Emotion Regulation

Definition, signs, causes, importance, regulation process, strategies, assessment, research, recommendations for practice

Three sections follow:

1. Background Material that provides the context for the topic

2. Suggestions for Practice

3. A list of Supporting Material / References

4. Appendix 1: Emotion-Focused Therapy

Feedback welcome!

Background Material

Introduction

Emotions involve loosely coupled changes in a person’s experience, behavior, and the body’s physiology. Emotion regulation (ER) refers to people’s efforts to influence emotions in ways they think will increase the chance that their choice will be helpful rather than harmful (unfortunately, not all choices are helpful).  After the situation is appraised, attention is then focused on a response to manage the emotion.  ER can be considered as a cycle that continues over time with various adjustments made on the way.  These adjustments involved changes in three areas: (1) a subjective experience leads to (2) behaviour change that (3) impacts on multiple organs, tissues and systems, such as cardiovascular and respiratory.  (Gross, 2015).

Definition

Emotion regulation (ER) refers to the process of modulating one or more aspects of an emotional experience or response. It involves actions to initiate, increase, maintain, decrease, or transform both positive and negative emotions in response to changing demands of emotion-evoking situations (Iwakabe et al., 2023).  It can be conscious, such as actively deciding to calm yourself down after a stressful meeting, or unconscious, such as automatically feeling relief after a deep breath.  Essentially, ER helps to maintain balance, ensuring that emotions do not overwhelm or disrupt day-to-day functioning (McGarvie, 2025).  Difficulties with regulation can have a profound effect on a person’s sense of wellbeing, relationships, and ability to function in society.  For both adults and children, cultivating emotional regulation skills fosters resilience and enhances quality of life.  It is intrinsic to mental health and adaptive psychological functioning (Iwakabe et al., 2023).

Regulated emotion keeps the individual within a window of tolerance, i.e. the optimal arousal zone in which a person can function effectively – thinking, feeling, and relating at the same time. When emotional intensity pushes someone above this window (hyperarousal), they may experience panic, rage, or impulsivity. When pushed below it (hypoarousal), they may become emotionally numb, shut down, or dissociative.  Many clients with trauma histories have narrow windows of tolerance, meaning even moderate emotional stimuli can feel overwhelming. Therapy aims to expand this window by building ER capacity over time (MHA, 2025).

ER can be introduced at any stage of the emotional process, either before or after the occurrence of the emotional response (Kozubal et al., 2023).  There are two sides to emotion regulation: self-regulation (managing our own emotions) and co-regulation (helping others manage theirs). Both are essential for healthy relationships, learning, leadership, and well-being. Importantly, regulation doesn’t eliminate painful feelings—it teaches us to respond intelligently rather than react impulsively (Brough, 2025).  [Coregulation is a topic on this website:  https://www.thesocialworkgraduate.com/post/co-regulation-and-social-work]

Effective ER helps:

• Navigate challenges without becoming overwhelmed

• Express feelings in ways that foster connection

• Make thoughtful decisions, even under stress

• Recover more quickly from emotional setbacks

• Maintain healthy relationships

ER develops over time, starting in childhood. But life experiences – such as trauma, neglect, chronic stress, or mental health challenges – can disrupt this development (MyLife Psychologists, 2025; Talked Education Team, 2025).

Signs and Symptoms of Emotional Dysregulation

Common signs and symptoms that suggest ER is not functioning in an optimal manner include:

• Acting impulsively

• Emotions that get in the way of setting or reaching goals

• Feeling frustrated easily by small problems or annoyances

• Losing one’s temper often

• Mood swings

• Ongoing irritability or anger between outbursts

• Shutting down or going numb when overwhelmed

• Feeling detached from emotions or body (dissociation).

Some of the more serious effects of poorly developed ER include:

• Verbal outbursts, like shouting, yelling, screaming or crying

• Aggressive or violent behavior toward objects, animals or people

• Trouble keeping friendships, relationships or other social connections (Cleveland Clinic, 2025).

Causes of Emotional Dysregulation

High-intensity emotions often trace back to early attachment experiences where the individual was left alone with emotions that were too big to process. For example:

• A child who cried and was ignored or punished may grow into an adult who feels ashamed or terrified when they become tearful.

• A child who experienced inconsistent care may develop difficulty tolerating uncertainty or emotional ambiguity in relationships, leading to panic or angry outbursts.

These early patterns shape emotion schemas—the unconscious templates that guide how we feel and react. Effective therapy often involves updating these emotional templates through relational repair, emotional processing, and self-reflection (MHA, 2025).

