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Transcript of CEUcast, Episode #1 “Emotional Regulation in Children and Teens” with Kayla Jones, M.A., L.P.C. and Micah Perkins, M.S., L.P.C., L.A.D.C.

Micah Perkins: Today, we have with us Kayla Jones. Kayla, you are our first ever guest on CEUcast. Kayla, tell us a little bit about you and your background and your training.

Kayla Jones: Yes, of course. Well, I have a master's in Marriage and Family Counseling from Southern Nazarene University and I'm currently licensed here in the state of Oklahoma as an a Licensed Professional Counselor, I actually have some specialized training and Trauma Focused Cognitive Behavioral Therapy and Trust Based Relational Intervention. And I use these approaches to give some of the information that I have for you today.

Micah Perkins: Oh, that is fantastic. And I know you are going to talk with us today about emotional regulation with children and teens. So can you define that a little bit for us and tell us what emotional regulation is?

Kayla Jones: Yes, of course. OK, so first off, self-regulation is defined as being able to regulate yourself without interventions of the outside world. It is also the ability to express our thoughts and our feelings and our behaviors in a socially appropriate way. So emotional regulation is kind of learning to calm down when we're experiencing extreme anger or excitement and persistent difficulty, difficult tasks, are different examples of ways that we can self regulate. So the idea of emotional regulation is the ability to manage our emotional responses. So when it comes to regulation, we also want to talk about dysregulation, which is the opposite. The term emotional dysregulation was actually coined by Marsha Linehan who developed Dialectical Behavioral Therapy and she defines emotional dysregulation as the pervasive dysfunction of emotional regulation system. And so it's kind of the opposite, we're not able to really calm our system down when we're feeling extreme emotions.

Micah Perkins: Linehan came up with a Dialectical Behavior Therapy used in the treatment with people suffering from Borderline Personality Disorder. Is that correct?

Kayla Jones: Yes, yes.

Micah Perkins: So a lot of her concepts then are being used with other types of conditions that people suffer from.

Kayla Jones: Yes, lots of different types of mood disorders, including people that struggle with extreme anxiety and depression and even those who suffer from traumatic experiences.

Micah Perkins: So these types of techniques that you're talking about today are helpful for people not just suffering from Borderline Personality Disorder, but all types of different emotional regulation problems.

Kayla Jones: Yes, and I think everybody disorder or not has the ability to learn how to emotionally regulate struggles to emotionally regulate at times. So I'd like to describe a little bit about what emotional dysregulation looks like. So for children, you might see them acting overly silly, especially in moments when they're needing to be serious. You're seeing them struggle in moments where they're needing to transition from one activity to the next, maybe they struggle with taking turns or being impulsive, maybe touching, not being able to keep their hands to themselves or other behaviors that we see with emotional dysregulation include tantrums, running away, maybe withdrawing from situations, shutting down or what we call disassociating. You will also see yelling and screaming. Now with teens and older children you might even see self-harming behaviors including cutting or burning or taking excessive risks along with having suicidal thoughts and ideation. Emotional dysregulation is an emotional reaction that would be considered extreme or intense for the context of that situation and possibly not quite age appropriate

Micah Perkins: Types of problems that school counselors are working or maybe in an in-patient settings with some of the staff and therapists that work with children and teens in that setting.

Kayla Jones: Definitely, definitely. But we also see dysregulation, emotional dysregulation with adults, so oftentimes if you see adults becoming really aggressive or baiting or often testing others and are trying to often cause conflict with one another as well, things that we see with children and teens.

Micah Perkins: When you say testing others, what do you mean when you say testing?

Kayla Jones: Just constantly trying to push other people's buttons or I'm just pushing other people to the brink of trying to get them to become emotionally dysregulated.

Micah Perkins: Oh, I see what you're saying. So trying to maybe purposefully or inadvertently get them stirred up as well. Yes. Yes. So tell me a little bit more about what is helpful as far as a clinician? What types of things can he or she do to try to help teach children, teens and adults how to better be able to emotionally regulate themselves?

Kayla Jones: Well, there's a lot of different skills that we can use in session or teach parents or caregivers at home to use with their children and teens to build emotional regulation. And I also wanted to talk a little bit about how we build emotional regulation from the ground up. So, which would you like to start with

Micah Perkins: Let's talk about the second one first. How, how does one build emotional regulation?

Kayla Jones: Yeah. So as an adult you will, you probably expect yourself or others to be able to regulate themselves. And at times we do it subconsciously. Sometimes we bite our nails, take a break, we'll walk away, to give ourselves a chance to emotionally regulate ourselves in whatever situation that we're in. Self-regulation crucially depends on our perception though, of our safety and our connection with our environment. So, if we feeling threatened, then we're unable to regulate in that moment typically. And so this is something that's important to realize that when a child is feeling threatened, that their ability to self-regulate may not be what we expect at that moment.

