My education and experience of emotional dysregulation

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By Helen Kehoe  @Helsbels88
Joint Appointment lecturer in Mental Health and Practice Development lead, My Care Academy.

This blog intends to give a brief introduction of emotional dysregulation and to share my experience of my own learning and the positive effects of relevant training and experience. I hope that this small piece will interest anyone in a clinical setting who is interested in improving their practice whilst caring for a person with a personality disorder.

What is emotional dysregulation?

Emotional dysregulation is the inability of a person to control or regulate their emotional responses. Most people are exposed to stressful life events or moments such as relationship conflicts or personal criticism. A person with emotional dysregulation reacts in a very emotionally exaggerated manner to these challenges by possibly having outbursts of anger or upset. Many people with Borderline Personality Disorder (BPD) experience these difficulties. Types of psychotherapy which have been particularly helpful for people with BPD include cognitive behavioural therapy and dialectical behavioural therapy.

My learning 

My first experience of nursing patients with emotional dysregulation was when I began working in a CAMHS (Child and Adolescent Mental Health) ward within BEHMHT. I began working as a registered mental health nurse, an RMN, in an inpatient setting three years ago. I was part of an intervention team to help improve care and management, previously  I had had no experience of nursing adolescents but due to the fast pace of the ward and the knowledge shared by the experts around me –  I soon settled in and learned a vast amount daily.

As part of the project to improve the care for patients, managers (nursing and medical) worked together to improve education and training for all ward staff.  Due to the increasing number of young people having difficulties regulating their emotions we wanted to take the first steps towards having the start of a Dialectoral Behavioural Therapy service. It was important that additional training wasn’t just given to one or two staff but for all nursing and healthcare assistant staff so that the care provided was consistent.

The Dialectoral Behavioural Therapy (DBT) training was run by an independent external training provider for 3 days. The training course covered several key and very beneficial areas such as:

  • validation
  • metaphors
  • relentless problem solving
  • contingency management
  • emotional regulation exercise
  • mindfulness
  • distress tolerance

The training definitely had a positive effect on the ward and we were all about to start using it in practice. The environment was far more containing and validating thus a far more therapeutic and caring ward.  When staff had to respond to very severe behaviour they were able to do so in a caring way without reinforcing the severe behaviour.

We introduced mindfulness to many different tasks and activities so this became a natural way of thinking for both the service users and staff. For example, in the early evenings we noticed that it seemed to be a particularly difficult time for our patients, due to it being a time for visitors and approaching bedtime; so we introduced mindfulness sessions incorporating art, music or film. This was particularly useful when helping others tolerate distress so that situations did not spiral out of control.

I believe that the training myself and colleagues had was invaluable especially as there’s I’ve encountered stigma and misconception of Borderline Personality Disorder along my career journey.  On the CAMHS ward, we had the knowledge and tools to see things differently, not just about our care but it’s about the individual we are caring for.

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