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Emotions…
• …arise when one attends to situations relevant (meaning)
to one’s goals.
EMOTION REGULATION
• … involve changes in subjective experience, behavior,
and central and peripheral physiology.
Adapted from Gross &Thompson
Handbook of Emotion Regulation
• … not only make us feel something, they make us feel like
doing something.
• … possess an imperative quality - can interrupt what we
are doing.
The Modal Model of Emotion
Serial response-situation changes
SITUATION→ATTENTION→APPRAISAL→RESPONSE
• Situation – relevant, external or internal
• Attention – attending to the situation
• Appraisal - situation’s familiarity, valence, and value
relevance
• Response - often changes the situation
• A parent and child in situation S (argument)
• One has response R (starts to cry).
• New situation -S’ (interacting with someone you’ve just
made cry).
• This gives rise to a new response R’ (an apology)
• New situation →S’’ (responding to someone who has just
apologized).
• New response, R’’ (embarrassment), and so on.
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Emotion Regulation
• diminish/ intensify / maintain emotion, depending
on an individual’s goals.
• continuum between conscious, effortful, and
controlled regulation to unconscious, effortless, and
automatic regulation.
• intrinsic processes – self-regulation
• extrinsic processes (emotion regulation in other),
• both – co-regulation.
“Is emotion ever not regulated?”
• bidirectional links between limbic centers that
generate emotion and cortical centers that regulate
emotion.
• Hypothesis:
• (a) emotion regulation often co-occurs with
emotion, whether or not emotion regulation is
explicitly performed;
• (b) emotion regulation engages some of the same
brain regions that are implicated in emotion
generation.
Emotion Regulation Strategies
• antecedent-focused ER (1-4) - they occur before appraisals give rise
to full-blown emotional response tendencies
• response-focused ER (5) - occurs after the responses are generated.
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Situation Selection
Example - Situation Selection
• Exposing to or avoiding situations that one expects
will give rise to desirable (or undesirable) emotions.
• Requires:
• Extrinsic emotion regulation most evident in infancy
and early childhood when parents create daily
routines with manageable emotional demands for
their offspring → early emotional life is strongly
influenced by situation selection.
• What's going to happen? - likely features of the
future situations
• What am I going to feel and do? - expectable
emotional responses
• What is the consequence? - of the emotional
response
Situation Modification
• Altering an emotion-eliciting situation just enough
to prevent/facilitate an outcome.
• Afraid of this barber? Wait until the other barber is
available.
• The child is frustrated with the puzzle? Parent
provides validation then, verbal prompts to assist in
problem-solving or set limits.
• Parents must arrange the schedule of their offspring
with due regard to their particular child’s
temperamental qualities, activity level, interests,
and capacities for managing arousal
Toddlers’ coping
=
specific maternal interventions
+
secure attachment.
• Parental intervention
• supportive and sympathetic - more adaptive coping
(immediate and in the long run)
• denigrating, punitive, or dismissive - more negative
outcomes are likely.
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Example
Attentional Deployment (AD)
• A and B are engaged in an angry interaction
• A suddenly looks sad - change in situation for B
• B pauses to express concern, pulls back, or offers
support → alters the angry interaction (A's sadness
extrinsically regulated B's anger)
• The intensity of emotion diminishes/increases over
time as one thinks less/more of the emotionallyarousing situation.
• Strategies: distraction and concentration.
• One of the first emotion regulatory processes to
appear in development.
• AD may help children who are waiting for delayed
rewards.
• Can be done intrinsically and can be done to others
extrinsically
• EE (emotional expressions) → SR (social responses)
→ SM (situation modification) → (+/-)ER (emotion
regulation).
Examples
• physical withdrawal of attention (such as covering
the eyes or ears)
• look away from aversive events
• "ignore it"
• "look the other way"
• focus attention on another aspect of the situation
• look towards pleasant events
• internal redirection of attention (invoke thoughts or
memories conducive to the desirable emotional
state or away from the undesirable ones)
“Malfunction”
• Concentrating attention at certain emotional
features of a situation may lead to a "controlled
starting" of the emotion
• When attention is repetitively directed to one’s
feelings and their consequences, this is referred to
as rumination.
• Ruminating on sad events leads to longer and more
severe depressive symptoms.
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Cognitive Change
• Situation Selection → Situation Modification →
Attention deployment → Basic perception →
Appraisal → Emotion
• Basic perceptions + meaning + assessment of one's
capacity to manage the situation.
