REHABILITATION SERVICES

PATIENT EDUCATION MANUAL

EMOTION REGULATION
SKILLS

UNIVERSITY OF CALIFORNIA SAN FRANCISCO

Langley Porter Psychiatric Hospital & Clinics

THE GOALS OF EMOTION REGULATION

THE GOALS OF EMOTION REGULATION

...how to cope with emotional suffering and how to increase

positive emotional experiences in everyday life.

UNDERSTANDING YOUR EMOTIONS

The first step in regulating emotions is learning to identify
and label your emotions. Learning the function (purpose)that
your emotions serve is helpful so that you can identify what
gets in the way of reducing painful emotions.

REDUCING EMOTIONAL VULNERABILITY

The goal is to reduce emotional vulnerability by learning to
decrease negative emotions and to increase positive
emotions.

DECREASING EMOTIONAL SUFFERING

We can learn to let go of painful emotions by being mindful
of them, instead of fighting them or walling them off. We
can also learn to change negative or painful emotions by
acting in a manner opposite to them.

2
 PREVENTION BASICS
These steps will strengthen your ability to regulate your emotions

1. Take care of your body. See a doctor when

necessary. Take prescribed medications.
2. Don’t eat too much or too little. Stay away from
foods that make you feel overly emotional (such
as foods with lots of sugar or caffeine).
3. Stay off non-prescribed drugs, including alcohol.
4. Try to get the amount of sleep that helps you
feel good. Keep to a sleep program if you are
having trouble sleeping.
5. Do some sort of exercise every day; try to build
up to 20 minutes of aerobic exercise.
6. Try to do one thing each day to make yourself
feel competent and in control (for example, cook
a favorite dish, write a letter, fix something
broken, clean one room, rake some leaves…).

3
WHY LEARN TO OBSERVE AND DESCRIBE
EMOTIONS?

Studies have shown that people who can identify their

emotions move through depression faster. By learning
to observe and describe your emotions, you learn both
to be separate from them and also to accept them so
they don’t distress you so much.

In order to better
regulate your emotions,
you must be able to
separate or step back
from them so you can
think of using coping
strategies. At the
same time, remember
to accept them as part
of yourself and not
something outside of
you.

Try the worksheet on the next page to help identify

where and how you experience emotions in your body.

4
 IDENTIFYING WHERE AND HOW YOU
EXPERIENCE EMOTIONS IN YOUR BODY

Draw where in your body

you feel different
emotions. Use colors or
drawing to show how you
feel these emotions:

LOVE
JOY
SADNESS
SHAME
FEAR
GUILT
ANGER

Which emotion is easiest

to identify?
Which is hardest?

5
CAN YOU IDENTIFY THE EMOTIONS
THAT YOU EXPERIENCE?

6
 TAKING STEPS TO GET BACK IN
CONTROL OF YOUR EMOTIONS

1. Start by taking a time-out…decrease the

stimulation around you; go to a quieter place away
from distressing triggers.

2. Stop what you’re doing….when you feel warning

signs of strong anger or distressing feelings and you
start to thinking angry or disturbing thoughts, tell
yourself to stop. This may help you calm down and
think more clearly.

3. TRY TO RELAX
Count to 10 or 100
Get a drink of water
Take a walk
Take several slow deep breaths

4. Return when you’re calm…Once you’ve got your

overwhelming emotions under control, go back and
talk to the person or face the situation that
triggered your emotional distress.

7
 THE FUNCTION OF EMOTIONS
What good are emotions? Why do we have emotions?
Until we begin to understand the functions of
emotions, why we have them, what their effect is on
others, we cannot expect to change or regulate them.

Emotions communicate to and influence others

We communicate our emotions to others with verbal and non-verbal (facial

expressions, body gestures or postures) language. In human society, we use non-
verbal communications to better understand each other and to respond to each
other’s needs. For example, we might want to reach out to help someone who
appears frightened, or we might want to take action to rectify a concern when
someone shows an angry face.

Emotions organize and motivate action

Emotions prepare for and motivate action. There is an action urge connected to
specific emotions, it’s an automatic, built-in part of our behavior. For example, if
you see a two-year old child in the middle of the street and a car is coming, you will
feel an emotion, fear, and this emotion will prompt you to run to save the child. You
don't stop to think about it. You just do it. Your emotion has motivated your
behavior without you having to take the time to think. The anxiety you feel when
you are about to take a test, though it's uncomfortable, helps to motivate you to
study so you will do well on the test. Anger may motivate and help you respond to
injustices.

Emotions can be self-validating

Emotions can give us information about a situation or event by providing

subconscious signals that something important is going on. An intuitive feeling of
"something doesn't feel right about this" or "I had a feeling something was going to
happen and it did" are some of the signals we might get. Is there some time when
you felt anxiety or apprehension that turned out to be justified? Or that you had a
good feeling about someone that turned out to be right? If so, these emotions were
“self-validating”.

