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.