• Cognitive change = appraisal change = changing
how one thinks about:
– the situation itself ("it's not that bad")
– one’s capacity to manage the demands it poses
("I think I can deal with it")
Parents extrinsically …
• Social comparison = comparing one’s situation with
that of a less fortunate person → altering one’s
construal and decreasing negative emotion.
• Situation → physiological arousal → interpretation
– competence-enhancing interpretation (“getting pumped
up”)
– debilitating interpretation (“stage fright”)
• Reappraisal = changing a situation’s meaning in a
way that alters its emotional impact.
Parents…
• Select information about the situation (describing a
camping trip as fun outdoors, but not mentioning
mosquitoes or bears)
• Coach emotion regulatory strategies involving
cognitive change (such as thinking happy thoughts
in the dark at bedtime),
• Explain the causes of the emotions the child feels or
observes in others (“Your brother is scared of the
dog because another dog barked at him yesterday”)
• Reinterpret the situation for the child (“We don’t
laugh at people who fall down -- how do you think
they feel?”).
• Use feeling rules or emotion scripts (“Big kids don’t
fuss and cry when they’re at someone’s home”).
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Response Modulation
• Extrinsic:
• Drugs may be used to target physiological
responses such as muscle tension or sympathetic
hyper-reactivity.
• Exercise and relaxation - decrease physiological and
experiential aspects of negative emotions
• Alcohol, cigarettes, drugs, and even food also may
be used to modify emotion experience.
Regulating emotion-expressive behavior
• hide one’s true feelings from another person (e.g.,
hiding one’s fear when standing up to a bully)
• initiating emotion-expressive behavior slightly
increases the feeling of that emotion (acting).
• decreasing emotion-expressive behavior has mixed
effects: decreases positive but not negative
emotion experience
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Behaviors and Mental States
• Explaining behavior in self and others is necessary
MENTALIZATION BASED
INTERVENTIONS
Compilation based on the works of
Peter Fonagy PhD and Anthony
Bateman MD
• We explain behaviors in terms of Mental States
• Mental States are based on Representations
• Representations (beliefs) can be false (wrong)
• A behavior can be based on a mistaken belief
• If the behavior is a problem, changing it is a matter of
altering the mistaken belief
Mentalization/Mentalizing
• Thoughts/ideas that:
– assign intentions and meaning to human
behavior
– make reference to emotions, feelings, thoughts,
intentions, desires
Mentalizing
• To see ourselves from outside and others from
inside
• Understanding misunderstanding
• Having mind in mind
• Introspection for subjective self-construction –
know yourself as others know you but also know
your subjective self
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TOM
• Prementalizing child (three-year-old) - he is shown a
tube of M & Ms and is asked what it contains. He
says: “Candies.” The tube is opened and he is shown
a pencil.
• If asked what would his friend waiting outside think
is in the tube will reply:
• “Candies” - has a theory of mind; he attributes a
false belief.
• “A pencil” - no theory of mind; equates mental state
with reality.
REFLECTIVE FUNCTION
(PARENT)
REFLECTIVE FUNCTION
(CHILD)
SECURE
ATTACHMENT
Theory: Birth of the Self
• Attachment figure “discovers” infant’s mind
Internalization
Representation
of infant’s mental
state
Core of
Psychological
self
Inference
Attachment figure
Infant
• The infant internalizes caregiver’s representation to
form psychological self;
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Mentalization and the lack of it
– Differentiating self and other
– Implicit vs Explicit
– External vs Internal
– Affect/Cognition splitting vs. integration
(1) Differentiating self and other
• Acknowledging the perspective of the other while
giving enough voice to the self.
• Acknowledging the impact of the other on self
while aiming at reducing it.
• In the patient discourse indentify:
– Self exists
vs.
– Other exists
vs.
– Self-Other differentiation vs.
(2) Implicit vs. Explicit Mentalizing
• Capacity to describe the events in some detail,
with plausible causality
• Automatic assumptions – “Because he hates me”
Self is absent
Other is absent
Self-Other fusion
(2) Implicit vs. Explicit Mentalizing
• Psychological understanding drops and is replaced
by confusion about mental states under high
arousal.
• Controlled
AROUSAL
Automatic
• “I don’t know” or a growl - pretty primitive
• At extreme, the implicit stance: “silence”
• The demand to explore issues (Why?) is a demand
to mentalize that may not be possible when the
arousal is high.