Micah Perkins: It's really important for them to be in an environment where they feel safe if we expect them to be able to emotionally regulate themselves.

Kayla Jones: Yes. And I go into a little bit more detail. I have some more information about that a little bit later in specifically how to build that kind of safe environment for them. So Dr Karen Purvis, who is one of the founders of Trust Based Relational Intervention from Texas Christian University, talks about how there's three different types of regulation; external regulation, co-regulation and self-regulation. So as infants, we rely on the world mostly to regulate our bodies. So when we're hungry we cry, and hopefully someone comes and meets our need when we are wet, we cry and then someone comes and meets our needs. And so there's this cycle here and we're constantly being externally regulated in our environment to meet our needs and to help us get back to a calm and resting state. At times infants also do show that the abilities to self soothe, which is considered a self-regulation techniques. But typically we see an externally regulated system.

Micah Perkins: So what are some of the things infants do to self soothe?

Kayla Jones: Oh, definitely. So if you see them like chewing on her hands or sucking their thumb. Another way of co regulation would be the use of a pacifier or a bottle. Um, that second motion is definitely a self soothing technique that children use. Sometimes they might rub their eyes or I'm scratch the surface with the nails. That's something that they do to kind of understand their environment around them, but also provides a self soothing technique. Yes. And so, as we get older, as children age, we start to learn and understand our world around us. And so with the use of language, we begin to regulate ourselves on our own. And so then parents, caregivers and children kind of do this dance between co-regulation and self-regulation. And co-regulation is the idea of if a child is like, if the child is thirsty, then we provide them with a cup of juice. So we're helping them regulate in that moment. If a child is crying or screaming, maybe we'll pick them up and comfort them, which is another example of co-regulation. And then again, as the child ages, then they have more opportunities for self-regulation when they're realizing I'm really angry and so I need to calm down, so maybe they'll step out and calm down or find something else, like run it off.

Micah Perkins: They're able to start internalizing that, that voice a little bit to help them self regulate.

Kayla Jones: Yes. And that's what's really important about that co regulation as a transition is you're helping your child learn to do this on their own. They just need kind of that extra coaching and extra help.

Micah Perkins: Is there a particular age that you see where dialogue begins to kick in and children are able to self regulate better?

Kayla Jones: That's a great question. But it's very hard to answer because every child is very different. And so for instance, we expect children at times to do this on their own and sometimes they're not quite ready. That's brings up a good point about like our developmental age versus your chronological age. So a child may be 10, they were born 10 years ago, their 10, but their developmental age, maybe much younger due to medical needs, health problems or even trauma experiences in their past. And so we have to keep an eye out for this and understand what is their ability right now in this moment. I'd like to give you a clear answer for that, but it's really a case by case basis. And so there's actually a study by Becker and Whiteman that talks about children who experienced trauma can considered developmentally to be half their chronological age, and these behaviors can include emotional regulation behaviors,

Micah Perkins: Chronological age. So if we have a 14 year old teenager that they'd gone through a lot of trauma then expecting them to behave emotionally like a seven or eight year old.

Kayla Jones: Yes, yes. But with the coaching and the ability and the flexibility of their caregiver or a case worker or even clinician to stay in that co regulation state for awhile, you can get them and build them back up to their more age appropriate level.

Micah Perkins: So there's a hopeful side to this as well.

Kayla Jones: Definitely, definitely. And anybody has the ability to build their skills and their process through that extra coaching. I believe it's best practice not to assume the children we come in contact with to have the ability to emotionally regulate at the level of their chronological age. We have to consider their prenatal and developmental history along with other traumas that could've changed the composition of their brain, which often inhibit them to develop on track, like with other kids their age. We have to be willing to help co-regulate the child as long as they need that support and until repetition creates the pathways, and becomes hardwired skills.

Micah Perkins: So what are some of these specific emotional regulation techniques that you've found have been helpful for children and teens?

Kayla Jones: Yes. OK. Well, hopefully by now you can understand the benefit of building these emotional regulation skills, but research says that there's a strong social and emotional foundation in early childhood that powerfully impacts children's positive attitudes and behaviors. So again, if we're building this emotional regulation early on, it's going to help them in different aspects of their life later and again, I want to emphasize that we have to be willing to meet the child where they're at emotionally and developmentally with knowing those two things. The first thing I like to make a point is to understand and promote a healthy life balance, making sure that the child is getting adequate sleep, adequate hydration and adequate nutrition. In my office, I often like to offer bottles of water, small snacks and bubble gum. And lollipops or like suckers in my office at any moment that child is feeling a little dysregulated. It might be because they're hungry or thirsty. And so I have these things available in my office to anybody that I can help regulate their system in that moment.