Emotional dysregulation often appears with other conditions. Many people have more than one factor that causes it.  Common causes include mental health conditions, neurodevelopmental differences (neurodivergence), brain conditions or injuries and trauma.

Mental health conditions that can cause emotional dysregulation include anxiety disorders, depression, bipolar disorder, disruptive, impulse-control and conduct disorders. personality disorders. post-traumatic stress disorder and obsessive-compulsive disorder

Neurodivergent conditions the can impact on ER include attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and rejection sensitive dysphoria (RSD) - feeling intense pain or stress when rejected or after failing at something.

Brain conditions can include tumours, delirium degenerative brain diseases (like Alzheimer’s disease or dementia), epilepsy, head injuries, infections (like encephalitis or meningitis), intoxication or substance use disorders and stroke.

Emotional dysregulation can also be sourced to trauma and environmental causes.  Harmful experiences like long-term bullying, abuse or other types of extreme stress can change how the brain and nervous system respond to danger, keeping them on “high alert.” Over time, that can make it harder to manage emotions, even when no longer in danger (Cleveland Clinic, 2025).

Importance of Emotion Regulation

When emotions are too intense, last too long, or come too frequently, they can interfere with everyday life.  High emotional arousal can override logical thinking, leading to reactions that feel urgent in the moment but are often out of proportion to the situation, e.g. yelling during disagreements, withdrawing completely, or turning to harmful behaviours such as self-injury or impulsive spending.  ER issues are often at the core of many mental health concerns, including anxiety, depression, anger issues, burnout, relationship difficulties, substance use problems, eating disorders and personal disorders.  Poor ER can lead to poor physical health—being more sedentary, being overweight, having high blood pressure and other stress-related problems.  On the other hand, people with good emotion regulation skills tend to have healthier behaviors and better overall health. They are physically active, have a good diet, and do not smoke (Brough, 2025; Catanese, 2024; MyLife Psychologists, 2025; Talked Education Team, 2025).

Theories of Emotion Regulation

Four theories have been proposed to explain how ER works:

1. The dual-process theory        ER involves both automatic and controlled processes. Automatic regulation happens without conscious thought, while controlled regulation is a deliberate attempt to manage emotions.

2. The polyvagal theory      Polyvagal theory focuses on the role of the autonomic nervous system (especially the vagus nerve) in ER. The theory posits that social engagement and self-soothing are key for maintaining emotional balance.

3. Gross’s process model of emotion regulation       This model breaks down emotion regulation into five stages: situation selection, situation modification, attentional deployment, cognitive change, and response modulation. It emphasizes that ER occurs at different points in the emotion-generating process.  This model will be examined in more detail in the following section.

4. The cognitive-behavioral model (CBT)   This approach highlights the role of thought patterns in regulating emotions. By altering negative or distorted thoughts, individuals can change their emotional responses.

The Regulation Process

For McRae and Gross (2020) the ER cycle begins with a discrepancy between someone’s goal state (i.e., the emotional state they desire) and the actual (or projected) state. This discrepancy is then identified as an opportunity for regulation (1), a regulation strategy is selected from alternatives—see below (2), the strategy is implemented through specific tactics—see below for examples (3), and the whole cycle is monitored for success in achieving the regulatory goal (McRae & Gross, 2020).

When people want to influence these rising emotions, they utilise five families of strategies (McRae & Gross, 2020):

Situation family	Selected strategies	Example tactics
Situation selection	Avoidance	Declining initial engagement with emotional situations (e.g., declining interview request)
Situation modification	Direct response	Taking action to influence a situation once engaged (e.g., asking to move interview to a private location)
Attentional deployment	Distraction	Directing attention (internal or external) away from the emotional situation toward non-emotional aspects of the situation or non-emotional situations (e.g., glancing at notes rather than the interviewer’s face)
	Rumination	Recurrently directing attention toward causes and consequences of emotion (e.g., mentally replaying a moment in which the interviewer appeared to frown at your response)
Cognitive change	Cognitive appraisal	Reinterpreting or re-evaluating the emotional situation and/or your goals (e.g., telling yourself the interviewer was likely coached to not give overt positive feedback to applicants)
	Acceptance	Welcoming emotions with nonevaluative judgment (e.g., noticing and cultivating curiosity about manifestations of anxiety in the interview)
Response modulation	Expressive suppression	Preventing outward expression of internal emotional state (e.g., keeping face neutral to avoid expressing disappointment)
	Physiological intervention	Directly altering emotion-relevant physiology using actions or substances (e.g., slowing one’s breathing rate)

Gross (2015) provides additional examples for each of the above situations.