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(2) Implicit vs. Explicit Mentalizing
IMPLICIT
EXPLICIT
Perceived
Nonconscious
Nonverbal
Unreflective
e.g mirroring
Interpreted
Conscious
Verbal
Reflective
e.g. explaining
(3) External vs. Internal Mentalizing
• With the loss of mental interiors, external features
are given inappropriate weight and are
misinterpreted as indicating dispositional states
• Internal focus “I wonder if he feels his mother loved
him?”
• External focus “ He looks tired, perhaps he slept
badly”
• External focus “You’re covering your eyes; you can
hardly bear to look at me”
(3) External vs. Internal Mentalizing
• “External” Mentalizing establishes a causality for
the behavior based on external attributes of the
subject, based on appearances.
• “Internal” Mentalizing establishes a more layered
causation for the behaviors or the events occurring,
based on a more integrated inference on the mental
states of the subject.
(4) Affect/Cognition
Cognitive agent
Doubt of Cognition
Affective self
Certainty of emotion
Inhibitory System
Belief-Desire Autonomy
Imitative System
Emotional Contagion
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Non-mentalizing talk
• Excessive detail without motivations, feelings,
thoughts
Non-mentalizing talk
• Preoccupation with rules, responsibilities (in other)
• Blaming
• Focus on external social factors, such as the school,
the neighbors etc.
• Denial of involvement, responsibility (in self)
• Focus on labels (tired, lazy, clever, self-destructive,
depressed, safety etc)
• Expression of certainty about the thoughts and
feelings of others
Mentalizing talk
• About other’s thoughts and feelings
– Accepting we cannot know what the Other thinks
– Absence of paranoia
– Contemplation and reflection
– Perspective taking
– Genuine interest
– Openness to discovery
– Forgiveness
– Etc.
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MBT - Mentalization Based Therapy
– What is the therapist doing?
• Monitoring the Patient-Therapist discourse with the
purpose of identifying when the mentalization is
lost.
• When that occurs, the MBT therapist acts to restore
mentalization to the best possible.
• First, we have to restore the mentalization with
ourselves; most of the time this restores the
mentalization in the other.
Mentalizing Tasks
• What is the other doing?
– What is the behavior?
• What is the meaning of the behavior?
– What is the other’s intentional stance?
• What is in the other’s mind?
– What is the other’s mental state?
Summary of Intervention
• Identify a break in mentalizing
• Stop and rewind to the moment before the break in
subjective continuity
• Micro-slice the process
• Explore current emotional context in session by
identifying the momentary affective state
• Identify your contribution to the break in mentalizing
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Therapist’s stance
• Stick with the goal to restore mentalizing
• Focus on current events, relationships, feelings etc.
• Not-knowing
– Reasons: strategic
– Reasons: consistency in modeling doubt
– Identify differences - “I can see how you get to that but
when I think about it occurs to me that ….”
– Acceptance of different perspectives
– Curiosity about experience – serves to validate it
Therapist’s stance
• Monitor own mistakes
– Model honesty and courage via acknowledgement of
your own mistake
– Mistakes offer opportunities to re-visit to learn more
about contexts, experiences and feelings.
– Quickly step back if patient seems to lose control
– Lower arousal by bringing it to the person of the
therapist: “What have I done?”
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PASSIVE-AGGRESSIVE BEHAVIORS
Clinical Presentation
And
Interpersonal Understanding
HISTORY
Technical Bulletin - U.S. War Department 1945
Lieutenant James R. Hodge -1955 United
States Armed Forces Medical Journal
• “concern about soldiers who were shirking duty by
willful incompetence”.
• They were not openly defiant, but expressed their
aggressiveness “by passive measures, such as
pouting, stubbornness, procrastination, inefficiency,
and passive obstructionism.”
• “The passive-dependent character is a boy in man’s
clothes”; “he is the child who never got away from
his mother’s apron strings”
• “After he is married, if he ever is ... he brings his
marital squabbles home to Mamma’s big bosom
and embracing arms”
• The behavior was seen as an “immaturity” and a
reaction to “routine military stress”
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DSM-IV-TR - Criteria: 4 or more
1.
2.
3.
4.
5.