(adapted from http://www.dbtselfhelp.com/html/emotion_function.html)

8
 THE IMPORTANCE OF
“SECONDARY EMOTIONS”
Much emotional distress is a result of “secondary” emotional responses.
Secondary emotions (such as intense shame, guilt, anxiety or rage) are often
responses to primary emotions. The primary emotions are usually adaptive
and appropriate to the triggering event or context (see the previous page
about the function of emotions). Primary emotions tend to be short-lived
once the triggering event has passed.

If we have grown up with beliefs that certain emotions are not acceptable
(e.g. “If I get angry, I’ll lose control” or “If I show fear, it’s a sign of
weakness”), we tend to shift into a secondary emotion. We do this, often
without thinking about it, as a way to protect ourselves from the
“unacceptable” primary emotion. The problem is that the secondary emotions
that arise (e.g. guilt, anxiety or rage) tend to become longer lasting and
actually create greater suffering for us.

What Can Be Done?

The first step in reducing your secondary emotional

responses is to increase your awareness of your
emotions. This can be done through the exercises on
pages 11 and 12 (Emotion Diary, Mindfulness of My
Emotions). In these exercises, identify and evaluate
your emotional responses to a situation. Try to
capture your thoughts about your primary emotions,
as well as how you feel as a result of those thoughts.

With time, you will be able to recognize if your thought habits are leading
you into secondary emotions that create suffering. Once you are mindful of
these thoughts, you may be able to challenge them or let them go (“my
thoughts are just thoughts, that does not make them facts”). By learning to
focus your attention on your original, primary emotion, your emotional life
can become an ally to you, rather than a source of suffering.

(Adapted from Greenberg, L. S. and Safran, J. D. (1987). Emotion in Psychotherapy. New York, NY: Guilford Press.)

9
THE SPECIAL CASE OF ANGRY FEELINGS

Angry feelings often follow and

replace a different initial emotion
that is too “uncomfortable” to let
ourselves acknowledge. We quickly
skip over this uncomfortable
feeling—so fast that we’re usually
not even aware of it—and replace
it with an angry type of feeling.
The anger is really a reaction to
that initial emotion, whether
we’re consciously aware of it or
not.

EXAMPLES

When you were too busy to talk to me, I felt < (ABANDONED) > “angry”.
When you don’t let me help you, I feel < (OUT OF CONTROL) >“frustrated”.
When you criticize me, I feel < (INADEQUATE) > “enraged”.
When you yell at me, I feel < (ABUSED) > “revengeful”.
When you don’t make time for me, I feel < (UNIMPORTANT) > “resentful”.
When you don’t stick to our agreements, I feel < (POWERLESS) > “infuriated”

ANGRY FEELINGS are valid and important, but are most

beneficial when used as indicators that someone or something
is triggering an uncomfortable feeling in you. To accurately
figure out what you are reacting to, it’s necessary to
backtrack and identify the feeling that came FIRST – before
the angry reaction replaced it.

10
 EMOTION DIARY
(How to observe and describe your emotions)

Choose two current or recent emotional reactions you

had and fill out as much of the worksheet below as
you can.
______________________________

Record your strongest emotion of the day, or the longest-lasting

one, or the one that was most painful or gave you the most
trouble. Analyze that emotion. Fill out the “MINDFULNESS OF
MY EMOTIONS” worksheet on the next page as well.

Day Event Emotion Function

(What happened?) (What are you trying to communicate,
how does it serve you, what do you need?)
_____ _________________ ____________________
_________________ ____________________
_________________ ____________________

Emotion: _________________________________________

Day Event Emotion Function

(What happened?) (What are you trying to communicate,
how does it serve you, what do you need?)
_____ _________________ ____________________
_________________ ____________________
_________________ ____________________

Emotion: _________________________________________

11
 MINDFULNESS OF MY EMOTIONS

EMOTION NAME(S):____________INTENSITY (0-100):___

Prompting event or trigger for my emotion (who, what, when

where – just the facts):

Thoughts/interpretations (beliefs, assumptions, about the

trigger…):

Body sensations (where in my body do I feel this emotion? What

was my body language—facial expression, postures?):

Action (What did I do? What did I say?):

How did the emotion affect me afterwards? (Were there secondary

emotions? What did I do after the event or trigger?):

12
 THREE WAYS TO LET GO OF
EMOTIONAL SUFFERING

1. Observe your emotion

Notice its presence (without

judging it as good or bad).
Step back!
Get unstuck.
Detach from your emotion.
(This is practicing
“mindfulness”)

2. Experience your Emotion

Experience it as a wave, coming and going. Try not to

block emotion. Open yourself to the flow of the emotion.
Try not to suppress emotion. Don’t push the emotion
away. Don’t try to get rid of emotion. At the same time,
don’t try to keep emotion around. Don’t hold on to it.
Don’t amplify it.

