the risk of violence by decreasing feelings of anger and frustration. He added, “Future research may address the question of whether changes in anger following violence (or aggression) have similar relations to future violence.”

Reference:
Bresin, Konrad, and Kathryn H. Gordon. (2013). Aggression as affect regulation: Extending catharsis theory to evaluate aggression and experiential anger in the laboratory and daily life. Journal of Social and Clinical Psychology 32.4 (2013): 400-23. ProQuest. Web.

“The greatest hazard of all, losing one’s self, can occur very quietly in the world, as if it were nothing at all. No other loss can occur so quietly; any other loss—an arm, a leg, five dollars, a wife, etc.—is sure to be noticed.” ―Søren Kierkegaard

So often, people come to therapy seeking to “find themselves,” typically after a tragedy has occurred or some major shift has taken place in life and they realize they have somehow “lost” themselves along the way. But there is another way of losing oneself that is more insidious, more subtle, and can be even more damaging. This is what I call self-erosion.

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Self-erosion occurs over a period of time and happens so quietly that the person doesn’t even realize it’s happening. Self-erosion happens when we are so busy doing other things—such as working, going to school, raising kids, and being in incompatible relationships—that we slowly lose touch with who we are. Our lives become so much about what we do, how we contribute, and what we offer the world that we lose touch with who we are. The tragedy of the self-erosion experience is that when we finally come face to face with the reality that we have no idea who we are anymore, we have no idea where to start.

You might be experiencing self-erosion if you have noticed any of the following:

• You don’t know what you like to do for fun.
• You can’t remember the last time you had a really good laugh.
• Your identity is tied to what you do (“I’m Jane’s mom,” “I’m a therapist,” “I’m a CEO,” and so on).
• You rarely take time for yourself.

If you are experiencing any of these, it is likely that you have lost touch with yourself. You may be very content with your life in many ways, but in some ways you find yourself longing for more. Whatever that “more” consists of is very personal and different for everyone, but the important thing is that you get back in touch with it.

Start with allowing yourself to do something you’ve always liked but don’t do often, whether that is taking a long, luxurious bath or going for a walk. It may be hiding away in a coffee shop and reading a book you have wanted to read but haven’t made time for. Maybe it will be going to Baskin-Robbins and trying every flavor until you find just the right one for you. Spend some time reflecting on all the things you used to do and greatly enjoyed, even when you were a child. You may find some keys to things that bring back the spark to your eyes, the joy to your living, and the passion in your existence.

The path to finding yourself does not have to begin at the crossroads of crisis; you can decide to own your life anytime you choose. I hope you choose today—this moment—to begin.

It’s a classic dynamic in nearly every relationship: One partner tends to be the more vocal, outwardly emotional communicator, while the other partner is stoic, bottled-up, and emotionally reserved. Sometimes, one partner can be both. When the communicator tries to get the bottle to open up, the result can be a tug of war that ends in criticism and distancing. In a recent article, licensed clinical social worker Terry Gaspard describes why the “pursuer-distancer” pattern can be lethal to your marriage. Gaspard says that even though the pursuer partners, usually women, have nothing but good intentions when they try to coerce their spouses to crack open their emotional vaults, they approach it the wrong way.

Harassing and nagging a reserved person to communicate will usually cause that person to close up more tightly. They can become avoidant, angry, defensive, and even hostile. The nagging partner will then escalate the nagging, maybe throwing in a little criticism as a negative motivator, all with the goal of creating a more intimate union with their spouse. Relationship expert Dr. John Gottman also warns against pushing your relationship into this downward spiral. He believes that gender differences are at the core of how partners communicate. He suggests that if communication issues are developing in a relationship, the couple should examine how they are addressing those issues before they find themselves in the pursuer-distancer­ vortex.

Gaspard notes that our culture is partly responsible for perpetuating this destructive dance. “The irony of the pursuer-distancer pattern is that it’s reinforced by popular self-help books and websites to save your marriage,” said Gaspard. Even therapists encourage their clients to develop healthy communication strategies. But without proper guidance, couples can enter into a dialogue without boundaries that can quickly take on a life of its own. Gaspard suggests that couples remain open with each other and think of communicating honestly as a way to share information with each other. Learning more about your partner’s feelings should be a pleasure, not a chore.

Reference:
Gaspard, Terry. (2013). How the pursuer-distancer pattern can destroy your marriage. (n.d.): n. pag. Huffington Post. Web. http://www.huffingtonpost.com/terry-gaspard-msw-licsw/how-the-pursuerdistancer-_b_2856533.html

Individuals have different reactions to trauma. People who have experienced significant childhood trauma, including childhood sexual abuse, physical abuse, or emotional abuse may develop serious psychological problems as a result. Some people who suffer the loss of a loved one can develop symptoms of depression and children of depressed parents may have impaired ability to express their emotions, leading to externalizing or internalizing behaviors. When trauma affects daily functioning and leads to extreme anxiety, it can be seen as a predictor of posttraumatic stress (PTSD). And although it has been well established that people with PTSD have decreased emotional regulation via hyper-vigilant threat bias and limited brain region accessibility, it is less clear whether these same deficits are present in individuals without PTSD who have experienced trauma.