Micah Perkins: I'm going to play Devil's advocate for a minute. What if a child who maybe you don't think is emotional dysregulated says I would like a sucker now because I'm upset.

Kayla Jones: I actually haven't had that happen very much because I don't necessarily promote it like If you're feeling upset, let me give you a sucker. I like to give the sucker specifically to help kind of rev engines up .If I feel that a child or I’m observing that a child is like really low energy. Then I might say, would you like a sucker? And again, I should point out that I usually get permission. I must always get permission from the caregiver before this was even prompted, that it's OK with them that I give them this type of sugar. But no I haven't, had somebody kind of use the system like that.

Micah Perkins: Any times that you felt manipulated by the kid, that they just wanted to get a sucker?

Kayla Jones: No, but I will say that if it is happening, I'm going to give them that yes, they can have a sucker because they use their words.

Micah Perkins: One of the things that, even if they don't really appear emotionally dis-regulated, they are seeing you as being a caring individual that cares about them. And as long as there's some limits. They can't have 10 suckers, but if they want to a sucker it's OK. You're not going to tell them no on that.

Kayla Jones: And if anything it helps in aiding and building rapport and trust in that safe environment, with that child. So that's another thing is we want to disarm what we call the fear response. And so, like I said before, how if we're feeling threatened in our environment, it's hard, very, very hard for our body to self-regulate. There's a lot of like chemical components in body reactions that I could go into deep detail with. But really what we need to know is that if our child is feeling scared, um, for any reason, maybe it's overt, maybe it's really underneath the surface or internalized. We have to kind of understand what their fear responses is, how they're triggered and create what we call safety. So felt safety is a term created by the trust based relational intervention, and they believe, felt safety is, is built through empowering the child, providing for their basic needs and building a strong connection.

Kayla Jones: And so if we can do those three things, then we're creating felt safety. So for instance, that question about the sucker, if they use the words and say, Hey, Miss Kayla, can I have a sucker? I'm, I'm feeling low, or I'm feeling dysregulated that I'm going to say yes, you can, even if I don't necessarily fully believe that they're dysregulated, the fact that they have the ability to ask for what they need, I'm going to empower them by giving them that yes. And so the next thing I think is another great thing to do to help build emotional regulation is building awareness, awareness of their feelings and awareness of their body and behaviors in their environment. And so I want to help this child or this teen build language to label and understand their feelings that they are experiencing. Another thing is building how their understanding of how their emotions and actions are related. So for instance, I use a lot of crafts and games and worksheets to do these things and to intertwine these educational pieces together. So one thing that I often like to use, especially with older children is the cognitive behavioral triangle. How thoughts, feelings, and actions are related and can be adjusted when one part of the triangle is worked on.

Micah Perkins: How would you present that then to a teenager? If I were a teenager and I came into your office, what would you say to me specifically to help me understand that?

Kayla Jones: OK, yes, yes, yes. And I like to use a really neutral scenario. Sp, I kind of identify what a thought is and making sure that they understand what a thought is specifically and then making sure they understand what a feeling is. And sometimes people get confused of thinking and thoughts and how they're at times like I'm feeling, like I don't like you right now is really an idea of a thought and not quite a true feeling, so, you're feeling disgust that you're thinking about you don't really like me right now is how I would reword that or help them understand. So I would use neutral scenarios one scenario that I love to use is a kid in a cafeteria. He got bumped into and spilled chili all over his brand-new sweatshirt. So we talked about what he's thinking, what he's feeling and then how he behaves, and then I prompt them to talk about, well, what if you thought something else like, oh, it was an accident versus it was on purpose and how the feelings change and how his behaviors then might change and that helps them really conceptualize how they can work on changing their thoughts and how just thinking about different scenarios to can ultimately affect and change their feelings and thoughts or behaviors

Micah Perkins: Great example. So it helps them to see how their thoughts about how they interpret the situation really influences their feelings, interactions.

Kayla Jones: Exactly. And then there's this other worksheet that I use almost with everybody and it's a feelings in the body worksheet. It's an outline. It's really simple to make or you might be able to find one online, but it's an outline of a body with five boxes that represent different feelings. So the feelings that I typically use are sadness, anger, fear, happiness and worried. And so they use five different colors to color in these boxes so each feeling has its own color and then we go through each feeling one by one, and they mark on or color on the body where they feel that emotion. And so if they feel in their heart, they'll color on the heart or the color on their arms or their color on their feet. And then we'll talk. We'll have this dialogue while we're doing this worksheet about what makes them angry, what makes them sad, what makes them scared and how their body is reacting. So oftentimes with little kids, I have to kind of help because they want to do it perfectly, but there's really no wrong way to do this. And I have to remind children that often that there's no wrong way to talk about the feelings in the body or what kind of marks you want to do. If you want to do like circles or if you want to like color all the way through or whatnot. But it's great because then they can see. I feel scared and happy both in my brain and in my heart and in my belly. And they can see that they might be feeling different feelings in the same spots too.

