by Sarah Hunter, LCSW

This article is part of a series that will help readers understand the purpose of twelve basic human emotions: guilt/shame, pride, compassion, gratitude, disgust, joy, fear, curiosity, anger, love, sadness, and connection.

Understanding Guilt

Human beings come wired to experience the emotion of guilt. It is appropriate to feel guilty when we cause harm to someone or something. This uncomfortable feeling is the body’s way of saying “I did something bad.” Appropriate guilt motivates repair. It creates the thought “I need to make this right.” When felt fully, guilt is also a deterrent for causing future harm. The emotion is uncomfortable and just like pain prevents people from touching a hot stove more than once, guilt makes people want to stop doing the behavior that caused it.

Pause for a moment to imagine a world where humans feel no guilt over wrong doing. Most people would not want to live in such a world because they can see that a guilt-free world is a world where people harm each other and destroy things and show no remorse for their actions. Guilt is an essential emotion that is meant to be felt, acted on and then released. At its core, it is a functional emotion.

Guilt vs. Shame

Yet, when guilt is not understood or when it is misdirected, it can become problematic. Guilt that grows too big turns into shame. Dr. Brené Brown has spent decades researching shame and its consequences. A thorough discussion on shame is beyond the scope of this article. For further reading on the topic, try any of her published books. Her first book, I Thought It Was Just Me (but it isn’t): Telling the Truth About Perfectionism, Inadequacy, and Power (Penguin/Gotham, 2007) is a good choice for women wanting to understand more about shame.  Her second book, The Gifts of Imperfection: Letting Go of Who We Think We Should Be and Embracing Who We Are (Hazelden, 2010) is a short read that gives a good overview on shame and how to combat it in order to live wholeheartedly.

For the sake of simplicity, shame can be defined as what happens when the belief switches from “I did something bad” (guilt) to “I am bad” (shame). Rather than motivate repair, the voice of shame motivates people to hide from others and isolate. Shame takes away hope of repair and improvement. It leads to feelings of being unworthy and unlovable. This makes it difficult to keep enough motivation to keep striving.

When shame rears its ugly head, the most helpful thing to do is to recognize it for what it is with a thought like “I’m in shame” ride the wave of emotions that sweep over you and then reach out to a trusted friend or relative and tell the story of what happened. This is an example using a skill called opposite action. Shame says “hide, stay in the dark, you’re not worthy of love.” Rather than giving in and obeying the voice of shame, doing the opposite action of reaching out to someone who cares about you will help you move through shame and back into connection.

Inappropriate Guilt

Another potential downfall when learning to allow guilt to become a healthy part of your emotional experience is the existence of inappropriate guilt. Inappropriate guilt is when a person feels bad about something that is not his fault. This is a common problem; children are especially prone to responsibility for things that were beyond their control. One example is a child feeling guilty for her parent’s divorce. The child may be under the false impression that if she would have not picked so many fights with her brother her parents would still be together.

Another example of inappropriate guilt is when an adult feels guilty for having cancer. Self-talk in this situation may sound like “This is my fault. I should have eaten more salads and exercised more.” Inappropriate guilt is not helpful because it leaves the person experiencing the guilt unable to correct the perceived wrong. For example, the child cannot make her parents get back together. The man with cancer cannot cure himself. In these instances, the appropriate emotional response is self-compassion which will be discussed in a future post.

Practicing Appropriate Guilt

There are many ways to help yourself or your child learn to let appropriate guilt do its job. Here are a few suggestions:

Identify the behavior. Get clear about what you did that was wrong. Journaling about the situation may help with this. Come from a place of seeing yourself as a good person who acted outside of your values rather than as a bad person (shame) who can never change. It can actually be empowering to admit “I was not my best self in that moment.”

Offer a sincere apology. A sincere apology can go a long way toward correcting a problem. Sincere apologies are not done in anger or resentment. They do not contain “buts.” For example, stay away from saying things like “I’m sorry I yelled at you, but you make me so mad I can’t control my temper.” Acknowledging that what you did was wrong regardless of the circumstance is important. Sometimes simply stating “I shouldn’t have done that” helps with this.