Situation selection refers to taking actions that make it more (or less) likely that one will be in a situation that one expects will give rise to desirable (or undesirable) emotions. Examples include arranging to go to a movie or avoiding a mean coworker.

Situation modification refers to taking actions that directly alter a situation in order to change its emotional impact. Examples include filing away a rejection letter rather than leaving it on one’s desktop, or—as a teacher—assigning students to work groups in order to (a) increase their interest (extrinsic regulation) and (b) decrease one’s own frustration at trying to help each in turn when classroom time is limited (intrinsic regulation).

Attentional deployment refers to directing one’s attention with the goal of influencing one’s emotional response. This family of emotion regulation strategies (e.g. distraction or rumination) is used from infancy.  One common form of attentional deployment is distraction, which redirects attention within a given situation (e.g., from an emotion-eliciting feature of a scene to a neutral feature of a scene) or shifts attention away from the present situation altogether (e.g., thinking about one’s vacation plans while in a depressing meeting). Kozubal et al. (2023) compare distraction with rumination.  The distraction strategy is perceived as shifting one’s attention to a positive or neutral thought or focusing one’s attention on a different activity. The rumination strategy is perceived as concentrating one’s attention on thoughts and feelings concerning an unpleasant situation or analysing its causes and consequences.

Cognitive change refers to modifying one’s appraisal of a situation in order to alter its emotional impact. One particularly well-studied form of cognitive change is reappraisal, which targets either the meaning of a potentially emotion-eliciting situation (e.g. “My racing heart isn’t a sign of anxiety; it means my body is preparing for the speech.”), or the self-relevance of a potentially emotion-eliciting situation (e.g. “This event doesn’t directly involve me or anyone I love.”)  Kozubal et al. (2023) suggest this strategy changes thinking about a given situation and the opportunities of handling it. Just like attention deployment, cognitive change is one of the anticipative strategies applied when a situation triggering negative emotions cannot be avoided or changed. Mental attitude then becomes an effective way to change one’s emotional state through involving acceptance as part of the regulation process, something recent and more popular strategies such as ACT, DBT and mindfulness approaches are currently suggesting. 

Response modulation refers to directly influencing experiential, behavioral, or physiological components of the emotional response after the emotion is well developed. Examples include using alcohol, cigarettes, drugs, and even food to alter one’s feeling state or using physical exercise and deep breathing to alter one’s physiological responses. One of the best studied forms of response modulation, however, is expressive suppression, which refers to ongoing efforts to inhibit one’s emotion-expressive behaviour.  Kozubal et al. (2023) add that the ability to use both expression and suppression of emotions is important in maintaining mental health.

Enhancing Emotional Regulation – Psychotherapies / Strategies

Frequent methods of enhancing patient ER across a variety of treatment packages include: (a) undoing avoidance of negative emotions, (b) enhancing emotional awareness, (c) allowing the full experience of feared or avoided emotion, (d) learning effective cognitive reappraisal, and (e) learning behavioral and action strategies to modulate unpleasant emotions.  Psychotherapies that address emotion regulation can be roughly divided into two groups: structured methods and affect-focused methods (Iwakabe et al., 2023).

Structured methods are rooted in the cognitive behavioural tradition and progressively build emotion regulation capacities through various modules such as the unified protocol (UP), acceptance-and commitment therapy (ACT), dialectical-behavior therapy (DBT), and mindfulness-based cognitive therapy (MBCT). The methods developed specifically to address emotion regulation skills include skills training in affect and interpersonal regulation (STAIR), acceptance-based behavioral therapy (ABBT), emotion regulation therapy (ERT), and affect regulation training (ATR). Structured methods frequently address ER skills by means of psychoeducation, skills training, and homework exercises. The outline of each session typically includes specific tasks to be completed with accompanying workbooks that patients use for homework (Iwakabe et al., 2023).  Other structured methods suggested include Behavioural Activation (Menefee et al, 2022) and Schema Therapy (MyLife Psychologists, 2025).  [ACT, DBT, Mindfulness and Schema Therapy are topics outlined elsewhere on this website – if interested, use the Contents tab to find them.]

In affect-focused methods, therapists use consistent empathy, warmth and validation as they help the person access and the experience of adaptive emotion that has been previously inaccessible, blocked, or avoided. The therapist’s consistent empathy, warmth, and validation is internalized by the patient and becomes a part of the way the patient subsequently responds to upsetting events.  These approaches include emotion-focused therapy (EFT), accelerated experiential dynamic psychotherapy (AEDP), affect phobia therapy, and intensive short-term dynamic psychotherapy (ISTDP) (Iwakabe et al., 2023).  [An outline of EFT can be found in Appendix 1 after the References section below.]

