Experiential and Humanistic

Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=wjfp21

Journal of Family Psychotherapy

ISSN: 0897-5353 (Print) 1540-4080 (Online) Journal homepage: https://www.tandfonline.com/loi/wjfp20

Bottled Up: An Experiential Intervention for Emotional Suppression

Keaton Brown & Roya Taghehchian

To cite this article: Keaton Brown & Roya Taghehchian (2016) Bottled Up: An Experiential Intervention for Emotional Suppression, Journal of Family Psychotherapy, 27:4, 302-307, DOI: 10.1080/08975353.2016.1235435

To link to this article: https://doi.org/10.1080/08975353.2016.1235435

Published online: 07 Nov 2016.

Submit your article to this journal

Article views: 3007

View related articles

View Crossmark data

INTERVENTION INTERCHANGE

Edited by Thorana S. Nelson, PhD

Bottled Up: An Experiential Intervention for Emotional Suppression Keaton Brown and Roya Taghehchian

Marriage and Family Therapy Program, University of Nevada at Las Vegas, Las Vegas, Nevada, USA

ABSTRACT The regulation, expression, and suppression of emotion is often conceptualized differently in different cultures (Su, Wei, & Tsai, 2014). A common factor, however, between cultures is the need of the individual to exercise a sense of control, or regulation, over their emotions (Gross, 1998). Emotional regulation is defined as the process by which individuals influence which emotions they have, when they have them, and how they experience and express these emotions (Gross, 1998). An individual may present regulation through deliberate internalization of positive or nega- tive emotions (Kim & James, 2015). In turn, this internalization can have positive or negative effects depending on the context. Emotional suppression is a common maladaptive coping mechanism (Gross & Levenson, 1993). Emotional suppression can be defined as an internalization of emotions during emo- tional arousal (Gross & Levenson, 1993). Bottled Up is an experi- ential intervention, developed by the authors, for use with clients experiencing emotional suppression. This article provides a review of literature that covers emotional regulation, specifically emotional suppression. We then explain the intervention (Bottled Up), how to implement it, and its relevance to the marriage and family therapy more broadly.

KEYWORDS Adolescents; emotion intervention; emotion regulation; experiential therapy; family therapy

Emotional regulation

Emotional regulation is essentially the manipulation of one’s own emotions. Without this regulation, there might be limited control over inappropriate outbursts or impaired ability to connect with a loved one. Proper emotional regulation facilitates healthy communication and social encounters through social appraisal and interpersonal reinforcement (Parkinson, Fischer, & Manstead, 2005). Emotional regulation is an automatic, controlled, con- scious, or unconscious process that influences the emotions that individuals experience, how they experience these emotions, and when they experience them (Gross, 1998; Joormann & Vanderlind, 2014).

CONTACT Keaton Brown brownk13@unlv.nevada.edu Marriage and Family Therapy Program, University of Nevada, 4505 Maryland Parkway, Box 453045, Las Vegas, NV 89154, USA.

JOURNAL OF FAMILY PSYCHOTHERAPY 2016, VOL. 27, NO. 4, 302–307 http://dx.doi.org/10.1080/08975353.2016.1235435

© 2016 Taylor & Francis Group, LLC

Emotional regulation is often related to coping; however, emotional reg- ulation is actually a function of coping and should not be considering a coping mechanism in and of itself (Joormann & Vanderlind, 2014). Ineffective emotional regulation is directly linked to maladaptive behaviors such as, but not limited to, substance abuse, deliberate self-harm, and depression (Fox, Hong, & Sinha, 2008; Gratz & Roemer, 2008). Additionally, mood regulation and repair should not be confused with emo- tional regulation as the former refers to altering emotional experience rather than behavior. Emotional regulation is a self-monitored skill to aid in adaptive functioning of both positive and negative emotions (Weiss, Gratz, & Lavender, 2015).

Emotional suppression

Emotional suppression can be simplified as the deliberate internalization of negative emotions in attempt to control negative feelings (Kim & James, 2015). Research suggests that emotional suppression is linked to having more intense experiences of depression, disgust, sadness, and an overall lower satisfaction with life (Gross, 1998; Gross & John, 2003; Gross & Levenson, 1997). High levels of emotional suppression have also been associated with increased risk for suicidal ideation (Kaplow, Gipson, Horwitz, Burch, & King, 2014). Individuals that suppress their emotions may have difficulty in form- ing new relationships due to the inability to express their emotions. Additionally, if individuals suppress their emotions in relationships, a lack of intimacy may develop and their partners may find it difficult to find comfort and stability in the relationship. In the following section, we intro- duce a new intervention technique specifically designed to address and treat emotional suppression.