Practice empathy. If it’s difficult for you to be sincere in your apologies, try putting yourself in the other person’s shoes. Can you see how what you said affected her? Can you see why he was upset with what you did? Taking the time to see the situation from another person’s viewpoint will reduce defensiveness.

Take appropriate action. Rather than becoming stuck by ruminating on what you did wrong or what you wish would have happened, ask yourself “What can I do about it now?” Take whatever corrective action you can. Sometimes you do not know how to make it right. Sometimes asking the person you hurt “What can I do to make it right?” will give you a forward direction.  Do the things that are within your power to correct the problem.

Let it go. Once you have examined your behavior, identified what you did that was wrong, taken accountability for it and done what you could to repair, guilt has done its job and its time to let it go. Holding on to guilt for long periods of time in the spirit of wanting to punish yourself enough that you will never make another mistake will actually make it harder for you to feel appropriate guilt. You want your internal system to know that you can recover from mistakes and that making a mistake does not mean you have to punish yourself excessively for long periods of time. When your system can trust that guilt is a safe emotion to feel, you will increase your ability to acknowledge wrong doing.

Once you understand the purpose of guilt and you have had some successes in letting it do its job, it’s time to help your children do the same. Adults need to help children navigate guilt by focusing on the behavior that was wrong rather than focusing on defining a child’s character. Telling a child “It’s not ok to hit” is more helpful than saying “You are so mean.”

Remember, children will learn to handle guilt not just from what you say, but also (more importantly) by watching what you do when you feel guilty. Set a good example by admitting when you do something wrong, taking appropriate action to correct the problem, then letting the guilty feeling go.

by Sarah Hunter, LCSW

A significant portion of the work of a therapist involves helping clients understand emotion. Human beings initially learn about emotion from experiences in their first family. Most of these lessons are not explicitly taught but were learned implicitly through observing parents or siblings navigating their emotional experiences.

People who grow up in families that model healthy ways of coping with emotion tend to develop healthy ways of coping as adults. People who grow up in families who demonstrated maladaptive ways of responding to emotion often struggle with emotion as adults. They find themselves responding to emotion in ways that make it difficult to function at an optimal level. These unhelpful responses tend to land on the more extreme ends of a spectrum where avoidance of emotion is on one end and becoming completely swept away by emotion is on the other end.

Because of this, many people struggle to find the sweet spot in the middle where one can be present with emotion, allowing herself to feel it fully without becoming fused to the emotion letting it take over and overwhelm the system.

When emotions are not understood, they can feel scary and complex. When people lack the skills to navigate the inner experience of emotion, they come to see certain feelings as bad. In fact, some people come to therapy so they can get rid of the “bad” feelings they are experiencing. They want the pain and distress to stop. They have tried everything they know how to do including using avoidance and numbing to escape upsetting thoughts and feelings. But, instead of helping, these strategies cause more problems.

People who numb find themselves unable to experience life as fulling and joyful. They often get stuck engaging in problematic behaviors such as over eating, spending hours scrolling online, shopping for things they don’t need and can’t afford, spending extra hours at the office, and the list goes on.

People who avoid find themselves structuring their lives around avoiding all things unpleasant. When this happens, their world quickly gets small and it can become difficult to do meaningful things because fear gets in the way.

Research has shown that these ways of dealing with emotion are problematic because avoidance behaviors maintain and enhance anxiety and numbing can never be selective. When you choose to numb difficult emotions you also chose to numb the emotions that are the most fulfilling such as love and joy.

If you are one who struggles with experiencing emotion, or you have a child who struggles, consider learning all you can about emotions. Here are a few suggestions you can try for yourself or practice with a child who is struggling.

1. Practice naming feelings. If naming feelings is hard, try using a list of emotions (I like emotion wheels which can be found online) and choose what fits. Remember, it is common to feel more that one feeling at a time so continue to look for words to describe what you’re feeling until it feels like you’ve fully captured the emotional experience.
2. Practice noticing the felt body sensation of different emotions. After you name a feeling you are experiencing, ask yourself “Where am I feeling this in my body?” See if you can locate areas of the body where the emotion is most intense. See if you can find words to describe the sensation. Words like light, heavy, hot, cold, knots, butterflies, tight, loose, tingling, open, caged are some of the ways people describe sensations.
3. Practice noticing thoughts that are connected with emotion. Ask yourself “What is going through my head right now?” You may find one thought that is on repeat running through your head over and over again. You may find thoughts racing through you mind so quickly that it is hard to slow them down enough to notice them. You may notice yourself having thoughts about your thoughts. Don’t worry about doing anything with the thoughts, simply notice that they are there.
4. To tie it all together, practice approaching experiences with a curious observer attitude. Use phrases like “I’m feeling ________.” “I’m noticing a sensation in my ________that feels _______.” “I’m having the thought that ________.”