Strategies people can use in daily life to maintain healthy emotional regulation and build emotional resilience include:

• Practice regulation skills. Try meditating, mindfulness or relaxation exercises. Keep regular routines for sleep, meals and physical activity (Cleveland Clinic, 2025; McGarvie, 2025; MyLife Psychologists, 2025; Talked Education Team, 2025).

• Reframing negative thoughts      When faced with a challenging situation, rather than catastrophizing, reframe the event to focus on the learning opportunity or silver lining (McGarvie, 2025).

• Express emotions constructively           Use calm, assertive communication to express feelings appropriately instead of bottling them up or lashing out (McGarvie, 2025).

• Problem-solving                Instead of ruminating on negative feelings, identify actionable steps to address the root cause of the emotion (McGarvie, 2025).

• Name It to Tame It            Labelling emotions reduces their intensity. Try saying: “I’m feeling anxious right now.” It creates space between the person and the feeling (MyLife Psychologists, 2025; Talked Education Team, 2025).

• Use the ‘STOP’ Skill           This skill suggests pausing and choosing a response: S: Stop, T: Take a breath, O: Observe feelings and thoughts, P: Proceed mindfully (MyLife Psychologists, 2025).

• Engage Your Body         Emotions live in the body. Gentle movement, stretching, walking, or even splashing the face with cold water can help shift emotional states (MyLife Psychologists, 2025).

• Use creative expression and physical outlets to process emotions         Activities such as journaling, painting, photography, music, or dance can stop emotions from building to an overwhelming point.  Physical activities can also help release emotional energy, improve mood, and restore a sense of balance (Talked Education Team, 2025).

• Set healthy boundaries           Reduce ongoing stress when possible and schedule time for rest (Cleveland Clinic, 2025; Talked Education Team,2025).

• Limit substances          Alcohol and addictive substances can worsen mood swings and reduce impulse control, making it harder to manage emotions (Cleveland Clinic, 2025).

McGarvie (2025) also suggests a number of emotion regulation activities for children.  The activities with links to each website follows the McGarvie listing in the reference section that follows.

Assessing ER Approaches

There are no specific measures of ER methods.  However, several observer-rated scales measure in-session behavioural indications of ER: the Observer-Measure of Affect Regulation, the Client Emotional Productivity Scale-Revised, the Classification of Affective-Meaning State, the Achievement of Therapeutic Objectives Scale and the Client Expressed Emotional Arousal Scale-III-R.

In addition, there are a number of self-report measures of ER that would typically be completed by patients’ post-session: Emotion Regulation Questionnaire, Difficulties in Emotion Regulation Scale, Emotion Dysregulation Questionnaire, Action and Acceptance Questionnaire-II, Affective Style Questionnaire, Emotion Regulation Skills Questionnaire, Cognitive Emotion Regulation Questionnaire, Affect Integration Inventory, Distress Tolerance Scale, Meta-emotion Scale, Emotional Processing Difficulties Scale-Revised, Emotion Regulation Goals Scale, and Dimensions of Openness to Emotions.

Several scales tapping common positive and negative emotions are also sometimes used as client self-report measures of emotion regulation: The Positive and Negative Affect Schedule and Profiles of Mood State Questionnaires. In addition, the Self-Compassion Scale measures how individuals respond to emotionally distressing events (Iwakabe et al., 2023).

Research

The newest research results indicate that people who have a free choice usually apply a lot of ER strategies rather than just one.  Scholars are currently paying more attention to the significance of contextual factors which influence the selection and effectiveness of ER strategies. As a result, more and more studies are being conducted by the use of the longitudinal, daily diary or momentary report method. Such studies refer to their participants’ everyday experiences.

Suppression is the strategy based on modulating the emotional response which has already occurred, and inhibiting emotion expressing behavior.  The research on applying the suppression strategy revealed that the ability to use both expression and suppression of emotions is important in maintaining mental health.

Intensity of a given emotion is one of its most characteristic features. It exerts an influence on people’s motivation and behavior. It is a variable feature and often does not reach the maximum level. Just like in the case of the emotion itself, its duration is limited.  Recent studies indicate that emotional intensity exerts an influence on the selection of applied regulation strategies. More intensive negative emotions require people to apply a higher number of regulation strategies. It may result from a higher motivation for change, and result in more effort being targeted at regulation to avoid experiencing an unpleasant emotional state.  

