Emotional Health and Well-Being in Recovery, Part II

In my previous article, I discussed issues affecting emotional health and well-being affecting clients with behavioral health (BH) disorders and their families. This follow-up article discusses BH treatments that focus on emotional or mood problems, and recovery strategies to manage emotions and moods.

Recovery helps clients and family members improve their emotional well-being since feelings and moods often cause personal distress and create an emotional burden. Recovery also aims to help individuals use negative emotions in ways that promote positive behavior change, decrease negative emotions, and increase positive emotions. This process helps clients or family members become educated on emotional health and recovery, gain awareness of their own emotions and how they manage or mismanage these, and develop and use emotional management skills. These skills include identifying and improving emotions and moods with the use of cognitive and behavioral strategies. Medications may be needed if a more severe mood or anxiety disorder exists.  

Many studies and treatment manuals identify emotions and moods as significant issues to address in the treatment of BH disorders. Research by the late Dr. Alan Marlatt identified “negative emotions” as the most common relapse precipitant across a range of addictive behaviors, which means this should be addressed as part of an ongoing recovery and relapse prevention plan. However, it is not the emotion, but the inability of the client to use effective coping strategies that determines if an emotional state will lead to a relapse (Marlatt & Donovan, 2005).   

Most of the evidence-based interventions for substance use disorders (SUDS), grief or trauma therapies, and co-occurring disorders focus on emotional issues. For example, one of the four major skill modules in dialectical behavior therapy (DBT) helps clients manage emotional lability by learning emotion regulation skills such as how to identify and describe emotions, let go of painful emotions, decrease vulnerability to negative emotions that contribute to self-harm or interpersonal conflict, respond more appropriately to emotions, and increase positive emotions (Linehan, 2014). Cognitive behavioral therapy (CBT) is used with anxiety, mood, and other BH disorders to help clients change thoughts and beliefs, use distraction skills, and engage in pleasurable activities, all of which can improve their emotional well-being. 

Many therapies for substance use disorders teach clients general skills to manage high-risk emotions as well as specific skills to manage anger, boredom or guilt and shame. Interventions for co-occurring disorders also focus on helping clients improve their ability to manage emotions and moods. Seeking Safety teaches strategies to detach from emotional pain, heal from anger, and address thinking, triggers, and relationships that affect emotional well-being (Najavits, 2001).

Following are strategies to promote recovery and enhance emotional well-being. See references and suggested readings for more details on these and other coping strategies. It helps to use different strategies, depending on the circumstances and what works or does not work for a given client or in a given situation.

This means being aware of factors that contribute to emotions or mood states, knowing how to identify them in behaviors, thinking, and bodily sensations. Such awareness helps clients determine if an emotion is excessive or intense, or if the way it is managed creates significant distress or causes problems. 

Emotions that we usually think of as negative, which create discomfort or stress, also can be useful in examining our behaviors and making positive changes (Kashian & Biswas-Diener, 2014). For example, anger can lead to resolving a dispute with another person or solve a problem in life, work hard to achieve a personal goal or overcome a difficult past. 

For example, if food, substances, other addictions or other unhealthy behaviors are used to bring temporary escape or relief from negative emotions, other strategies will be needed as these strategies may help short-term, but create more serious problems over time. Or, if strategies used lead to self-harm (isolation, cutting or burning self) or harm to others (verbal or physical violence), these will need to change so that more effective coping skills are used.  

Emotions or moods that cause the most suffering and create the most difficulties include depression or sadness, anxiety or fear, and anger or hostility (Anderson & Anderson, 2003). It takes time to learn to cope with these emotions and increase personal resilience so these are less distressful. The use of self-calming or soothing strategies, and recognition that a painful emotional state can persist and may never completely leave, can be helpful. Accepting small improvements paves the way for living with these emotions. 

A daily rating of emotions or moods raises awareness of changes in emotional states over time.  This helps clients view progress as well as setbacks. When a mood or emotional state worsens, the client is alerted and can then use other coping strategies.  

This allows a person to challenge distorted thinking that contributes to negative emotions or mood states such as anxiety or depression. CBT and other therapies focus considerable attention on disputing faulty thinking (sometimes called “cognitive distortions”) by checking the facts and being less judgmental of oneself. 

