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Introduction

Emotional regulation is a process in which an individual has the ability to control their emotions and is essential for physical and mental health of an individual (Gross, 2007). Deficits in emotional regulation can negatively affect an individual’s’ role of parent, spouse, friend, or employer/employee. In regards to relationships, when there are “fairly stable patterns of interactions in which positive affect is experienced to a substantially greater degree than negative affect” the relationship is characterized as successful (Gross, 2013). When this is not the case, emotional dysregulation can occur.

Theory

The Health Belief Model is chosen because it is very client centered. If the client does not perceive a need to change they will not change. However, if the client finds that there are more negative consequences in maintaining the current behavior, they are more inclined to make a change (Henshaw & Freedman-Doan, 2009). In this case, Leslie has experienced more negative situations (due to her inability to effectively control her emotions during social interactions) than she would like. This is causing her to seek help at the women’s shelter so that she can control her emotions.

Evidence

Victims of domestic abuse experience multiple emotional problems and targeting their emotion regulation can be beneficial to incorporate them into society (Iverson, Fruzzetti, Shenk, 2009). A randomized controlled trial conducted by (Cook et al., 2012) to examine the effects of the WRAP (Wellness Recovery Action Plan) on depression, anxiety and recovery indicated that “the greater the participants’ exposure to WRAP, the more they improved on depression and anxiety symptom severity and self-perceived recovery.” A report shows that using the WRAP significantly decreased symptoms in a period of one month (Cook, Copeland, Hamilton, Razzano, Floyd, Hudson, Macfarlane, Grey, 2009).

Case Study

While Leslie worked at her desk, her boss approached her from behind, touched her shoulder and reached out to hand her a large stack of files. Being unexpectedly touched triggered thoughts of the abusive relationship she just removed herself from. She reacted by jerking away, crying uncontrollably and running out of work. Leslie arrived to the women’s shelter in a distraught state to speak with her occupational therapist about what occurred. She expressed that her reactions are affecting her social interactions and causing anxiety. She would like to reduce her maladaptive coping strategies. With her permission, we suggested the WRAP based on the evidence of its effectiveness.

Intervention Plan
Problem Statement: Client is having difficulty with appropriate social interactions secondary to inability to regulate emotions.

Outcomes: The desired outcome is for the client to identify and implement adaptive emotional regulation coping strategies to help her successfully participate in social situations.

long term goals

1. During 4 out of 5 group sessions, client shares one positive coping strategy that she implemented during social interactions by discharge.
2. Client will participate in 3 role play activities without negative emotional reactions (i.e. crying, storming out of room) to improve social participation in 4 weeks.

short term goals

1. Client will identify 5 triggers that lead to emotional stress with 3 verbal cues in one treatment session in order to improve social participation in 2 weeks.
2. Client will select two positive coping strategies for emotional regulation during social interaction in 1 week.
3. During group session, client will share 1 interaction where she implemented positive coping strategies in 2 weeks to improve social participation in 3 days.

Intervention format:

Individual 60 min session at the shelter for women and children who have been impacted by domestic abuse.
Client would be seen at the shelter twice a week at 4:00 pm.

Supplies (if any): WRAP worksheet

Agenda & description:
Instruct on mindfulness techniques (15 minutes)

• Dimming the lights
• Breathing techniques
• Meditation

Discussion of triggers (10 minutes)

• Things that happen to you that cause distress
• These things may be unexplained.

Discussion of strategies, tools, and/or skills you need to use in order to keep yourself well (10 minutes)

Completion of two sections of the WRAP- Wellness, Recovery, Action Plan (20 minutes)

Summary of what she was able to take away from this treatment session and activity (5 minutes)

Documentation:

SOAP Note

S: Leslie reports “anyone that touches my shoulder, triggers the emotions of my previous abusive relationship”.

O: Client participated in a 60 minute individual OT session at the women’s shelter. Leslie arrived to the shelter in tears. The therapist dimmed the lights and instructed client in breathing techniques and mindful meditation. In addition, client was educated on the identification of triggers. Using the WRAP, she was able to identify 3 triggers. Also, she identified 3 personal wellness strategies with 5 verbal cues.

A: Leslie cried and had difficulties speaking while explaining what occurred at work. With arms crossed she rocked herself in the chair but this method did not improve her emotional distress. This indicates her method of self-soothing is ineffective. Once the therapist altered the environment by dimming the lights and breathing techniques were initiated the client stopped crying indicating that she was in a calmer mental state. Leslie demonstrates insight into her social anxiety by acknowledging that she has inappropriate emotional regulation strategies.

P: Client will benefit from further self-reflection and participation in group sessions to implement her chosen emotional regulation strategies.

References

Cook, J. A., Copeland, M. E., Floyd, C. B., Jonikas, J. A., Hamilton, M. M., Razzano, L.Boyd, S. (2012). A randomized controlled trial of effects of wellness recovery action planning on depression, anxiety, and recovery. Ps, 63(6), 541-547. doi:10.1176/appi.ps.201100125

Cook, J. A., Copeland, M. E., Hamilton, M. M., Jonikas, J. A., Razzano, L. A., Floyd, C. B., Hudson, W. B., Macfarlane, R. T. & Grey, D. D. (2009). Initial outcomes of a mental illness self-management program based on Wellness Recovery Action Planning. Psychiatric Services, 60 (2), 246-249.

Gross, J. J. (2007).Handbook of emotion regulation. New York,NY: Guilford.

Gross, J. J. and Muñoz, R. F. (1995), Emotion Regulation and Mental Health. Clinical Psychology: Science and Practice, 2: 151–164. doi:10.1111/j.1468-2850.1995.tb00036.x

Henshaw, E. J., & Freedman-Doan, C. R. (2009). Conceptualizing Mental Health Care Utilization Using the Health Belief Model. Clinical Psychology: Science And Practice, (4), 420.

Iverson, K. M., Shenk, C., & Fruzzetti, A. E. (2009). Dialectical behavior therapy for women victims of domestic abuse: A pilot study. Professional Psychology: Research and Practice, 40(3), 242-248. doi:10.1037/a0013476