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Journal of Emotional and Behavioral Disorders
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Offers interdisciplinary research, practice, and commentary related to individuals with emotional and behavioral disabilities. Each issue explores critical and diverse topics such as youth violence, functional assessment, school-wide discipline, mental health services, positive behavior supports, and educational strategies. Journal of Emotional and Behavioral Disorders is available electronically on SAGE Journals Online at http://journals.sagepub.com/home/ebx . Submit to JEBD
The Journal of Emotional and Behavioral Disorders publishes quality scholarship related to individuals with emotional and behavioral disorders. Articles represent a wide range of disciplines, including counseling, education, early childhood care, juvenile corrections, mental health, psychiatry, psychology, public health, rehabilitation, social work, and special education. Articles on characteristics, assessment, prevention, intervention, treatment, legal or policy issues, and evaluation are welcome.
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- v.16(1); Jan-Feb 2022
The Importance of Emotional Regulation in Mental Health
Mental health is a critical component of overall well-being and exists on a continuum much like physical health. Although many ways to assess mental health exist outside of either having a disorder or not, practitioners often rely on the presence or absence of symptomatology. The assessment and promotion of emotional regulation in patients is one way to encourage individuals to engage in mental health-promoting behaviors. Specific techniques are discussed that address emotional regulation. Overall, providing patients with the tools to regulate emotional responding will likely have a direct impact on well-being as well as reduce MH symptomology.
“Instead of intervening when a diagnosis is given, practitioners can help individuals to have improved MH and to decrease the likelihood of disorders.”
Introduction
The field of lifestyle medicine posits that well-being rests on 6 behavioral pillars representing diet, exercise, sleep, substance use, stress, and relational skills. 1 Mental health (MH) status influences the extent to which individuals are able to adopt health-promoting behaviors within each pillar, and conversely, practicing health-promoting behaviors will influence MH status. 2 This bidirectionality highlights the role of MH as a fundamental change agent in meeting lifestyle goals. Further, given that 27% of patients from a variety of medical outpatient clinics have clinical or subthreshold diagnoses of depression 3 and 6% of primary care patients have anxiety or subthreshold anxiety disorders, 4 strategies to promote MH may enhance the ability of lifestyle medicine practitioners to facilitate positive behavior change among many of their patients.
Thus far, the field of lifestyle medicine has not sufficiently addressed the relationship between health-promoting behaviors and MH. Merlo and Vela (2021, this issue) have issued a call to action for lifestyle medicine researchers and practitioners to integrate existing MH conceptual models with the lifestyle medicine framework in service of delivering innovative integrated lifestyle medicine interventions. In this paper, we propose a transdiagnostic, self-regulatory concept (i.e., emotion regulation) and accompanying evidence-based change strategies that may facilitate the lifestyle medicine approach to promote mental and physical health.
Self-regulatory processes include executive functions (e.g., goal setting and monitoring), cognitions (e.g., self-appraisals and self-efficacy), and emotional responding to internal and external stressors (e.g., inhibition, control, and expression). 5 Behavior and emotion are linked. 6 Emotion regulation requires metacognitive awareness of one’s current emotional state and involves implementation of effective problem solving or acceptance/coping strategies. Emotional dys regulation exists along a continuum from extreme emotional control to the complete inability to regulate responses. Emotional dysregulation is a transdiagnostic symptom of several MH problems, including anxiety, substance use, eating pathology, and depression, and may derail attempts to adopt health-promoting behaviors. Consequently, learning to regulate emotional responding to internal and external stressors will likely have a direct impact on quality of life and well-being as well as reduce MH symptomology. In this commentary, we will review 2 behavioral, psychotherapy models as well as introduce cross-cutting interventions for use with patients.
Notable Practices for Skill Development in Emotion Regulation
Acceptance and Commitment Therapy (ACT ). 7 , 8 The ACT approach focuses on creating a quality of life that embraces the inevitable pain that goes with living a meaningful life. 9 ACT encourages patients to (1) accept internal events (e.g., effectively managing painful thoughts and difficult emotions without avoidance) and (2) clarify and define personally held values, which form the foundation for goal setting and behavior change. Behavior change is possible through psychological flexibility, or the ability to be present in the moment, accept lived experiences with openness, and take value-guided actions to do what matters. When working with patients, providers may notice psychological inflexibility in those who have limited self-awareness or who spend too much of their energies on the past (depression) or future (anxiety). 10 ACT encourages providers and patients to non-judgmentally examine “unworkable actions” and the lack of congruency between values and actions with curiosity and mindfulness to overcome resistance and to clarify motivation for change. Evidence supports the use of ACT with pain, anxiety, chronic pain, patients facing disability, and similar medical conditions. 11
Dialectical Behavior Therapy (DBT). DBT is a biopsychosocial, cognitive-behavioral intervention originally designed for the treatment of borderline personality disorder, but recent evidence suggests effectiveness with anxiety, 12 alcohol misuse, 13 and eating pathology. 14 , 15 DBT focuses on developing skills to cope with difficulties in emotion regulation, both over control and lack of control. DBT posits a theory of emotion dysregulation that includes an emotional vulnerability to internal and external stressors and an inability, even when giving a best effort, to self-soothe or regulate intense emotional arousal or nonverbal and verbal expressive emotional responses. In addition, some individuals struggle with a slow return to emotional baseline following intense responses. DBT incorporates skills for increased distress tolerance, interpersonal effectiveness, and impulse control. 16 Patients are introduced to a “WISE mind” concept, which refers to the balancing of both emotions and reason in reacting to situations that stimulate intense emotional arousal. Collaborating with patients to build coping skills without intense emotional arousal will increase their abilities to meet their lifestyle goals.