 

While everyone’s road to relapse differs, one common factor is not managing a negative emotion or mood state. Clients can benefit from identifying personal high-risk emotions and developing a plan to manage these.

This can be a therapist, sponsor in a Twelve Step program, peer in recovery or trusted family member or friend. This discussion can help a client figure out why a particular emotion is experienced. Mutual support programs offer a safe haven in which upsetting emotions can be shared (e.g., “drop your resentments off at a meeting”).

Some clients with depression, for example, may benefit from not watching sad movies or listening to music that evokes negative emotions. Others need to limit the amount of energy devoted to obsessing over past events or experiences that were distressing. Working less time, not working during lunch or break periods, reducing time spent responding to emails or text messages, and spending less time on the computer and Internet may help reduce stress and negative emotions. 

These include but are not limited to

• Meditation, which reduces stress and negativity
• Mindfulness, which aids self-acceptance of all emotions
• Exercise or physical activities, which reduces anxiety or depression
• Engaging in pleasant activities, which improves depression or anxiety or reduces boredom
• Using creative media such as arts, crafts, painting, drawing, and others

Many people who practice yoga or mediate regularly say these practices have a calming effect and reduce negativity. Finally, engaging in activities that are fun, enjoyable or rejuvenating can improve emotional health.  

These include prayer, contemplation, reading spiritual literature, engaging in formal religious or spiritual rituals, and focusing on meaningful relationships or activities in life. These can help take the focus off of internal thoughts or feelings onto the external world.

In a recent column in the Counselor Connection digital newsletter, I discussed how positive emotions like kindness, gratitude or self-compassion can improve physical or emotional health. In another column, I focused specifically on ways to increase the expression of gratitude. The field of positive psychology has produced an impressive portfolio of research and strategies to use to manage negative and increase positive emotions (Biswas-Diener, 2013; Emmons, 2013; Fredrickson, 2009; Huffington, 2014). An increase in positive emotions can help offset negative ones, and improve relationships and the quality of life.

This can help clients identify and reflect on emotions or distress experienced during the day. Then, steps can be taken to deal with specific issues related to any upsetting emotional state. Additionally, it can help clients assess the effectiveness of coping strategies used to deal with specific emotions.

Many effective therapies and medications exist for mood and anxiety disorders, or addictive disorders to reduce cravings for alcohol or drugs. Generally, if a client’s mood does not improve significantly after an agreed upon period of time in treatment, medications should be considered. Recurrent and chronic forms of mental disorders often require therapy in addition to medication to help address mood symptoms.

Many factors contribute to personal distress and negative emotions or moods. A focus of therapies for many BH disorders is helping clients become more aware of emotions, what causes them, how they show, and how they affect well-being. Clients can benefit from learning personal coping strategies that enable them to manage a range of negative emotions and increase positive emotions. Focusing on motional recovery offers many benefits to clients and family members.

Anderson, N. B., & Anderson, P. E. (2003). Emotional longevity: What really determines how long you live. New York, NY: Viking.

Biswas-Diener, R. (2013). Invitation to positive psychology: Research and tools for the professional. Charleston, SC: CreateSpace.

Daley, D. C. (2012). Coping with feelings and moods. Murrysville, PA: Daley Publications.

Emmons, R. A. (2013). Gratitude works! A 21-day program for creating emotional prosperity. San Francisco, CA: Jossey-Bass.

Fredrickson, B. L. (2009). Positivity: Top-notch research reveals the upward spiral that will change your life. New York, NY: Harmony.

Huffington, A. (2014). Thrive: The third metric to redefining success and creating a life of well-being, wisdom, and wonder. New York, NY: Harmony Books.

Kashian, T., & Biswas-Diener, R. (2014). The upside of your dark side: Why being your whole self—not just your “good” self—drives success and fulfillment. New York, NY: Penguin.

Linehan, M. M. (2014). DBT skills training manual (2nd ed.). New York, NY: Guilford Press.

Marlatt, G. A., & Donovan, D. M. (2005). Relapse prevention. New York, NY: Guilford Press.