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Introduction

Emotional regulation has emerged as an important dimension that may be relevant to intervention as well as prevention of substance abuse. Impulsive behavior and emotional control are the main areas of concern, particularly in regard to this population. The ability to experience, acknowledge, process, and tolerate different emotions is viewed as a necessary aspect of psychic growth. Often, individuals who struggle with feelings of depression and anxiety are swept into uncomfortable emotional states that may make them more vulnerable to substances that provide distraction or numbing. Occupational therapists can play a major role with individuals with substance abuse disorder, using emotional regulation techniques as a tool to decrease their impulsivity and help control their emotions.

Theory

Cognitive Behavior Therapy (CBT) is a broad category that seeks to modify patterns of thinking and behavior. Multiple studies have found that CBT has been useful for individuals struggling with substance abuse. In this approach, CBT would allow clients to alter negative thoughts, which lead to effective coping strategies.

Evidence

Research suggests that difficulty with managing emotions is a key factor of substance use. Because of this, individuals who cannot tolerate heightened states of emotions may turn to substances for relief (Siegel, 2015). A study done by Axelrod, Perepletchikova, Holtzman, and Sinha (2011) demonstrated improvement in emotion regulation in women with substance dependence that received DBT treatment. Improved emotion regulation accounted for decreased frequency of substance use, suggesting that developing effective emotion regulation skills may have allowed study participants to cease other less effective emotion regulation behaviors.

Case Study

Edie is a 35-year-old woman aspiring to become an actress. She has been dealing with alcohol abuse for about a decade, and struggles with regulating her emotions. Five years ago, Edie was involved in an emotionally abusive relationship that left her unable to tolerate her distress. Her emotional stress eventually led to her impulsive habits to find more substances. Edie struggles to find different methods to regulate her emotions other than substance abuse. She is currently receiving psychotherapy from her psychiatrist, while we are working on skills training using DBT.

Intervention Plan

Problem Statement:

Edie has difficulties with impulse control secondary to emotional dysregulation hindering her social participation

Short-Term Goals:

1. Edie will identify and label 3 stressful emotions while in group within 1 week for improvement in impulse control.
2. Edie will be able to identify and share 3 positive emotions while in group within 1 week for improvement in emotional regulation.
3. Edie will choose and practice one relaxing activity to refocus her attention from stressful emotions within 1 week in order to improve her impulsivity.

Long-Term Goals:

1. Edie will be able to identify and replace negative emotions when tempted with alcohol in a social situation to improve impulse control within 4 weeks.
2. Edie will share at least 1 tempting situation she encountered and the strategy she used during group discussion within 4 weeks for improvement in impulse control while in a social setting.

Intervention Format:

Group

Setting:

Edie will meet with the occupational therapist in an academic community outpatient substance abuse treatment program for 1 hour 2x per week for 1 month.

Supplies:

None

Agenda:

• Group members are introduced (5 min)
• Ice breaker activity (10 min)
• Therapist presents the session’s outline and discusses the session’s messages (5 min)
• The therapist lists and briefly discusses the skills to be introduced and practiced in the session (15 min)
  • • Identifying and labeling emotions
    • Mindfulness training
    • Relaxation techniques
• A group exercise is used to implement the strategies learned for emotional regulation (20 min)
  • • Role play real-life scenarios
• Provide a summary of the discussion (5 min)

Documentation

S: Edie states “I have a lot of trouble controlling my emotions when all I want to do is drink..and my friends don’t help at all”.

O: Edie participated in practicing emotional regulation skills during the therapy session. She was able to identify and share a vulnerable situation along with an effective coping strategy to the group. She also discussed strategies she used to regulate her emotions during a group discussion. Edie participated in a one-on-one role-play scenario in which she had to demonstrate coping strategies learned from her sessions.

A: Edie recognized negative emotions associated with challenging situations when role playing in group. Edie’s ability to identify positive and negative emotions shows an improvement in impulsivity and emotion modulation.

P: Edie will continue skills training and emotional regulation under Dialectical Behavioral Therapy in upcoming sessions in order to decrease impulsivity and manage her emotions. Continue to enhance and improve treatment plan when necessary. Client is to see occupational therapist 2x per week for 1 month.

References:

Siegel, J. P. (2015). Emotional Regulation in Adolescent Substance Use Disorders: Rethinking Risk. Journal of Child & Adolescent Substance Abuse, 24(2), 67-79. doi:10.1080/1067828x.2012.761169

Axelrod, S. R., Perepletchikova, F., Holtzman, K., & Sinha, R. (2010). Emotion regulation and substance use frequency in women with substance dependence and borderline personality disorder receiving dialectical behavior therapy. The American Journal of Drug and Alcohol Abuse, 37(1), 37-42. doi:10.3109/00952990.2010.535582

Cognitive Behavioral Therapy for Addiction. (n.d.). Retrieved February 05, 2018, from https://americanaddictioncenters.org/cognitive-behavioral-therapy/