If you practice navigating emotions in this way, you will notice that emotions become less frightening, mysterious and overwhelming. This is an important step forward in improving your emotional literacy which will help you create a more rich and meaningful life.

by Sarah Hunter, LCSW

Introduction

All parents and caregivers have had the frustrating experience of witnessing a childhood meltdown. When meltdowns happen, many parents and caregivers experience a feeling of helplessness and they are left wondering if what they are doing is helping or making things worse. Having a basic understanding of how meltdowns work in a child’s developing brain can help parents increase feelings of competency and improve their ability to help their child learn to regulate emotion.

Left Brain, Right Brain

Most people are familiar with the terms left-brain and right-brain. They have some understanding of the right brain as being the emotional, creative part of the brain and the left brain as being the logical, reasoning part.

One of the goals of parenting is to help children learn to use both sides of their brain in daily life. Children need to be able to use information from their sensing, feeling, creative brain centers. Children also need to be able to use logic, reasoning and story-telling to make sense of their world. Both right and left-brain functions are needed for optimal functioning.

Brain integration does not stop with left and right. As their brains develop, children also need opportunities to help their brain integrate from top to bottom. To explain this concept to parents, in their book called The Whole-Brain Child, neuropsychiatrist Daniel Siegel and parenting expert Tina Payne Bryson introduce the terms “upstairs” and “downstairs” brain.

Upstairs Brain, Downstairs Brain

The upstairs part of the brain (cerebral cortex) is undeveloped at birth and is under construction for the first twenty plus years of life. It is responsible for thinking, planning and imagining. It can predict consequences and it allows humans to guide behaviors based on desired future outcomes.

The downstairs part of the brain (brain stem and limbic region) is more primitive and almost fully developed from birth. The downstairs brain controls basic functions like breathing and blinking. It is responsible for our fight or flight response. It is also the place where strong emotions like anger originate.

So how does this information help parents navigate melt downs?

First, parents can learn to tell the difference between upstairs and downstairs meltdowns.

Upstairs meltdowns

An upstairs meltdown is what most people think of when they think of a childhood temper tantrum. The upstairs melt down is a strategic attempt for the brain to get something it wants.

Picture a young child at the grocery store who sees a fun looking toy or a favorite treat. They may ask for the toy or grab for the treat and their parent or caregiver tells them no. Their brain does not like this answer and so they start to use behaviors to get what they want.

At first, the behaviors may look like polite asking, begging or pleading. If the answer remains no, it may turn to yelling, crying, thrashing about or any number of intense behaviors designed to change their parent or caregiver’s mind. One of the tell-tale signs of an upstairs meltdown is that the parent or caregiver has the sense that if they give the child exactly what she wants the meltdown will stop because the objective has been achieved.

The main thing parent and caregivers need to remember when dealing with upstairs meltdowns is to not reward the behavior. In the words of Siegel and Bryson “never negotiate with a terrorist.” If a child escalates behaviors and parents or caregivers respond by giving them what they want, they are teaching the child that throwing a tantrum is an effective way to get their needs met. This prevents children from learning to use appropriate behaviors (for example polite requests) to get what they want. It also prevents them from learning how to handle disappointment.

Instead, a parent can quickly and firmly set boundaries and enforce the limits they are setting. An example of this would be stating “I know you want that candy bar but this is not the way to get what you want. If you don’t stop now, our trip to the store is over.” After a boundary is set, parents and caregivers need to make sure they follow through with what they have said will happen. Over time, this consistency will teach the child that tantrums are not an effective way to get their wants and needs met.