Micah Perkins: So whenever you ask them to identify a particular situation that they feel sad, do you have kids who aren't able to identify a particular situation?

Kayla Jones: Yes, that does happen occasionally. And at that time we'll talk about what sadness feels like and maybe they can identify it in something that they've seen like a TV show or maybe another person in their life has been felt sad before. But that's hard to then relate to their body. And so I give them the opportunity to change the feeling on the worksheet. Well, what feeling do you feel and what we could color on our, on our body here.

Micah Perkins: Right in that moment?

Kayla Jones: or that they have experienced feeling. So, maybe instead of feeling sad, maybe they felt upset before and just changing the wording a little bit. Or I had a kid that didn't really feel worried very often and I kind of believed that he just didn't have a lot of worries, but he was very excited all the time. So we changed that word to excited and we were able to apply that to the worksheet instead.

Micah Perkins: Great. So what other techniques that you have found that are helpful with children?

Kayla Jones: Yes, so we're talking about like kind of building emotional regulation, right? So those, those things were kind of helping us build awareness of our feelings and our body and behaviors. So another great ritual or something that you can help parents, caregivers, or something that you can do in your office is ask these next three questions. This helps the child really assess and reflect on what's going on. So the first question is, what does your body feel right now? You can have a dialogue with them in the office about what your body's feeling like right now.

Kayla Jones: And then the second one is, what strategies can I use to fill in the blank? And so we fill in the blank of what strategies can I use to relax or what strategies can I use to calm down and so then creating a dialogue of different skills that they can use to calm down and I'm going to go over some skills really specifically of what you could fill in with that question there. And then the third question is how will my body feel after using this strategy? I love this question because it builds awareness of the self and what the outcome could be by using the skills. So it builds motivation of, well I guess if I use these skills I won't feel angry anymore. Or I'll feel less angry than before. So those are three great questions to help again, build awareness of how we can emotionally regulate and what the benefit of emotional regulation is.

Kayla Jones: Some of the specific skills I like to use, I have detailed information here, but I'd like to point out that we want to make sure that we're modeling these skills. So as a clinician or as a caregiver or somebody that just interacting with children and teens, I want to make sure that we're modeling emotional regulation skills and these strategies,and then oftentimes trying to motivate parents to model these behaviors at home or at school as well because the more the child is exposed to it, the more they're going to be willing to use these skills.

Micah Perkins: So these are things that you may go over with the parent in session as well that they can learn so that then they can be better at co-regulating their child whenever their child becomes upset.

Kayla Jones: Yes, the younger the child is, the more you want the parent to be involved. And again, depending on their developmental level, you want to keep that in mind as well because, even if you have an older child, but they need a lot of co-regulation, you want to make sure that that parent can be able to co-regulate in a way that is helpful for them that you're teaching in session.What I love to do is teach the child the skill in session and then at the end of session bring the parent in and have the child teach the parent and so this allows them to show off their new skill, but also helps me understand how well they understand the skill and teaching someone else how to do it.

Micah Perkins: That was good practice for them to go over it again before they end up leaving the session.

Kayla Jones: Exactly. Yeah. And then I can answer or clarify anything for the parents if need be. So, some of the specific things I love bringing games and playfulness and fun into session and so, emotional regulation, games and activities help build learning skills, help support problem solving and planning, help improve memory and attention and motor control. And so those are great to keep in mind when incorporating games into session or with your activities with kids. They get practice and following directions, how to move their body appropriately and space and to calm yourself down. If they're feeling really frustrated,

Micah Perkins: it's frustrating because they're not winning.

Kayla Jones: Right? Exactly. I never let kids win.

Micah Perkins: I think I know some adults that could probably use some of this as well.

Kayla Jones: Yes. And what's great is, is if you incorporate parents or the other family members in the game time, then they all get practice to emotionally regulate together, but then they also have fun doing it. So some of the games that I like to use some physical movement games include red light and green light. Do you remember that game Micah?

Micah Perkins: oh yeah, that's great.