Karina. S. Blair of the National Institute of Mental Health and the Department of Health and Human Services in Maryland recently conducted a study to determine the difference in parietal and frontal cortex accessibility in individuals with and without PTSD. Blair performed MRIs on 14 trauma-exposed individuals without PTSD, 14 with PTSD and 19 nonclinical participants who were not exposed to trauma. She measured their brain activity while they performed attention tasks using the Stroop test and found that there were significant differences between the groups. Specifically, the individuals with PTSD had difficulty performing the task when compared to the non-PTSD and control groups. They had limited accessibility to certain regions of the brain responsible for emotion regulation. However, other regions caused overstimulation of attention, which when focused on threat could perpetuate symptoms of PTSD.

When Blair looked at the control group, she found more cortex accessibility and better performance on the Stroop. But surprisingly, the non-PTSD trauma exposed group had enhanced, not diminished levels of cortex accessibility and brain recruitment during the Stroop task. “These regions of the lateral superior and inferior frontal cortices and parietal cortex are repeatedly implicated in emotional regulation,” said Blair. Perhaps this enhanced recruitment acted as a buffer, insulating individuals exposed to trauma from developing symptoms of PTSD. Blair believes that although this finding has positive implications, more work needs to be done in this area to determine how to prevent or decrease PTSD in individuals who have experienced trauma.

Reference:
Blair, K. S., et al. (2013). Cognitive control of attention is differentially affected in trauma-exposed individuals with and without post-traumatic stress disorder. Psychological Medicine 43.1 (2013): 85-95. ProQuest. Web.

The third module of dialectical behavior therapy (DBT) is emotion regulation, which teaches clients how to manage negative and overwhelming emotions while increasing their positive experiences. This module encompasses three goals:

1. Understand one’s emotions
2. Reduce emotional vulnerability
3. Decrease emotional suffering

An important aspect of emotion regulation is understanding that negative emotions are not bad, or something that must be avoided. They are a normal part of life, but there are ways to acknowledge and then let go of these feelings so that one is not controlled by them.

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Often, clients with extreme emotional sensitivity go through cycles that begin with an event that triggers automatic negative thoughts. These thoughts then prompt an extreme or adverse emotional response, which may subsequently lead to destructive behavioral choices. The detrimental behavior is then followed by more negative emotions, such as shame and self-loathing.

Understanding and Labeling Emotions
The first skill in emotion regulation involves recognizing and naming emotions. Clients are taught to use descriptive labels such as “frustrated” or “anxious,” rather than general terms like “feeling bad,” because vaguely defined feelings are much more difficult to manage.

Another important distinction is that of primary and secondary emotions. A primary emotion is the initial reaction to an event, or to triggers in one’s environment, while a secondary emotion is a reaction to one’s thoughts, i.e., feeling depressed about having gotten angry. Secondary emotions are often destructive, making an individual more vulnerable to unhealthy behaviors. Therefore, in addition to naming both primary and secondary emotions, it is important for clients to learn to accept their primary emotion without judging themselves for experiencing it.

In DBT skills sessions, group leaders also discuss myths about emotions, such as the misconception that there are “right” and “wrong” ways to feel in certain situations. An additional topic is the purpose that emotions serve—which is to alert us that something in our environment is either beneficial or problematic. These emotional responses are stored in memory, and we are then more prepared when encountering similar situations in the future. Additionally, our emotions communicate messages to others through our words, facial expressions, and body language.

Reducing Emotional Vulnerability
The acronym for the first skill set in reducing emotional vulnerability is PLEASE MASTER:

PL – represents taking care of our physical health and treating pain and/or illness.

E – is for eating a balanced diet and avoiding excess sugar, fat, and caffeine.

A – stands for avoiding alcohol and drugs, which only exacerbate emotional instability.

S – represents getting regular and adequate sleep.

E – is for getting regular exercise.

MASTER – refers to doing daily activities that build confidence and competency.

The second skill designed to reduce emotional vulnerability is the building of positive experiences in order to balance life’s negative incidents and feelings. To accomplish this, clients are encouraged to plan one or more daily experiences that they can look forward to and enjoy. This might be participating in a hobby or sport, reading a book, spending time with a friend, or anything that brings the individual contentment. It is important to engage in these activities mindfully, centering attention on what one is currently doing. If an individual has difficulty focusing on the activity, he or she is advised to try something different. The client is also encouraged to identify long-term goals that will bring increased positive experiences into his or her life, such as learning a new skill or making a job change.

Decreasing Emotional Suffering
The last component of this module, decreasing emotional suffering, is comprised of two skills:

1. Letting go
2. Taking opposite action

Letting go refers to being aware of the current emotion through mindfulness, naming it, and then letting it go—rather than avoiding, dwelling on, or fighting it. This might involve taking a breath and visualizing the thought or feeling floating away, or picturing the emotion as a wave that comes and goes.

Taking opposite action means to engage in behaviors that would be typical when one is experiencing the emotion that is in direct contrast to the current feeling. For example, if a client is sad, he or she might try being active, standing straight, and speaking confidently—as the person would if he or she was happy. When an individual is experiencing anger, the person behaves as if he or she were calm by speaking in a soft voice and doing something nice for someone. This skill is not aimed at denying the current emotion; the individual should still name the emotion and let it go. However, acting opposite will likely lessen the length and severity of the negative feelings.

Some of the emotion-regulation skills may sound a bit vague to those unfamiliar with dialectical behavior therapy. In group sessions, DBT leaders cover these skills with clients in more detail, incorporating role playing so that the clients can transfer the new skills to situations in their own lives. Ultimately, these skills empower people to manage their emotions, rather than being managed by them.