Downstairs Meltdown

A downstairs meltdown is different from an upstairs meltdown. When a downstairs meltdown occurs, the upstairs part of the brain that is responsible for thinking, reasoning and regulating behavior is offline. The child feels out of control and no matter what rewards the parent or caregiver offers or what consequences the parent or caregiver threatens, the meltdown continues.

Rather than viewing this as an act of defiance, parents and caregivers can think of this as a child’s version of a panic attack. The child is overwhelmed by emotion and is unable to calm herself down. In fact, many children with anxiety or sensory processing issues experience frequent, intense downstairs meltdowns. These are often mistaken for behavioral problems or opposition when in fact they are anxiety driven.

When a child is experiencing a downstairs meltdown, the best thing a parent or caregiver can do is to regulate themselves, connect with their child and help him calm down.

Parent Regulation

Sometimes melt downs are so intense and even scary for parents or caregivers to witness, they become dysregulated themselves. This can be highly distressing to a child who is already feeling out of control. In order to regulate themselves, parents can tell themselves things like “It will be over soon.” “I can handle this.”

Sometimes just knowing what is going on and recognizing that this type of meltdown is a normal part of childhood and is an opportunity to help a child’s brain development is enough to help parents and caregivers regulate themselves enough to be helpful to their child.

However, if none of these strategies are working, it is usually better for a parent or caregiver to put themselves in “time out” and give themselves time to regulate before interacting with their child.

Child Regulation

Once regulated, a parent or caregiver can connect with the emotion the child is expressing and help her calm down. Each child is unique, and parents and caregivers can experiment with what works best for their child.

Generally speaking, giving a name to the emotion the child is feeling, speaking in a calm, nurturing voice and using soothing touch will be most effective. For example, (using a soothing voice, and/or loving touch) “You look very angry now. I’m right here with you. We can talk about this as soon as you are ready.”

At this point, trying to give consequences will not be effective because the child does not have access to the part of his brain that can use that information. Once the child is regulated enough that he is receptive to taking in information, it is appropriate to talk about behavior expectations. For example, “Did you not like it when I put mustard on your sandwich? I understand you didn’t like that, but it’s not ok to hit when you’re mad. Use your words and tell me ‘I don’t like mustard.’”

Depending on how intense the melt downs are, this type of conversation may need to happen hours after the melt down or even the next day.

Remember it is not only toddlers that have downstairs meltdowns—older children, teenagers and even adults can lose access to the thinking part of the brain when they are overwhelmed with intense emotion.

If your child’s meltdowns become dangerous, seem excessive or are more intense than others his or her age, you may consider bringing them to be evaluated by a therapist or other medical provider.

Information for this article was taken from: The Whole-Brain Child by Daniel J. Siege and Tina Payne Bryson, 2011, New York.

“Discomfort is a wise teacher” —Caroline Myss

“And sometimes you meet yourself back where you started, but stronger” —Yrsa Daley-Ward

I just got back from Oconomowoc Wisconsin where I was able to attend the International Obsessive Compulsive Disorder Foundation (IOCDF) Pediatric Behavior Therapy Training Institute (BTTI). The IOCDF’s Pediatric BTTI is an intensive three-day training course providing in-depth education on the diagnosis and treatment of OCD in children and adolescents. I was able to learn the best evidenced based practices from leaders in the field, such as Eric Storch PHD, Aureen Pinto Wagner PHD, Stephani Eken MD, FAAP, and Martin Franklin PHD. and bring back the information to all our therapists here at the Child and Adolescent Treatment Specialists (CHATS).

Some of the topics included in the training were: 1. Cognitive Behavioral Treatment of Pediatric OCD, 2.Cultivating Readiness: Dismantling reluctance in Pediatric OCD, 3. Psychopharmacology in OCD, 4. Trichotillomania and Tourette Syndrome, 5. Pediatric Body Dysmorphic Disorder, 6. Comorbidity in Pediatric OCD.

I was able to bring the most recent research and training regarding pediatric anxiety and OCD back to all our therapists here at the Child and Adolescent Treatment Specialists (CHATS).We are strongly committed to providing good and effective treatment to children and adolescents who come to our clinic.

One in 200 children in the United States suffer from OCD. That is nearly half a million children. However, many children with OCD go undiagnosed and/or receive ineffective treatment. It is thought that 80 percent of adults with OCD actually began having it in childhood.