Kayla Jones: So using space in that, in the office or maybe even outside, they have to practice stopping and going whenever they're prompted. Some other games are freeze tag hide and seek, Simon says, or musical chairs. So all these games are things that they have to really control their body, control their emotions and follow directions as well. Something that's really calming because those games can be kind of high energy. A common game is incorporating some yoga movement in session and you can find those on youtube really easily. Another physical movement game that I love to use is called Mirror Mirror. And this helps build awareness of the movement and body, but it also builds rapport and attachment with whoever you're doing it with. So Mirror Mirror is really simple. You just sit across from each other and one of you is the mover and one is the mirror. And so if one raises their hand in the mirror that person is going to raise their hand. So you're copying the motions. Does this make sense?

Micah Perkins: Yes, absolutely. So help me understand, doing mirror, mirror, what is it about that particular technique that then helps the child to internalize some of the emotional regulation.

Kayla Jones: So they're having to work on controlling their body, especially if they are excited they have to follow what the other person is doing and kind of give up on any impulses or behaviors that they are wanting to do. So they're having to learn to give up a little bit of control. So like if someone is making a sad face but they really want to laugh because it looks funny, they have to work on controlling themselves to follow and be the mirror.

Micah Perkins: So it really takes a lot of effort, focus and concentration then to be able to do that for some children.

Kayla Jones: Definitely all of these things promote emotional regulation. There's also some board games that are really good to use in session. Jenga, Operation, Candy Land. I love using uno cards, because there's four different colors and a way that I turned it into an emotion game is matching a color with a feeling so red for angry, yellow for happy, green for scared and blue for sad. And so when you're playing, you know, anytime that you lay down a colored card, you have to either talk about it, a time they felt that feeling, show me with your face, that feeling so I can see it or talk about a time they saw it on tv or in a movie. And so they have different options of how to express that motion and kind of build emotion language.

Micah Perkins: That can be more of a safe way to express emotions for some children that maybe have gone through trauma and maybe aren't ready just to sit down and talk about everything they've been through.

Kayla Jones: Exactly, yes. It's a great beginner option. So those are kind of the games and, and activities that you can do in session, but I have some specific what I call coping skills that I like to teach that help really regulating emotions in the moment. So breathing exercises are really, really important because when we're feeling upset or dysregulated, our body starts to go into kind of a fight, flight or freeze feeling where our adrenaline starts pumping, our breath becomes more shallow and more rapid and a lot of other bodily functions are happening as well. But if we can control our breathing, then we can control our heart rate. We can control the blood pumping and we can control our breathing to promote kind of a calmer state in the body. So that's be a little hard to explain, but I'm going to do my best.

Kayla Jones: So the first one is called square breathing and it's counting typically to four when you inhale, hold, exhale and pause. So I like to kind of draw with my finger a square in the air while I'm talking about it. So I moved my finger up during the inhaled counting to four, one, two, three, four, holding, drawing the finger across, and exhale bringing the finger down and then hold and pause, pulling it across. And I'm drawing a square in the air with my finger. And so it's a square painting. You're counting to four each time, inhaling for four, holding for four, exhaling for four and a pausing for four before you do the next breath. So that's a great one because it's, it's promoting kind of control and really needing to slow the inhale and exhale down, which sometimes kids kind of struggle doing

Micah Perkins: So that really rapid, shallow breathing that goes along with stress anxiety to help them learn to slow down and count. And then they have that image of the four in their mind, so I'm sure that that really helps too with the square breathing to help them visualize that.

Kayla Jones: So one thing I like about square breathing is that they can visualize kind of counting to follow their breath, your inhale and exhale down, but can also draw the square themselves so then they're in control of how fast or how slow they go. But really we want to promote slow is better. So then there's another breathing skill that I love called bubble breathing. I actually liked to incorporate bubbles in my office, but some people don't like to do that and some parents don't like bubbles inside so you have to get permission for these things. But what's great about blowing bubbles is that you really have to control your inhale. You don't want to suck in the soap or the bubble juice, right?

Kayla Jones: You have to inhale slow and deep and be really mindful. I'm with smaller kids. Sometimes they just even have trouble making a bubble, in have to tell them to exhale slowly into the circle and see how many bubbles you can have. With older children, or with some a little bit more control, I like to see if they can make the biggest bubble possible. And so with this they really have to blow as low as they can to make the bubble really, really big. So then what's great about this is I often prompt them to smash or pop the bubbles and pretend it's their anger and so they can visualize, kind of let go of their anger bubble with a pop. And kids really, really enjoy that with the bubbles specifically. But there's a way to do bubble breathing if you don't have bubbles as well. And it's just visualizing blowing a bubble and making it as big as you can. Kids love to use their imagination. So this visualization can be really fun to do in session or at home. Another one that I love is called color breathing. I actually have a great example of color breathing that Edmond Counseling and Professional Development Facebook page or at MindfulnessWithJeff.com. It's about a 10 minute video with a little bit of explanation about breathing and then it goes into the actual skill of color breathing. So I invite you to check that out.

