CONTENT
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1) Welcome, Review of Treatment Map, and Agenda-Setting
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Review goals/homework from previous sessions.
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Topics today: (1) defining mood intolerance + (2) broadening your repertoire of emotion regulation strategies.
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2) Review of Goals/Homework from Previous Sessions (approx. 20 mins)
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Review dieting behavioural experiment
Questions to ask client:
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How did you go with challenging a fear food/situation or dietary rule?
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What happened?
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What did you learn?
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What will you challenge next?
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Review exercise exposure and response prevention task
Questions to ask client:
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How did you go with exposing yourself to the urge to exercise and then resisting that urge to exercise?
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How did your anxiety change over time?
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What thoughts and feelings popped up when completing the task?
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What did you learn?
3) Mood Intolerance (approx. 10 mins)
Questions to ask client:
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What comes to mind when you hear the phrase mood intolerance?
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Mood intolerance - refers to being very sensitive to, or having difficulty tolerating, negative emotional states (e.g., distress + anxiety + sadness).
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Unhelpful MD behaviours are often related to wanting to control our mood and avoid negative emotional states.
Questions to ask client:
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Do you know what the difference between a primary and a secondary emotion is?
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Primary emotion: the original emotion (e.g., feeling upset if a close friend makes a negative comment about your body).
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Secondary emotion: results from our appraisal of the primary emotion (e.g., feeling shame or anger because you were upset that their commented affected you).
All emotions are valid and provide useful information – when we attempt to suppress a negative primary emotion, we often create a cascade of unhelpful secondary emotions which make it difficult to address the root cause of the original problem (e.g., perhaps this friend is not someone I want to hang around with going forward or I should tell them that this comment was inappropriate).
Questions to ask client:
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Can you think of any recent examples where you might have experienced both a primary and secondary emotion? What happened?
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4) Using Exercise/Diet to Regulate Affect
(approx. 15 mins)
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Exercise/diet can be helpful tools to regulate our emotions – they can induce positive mood states and decreasing feelings of stress + anxiety + low mood.
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However, a large number of people with MD become reliant/dependent on exercise/diet to regulate their emotions and lack other helpful strategies.
Questions to ask client:
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Does this resonate with you? What are some downsides of this approach?
Being reliant on exercise/diet to regulate affect has a number of downsides:
(1) can reinforce unhelpful diet/exercise behaviours that maintain MD + (2) does not enable you to learn to regulate emotions using other strategies + (3) makes you vulnerable in situations where you are unable to exercise (e.g., due to health issues + injuries + accidents).
Questions to ask client:
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What are some other strategies that you could use to regulate their emotions? What have you used in the past?
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Possible strategies to induce positive mood states → have meaningful relationships + engage in other activities that provide satisfaction.
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Possible strategies to cope with negative mood states → acceptance + cognitive reappraisal + breathing + meditation + distraction + speaking to a friend/counsellor + soothing activities.
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5) Developing Alternate Emotion Regulation Strategies (approx. 15 mins)
Content
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There are a number of strategies we can use to cope with negative emotional states.
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Think of a recent example where you experienced a negative emotional state, and it reinforced your desire to exercise and/or diet harder or led you to respond in a way you are not proud of (e.g., getting angry at someone). Let’s use this example as we think about some ways you could have coped better with that situation.
(1) Reduce vulnerability to events that trigger negative emotional states (e.g., being sleep deprived + hanging around toxic people).
(2) Be more accepting of negative emotions in the moment – emotions are a part of life and there is often a good/understandable reason we experience them.
(3) Engage in cognitive reappraisal of the event.
(4) Replace the unhelpful coping behaviour with another more helpful behaviour (e.g., going for a walk + calling a friend + having a shower).
Example
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Use the following sequence as a template to map out a difference sequence of events in hindsight using the above strategies:
(1) Occurrence of triggering event – get feedback from a boss (work) or tutor (school) that a piece of work you submitted needs substantial changes.
(2) Cognitive appraisal of event – “I already spent so much time working on this” + “This person has no idea and is an idiot” + “Why do I even bother?”
(3) Primary emotions – frustration + disappointment + some anger.
(4) Cognitive appraisal of the mood change – “Why do I always let this stuff affect me so much?” + “What did I expect when I didn’t even put in that much effort?” + “I have no control over anything except my body”.
(5) Secondary emotions – high anger + shame.
(6) Unhelpful coping behaviour – send aggressive email to boss/tutor + stop putting in effort at work/study for a week + resort to spending more time exercising and dieting harder to regulate mood and boost sense of self-efficacy.
Reflection
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Questions to ask client:
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What could you have done differently in hindsight?
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What would have reduced your vulnerability to being susceptible to this negative mood state?
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What strategies could you use in future to cope with this negative mood state if it occurs again?
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What would be some more helpful behaviours to resolve this situation?
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6) Setting Goals/Homework
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Complete another 2-3 example sequences (based on activity 1) over the next week (either past examples or ideally examples that occur in real-time during the next week).
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Carry out second exposure and response prevention task related to exercise.