Studies suggest people prefer to apply reappraisal when the emotion intensity is low, and distraction when the emotion intensity is high.  Distraction, as the strategy based on backing out and lack of engagement, requires less cognitive resources than reappraisal. Studies indicate that while making decisions people tend to minimize cognitive effort (appraisal and acceptance), especially in situations connected with a high level of stress and danger

  A study with adolescents demonstrated that in case of low intensity negative emotions teenagers more often applied the acceptance strategy, whereas in case of high intensity negative emotions they more frequently employed the suppression, distraction and rumination strategies. Adult studies indicate that reappraisal is used more often when emotional intensity is lower, whereas rumination is used more often when emotional intensity is higher.  The use of distraction was associated with a higher intensity of negative emotions compared to reappraisal. Acceptance was used less frequently when stressors were more intense (Kozubal et al., 2023).

Suggestions for Practice

Principles

There are eight common principles to follow when facilitating effective ER:

1. engage in an ongoing assessment of client’s capacity to modulate emotions;

2. develop a compassionate, accepting, and genuine therapeutic relationship;

3. educate clients about emotions and their function;

4. promote awareness and acceptance;

5. help clients reduce problematic avoidance and inhibition of emotions;

6. increase the capacity to adaptively express emotion;

7. increase positive emotional experiences;

8. facilitate changes in emotional processes by providing opportunities for new experiences (Iwakabe et al., 2023).

The Therapeutic Alliance

A strong therapeutic alliance forms the foundation for working with high-intensity emotions. Empathy, safety, and emotional attunement foster an environment where clients can risk emotional vulnerability.  For many clients, particularly those with a history of relational trauma, the therapist may be the first consistent and emotionally available figure in their lives. In these cases, the alliance becomes not just a medium for healing, but the healing intervention itself. A strong alliance can repair internal working models that equate emotional vulnerability with danger or rejection (MHA, 2025).  The therapist should be alert to potential breakdowns in this alliance and respond accordingly.  The following comments by the therapist may be relevant if the person becomes withdrawn or reacts in a way the therapist does not expect:

• “If at any point you feel overwhelmed, know that we can slow down and work with that feeling together. You won’t be alone in it” can be used early in a session.

• “It seems like something I said felt invalidating or made things harder. I want to understand that better—can we talk about what happened?” can be used to repair a potential misunderstanding.

Practical Suggestions

Iwakebe et al. (2023) make the following suggestions when engaging with a client:

• Use either affect-focused methods or structured psychoeducational and skill training methods to work with ER.  [A number of these are mentioned above and are outlined in detail elsewhere on this website – use the ‘contents’ button to access them—ACT, DBT, Mindfulness, Behavioural Activation, Co-regulation, Internal Family Systems, and Schema Therapy.  Furthermore, Emotion-Focused Therapy (EFT) has been described in Appendix 1 that follows the References section below.]

• Develop a strong therapeutic relationship characterized by empathy, validation, and support as outlined above. Such a relationship is frequently internalized by the patient and may function to change schemas that are thought to be at the root of emotional dysregulation.

• Address patients’ fearful avoidance or suppression of emotional experience via psychoeducation.

• In evaluating the appropriateness of ER, consider the patient’s cultural identity and worldview as well as the context in which the patient’s emotional experience occurs.

If emotion regulation issues arise as part of normal practice, outlining some of the strategies mentioned above that can be used in everyday life may be appropriate:

• Practice regulation skills. Try meditating, mindfulness or relaxation exercises. Keep regular routines for sleep, meals and physical activity.

• Reframe negative thoughts           When faced with a challenging situation, rather than catastrophizing, reframe the event to focus on the learning opportunity or silver lining.

• Express emotions constructively           Use calm, assertive communication to express feelings appropriately instead of bottling them up or lashing out.

• Problem-solving          Instead of ruminating on negative feelings, identify actionable steps to address the root cause of the emotion.

• Name It to Tame It        Labelling emotions reduces their intensity. Try saying: “I’m feeling anxious right now.” It creates space between the person and the feeling.

• Use the ‘STOP’ Skill       This skill suggests pausing and choosing a response: S: Stop, T: Take a breath, O: Observe feelings and thoughts, P: Proceed mindfully.

• Engage Your Body       Emotions live in the body. Gentle movement, stretching, walking, or even splashing the face with cold water can help shift emotional states.

• Use creative expression and physical outlets to process emotions      Activities such as journaling, painting, photography, music, or dance can stop emotions from building to an overwhelming point.  Physical activities can also help release emotional energy, improve mood, and restore a sense of balance.

• Set healthy boundaries         Reduce ongoing stress when possible and schedule time for rest.

• Limit substances         Alcohol and addictive substances can worsen mood swings and reduce impulse control, making it harder to manage emotions.