Micah Perkins: I also put a link to that in the show notes as well, so people can go directly to that as well.

Kayla Jones: Wonderful. And then the last exercise that I love to do in session is called belly breathing and it's just mainly helping the children and the teens learn to extend their belly to take that really deep diaphragmatic breath and to release . For younger kids there is this great video on youtube of sesame street videos. Just type in sesame street belly breathing. it's a music video with Colbie Caillat and Elmo and it's really fun and really catchy. And so having something novel like that when learning a skill kids really loved to use. And then they often times want to watch the video again and again until they're practicing the skill. Every time that they watched the video, which I think is really great.

Micah Perkins: Yeah, who doesn’t love sesame street?

Kayla Jones: And so that's it for breathing, but there's this other type of skill called progressive muscle relaxation that I love and so I teach, I often times teach children to do what I call lemon squeezes. And so with progressive muscle relaxation, we're focusing on a specific muscle group, creating tension and then releasing the tension to relax. And so with lemon squeezes you specifically picture lemon or some type of citrus fruit. Some kids hate lemon so they choose oranges or whatever, and that's fine. Whichever one they want to use is fine picturing. They have a lemon in their hand, they squeeze, squeeze, squeeze, squeeze, squeeze, and then they release. And what they do is picture squeezing the juice out of the lemon and then they relax and let the lemon go. My rule is, however old you are, is how many times you squeeze the lemon. So if I'm dealing and working with a six year old that I'm going to prompt that six year old to squeeze the lemon six times and release six times, and then that completes the skill. We want them to do repetition to create a habit, but to also really get the ability to kind of relax that muscle group.

Micah Perkins: Progressive Muscle relaxation has been around for a long time, but I love the visualization of squeezing the lemon, having them imagine, that and then also doing however old they are. So that's a great take on that.

Kayla Jones: Yes, and there's a bunch of different ways you can do progressive muscle relaxation around a body. There's different types of skills, but the lemon squeezes is kind of the easiest one to teach and session. They can do it really secretively if they don't want other people to know that they're needing to use a skill in class or at home or in session even. It's just literally just squeezing their fists and then letting go. It's also a great one to use if you're dealing with somebody, a child that typically gets really angry really easily because they're making fists anyways when they're angry and so prompting them to practice lemon squeezes without getting angry helps them learn to not react in their anger. But instead is practicing something proactive

Micah Perkins: Yeah, cause they're already rolling up their fist, but you're teaching them to let that go and relax.

Kayla Jones: Another progressive relaxation skill that I'd actually like to walk you through if that's OK. So do you know who woody and buzz are from toy story?

Micah Perkins: Of course. I’ve seen toy story one, two, three, four, five. I don't know how many are there now, but I love every one of them.

Kayla Jones: So, so this is a progressive muscle relaxation and woody and buzz are great visualizations to use. So how would you describe woody from toy story?

Micah Perkins: Uh, as a toy, floppy.

Kayla Jones He's really floppy, right? He's actually like a cloth toy. He just kind of flops around everywhere. What about buzz, how would you describe buzz?

Micah Perkins: Very stiff, plastic. Y

Kayla Jones: Yes. Stiff, plastic, almost robotic, right? So we're going to use these visualizations, in our progressive muscle relaxation. So I'm going to ask you to just sit and kind of a comfortable position. And when I say buzz, I'd like you to tighten every muscle in your body as best as you can without hurting yourself. OK? I'm going to prompt and I'm going to say woody, and when I say woody, I want you to relax and drop every muscle and every part. So you're gonna, tighten, tighten, squeeze. And then you're going to relax every muscle that you can all at once. So you ready?

Micah Perkins: I'm ready.

Kayla Jones: OK, buzz, tight, tight, tight, tight squeeze, and woody and melt. Great one, because kids love toy story. They can picture buzz and woody that can you pretend to be these characters during this skill. What's so fun is oftentimes they want to relax so hard that they'll melt off the chair. I’ll just let them. It's so fun to watch. And, and tells me that they're really into it. So then they'll remember it later. So, as and you are working on skills something that I want to kind of bring up and with, with children that are often dysregulated, physical touch can be a powerful tool that you can use to help with calming their bodies down. If you are not the caregiver, I highly asked for you to gain permission from their caregiver and from the child to before doing these next couple of skills if you decide to do them in your office or promote that the parent does this in the office or at home with their child.

