How Self-Regulation Builds Recovery Success

Emotions are powerful.  From emotions come passions, wild and driving, which spur us to create or to destroy.

Evidence about decision-making through neuroscience suggests that most decisions are determined not by logic, but by emotion.  Neuroscientist Antonio Damasio discovered that his patients with damage to the part of the brain that controls emotion have difficulty making decisions.  Later, a 2006 study by De Martino et al. found that people undergoing an fMRI while presented with gambling options made their decisions emotionally.

“Emotions move us. The word, ’emotion,’ derived from the Latin, literally means ‘to move.’ The ancients believed that emotions move behavior; in modern times we say they motivate behavior. They energize us to do things by sending chemical signals to the muscles and organs of the body; they prepare us for action.”
Steven Stosny, Ph.D. on Psychology Today

It is not surprising, then, that emotion regulation or dysregulation has been shown to have profound effects on human behavioral patterns throughout life.
Awareness gives me a chance to change

Several studies (Nikmanesh et al. 2014, Gerra et al. 2014, Banducci et al. 2014) have found a connection between emotion dysregulation due to childhood trauma, and behaviors such as gambling, eating disorders, substance use disorders, and violence.  They indicate that the ability to regulate one’s emotions is not innate, and can be severely compromised by emotional and physical trauma incurred in childhood.  Teaching emotion regulation skills to a child, and particularly to victims of trauma, is imperative to help the individual avoid substance use disorders and other behavioral disorders later in life.

Emotion regulation is the ability to assess and change one’s emotional state, particularly in cases of extreme distress.  In a broader sense, emotion regulation is a set of skills and abilities that keep one’s emotional system healthy and functioning.  This introductory article suggests that emotion regulation encompasses the following skills:

  • Recognizing one is having an emotional response.
  • Understanding what the emotional response is.
  • Accepting the response, rather than becoming afraid.
  • Assessing and choosing strategies to reduce the intensity of the emotional response.
  • Engaging in goal-directed behavior toward these strategies.
  • Controlling impulsive behaviors during the emotional response.

Emotion regulation also helps one to align one’s actions with one’s deepest values.  It begins with awareness of one’s emotional state.  Without awareness of emotions, there can be no clear awareness of decisions as decisions are made.  Perhaps this is why a choice to drink or use drugs becomes a habit of drinking or using, which insidiously becomes an addiction without one knowing exactly when the shift took place.

Substance use disorders are strongly linked to emotion dysregulation in the literature (Nikmanesh et al. 2014, Fox et al. 2008, Matthias et al. 2011, Axelrod et al. 2011, Dishion et al. 2011).  It has been proposed that substance use begins as an effort toward emotion regulation or self-regulation, but that if it leads to addiction it only worsens one’s ability to self-regulate.  This is known as the self-medication hypothesis of addiction, an older hypothesis which is still supported by scientific literature.  The perceived need to self-medicate begins when emotions become intolerable, and when an individual is unable to regulate those emotions. In fact, “negative affect,” or unregulated, negative moods such as anger, frustration, and depression, is the primary predictor of relapse for addicted individuals.

Yet it would be monumentally unfair to call this difficulty in emotion regulation a moral failing.  Emotion regulation is a skill set, which can be compromised by severe or repeated trauma and stress.  If a person had never thrown a ball before, or perhaps had had an injury in that arm that impaired throwing accuracy, one would not condemn that person even if they messed up and threw the ball directly into someone’s face.  One would have compassion for that person’s compromised ability, and perhaps work with them to improve their throwing.

And fortunately, there are approaches to building emotion regulation skills that are supported by the literature.

Cognitive Behavioral Therapy is a form of talk therapy in which a therapist actively guides a person in examining the relationships between thoughts, feelings, and actions.  The therapy focuses on discovering and changing the thoughts and feelings that lead to detrimental behaviors.  Cognitive Behavioral Therapy, particularly when combined with acceptance, tolerance, and active modification of negative emotions, has been shown to be effective training for emotion regulation.

Dialectical Behavioral Therapy has even more support in the literature for cultivating emotion regulation (Linehan et al. 1999, Neacsiu et al. 2014).  It is another form of talk therapy, originally developed to treat people with borderline personality disorder.  DBT is similar to CBT, but with the focus on acceptance of the negative thoughts and emotions that trigger detrimental behaviors.  Through acceptance, people are able to see change as actually possible and so engage with the therapist in planning a gradual change for recovery.

Mindfulness Training is a rising star in talk therapy, derived from the Buddhist meditation practice anapanasati.  In essence, mindfulness training cultivates a person’s ability to be exactly in the present moment, aware of one’s breath, feelings, thoughts, perceptions – everything.  Mindfulness practice inserts a pause of awareness between one’s internal reaction to something and one’s actions.  This pause is essential for one to assess one’s self and to temper emotional decisions with one’s deepest values.  Mindfulness training is simply an Eastern, meditation approach to cultivating this pause.  Mindfulness is supported in the literature as a promising approach to cultivating emotion regulation.

It is clear that emotion regulation is a fundamental skill set for assuming autonomy and control over one’s decisions and actions.  Without emotion regulation, people are at higher risk for many detrimental behaviors and disorders, including substance use disorders. Emotion regulation training is an important element for professionals to consider when developing recovery programs for people with substance use or process disorders.  This training is a direct and influential measure one can take toward recovery success.

Update: The section beginning “Substance use disorders are strongly linked to dysregulation in the literature” was last updated 5/3/16.

Laurel Sindewald is a writer, researcher, and editor.

The content of this post is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

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  1. Step 1. I admitted to myself that I am powerless over drugs and alcohol and that my life has become unmanageable.
    I know nothing good dwells in me, that is, in my flesh. For I have the desire to do what is right, but I cannot carry it out (Romans 7:18).

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