Supporting Material / References

Brough, E. (2025). Emotion regulation is the linchpin for mental health.  Yale School of Medicine.  https://medicine.yale.edu/news-article/emotion-regulation-is-the-linchpin-for-mental-health/  Extracts from Dealing with Feeling by Marc Brackett (2025).

Catanese, L. (2024). Self-regulation for adults: Strategies for getting a handle on emotions and behaviour.  https://www.health.harvard.edu/mind-and-mood/self-regulation-for-adults-strategies-for-getting-a-handle-on-emotions-and-behavior

Cleveland Clinic. (2025). Emotional dysregulation.  https://my.clevelandclinic.org/health/symptoms/25065-emotional-dysregulation

Elliott, R., & Greenberg, L.S. (2016). Humanistic-experiential psychotherapy in practice: Emotion-focused therapy. In A.J. Consoli, L.E. Beutler, & B Bongar (eds.), Comprehensive textbook of psychotherapy: Theory and practice (2nd ed.) (pp. 106- 120). Oxford University Press.

Gross, J. J. (2015).  Emotion regulation: Current status and future prospects.  Psychological Inquiry, 26,1-26.  Doi: 10.1080/1047840X.2014.940781

Iwakabe, S., Nakamura , K. & Thoma, N. C. (2023) Enhancing emotion regulation. Psychotherapy Research, 33(7), 918-945. https://doi.org/10.1080/10503307.2023.2183155  

Kozubal, M., Szuster, A. & Wielgopolan, A. (2023) Emotional regulation strategies in daily life: The intensity of emotions and regulation choice.  Frontiers in Psychology, 14, 1218694.  doi: 10.3389/fpsyg.2023.1218694

McGarvie, S. (2025). Emotional regulation: 5 evidence-based regulation techniques.  https://positivepsychology.com/emotion-regulation/ 

McGarvie suggests the following as educational emotional regulation activities for children:

• Use a feelings chart to help kids identify their emotions with visual aids like different faces that represent emotions. The My Feelings, My Body (https://positive.b-cdn.net/wp-content/uploads/My-Feelings-My-Body.pdf) and Inside and Outside (https://positive.b-cdn.net/wp-content/uploads/Inside-and-Outside-Worksheet.pdf) worksheets are great examples of charts that help children identify and manage their emotions.

• Teaching children breathing techniques like Balloon Breathing (https://www.youtube.com/watch?v=2PcCmxEW5WA) or Dragon Fire Breathing (https://positive.b-cdn.net/wp-content/uploads/2020/04/Dragon-Fire-Breathing.pdf ) can help them calm their nervous system and regulate their emotions.

• Using mindfulness activities where kids use their senses to focus on their surroundings helps them stay grounded. The Count Down to Calmness (https://positive.b-cdn.net/wp-content/uploads/2020/10/Countdown-to-Calmness.pdf) worksheet can be adapted as a fun activity to help children connect to the present moment.

• Kids Yoga (https://www.youtube.com/watch?v=utSLbp4GCkE) is also a great way to help children regulate their emotions.

McRae, K. & Gross, J. J. (2020).  Emotion regulation. Emotion, 20(1), 1–9. https://doi.org/10.1037/emo0000703

Menefee, D. S., Ledoux, T., & Johnston, C. A. (2022). The importance of emotional regulation in mental health.  American Journal of Lifestyle Medicine, Jan – Feb, 28-31.  doi: 10.1177/15598276211049771

MHA: Mental Health Academy.  (2025, July 2). Managing High Intensity Emotions in Therapy. https://www.mentalhealthacademy.com.au/blog/managing-high-intensity-emotions-in-therapy

MyLife Psychologists. (2025). Emotion regulation: learning to ride the emotional waves.  https://mylifepsychologists.com.au/emotion-regulation-learning-to-ride-the-emotional-waves/

Talked Education Team. (2025). Emotional regulation guide for adults.  https://www.talked.com.au/blog/emotional-regulation

Wiginton, K. (2025, June 25).  What is emotion-focused therapy (EFT)? https://www.webmd.com/mental-health/emotion-focused-therapy

Appendix 1

Emotion-Focused Therapy (EFT)

This outline is essentially a summary of the Elliott and Greenberg article referenced below.  Information from the Wiginton post has been referenced in the places it occurs.

Elliott, R., & Greenberg, L.S. (2016). Humanistic-experiential psychotherapy in practice: Emotion-focused therapy. In A.J. Consoli, L.E. Beutler, & B Bongar (eds.), Comprehensive textbook of psychotherapy: Theory and practice (2nd ed.) (pp. 106- 120). Oxford University Press.

