Adolescent Affect Regulation Revisited
Charles Bonner, Ph.D
Clinical Psychologist
Private Practice
Pittsburgh. PA
Interpersonal Neurobiology: 3 Principles
1.
The growth of the brain occurs in
critical periods and is experience
dependent
2. Affect Regulation is a fundamental
by-product of how a secure attachment
benefits neurological development
3. Effective psychotherapy transforms
neurobiology through the mirror neuron
system and other mechanisms of neural
plasticity
The growth of the brain occurs in critical
periods & is experience dependent (1)
“From
late pregnancy through the
second year the brain is in a critical
period of accelerated growth, a process
that consumes higher amounts of
energy than any other stage in the life
span ….” (Schore. A)
At birth, the neocortex is quite
underdeveloped and is yet to be shaped
through genetics and experience.
The growth of the brain occurs in critical
periods & is experience dependent (2)
“In
infants, the right hemisphere
dominates growth during the first 3
years of life…. [affecting] non-verbal
aspects of language (e.g. tone of voice,
gestures), facial expression of affect,
the perception of emotion, the
regulation of the autonomic nervous
system, the registration of the state of
the body, and social cognition…”
(Spiegel, D.)
Affect Regulation is a fundamental
by-product of how a secure attachment
benefits neurological development (1)
In
the child’s first three years, affect
regulation is particularly influenced by
the brain’s right hemisphere, whose
maturation is dependent upon daily
interactions with affectively attuned
caregivers.
The infant’s attachment experience &
emergent affect regulation capacities
are dramatically intertwined.
Affect Regulation is a fundamental
by-product of how a secure attachment
benefits neurological development (2)
“….
in infancy and beyond, the
regulation of affect is a central
organizing principle of human
development and motivation.”
(Schore, A.)
“Emotion is inherently integrative; it links
subcomponents together in a functional
whole” (Siegel, D.)
Effective psychotherapy transforms
neurobiology due to neuroplasticity

“Psychotherapy which works is
using an interpersonal relationship
to change self-regulatory circuits of
the brain…”, particularly due to
neural plasticity, which is defined as
“…the change in neural connectivity
induced by experience…” (Siegel, D.)
The Mirror Neuron System
and Psychotherapy (1)
Discovered in early 1990’s primate
research, a mirror neuron fires both
during the performance of an action and
in the observation of the identical action
Mirror neurons seem to account for the
remarkable ability of children to learn
relatively complex activities simply by
observing another person perform them.

The Mirror Neuron System
and Psychotherapy (2)
Mirror
neurons help account for the
powerful intersubjective bonds between
the brains of caregivers & their children,
wherein a specific affect in one party
directly evokes the same affect in the
other simply through it being observed
(such as through facial expression).
Affect is contagious, both positive and
negative (Neural WiFi: Goleman, 2006).
The Mirror Neuron System
and Psychotherapy (3)
Same
dynamic applies between
therapist & patient, and has been
referred to as “empathic resonance”.
“Being empathic with patients may be
more than just something that helps
them ‘feel better’; it may create a new
state of neural activation with a
coherence in the moment that improves
the capacity for self-regulation” (Siegel)
Implications of Interpersonal
Neurobiology for Psychotherapy (1)
Problems
with emotion regulation are at
the core of most psychopathology
We must employ therapeutic methods
that tap into limbic system structures
that overwhelm the cognitive capacities
of the neocortex.
How can we refine psychotherapeutic
interventions to reflect the lessons of
interpersonal neurobiology?
Implications of Interpersonal
Neurobiology for Psychotherapy (2)
The limbic system’s amygdala
plays a substantial role in fearconditioned learning, and 6 times more
neuronal connections run from the
amygdala to the neocortex than the
converse.
How do we as therapists help our teen
patients overcome this neocortical
disadvantage & improve affect
management skills?
E.G.--
Affect Management Skills Training (AMST)
John Omaha, Ph.D. (1)
Rather
than attempting to change
emotions by changing behavior or
cognitions, AMST seeks to regulate
emotions more directly, by employing
the same modalities the system uses in
development: images, memories,
sensations, and affects.
A departure from the basic theoretical &
psychotherapeutic tenets of C.B.T.,
where cognition assumes supremacy.
Affect Management Skills Training (AMST)
John Omaha, Ph.D. (2)
Images
are theorized to more directly
access the neurological pathways along
which affect is generated—particularly
the limbic system.
A.M.S.T. is particularly well suited for
those teens whose problems with affect
regulation appear to complicated by a
trauma history (trauma coded affects).
The Distinction Between
Affects and Emotions (1)
“Affect is biology, emotion is biography”
(Nathanson)
 The nine hard-wired affects (Omaha):
1) anxiety, 2) sadness, 3) anger,
4) shame, 5) disgust, 6) surprise-startle,
7) yearning, 8) interest-excitement,
9) enjoyment-joy (see Worksheet #1,
A.M.S.T.-Teen Sample Tracking Sheet)

The Distinction Between
Affects and Emotions (2)
Hard-wired
affects can combine with
each other, with cognitions, with
appraisals, with memories, and with
images to produce a range of emotions,
each with a unique set of sensations
that identify it (Omaha, J.)
Consistent with this terminology, the
ultimate goal of the AMST protocol is
affect regulation rather than emotion
regulation, although in practice this
distinction need not be explicitly stated.
Primary vs. Secondary Emotions (1)



