Roller coaster rides give us the thrilling experience of getting strapped into a small car with no steering wheel or brakes, then slowly climbing a steep, narrow incline hundreds of feet in the air, knowing that once we reach the top, we will be whipped down and around through fast twists, turns, ups and downs, while having absolutely no control. It would be more terrifying than thrilling if forced onto a roller coaster ride when unprepared and with no choice. That’s what happens to people in close relationship to someone who is very emotionally sensitive, whose emotions become intense quickly, and change rapidly, then get reflected in behavior that can range from withdrawal and avoidance to demands, accusations, and threats, or worse. This behavior then triggers in family members and friends feelings of anxiety/fear, guilt, anger, and hopelessness, which can then trigger other feelings about these feelings, such as guilt about anger, anger about guilt, fear about hopelessness, etc. Family members do the best they can to manage these feelings while interacting with their loved one experiencing their own emotional roller coaster, but often find themselves feeling like nothing they do is right, leading to a greater sense of feeling scared, out of control and increasingly demoralized. This is “the emotional roller coaster” experience. Exhaustion and burnout can set in, especially if the ride seems like it will never end.
So what helps a person get off an emotional roller coaster? In my professional and personal experience, I believe it is a sense of self-confidence and sense of control from knowing how to handle different situations well, and hope that things can eventually get better, all in the face of a loved one’s many ups and downs, twists and turns. I remember reading about a large, well-designed study of how people coped with all types of very distressing situations such as natural disasters, homelessness and yes, even having a loved one with major depression. In examining characteristics of those who were more resilient to those who were not adjusting well, the two characteristics that stood out were “good social support” and “self-efficacy” (the sense that one was playing the hand they had been dealt as well as anyone could). It did not mention hope, but all the principles of recovery from mental health challenges all start with hope. Perhaps the need for social support, self-efficacy and hope explains the popularity of family support groups and family workshops, which often involve providing peer support, ideas about how to handle various situations and hopefully - a message of hope.
In our family support and education program at the Mental Health Association of Southeastern PA, known as T.E.C. for Training & Education Center, we have developed a 10-week family workshop that is geared to promote social support, self-efficacy and hope in both its content and structure for family members and friends of people with bipolar disorder, borderline personality disorder (BPD) and major depressive disorder. These three disorders are particularly challenging because they involve mood instability, emotional vulnerability/sensitivity, intense emotions easily triggered, Long- lasting emotions, as well as mood episodes like major depressive episodes, manic episodes, hypomanic episodes and mixed states. Not surprisingly, we call this workshop, “Getting Off the Emotional Roller Coaster.”
The content of the workshop is based on 4 skill sets that we see as critical and interdependent. I picture them like 4 pillars holding up the platform so we can step off the emotional roller coaster. These “pillars” are: self-care (so you can stay healthy and prevent burnout), emotion regulation (so you can calm yourself down enough to think straight and be skillful), emotional validation (so you can soothe an upset relative and promote trust in you so you are more likely to be heard), limit setting under calm conditions (so you can maintain your own boundaries and help your loved one learn greater self-control around you) and limit setting under crisis conditions, (for responding effectively to self-injury, suicidal thoughts/ threats, and potential violence). The more skillful a person is in each of these skills sets, the more a person will be able to respond and not just react emotionally to their loved one’s ups and downs. (One important topic we hope to cover in a separate workshop is responding to psychotic symptoms, such as hallucinations or delusions, especially if the person has no awareness that their experiences are not based on external reality and is refusing treatment. For this workshop we hope to use a similar format based on the skills outlined by Xavier Amador in his book, “I’m Not Sick, I Don’t Need Help!”)
By structure, I refer to the characteristics of the facilitators, the format of the classes, and how the material is taught. The workshop is co-facilitated by 3 people who wear different hats, a professional therapist who also has lived experience as a close family member of someone with a mood disorder or BPD, a peer specialist or certified peer specialist in recovery from either bipolar disorder, borderline personality disorder or major depressive disorder, and a “family peer specialist” (a family member who has learned to use these skills and has received training to provide mentoring and peer support to workshop participants). Since the peer specialist usually has only one of the 3 disorders discussed in this workshop, we have 2-3 other peer specialists to discuss their lived experience with the other 2 disorders and also a person to discuss recovery from co-occurring mood disorder and substance abuse/addiction. This aspect of the workshop is meant to promote hope, through hearing people who are now doing well, tell the story of their recovery journey, and how they got from some very dark places to the place they are today, often reiterating that recovery is possible. It also promotes empathy and understanding for the experience of these disorders. On a recent workshop evaluation, one person responded to the question of what they found particularly helpful in the workshop by writing, “The presentations by the people in recovery. It is very helpful to hear what the experience is and what it feels like. It gives a frame of reference for dealing with our loved ones.” Another person said, “To see through the eyes of our loved ones, see them from the inside. It was very revealing.”
Since we primarily want workshop participants to have a greater sense of control and self-confidence (so they can feel less like being on a roller coaster), the focus of this workshop is skill-building - in the 4 “pillar skills” previously mentioned. Therefore the format for most classes (except first and last) includes explaining a skill (using Power Point slides/handouts), demonstrating it or giving examples of it, having participants do some role playing and also assigning homework to apply these skills to their lives. Homework is then processed in the next class. The professional therapist and peer specialist share the Power Point presentations and role play demonstrations, while the family peer specialist focuses on helping to make sure the participants are understand the material being taught by using personal examples or trying to draw out questions or concerns. We use well-respected, well-researched sources for the content of the skill presentations.
We measure outcomes, by asking participants to complete questionnaires before and after the workshop, asking how frequently they find themselves feeling certain ways (such as having hope or feeling compassion for their loved one) and using each of the skills discussed (such as self-awareness, self-regulation, self-care, validation, limit setting, responding to self-injury, suicide or potential violence). Over the years, the evidence from these questionnaires and workshop satisfaction surveys is telling us that this workshop is accomplishing our goal of helping people feel more hopeful and supported while also regaining a sense of control and self-confidence through skill-building. Here are some comments from the fall 2012 workshop:
“I feel like I have a second chance for another life, a good Life. I feel freer. Thank you!”
“Thank you very much for this class. It helped me be more aware of my daughter’s illness, increased my self-esteem and decreased my guilt.” “The details of tools to use were very helpful to me. The many tools have also helped me learn about myself as well as learning about others.”
Since people generally need more than a one-time training to continue to build new habits and skills, graduates are encouraged to attend a monthly evening group for continued support and refreshers on using the skills. They can also take advantage of one-on-one consultation by phone or face-to-face appointments.
Our “Getting Off the Emotional Roller Coaster” Family Skill-Building Workshop is offered in the spring and fall of each year at Belmont Center (4200 Monument Road in Philadelphia and possibly at a suburban location). After completing the workshop graduates can attend a monthly evening support group for continued support and as a skills refresher. Also available are consultations by phone or in person. To learn more or to get on the waiting list, contact us: e-mail firstname.lastname@example.org or call Mary Catherine Lowery at 267-507-3865.
Published in “The Compass: A Mental Health Magazine” by New Directions, March 2013