Bottled Up

Bottled Up is a multiple session experiential intervention designed to target emotional suppression and to promote effective emotional regulation. It is a visual representation of the effects of emotional suppression as well as the benefits of emotional expression. It brings a sense of awareness, encourages autonomy for those who struggle with low levels of emotional inertia, and alleviates the effects of suppressing positive and negative emotions. This is often used with adolescents who struggle with emotional regulation due to the hormonal changes throughout the body. This intervention creates an emotional environment between the therapist and the client. Therefore, it should only be used once the therapist has created a safe relationship and joined with the client. This should be used once emotional suppression has been identified.

JOURNAL OF FAMILY PSYCHOTHERAPY 303

Imagery phase

The initial stage is the imagery phase during which the therapist engages the client in a descriptive conversation after the client has reported that they suppress emotions or “bottle them up.” The goal of this phase is for the client to create a mental image of a life-like bottle or object that they refer to as their internal container. Questions such as, “What is the size and color of your bottle?” “What is your bottle made of?” “Where is the bottle located within your body?” “Is the bottle always there?” are effective questions that give descriptive details to their internal container. This can be a bottle or box or any object that is designed to contain elements. For this report, we refer to the internal container as a bottle. The homework for the client is to find a bottle that represents their imagined internal bottle. They are then instructed to bring this bottle to the following session for the next phase.

Assessment phase

The second phase is the assessment phase. This phase is designed to promote interaction between the therapist and client to use the physical representation of the internal bottle. The first step is to assess the origin of the internal bottle. Therapist can ask questions like “When did you notice that you started to bottle up your emotions?” or “Have there been times you felt like there was no one there for you to talk to?” There may have been a traumatic event early in childhood where they learned to suppress emotions. The therapist then explores events throughout the client’s life around which emotions are suppressed. During the process, the client is filling up their bottle to represent how much suppressed emotion is associated with that event. Also, the client should express times throughout their past where their bottle has “popped.” Examples may be a suicide attempt, rage, depression, and other episodes of highly expressed reactive emotions. The client is then given the homework to bring the bottle back to next session.

Monitoring phase

Insight can be a powerful element of treatment and should be emphasized with this intervention. The client not only gains insight into the power of expression which ideally will result in lower levels of emotional inertia, but also provides the therapist with insight into the client’s reality. The subse- quent sessions are used as monitoring or “self-checks” for the client and therapist. The client should be instructed to carry around the bottle in subsequent weeks to fully feel its weight. There should be 2 days throughout the week where the client reflects and journals when they fill or empty the bottle depending on how much emotion they have suppressed, expressed, or

304 K. BROWN AND R. TAGHEHCHIAN

how many effective coping skills have been implemented. For example, a client will fill the bottle with water in an event where they unable to cope negative emotions. Once they are able to regulate this emotion, through an effective coping mechanism discussed with the therapist, the client will then pour out the water that represented the negative emotion. Essentially, the client is experientially adjusting the weight of their problems by filling and emptying their bottle with water. From that point onward, the therapist should explore how their client’s week went by examining the bottles. It allows the therapist to monitor the current status of the client and also allows the client to monitor his or her own status. Both the client therapist will start to notice the types of coping skills and expression styles that effectively works for the individual. Also, if the client and therapist engage in an emotionally charged session where uncovering suppressed emotion occurs, the therapist can instruct the client to take notice of the feelings after expressing the emotions by having the client pour out the amount of “suppressed emotion” within their bottle.

The final phase begins once the client demonstrates that they are making demonstrative changes and have noticeable improvements in expressing their emotions. Discussion about any themes or revelations they have gained should ensue. Additionally, therapist and client will identify future triggers where the client may need to use their bottle again. This intervention not only brings awareness into emotion identification, but also brings a sense of control and autonomy over emotions.