Wiginton, K. (2025, June 25).  What is emotion-focused therapy (EFT)? https://www.webmd.com/mental-health/emotion-focused-therapy

-------------------------

Emotion-Focused Therapy (EFT, also known as Process-Experiential Therapy) is a contemporary, evidence-based humanistic psychotherapy based on contemporary emotion theory, and posits that human experience is organized around personal emotion schemes and that emotion processes can be adapted when necessary.  EFT analyses a client’s emotion as a source of meaning, direction, and growth.  Change occurs by helping people make sense of their emotions through awareness, expression, regulation, reflection, and transformation.  The therapist supports this process by being  actively engaged, emotionally present, empathically attuned, and by offering positive regard and unconditional acceptance.

General EFT Practice Principles

1. Empathic attunement. The foundation of EFT practice is careful empathic attunement to the client's immediate and evolving experiencing.

2. Therapeutic bond. The therapeutic relationship is seen as a key curative element. The therapist seeks to develop a strong therapeutic bond with the client, characterized by communicating three intertwined relational elements: understanding/empathy, acceptance and presence/genuineness.

3. Task collaboration. The client is an active participant in therapy.  Client and therapist are involved in developing overall treatment goals and immediate within-session tasks and therapeutic activities.

4. Emotional deepening through work on key therapeutic tasks, particularly those tasks associated with their treatment goals.

5. Self-development. EFT therapists emphasize the importance of clients’ freedom to choose their actions, in therapy as well as outside therapy.

6. Emotional processing. EFT understands that clients have different ways of working productively with their emotions at different times. These emotional processing modes include

   1. mindful focus on immediate experiences or specific memories;

   2. careful attention to bodily reactions and their meaning;

   3. awareness of the immediate emotional experience;

   4. expressing wants or needs or the actions that go with them; and

   5. reflecting on the meaning, value, or understanding of experience.

Case Conceptualisation

EFT case conceptualization focuses more on process than content and relies primarily on emotion schemes and emotion response types.

Emotion schemes              Emotions are conceptualized as organizing networks of interrelated experiences known as emotion schemes.  For example, emotions may emerge in the following ways

• Situational-perceptual experiences (e.g., noticing that one is alone and isolated from others and remembering oneself as a lonely child)

• Bodily sensations and expressions (e.g., a sinking feeling in the chest accompanied by quivering lips)

• Implicit verbal-symbolic representations (e.g., being described as “Unlovable”)

• Motivational-behavioural elements (e.g., needing another person’s affirming presence, while at the same time withdrawing from contact)

• Conscious emotional experience (e.g., an old familiar sadness at feeling abandoned and unloved).

Emotion response types                 Four types of emotion responses are distinguished in EFT:

1. Primary adaptive emotion responses are the first, natural reactions to the current situation that would help clients take appropriate action, e.g. anger leading to assertive action.

2. Primary maladaptive emotion responses are also initial, direct reactions to situations; however, they involve overlearned responses based on previous, often traumatic, experiences, e.g. if caring offered by others when growing up was usually followed by abuse, the client may respond to the therapist’s empathy with anger..

3. With secondary reactive emotional responses, the person reacts to their initial primary emotional response (which can be either adaptive or maladaptive), so that it is replaced with a secondary emotion, e.g. a client who encounters danger and feels fear may become angry about the fear even though it increases the danger.

4. Instrumental emotion responses are strategic displays of an emotion for their intended effect on others, such as getting others to pay attention to or to approve of the person, e.g. crocodile tears, crying wolf and intimidation displays.

EFT case formulation focuses primarily on developing a shared understanding of the client’s core painful emotion and key in-session presenting issues.  A person’s character or patterns of relating to self and others is secondary to this primary focus. 

Wiginton (2025) suggests that each person moves at their own pace through EFT.  In the sessions, the therapist helps the client:

• Gain awareness of personal emotions

• Be open to welcoming these emotions, no matter what they are

• Allow these emotions to flow freely without restriction

• Regulate these emotions so they don’t overwhelm you

• Describe how the client is feeling in detail

• Understand the “why” behind these emotions

Once these outcomes are mastered, the next steps in therapy include:

• Identifying emotions as helpful or unhelpful

• Using emotions to guide actions

• Understanding where unhelpful emotions come from and changing them 

• Forming healthy coping strategies

• Establishing an internal monologue that helps overcome negative thoughts.