Kayla Jones: So what's great is you can use physical touch to promote that co regulation piece and the first one that I love to offer and to talk about or bear hugs. It's great when a child is feeling like really upset or even really excited to offer giving a bear hug, it sends signals down into their deep muscles that promote kind of a calming state. And again, with these, with these specific skills, including bear hugs, you want to make sure that you get that permission from the child and from the caregiver before doing. Another great one that I've learned from the trust based relational intervention practitioner training was something called the weather report. The weather report is, it's a relaxation skill that you use touching the back. And so with the child, you have them sit in front of you with their permission and you touch their back a gently and giving them a weather report.

Kayla Jones: So with your fingers or your hand, like it's sunny outside, so you gently rub their shoulders and then you're like with a little bit of clouds and then you'd kind of tapping their back with, with the cups of your hands. And then, oh, it's raining. So then you'd, use your fingertips to sprinkled down, down their back and so forth. Can you kind of picture that in your head?

Micah Perkins: That's fantastic.

Kayla Jones: Yes. And it's great. And what, what's so wonderful is the children love to do it back. So you'd like take turns. And this is not only a calming regulation skill, but also a very nurturing skill. I'm giving you nurture as a gift and you're receiving my nurture, which is great for attachment and bonding.

Micah Perkins: So how about for children who maybe have gone through sexual abuse or something like that? Is there any special caveats to using these techniques?

Kayla Jones: Yes, I cannot express enough that you have to get that permission. And so people need to know that if there is sexual abuse in the past maybe offering the back feels too sensitive, maybe doing it on their forearm or their calf, something that's different. Giving them permission to choose which body part or to even say, no, I don't want to do that. Oftentimes they're willing to do it to you instead. And so if they're not quite ready to be touched, then them giving them the ability to nurture, nurtured to someone else's, a great skill in a great way for them to regulate as well.

Micah Perkins: I know in particular settings, like working in an inpatient setting with children, staff members may be hesitant to give a whole lot of touch to children. And I think, unfortunately maybe staff and therapists might go too far the other way and instead of giving them a good side hug whenever a child is upset, instead they just try to resist touching them at all. And so it is trying to find that middle ground in there and train the staff and the other therapists in finding out what the appropriate level of touch would be for the client

Kayla Jones: If it feels more comfortable to do in a family therapy session or even during the visitation and in those types of environments. Maybe just walking the parent and the child through the activity together and just staying as a third party. And so just kind of being like the announcer, OK, now it's 72 degrees and sunny outside. And so, then if your comfort level, but then you're also teaching the family to use this skill together.

Micah Perkins: Oh, that's a great idea. Yes.

Kayla Jones: And I've done that in session with the parents during a family session. So, some other things, again, kind of going along with that deep muscle input is if you have the opportunity to get a weighted blanket or even a weighted pillow, this gives them the ability to get that comfort and that sensation of that hug without having to utilize touch. So that might be a great option for those children and teens that might be a little bit more sensitive to physical touch

Micah Perkins: You have one of these in your office because I whenever I talk to you I pick it up and hold it all the time.

Kayla Jones: Yes. It's actually really easy to make. I just got some like what they called mermaid sequence and stuffed it with some different weights until it's actually a five pound pillow.

Micah Perkins: When you say different weights, you're talking about like weight lifting weights, i what you mean?

Kayla Jones: No, I actually used glass, like a vase, beads, like beads that you'd put with flowers, wrapped them up in different, Ziploc bags, taped it up to make it kind of a flat surface. Wrapped it with some cotton. Um, some stuffing to go into the pillow.

Micah Perkins: Oh, that's a great idea. And everybody who goes in there and talks to you, pickup picks up that pillow

Kayla Jones: Yes, everybody.

Micah Perkins: Yeah, it's amazing.

Kayla Jones: Another way to promote kind of that the deep muscle relaxation is by using cushions on your chair or your couch. So in the trust based relational intervention practitioner training they called this a sandwich, but you can use any type of metaphor. So I had a kid the other day that I was talking with and he was really dysregulated he had a lot of hyper activity and was really wanting run around. So I asked him if he wanted to make a sandwich and it was so much fun. So I laid down the couch cushions and had him lay on top. I put some pillows on top of his back and then put the top cushion on top of all of that. And so he's getting kind of the weight of the pillows, the weight of the cushions all over his body giving that sensation, kind of a weighted blanket. But we made it a peanut butter and jelly sandwich where the cushions were the brand and the pillows. The pillow was the jelly and he was the peanut butter and so we made that sandwich and it was really fun and inviting

Micah Perkins: That compression feeling that helps him to be able to relax.

Kayla Jones: He relaxed in the moment. You saw kind of the excitement like melt off and he when he got out he goes, can we do that every week? And I said sure, buddy we totally can.

