Emotion Regulation
The remaining sessions in this phase of treatment focused on identifying skills that Michael could learn to help better manage his emotions. STAIR typically provides 5 interventions associated with each channel of experiencing (i.e., body, thoughts, and behavior). The selection of interventions is based on the client’s preferences and those which will support a growing sense of mastery and satisfaction.
Body Interventions. Michael responded well to focused breathing. He liked body-based interventions because they helped him “get out of his head.” He liked the idea of having an exercise that could be integrated into his fitness plan and that helped calm his mind. Michael was open to this intervention as a source of change. It did not require buying into a new ethos. The exercise was consistent with his values as a gay man: keeping fit and attractive was important. He viewed his body as armor against the world as well as a source of pride. In addition, he developed a routine before bedtime that included a nice warm shower and a cycle of focused breathing as a way to down-regulate his physical and mental energies to help him transition to sleep.
Cognitive Interventions . Michael rejected cognitive interventions that focused on critical evaluation and reappraisal of his beliefs. He found them invalidating. The therapist agreed that many of the negative beliefs Michael held resulting from his childhood trauma and the AIDS epidemic were supported by substantial evidence. Michael effectively used Emotion Surfing, a meta-cognitive strategy in which one maintains awareness of the intensity, and ebb and flow of one’s feelings. The exercise reinforces a connection to emotions, like a surfer riding a wave, in which being aware of the emotions but not being overwhelmed or “brought under” by them reduces fear and confidence in maintaining a connection to them. In this exercise Michael was asked simply to observe his feelings which he found easier than digging through and analyzing his thoughts. He also reported that through watching his emotions, he was able to more easily change his thoughts (e.g., “Anger is manageable.”). Michael recognized that while he had experienced and might continue to experience many traumatic and other stressors, he could better manage his reactions to them. Later, Emotion Surfing proved to be very valuable as Michael addressed sadness and grief related to the loss of his partner and friends.
Behavioral Interventions. Michael had ambivalent reactions to engaging in positive or pleasurable activities. He took on what he viewed as a “masculine” value that you engage in activities to meet a goal rather than to “have fun.” However, he was persuaded by the scientific literature on behavioral activation as effective for reducing depression. The therapist needed to be careful about reviewing the options for positive activities because some were not relevant to him (e.g., bowling) or beyond his resources (e.g., taking photos) which generated annoyance and risked disengagement. Michael was familiar with Time-Out and in the context of his growing ability to track his emotional state, He made a genuine effort to use the intervention in situations at the clinic. He was strongly motivated to get along with people there (e.g., case worker and reception staff) because he recognized the value of having a space where he felt at home and accepted. Despite his routine irritations, he felt a sense of belonging at the clinic and decided to make an effort to appreciate it more by interacting in a more positive manner with staff and other clients.