Research on the Efficacy and Effectiveness of Emotion-Focused Therapy

EFT is an empirically supported psychotherapy. It is the product of extensive psychotherapy process-outcome research, that has been reviewed in several publications.   For the past twenty years, however, much of the research on EFT has been on outcome, complemented by process-outcome prediction studies, qualitative research, and case studies.  However, a limitation of the existing research is that it is predominated by research carried out by advocates of EFT.

EFT is routinely offered to a diverse range of clients of all persuasions, origins, and abilities. EFT training and practice are carried out successfully, with appropriate cultural sensitivity, in most parts of the world.

Assessment and Selection of Clients

Assessment         Formal assessment and diagnosis are not essential to the practice of EFT; however, quantitative and qualitative outcome and change process research instruments are frequently used for assessing client’s presenting issues, for tracking client’s progress, and for monitoring the state of the therapeutic relationship and helpful and hindering factors. Assessment tools that are particularly compatible with EFT include the Personal Questionnaire, the Working Alliance Inventory, the Client Task Specific Change – Revised form, the Resolution Scale and the Self-Relationship Scale.

Selection of clients           EFT has now been applied to a wide range of clients, including those presenting with depression, couples’ difficulties, attachment injuries and unresolved relationships, complex trauma, anxiety, and eating difficulties.

Treatment

EFT occurs on two levels: therapist response modes and EFT tasks and markers.

Therapist Response Modes           Some of the key therapist experiential response modes used in EFT include:

1. Empathic understanding to indicate understanding of the client’s message including reflections and acknowledgements.

2. Empathic exploration responses to communicate understanding and help clients move toward what is difficult or painful to say, e.g. “What comes up inside when you hear that?”, “Does that fit your experience?" and guesses about what the client is experiencing but has not yet said out loud.

3. Process guiding responses such as speaking to an imagined self in another chair, educating about the nature of the emotional experience, offering support to work on the task at hand, and awareness homework to complete prior to the next session.

4. Experiential presence—the therapist’s genuine presence or manner of being with the client.

Markers and Tasks

EFT is marker guided.  Clients enter specific problematic emotional processing states that are identifiable by in-session statements and behaviors.  These demonstrate underlying affective problems that afford opportunities for particular types of effective intervention.  EFT therapists are trained to identify markers of different emotional processing problems and to intervene in specific ways that best suit these problems. Common task markers include the following:

• Problematic reactions—puzzlement about emotional or behavioral responses to particular situations.

• An unclear felt sense occurs when the person is confused about something or unable to get a clear sense of their experience (“I just have this feeling, but I just can’t put my finger on it”).

• Conflict splits involve one aspect of the self being critical, coercive, or interruptive towards another aspect, offering the opportunity for two chair work

• Unfinished business involves the statement of a lingering unresolved feeling toward a significant other, calling for an empty chair intervention.

• Stuck, dysregulated anguish occurs in the face of strong emotional pain or a powerful existential need (e.g., for love or validation) that has not or cannot be met by others

In 2025 Wiginton suggested EFT moves through three main stages, with each stage building on the previous one.  The stages are:

1.     Emotional awareness and bonding       This is the foundation stage where the client, with the therapist, will:

• Build emotional safety and trust

• Learn how emotions show up in the body and daily life

• Set a shared focus for therapy and what the client wants to work on

• Begin to name and explore emotional patterns as they happen

2.     Accessing and processing core emotions        Once the client feels more grounded, emotions that drive client reactions can be identified.  These are often feelings that the client tends to avoid or that keep showing up.  This stage may include: 

• Breaking down strong responses to understand what’s really going on 

• Using techniques like chair work or emotion coaching to process intense feelings

• Learning the difference between protective emotions (such as anger or defensiveness) and more vulnerable ones (such as fear, sadness, or shame)

• Connecting current patterns to earlier emotional wounds

3.     Emotional transformation and integration   With insight and support, emotional patterns start to shift with new ways to relate that feel more open, honest, and steady emerging.  In this stage, the client might:

• Express emotions more clearly and calmly

• Respond instead of react during stressful moments

• Build stronger self-compassion and healthier boundaries

• Feel more in control of his or her emotional world

By the end of therapy, many people feel more emotionally flexible and comfortable with their feelings. That emotional change often ripples outward, improving your relationships and lessening the stress of everyday life.

Wiginton (2025) suggests EFT is considered effective when the client:

• Become more aware of emotions overall

• Feels more in control during tough moments

• Can name and manage feelings more clearly

• Expresses emotions without shutting down or blowing up

• Stops avoiding emotions that make the client uncomfortable

• Builds more stable, connected relationships

As therapy progresses, the client may find that moments that were once overwhelming now feel easier to manage. The client may react with more patience, feel less stuck in old patterns, and start trusting emotions instead of fearing them.