Micah Perkins: Well, I think working in a psychiatric hospital, unfortunately there's kids who may be dysregulated and needing that sense of compressions, confinement, I guess for lack of a better word, and end up getting in therapeutic holds just so that they can get that feeling. This is a better way of being able to get that feeling without necessarily having to get into a hold. So I don't know as far as being able to use a cushion in that particular sense, but like a weighted blanket or something like that. Definitely great idea for kids in that setting.

Kayla Jones: Exactly. And I think it's really important to again meet the kid where they are, meet the child where they are and so if, you know, if you can see that, hey, this worked in the past, then offering it before you're seeing them become super dysregulated,

Micah Perkins: When you start seeing them kind of rev up a little bit. That's the time to intervene.

Kayla Jones: Yeah, exactly. Exactly. So those were some of the skills that I like to use in session and that I learned at other trainings. I've seen some really good reactions or responses to them. But I kind of wanted to talk and touch base a little bit about teens specifically. So all these things, these skills that I've mentioned can be utilized and modified to work with teens, but something that we don't quite see with younger kids is the building of the self talk when it comes to their emotions. So I want to touch base with Dr Linehan's Dialectical Behavioral Therapy for suicidal adolescents. She has a book in chapter seven. She talked about some specific kinds of self talk prompts that you can give to teens when they're dealing with so many emotions, and dysregulation. So I wanted to talk about those.

Kayla Jones: I'm going to read them directly from the book. So the first one was your emotions serve an important purpose. They help you react quickly, to protect you from threat, to bond you with others and to add color and excitement to your life. So it's states here the important purpose of emotions that they're there for a reason and sometimes as teens and even as adults, we don't quite understand why they're there. Another one is emotions must be experienced and acknowledged in order to serve the important survival and humanistic functions for which they were designed. So again, she's kind of addressing that emotions here are really important and they serve a purpose to keep us safe and alive. And again, we don't really acknowledge emotions having such an impact in our survival.

Micah Perkins: Wanting the person to understand that it's OK to have these emotions and that we don't have to just try to push them to the side that it's OK to experience these emotions.

Kayla Jones: Exactly, yes. Another one that she said was, feelings are always right. It is what you do with them and how you react to them that can be hurtful or harmful. So I think this is really a really good one because it's saying that every feeling is OK to have. I'm sad, mad, angry, whatever. It's OK to have it, but it's how we react to them. That can be, that can cause us that this distress and dis regulation.

Micah Perkins: So all feelings are OK and sometimes parents or whoever will inadvertently say don't be sad, don't be mad and inadvertently discount that feeling.

Kayla Jones: Exactly. Yes. And so there's one more that I really, really liked from her list, but she had a list of like 12 of these. The one I love is you are not your emotion. What you feel is only one important aspect of who you are. Your identity is not the same as what you were feeling. Don't you just like that one?

Micah Perkins: Yeah. That's really powerful because how many times do people start to identify with that feeling? Whenever they suffer a lot from depression, and they start thinking that I am just a depressed person.

Kayla Jones: I'm just depressed. That's who I am. Right,

Micah Perkins: Right. There's nothing else to me that's just that.

Kayla Jones: Instead of saying, I am feeling that I'm having a moment of feeling depressed or I'm, I'm experiencing the feeling of joy and sometimes we start to absorb it.

Micah Perkins: Yes. That's really powerful that I am not my depression, but I am a person who experiences depression from time to time or often even but I am not depression itself.

Kayla Jones: Yes, so she, again, she has a list of these in that chapter seven of the book dialectical behavioral therapy for suicidal adolescents Dr Linehan. If anybody wants to kind of check those out specifically,

Micah Perkins: We'll put a link to that one in the show notes as well,

Kayla Jones: Using self talk can be great skill for those who have the ability to engage in self talk and understand them and then those kind of physical skills that we talked about earlier are great ways to really build emotional regulation in children and teens.

Micah Perkins: Fantastic. Well Kayla, thank you so much for sharing those things with us today.

Kayla Jones: Thank you for having me.

Micah Perkins: If someone wants to reach out to you and has questions or wants make contact with you somehow. What's a good way for them to do that?

Kayla Jones: The best way to get ahold of me would be through my email at [email protected]

Micah Perkins: All right, fantastic. Well thanks again for being on the show today.

Kayla Jones: Of course. Thank you again for having me so much. I feel honored.

To earn Continuing Education credit for this episode of CEUcast. Go to CEUcast.com, Episode #1“Emotional Regulation in Children and Teens”, enroll in the course, pay the enrollment fee (if applicable), take the short quiz, and a certificate of completion will be emailed to you. For questions email Micah Perkins at [email protected]

CEUcast 1 Kayla Jones transcript.pdf

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