Primary emotions: the most immediate
reaction to an event contains adaptive
motivational info. re: event's meaning.
Primary emotions are the bearers of
what is valid or undistorted in the
person's reaction.
Secondary emotions: reactions to or
against primary emotions; often
include distorted cognitive appraisals.
Primary vs. Secondary Emotions (2)
Secondary
emotions inhibit or block
the experience and expression of
primary emotions.
Secondary emotions often motivate
behaviors that have destructive
consequences
All emotions may function as either
primary or secondary emotions, or
even as both at once-- eg fear of fear
The Shame-Rage Spiral in Teens
Anger
is often a secondary emotion
displacing a primary emotion (shame)
that has not been acknowledged
Adolescence is a minefield for shame
and its variants, which range from mild
embarrassment to mortified humiliation.
The shame-rage spiral operates
intrapersonally and interpersonally,
often at the same time.
The Vitality Affects: Yearning-Longing,
Enjoyment-Joy, & Interest-Excitement (1)
Yearning
or longing for nurture from
caregivers often underlies the more
common presenting affects of anger
and sadness (i.e. yearning is often the
primary affect; also affects addictions).
In psychotherapy, teens will usually not
become aware of their yearning affect
until their secondary sadness or anger
has been recognized & regulated.
The Vitality Affects: Yearning-Longing,
Enjoyment-Joy, & Interest-Excitement (2)
Enjoyment-joy
is the affect that is
elicited when our yearning for
connection is rewarded.
Joyfulness between infant & caregiver
provides some of the essential
experiences required to optimize the
neurological developments upon which
the affect regulation system is built.
Interest-excitement: The foundation of
motivation (at deficit in depression)
Disgust: How Biology
Becomes Biography (1)
The disgust response to taste, texture,
and smell is:
1)Virtually instantaneous (mediated by
the brain stem)
2) Not mediated by cognitive appraisals
(minimal initial neocortical activation).
3) Often involves activation of various
parts of the digestive tract, from the
stomach up through the esophagus,
mouth, tongue, and salivary glands.
Disgust: How Biology
Becomes Biography (2)
What
happens when the disgust affect
is transferred to the interpersonal
domain & people express disgust with
one another or toward specific groups?
The phrase “broadcast disgust”
describes the caregiver’s expression of
disgust toward a child-- conveyed via
words, tone, and facial expression.
Disgust + Anger = Hatred; Self-Hatred
Eating disorders include disgust affect
Surprise-Startle: Clinical Consequences
of a Trauma Coded Affect (1)
Surprise-Startle affect: Infants’ startle
reflexes the earliest example.
 An affect that is “trauma coded” has
been experienced repeatedly in adverse
circumstances & becomes
neurologically encoded in ways that
increase its likelihood of later being
triggered by situations or relationships
that may bear only a superficial
similarity to the original traumatic reality.

Surprise-Startle: Clinical Consequences
of a Trauma Coded Affect (2)
Surprise-startle
has a greater chance of
becoming “trauma-coded” when the
person has low threshold for this affect
(hard-wired affects have genetically
determined thresholds for being
evoked– differences in temperament).
The mind-blanking effect of startle affect
may be the basis of the dissociative
defenses (numbing, spacing out,
exaggerated startle response in PTSD).
Emotion Recognition, Tolerance, and
Regulation: The 3 Goals of A.M.S.T.-Teen
The
A.M.S.T. skills capture the main
skills emphasized in D.B.T. (Dialectical
Behavior Therapy): emotion recognition,
distress tolerance, mindfulness, and
emotion regulation
“The purpose of these skills is to
intervene in both the fast processing in
the limbic system & the activation of the
autonomic nervous system” (Omaha, J.)
The Neurobiology of A.M.S.T.-Teen: A
Detour from Taking the “Low Road”
Fast
processing has also been called
taking the “low road”, which is “the
direct pathway from perceptual receptor
through the thalamus to the amygdala.
The thalamic pathway is fast because it
is direct” (Omaha)
A.M.S.T. skills seek to establish a
parallel path that serves as a detour
from the “low road” of rapid affect
dysregulation
(1) The Positive Cognition (PC) &
The “Validity of Cognition Scale” (VoC)
The
Positive Cognition (PC) is an
affirmation developed at the end of each
AMST skill– e.g. “I’m learning how to
decrease my angry feelings”
Purpose of the PC is to link adaptive
cognitions with images, sensations, &
affects to build self structure (to connect
the neurological low and high roads).
(2) The Positive Cognition (PC) &
The “Validity of Cognition Scale” (VoC)
The
“Validity of Cognition Scale” (VoC)
assesses the truth of a specific PC,
using a 1-7 scale where “1” is
completely false and “7” is completely
true.
The VoC helps assess the teen’s
progress in learning AMST skills &
guide the therapist’s decisions about
which step to follow next in the protocol.
AMST-Teen: Seven Essential Steps (1-3)
1.
The Container: Separating from
and Storing Past Upsetting Stuff
(especially traumatic memories)
2.
The Safe Place: Developing an
Image & Sensations of Safety
3.
Sensation-Affect Identification:
Emotion Recognition Skill (especially
for the nine hard-wired affects)
AMST-Teen: Seven Essential Steps (4-7)
4.
Sensation as Signal for the
Grounding Image: Distress
Tolerance Skill
5. Just Notice: Mindfulness
of the Present Emotion
6. Disposal/Releasing Imagery:
Emotion Regulation
7. Increasing Positive Affects:
The Gauge Resource
A.M.S.T.-TEEN: SUMMARY OF IMAGES &
STEPS FOR MANAGING EMOTIONS
My Container is: _______________________
My Safe Place is:_______________________
To Teen: When you feel the first sign of a strong
emotion, usually a physical sensation, immediately
follow these 3 steps:
1. Connect with your Grounding Image
2. Just Notice (observe & list the physical sensations,
thoughts, action urges, images, and memories that
are part of the emotion)
3. Dispose and/or Release Excess Emotion (through
your disposal or releasing image)
Repeat these 3 steps as many times as you need
to decrease the emotion and help yourself make
good choices about what to do next!