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Introduction

All individuals experience a range of emotions whether positive or negative on a daily basis. These emotions may be basic, such as anger, happiness, and fear or they can be derived emotions such as guilt or joy (Brown, Stuffel, & Munoz, 2010). Being a productive member of society requires us to regulate our emotions so that they are expressed in an appropriate and acceptable manner. However, for some individuals, particularly those with a mental health disorder, emotional regulation can be an overwhelming difficulty.

Theory

Cognitive behavioral therapy is a theory and intervention used to assist an individual to recognize any irrational thoughts, fears or distress, to evaluate the legitimacy of the cognitive distortion and replace them with healthier ways of thinking. The ultimate goal for individuals receiving CBT is to work effectively towards their personal goals by becoming conscious of their own negative thoughts, monitoring such distortions and substituting them with constructive and beneficial ideas (Beck, 2011).

Evidence

Evidence shows there is a link between maladaptive emotional regulation and inception and continuation of binge eating disorder as well as other eating disorders (Dingemans, Danner, & Parks, 2017). Individuals with eating disorders are prone to suppress and obsess on undesirable emotions, leading to negative thoughts and symptoms as opposed to typical individuals whom use adaptive strategies to overcome unwanted emotions (Dingemans, Danner, & Parks, 2017). Strategies for emotional regulation such as coping mechanisms, mindfulness, and emotional modulation have been proven effective when treating individuals with eating disorders (Brown, Stuffel, & Munoz, 2010).

Case Study

Sandy is 13 years old and is struggling with bulimia, anxiety and emotional regulation. On a typical school day, Sandy skips breakfast and lunch due to feelings of guilt and shame. Immediately after school, she rushes home to binge and purge. Prior to Sandy’s diagnosis she was very social and was on the cheerleading squad in which she enjoyed very much. She is no longer socializing with her friends and has begun to isolate herself specifically during lunch. She feels uncomfortable around her friends while they eat and always excuses herself. Her relationship with her friends has diminished drastically over the past several months and it has affected her overall participation in school related events. After completing the COPM with Sandy, she identified cheerleading, attending pep rallies and hanging out with friends as her main priorities.

Intervention Plan

Problem Statement

Due to Sandy’s inability to regulate her emotions, social participation in school events  have declined.

Long Term Goals

1. Sandy will attend a pep rally, for the full duration of the event, to increase social participation within 4 weeks.
2. Sandy will walk to cheerleading practice with 2 friends to increase social participation within 4 weeks.

Short Term Goals

1. Sandy will identify 2 emotions that hinder her ability to engage in social activities in 1 week.
2. Sandy will participate in an emotional regulation therapeutic group to improve social participation in 2 weeks.
3. Sandy will develop 3 healthy strategies to cope with stress and anxiety, with moderate verbal cues from the OT within 2 weeks, to increase social participation.

Intervention Format

Individual

Setting

Sandy will meet with the occupational therapist individually for 60 minutes 2x a week.

Supplies

None

Agenda

• Meet Sandy & develop rapport (5 min)

• Create a list of her emotions that does not allow her to engage in social activities (10 minutes)

• Explore different healthy coping strategies that the client feels comfortable implementing (20 minutes)
• Role play with therapist while using different healthy coping strategies (25 minutes)

Documentation

S: I can not control my emotions when I am at school social events. I miss cheerleading.

O: Client created a list of 5 emotions that limit her participation in social events, that included excluded, tense, uneasy, nervous and withdrawn. Client explored several healthy coping strategies to implement when feeling anxious or stressed. In the role play session the therapist and client eat lunch together, in the lunchroom. Client was able to stay throughout the entire lunch session. Client was also able to engage in conversation with the therapist without showing any signs of stress.

A: Client was able to shows self-awareness by communicating different emotions that causes her to disengage from social events. Client was able to effectively implement healthy coping strategies when feeling anxious, which demonstrates clients ability to self regulate her emotions. During role play with the therapist, the client demonstrated confidence implementing the healthy coping strategies.

P: Client will continue participating in occupational therapy sessions 2 times per week for 60 min to continue working on emotional regulation. Next session client will include role playing with a friend while having lunch in the lunchroom.

References

Beck, J. S. (2011). Cognitive-behavioral therapy. Clinical textbook of addictive disorders, 474-501.

Brown, C., Stoffel, V. C., & Munoz, J. P. (2010). Occupational therapy in mental health: a vision for participation.

Alexandra Dingemans, Unna Danner, & Melissa Parks. (2017). Emotion regulation in binge eating disorder: A review. Nutrients, 9(11), 1274. doi:10.3390/nu9111274