Remember: You are not your emotion. Don’t necessarily

act on emotion. Remember when you felt differently.
3. Practice Loving your Emotion

Don’t judge your emotion. Practice willingness. Radically

accept your emotion. Respect your emotion. Don’t assume
it’s irrational or based on distortions.

13
 HOW TO INCREASE
POSITIVE EMOTIONS
1. Build Positive Experiences Short Term

Do enjoyable things that are possible

now. Do one thing each day from the
”Pleasant Events List” (see the Distress
Tolerance Manual). For example: soak in
the tub, do a crossword puzzle, play a
game of cards, write something in a
journal…

2. Build Positive Experiences Long Term

Make changes in your life so positive events will occur more

often. Build a “life worth living”. Work towards goals. Make a
list of positive things you want to have happen. List small steps
towards goals. Take the first step. Attend to relationships.
Repair old relationships. Reach out for new relationships. Work
on current relationships. Avoid avoiding…avoid giving up.

3. Be Mindful of Positive Experiences

Focus your attention on the positive things that happen. Re-

focus when your mind wanders to the negative. Accentuate the
positive, dismiss the negative.

4. Be Un-Mindful of Worries

Distract yourself from thinking about when the positive

experience will end. Distract yourself from thinking about
whether you deserve this positive experience. Distract
yourself from thinking about how much more might be
expected of you now.

14
 FOURTEEN QUESTIONS
to help you remember what
helps you to feel better

1. My favorite movie of all times is…

2. My favorite song of all times is…

3. Something I did that I am proud of is…

4. My perfect day is…

5. My most cherished possession is…

6. My favorite cheer me up music is…

7. I enjoy reading…

8. My fantasy vacation…

9. I don’t do it much, but I enjoy…

10. If I could lighten up a little, I’d let myself…

11. If I weren’t so stingy with myself, I’d buy myself…

12. Two people I admire are…

13. I am proud of myself for…

14. I am grateful for…

15
 TRY AN EXPERIMENT:

1. Rate your current mood

1—2—3—4—5—6—7—8—9—10
Worst…………………………………………………………..Best

(Name your mood/emotion:_________________)

2. Think of an activity that you find pleasant

(Walking in nature, taking a bath, doing your nails,

drinking a cup of good coffee, etc.)

3. IMAGINE yourself doing this activity….be in it

100%. Experience the activity with all your
senses…let yourself daydream about it.

4. Now rate your mood again

1—2—3—4—5—6—7—8—9—10

Worst…………………………………………………………..Best

What did you observe? Did anything shift for you?

Notice that even thinking about doing a pleasant
activity makes you feel better. Allow yourself to
have “IMAGINE” breaks during the day and see
what happens.

16
RESOURCE LIST FOR ADDITIONAL READINGS
This manual is part of a series discussing Mindfulness Skills, Distress
Tolerance Skills, Emotion Regulation Skills and Interpersonal Effectiveness
Skills. If you would like additional reading materials or resources related to
the skills discussed in these manuals, we would like to direct you to the
following:

Don't Let Your Emotions Run Your Life: How Dialectical Behavior Therapy Can Put You
in Control by Scott E. Spradlin, MA, New Harbinger Publications, 2003.

The Feeling Good Handbook by David D. Burns, M.D., Penguin Books, 1999.

Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain,
and Illness by Jon Kabat-Zinn, Ph.D., Dell Publishing, 1990.

Guided Meditations, Explorations and Healings by Stephen Levine, Doubleday, 1991.

The Language of Letting Go by Melody Beattie, Hazeldon Foundation Meditation Series,

1990.

Practicing the Power of Now by Eckhart Tolle, publisher New World Library,
(www.newworldlibrary.com), 1999.

The Relaxation & Stress Reduction Workbook by Martha Davis, Ph.D., New Harbinger
Publications, 2000.

The Spirituality of Imperfection by Ernest Kurtz, Ph.D., Bantam Books, 1994.

Turning Suffering Inside Out:A Zen Approach to Living with Physical and Emotional Pain
by Darlene Cohen, Shambhala Publications, 2000.

Women, Anger & Depression: Strategies for Self Empowerment by Lois P. Frankel, Ph.D.,
Health Communications, Inc., 1992.

TAPES AND CDs

Guided Mindfulness Meditation by Jon Kabat-Zinn, Stress Reduction CDs and Tapes, P.O.
Box 547, Lexington, MA 02420 or www.mindfulnesstapes.com

ACKNOWLEDGEMENT

Many of the materials discussed in these manuals are based on the works of Marsha M.
Linehan, Ph. D. as presented in her books Cognitive-Behavioral Treatment of Borderline
Personality Disorder and Skills Training Manual for Treating Borderline Personality
Disorder. Both are available through the Guilford Press, 1993.

17