Discussion

We believe this original intervention is best used with adolescents. It fosters autonomy in a way such that the adolescent will feel in control of their own emotions. It develops a high level of trust between the therapist and client as this can be seen as a “secret bottle.” Because a water bottle is such an everyday item, external parties will be none the wiser and only the adolescent and the therapist will know its real purpose. Additionally, it assists in emotion identification for adolescents, who often struggle identifying emo- tions. Furthermore, it allows the therapist to implement coping skills tailored to the client as it allows the therapist to physically see which coping strategies are most effective.

Bottled Up can also be used in conjoint sessions. For example, in a family session with parents and children, all family members would have their own bottles they would carry throughout the week. At session, each member of the family would discuss what they noticed about their bottle during the week and they would identify whether it is an event that empties the bottle (expression) or fills the bottle (suppression). Then the family members would fill or empty their bottles according to the effects

JOURNAL OF FAMILY PSYCHOTHERAPY 305

of the expression or suppression event. This brings awareness to effective modes of expression that allow a healthy type of regulation and help family members develop an understanding and appreciation for what fills or drains each person’s bottle.

This intervention does take a highly motivated client as its success is dependent on the client’s participation to complete. This intervention should not include expensive or exotic materials. Most bottles are cheap and can be bought by individuals of any demographic. If necessary, the therapist can have bottles in their office or room to be used as temporary containers.

With very little expense, this experiential intervention is a successful way to engage the client in the therapeutic process early on. Benefits include joining, gaining information for assessment of the problem, monitoring progress throughout the therapeutic process, and can continue long after the therapeutic process has been terminated. This intervention teaches a lifelong skill that can be implemented throughout the entire lifecycle. Emotion regulation is a skill that should be sought after by everyone and this intervention directly works to master this skill.

Acknowledgments

This article was supported and edited by Dr. Carissa D’Aniello and Dr. Katherine M. Hertlein.

References

Fox, H. C., Hong, K. A., & Sinha, R. (2008). Difficulties in emotion regulation and impulse control in recently abstinent alcoholics compared with social drinkers. Addictive Behaviors, 33(2), 388–394. doi:10.1016/j.addbeh.2007.10.002

Gratz, K. L., & Roemer, L. (2008). The relationship between emotion dysregulation and deliberate self-harm among female undergraduate students at an urban commuter university. Cognitive Behaviour Therapy, 37(1), 14–25. doi:10.1080/16506070701819524

Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271–299. doi:10.1037/1089-2680.2.3.271

Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348–362. doi:10.1037/0022-3514.85.2.348

Gross, J. J., & Levenson, R. W. (1993). Emotional suppression: Physiology, self-report, and expressive behavior. Journal of Personality and Social Psychology, 64(6), 970–986. doi:10.1037/0022-3514.64.6.970

Gross, J. J., & Levenson, R. W. (1997). Hiding feelings: The acute effects of inhibiting negative and positive emotion. Journal of Abnormal Psychology, 106(1), 95–103. doi:10.1037/0021- 843X.106.1.95

Joormann, J., & Vanderlind, W. M. (2014). Emotion regulation in depression: The role of biased cognition and reduced cognitive control. Clinical Psychological Science, 2(4), 402–421. doi:10.1177/2167702614536163

Kaplow, J. B., Gipson, P. Y., Horwitz, A. G., Burch, B. N., & King, C. A. (2014). Emotional suppression mediates the relation between adverse life events and adolescent

306 K. BROWN AND R. TAGHEHCHIAN

suicide: Implications for prevention. Prevention Science, 15(2), 177–185. doi:10.1007/ s11121-013-0367-9

Kim, M. Y., & James, L. R. (2015). Neurological evidence for the relationship between suppression and aggressive behavior: Implications for workplace aggression. Applied Psychology: An International Review, 64(2), 286–307. doi:10.1111/apps.2015.64.issue-2

Parkinson, B., Fischer, A. H., & Manstead, A. S. R. (2005). Eotion in social relations: Cultural, group, and interpersonal processes. Hove, UK: Psychology Press.

Su, J. C., Wei, M., & Tsai, H. (2014). Running away from unwanted feelings: Culture matters. Cognition and Emotions, 28(7), 13–27.

Weiss, N. H., Gratz, K. L., & Lavender, J. M. (2015). Factor structure and initial validation of a multidimensional measure of difficulties in the regulation of positive emotions: The DERS-positive. Behavior Modification, 39(3), 431–453. doi:10.1177/0145445514566504

JOURNAL OF FAMILY PSYCHOTHERAPY 307