Passively resists fulfilling (demands) tasks
Complains of being unappreciated by others
Sullen and argumentative
Unreasonably criticizes and scorns authority
Expresses envy and resentment toward those
apparently more fortunate
6. Voices exaggerated complaints of personal
misfortune
7. Alternates between hostile defiance and contrition
Possible Problems
• Seems kind of moralistic
• “Big brother” view on human interactions
• Authority figures need to be obeyed
• Suggests there is no way to decline on the demand
for “adequate performance”
• Demand to repress envy and jealousy in hierarchies
Often such individuals…
• (over)-dependent - with an individual or institution
• dares not express hostility openly
• chronic complaint - failing to find gratification in
the relationship
• lack self-confidence
• pessimistic about the future
• chronic undifferentiated unhappiness
• no realization that “their behavior is responsible for
their difficulties”
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Demands
Mentalizing PA Behavior
• The self is seen as unappreciated/victimized, not
having the good things
• The other is seen as unreasonable/hostile, having
too much of the good things
• Passive and oppositional to demands
– Do your homework
– Play nice
– Brush your teeth
– Not now
– Aren’t you ashamed?
– Etc.
– from postponement, refusal, to “spoiling it for the
other”
• The very basis of authority is rejected
• Still the relationship with the other is desired: the
other’s love, appreciation, praise, respect,
admiration etc.
The demand
• Can be:
• Children and adolescents are often seen as being
naturally obligated to accept adult authority.
1. Done/not done 2. “Properly”/”partially” -
• The preferred response to demands is sustained
attempt to the best abilities of the individual
(“adequate performance”).
3. In time/”later” -
4. Without/with resentment 5. Without/with retaliation –
Etc.
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Why would somebody refuse a demand?
(an incomplete list)
• The spectrum of “inadequate performance” starts
with brief, un-sustained attempts, delays, followed
by frank refusal, counterattack and eventually
grossly maladaptive behavior (regression,
dysregulation, aggression)
• Not interested or “motivated” to do so.
• Demand is asking for a capacity or skill that is
developmentally unavailable or variably available.
• Demand is asking for a known weakness; the choice
is to attempt and fail or fail to attempt.
• Demand triggers an emotional conflict.
• Demand is declined purposefully by an individual
who “should “ be motivated and is fully capable to
do it.
Developmental “reasons” for PAB
• Separation, individuation
• Trauma
DEVELOPMENTAL REASONS FOR REFUSAL
• Incompetence
• Under socialization
• Language delays
• Deficits of mentalization
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Behavioral Range
DESCRIPTION
• Passive
- postponing
• Passive-Resistant
- refusing, opposing
• Passive-Avoidant
- avoiding
• Passive-Aggressive - spoiling it
• Overtly Hostile
- threatening, swearing
• Overtly Aggressive - hitting
Passive Aggressive Behavior (PAB)
• A. Behaviors described as passive aggressive occur
in a context of a power relationship, where one
party has something (authority, etc.) and demands
something from another party who lacks it.
– Officer-Private
– Parent-Child
– Therapist-Patient
– Employer-Employee
– Supervisor-Supervisee etc.
PAB(2)
• B. The hierarchical relationship is generally
important to the “authority” for good or bad
reasons, for conscious or unconscious reasons.
– “this is how things are”
– “he needs to”
– “what are the neighbors going to think?”
– “he’s going to end up in jail otherwise”
– “he needs to know who is the boss”
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PAB (3)
PAB (4)
• C. The demand is unacceptable for the one who
receives it for good or bad reasons, for conscious or
unconscious reasons.
– “it is hard”; “it is frustrating”
– “I want you to do it for me”
– “you have enough of it”
– “he doesn’t have to do it …”
– “I don’t know how to do it”
– pain avoidance
– pleasure seeking
- envy
- jealousy
– saving face
PAB (5)
• F. The refusal of the demand challenges the
hierarchy of power and pushes the “authority”
towards the limits of what one can do to obtain the
compliance: coercion, pay etc.
• G. The shift in the balance of power is poisoned by
the mutual regression of the players. The radicalized
“former authority” tends to be rigid and
“hysterical”, the “new authority” is discovering a
new sense of “perverted” pleasure in the new
status quo.
• D. Not only that the initial demand is declined but
there is an implied (reactive) demand aiming at:
– (Re)claiming the position of power
– Getting (back) the “control”
• E. This move triggers irritation in the “authority”
figure, lowered empathy, higher tendency to be
judgmental and moralistic
– “He is lazy”
– “He is doing it for attention”
Cycles of Demand-Refusal
Demand
Righteous
Demand
Regressed
“subordinate”
Refusal
Radicalized
“authority”
Primitive
Refusal
Repeat until
Exhausted
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