Interventions for Maladaptive Emotional Regulation

There are many possible interventions to allow teens to improve their use of adaptive emotional regulation. However there is a scarcity of research for many of these. This is a collection of 5 interventions that have had some studies into them. Best advice:- choose an intervention that the teen will buy into.

Cognitive Behavior Therapy

Cognitive Behavior Therapy (CBT) has been used for many years to treat anxiety in all populations. Within people with Autism Spectrum Condition (ASC) and anxiety you need to ensure the CBT has been modified (Ehrenreich-May et al., 2014). Things to look for in a CBT program are modifications to make the program ASC friendly, parental training (increases the effectiveness of the program), length of program (too short and the interventions will not last) (Perihan et al, 2019). A point of interest is that CBTs in the general population have proven effective at removing anxiety as a mental health concern, however this is not the case in the ASC population (Ehrenreich-May et al., 2014). Two independent studies did identify that longer interventions did remove ASC in 3 and 5 people respectively (Perihan et al, 2019). A study has looked at CBT effectiveness in school using teachers as the therapy provider (Luxford, Hadwin & Kovshoff, 2016). The study found (based on students in 4 different UK secondary schools) that there was a decrease in anxiety, social worry and an increase in attention span as well as improvements in happiness and a reduction in fear and anger (Luxford et al, 2016).

Biofeedback Interventions

Biofeedback interventions are about utilizing body signals to help teens realize when they are going into a state of anxiety and thus potential rage or shut down cycle. There are a range of ways of doing this with either video games or in person. Video games with a bio monitor have been found to be effective in assisting with teaching players to use heart rate calming techniques (Vaudreuil, Chasser, Hoover, Jacobs & Hirsfeld-Becker, 2017). There has also been success in using this type of gaming at improving social skills (Friedrich, Sivanathan, Lim, Suttie, Louchart, Pillen, & Pineda, 2015). I have had personal experience with the effectiveness of pointing out to students with ASC when they are feeling anxious. It is not effective to just state that they are feeling anxious, this technique was only effective when I started stating why I knew the students were anxious. Phrases like “I know you are anxious because you are speaking faster and louder than normal.” were particularly useful and now some of these same students repeat back “I am speaking faster and louder than normal. I may be anxious.” There are also devices such as wrist watches that can help identify increasing heart rates.

Yoga

Yoga has been found to improve emotional regulation in people with ASD. Indeed Yoga as an intervention has been found to be highly effective for assisting in a range of ways including sleeping through the night, eating appropriate portions of foods, decreasing aggressiveness and self-harming behaviors (Narasingharao, Pardham, Navaneetham, 2017). These were in addition to an improvement in the use of adaptive emotional regulation (Narasingharao et al., 2017). A meta analysis of physical activity intervention also identified an additional yoga study (of 6 weeks duration) that found reductions in externalizing and internalizing maladaptive behaviors (Bremer, Crozier & Lloyd, 2016).

The Incredible 5-Point Scale is about learning how to regulate emotions appropriately using an adult with good emotional regulation to help (Dunn Buron, 2015). The scale is very simple but customized to individual children and then an adult, when noticing the child start to escalates will question the child about where they feel they are versus where the adult feels they are. Within the teenage age group, care would have to be taken so that the scale did not appear babyish. However, I work at a location where a 5 point scale is used as a universal check in system. It is highly effective at allowing students to identify how they are feeling without having to use words to express themselves. Many Autism support websites use the Incredible 5 point scale as anxiety interventions.

Art Therapy

Art Therapy has been used for a variety of reasons for years. When using this intervention, this is about providing an outlet for emotion and sensory stimulation, however additional benefits have been found. In a meta-analysis of Art therapy interventions for youth with ASD, benefits included improved cognitive flexibility, improved emotional regulation and a decrease in destructive behaviors (Schweizer, Knorth & Spreen, 2014). There was also an improvement in social communication making this another highly effective intervention due to the number of ASD traits and characteristics it impacts (Schweizer et al., 2014).

Classroom Use

These interventions have been selected because there is a range of types of activities. For instance, not all teenagers are going to be inspired to roll out a yoga mat each day, or sculpt some clay, however most teenagers would allow a 5 point scale of some kind – provided it was not obvious. CBT certainly could be useful for those teens who refuse to seek professional help (and there are many out there). It provides a compromise that can be used. “If you don’t want to speak to someone, you could try CBT.” People with ASC are as diverse as life itself.

The Incredible 5 Point Scale, biofeedback and Yoga can be used within any classroom setting. The scale, a subtle conversation between teacher and student, would be highly usable in all settings and provide the student with timely feedback in real life situations. Biofeedback interventions can be as simple as saying “You are started to sound like you could be anxious – is your heart racing?” and with the amazing ability of smart phones and fitness watches the teacher could get the student to track their heart rate – something that many young people would love. Yoga is a universal intervention and you would use it as a whole class, simply displaying a Youtube 10 minute yoga clip when the teacher started noticing signs of distress in the student (or any student). As a teacher myself, I would be more inclined to do this at the start or end of the lesson.

Simple ways to use Art Therapy in class is to allow students to draw or color when upset. Additionally the class could also practice CBT calming exercises and problem solving both in real time situations and prior to situations occuring.

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