Please see the following helpful videos:

International OCD Foundation-What is OCD?
Anxiety and OCD Quick Guide 14: What’s Normal, What’s OCD?
What’s normal, what’s OCD?
Anxiety and OCD Quick Guide 16: What makes OCD Worse?

Not all children and/or adolescents with OCD will need medication. If medication is recommended it will usually be an SSRI that is prescribed through a medical doctor. For information on how medications are used in pediatric OCD please see the American Academy of Child and Adolescent Psychiatry links (AACAP).

Obsessive Compulsive Disorder Resource Center
Psychiatric Medication For Children And Adolescents Part I – How Medications Are Used
Psychiatric Medication For Children And Adolescents: Part II – Types Of Medications

According to Eric Storch PHD, “If you don’t do anything it (OCD) won’t get better”.

Dr. Storch espouses that Cognitive Behavioral Therapy (CBT) including exposure based treatments are necessary to address symptoms of OCD. Treatment consists of Psycho-education, Exposure Response Prevention (ERP) (going toward fears in a slow step-wise fashion), Developmentally appropriate Cognitive Therapy, Family Therapy, Contingency Management (rewards, etc.), and Relapse prevention.

Eric Storch, PHD, discussed that 53 % of kids with OCD also have difficulties with “rage attacks” when parents tried to set limits around OCD triggers. He suggested that the rage is important to address in the treatment of OCD. Family involvement is key in this effort. OCD effects the family and is a family issue.

A treatment professional can help establish what Dr. Storch calls the “parents’ as therapists’ model”. This model involves parents in the therapy sessions (where appropriate) and helps parents and children learn skills to address the OCD. Parents learn about anxiety and OCD, learn how to address accommodation that may be intensifying OCD, and how to help their children practice skills between treatment sessions. The therapist takes the lead role and then eventually transfers that role to the parent(s).

As part of the pediatric OCD training, Dr. Storch told a story about his own young daughter. One day she asked her dad why he was gone so much. To this he replied that he was both helping other professionals learn how to help kids with worries and OCD and also helping children with anxiety and OCD. His daughter replied, “Don’t you just face your fears and do it over and over and over again.” Storch stated, his young daughter summarized his whole career in this one statement. OCD treatment and recovery focuses on a “general approach to life in which you face your fears no matter what”. Skills are taught and utilized in treatment to help children and adolescents be able to utilize this general approach.

Avoidance tends to be at the core of many difficulties with anxiety. Avoidance increases anxiety. With anxiety we see children and adolescents avoiding the things they are fearful of. These may include germs, new foods, movies or TV, class and school, etc. Exposure to fears and/or disgust, rather than avoidance, and response prevention can be done with creativity, engagement and fun by a therapist trained in CBT (cognitive behavior therapy) and ERP (exposure response prevention).  As a learning vehicle, exposure and response prevention (preventing the typically feared response) generally teaches that:

(1). Feared thing doesn’t happen. Or

(2). It does happen but it is not so bad.  And

(3). I can cope if given the chance. And

(4). Practice is helpful.

There are many other skills children/adolescents and parents learn over the course of cognitive behavioral treatment and treatment for anxiety and OCD. Dr. Storch emphasized that treatment can change brain functioning over time, especially in children and teens. Pediatric OCD is a treatable condition in which children and families can receive support and treatment.

Over my 25 year career I have had the privilege of treating many individuals with anxiety and OCD. In addition to being so grateful to learn about evidenced based practices for anxiety and OCD, I am also grateful for what I have learned from each person who bravely came into therapy and worked together with me towards healthy change.

For more information on pediatric OCD and/or OCD please see IOCDF.org.

Also see:

Understanding OCD: A guide for parents and professionals, Edited by Adam B. Lewin and Eric A. Storch

Up and Down the Worry Hill: A children’s book about Obsessive-Compulsive Disorder and its Treatment by Aureen Pinto Wagner, PHD

What to do when your Child has Obsessive-Compulsive Disorder: Strategies and Solutions by Aureen Pinto Wagner, PHD

(The information in this blog should not be used as a replacement for guidance, consultation, assessment or treatment by a qualified healthcare professional).