Cross-Cutting Skills for Emotion Regulation
Mindfulness practices. Mindfulness is a cross-cutting technique of DBT and ACT, among other interventions, and is best described as the practice of intense focus and concentration on one’s immediate situation with curiosity and acceptance rather than judgment and avoidance. 17 , 18 It involves present-centered awareness of sensory sensations (e.g., sight, smell, and touch) while experiencing the flow of one’s inner thoughts and emotions as an outside non-judgmental observer. Mindfulness increases awareness and tolerance of, and reduces reactivity to, emotional experiences. 19 A mindful approach to life may be cultivated with regular mindful meditation practice. Patients may experience emotion regulation benefits with as little as 5-10 minutes of daily mindful meditation practice per day. 20 During mindful meditation, the patient may experience mindfulness by anchoring attention on their involuntary breathing while sitting or lying comfortably without distractions. During this practice, the patient may focus on the sensation of the breath moving in and out of their lungs, and when their mind wanders, they can gently return focus to their breath. With the continued practice of returning attention to the breath, the ability to be mindful strengthens, and overall MH improves.
Behavioral activation is another cross-cutting emotion regulation practice that can be easily introduced to patients for a variety of MH concerns. It is well established that healthy lifestyle behaviors like exercise, good sleep, hygiene, participation in pleasurable activities, mastering skills, and spending time with friends/family elevates mood. 21 , 22 Overcoming the lethargy and inertia of depressed mood and paralyzing anxiety to engage in one or more of these behaviors helps to reverse the downward cycle into depression and anxiety. 21 , 22 Behavioral activation is a systematic process of identifying mood-elevating behavioral goals and outlining a plan to overcome obstacles and achieve those goals.
Integrated MH and Primary Care
Over the past decade, research has shown there are numerous healthcare benefits to patients when MH care services are co-located within the primary care setting. The Primary Care Mental Health Integration (PCMHI) model utilizes MH professionals for intermittent or time-limited, brief interventions, typically lasting 1 to 6 sessions. 23 The largest medical network in the US, the Veterans Health Administration, has adopted the PCMHI model across the US with positive satisfaction from Veterans, primary care providers, and MH professionals within those services. 24 , 25 Community practitioners without MH integration can encourage their patients to use internet-based programs and mobile phone apps. 26 For new onset or mild depression or anxiety, practitioners can refer patients to self-guided, internet-based ACT or DBT programs as effective options. 27 , 28
Conclusions
In lifestyle medicine, physical health is often viewed in terms of a continuum. Instead of dichotomizing individuals into “healthy” and “sick” categories, professionals understand well that certain characteristics lead to improved health, whereas others increase the likelihood of disease. It is important that we have a similar view of MH. Instead of intervening when a diagnosis is given, practitioners can help individuals to have improved MH and to decrease the likelihood of disorders. For example, assessing and encouraging steps to improve emotional regulation and helping clients to increase awareness of and tolerance for emotional reactivity can be extremely beneficial to improving both quality of life and decreasing the risk of symptoms reaching clinical levels. Although barriers to addressing MH in an integrated way are evident, the routine engagement of patients around factors that promote improved MH is critical in providing care that addresses the holistic health of our patients.
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work is a publication of the Department of Health and Human Performance, University of Houston (Houston, TX) and the Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. The views expressed are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.
Impact Feature Issue on Fostering Success in School and Beyond for Students with Emotional/Behavioral Disorders
Students with emotional/behavioral disorders: promoting positive outcomes.
Camilla A. Lehr is a research associate with the Institute on Community Integration, University of Minnesota, Minneapolis.
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Public schools are designed to provide instructional programs that foster the educational success of all students and shape citizens who can contribute in positive ways to society. Working to promote successful school experiences for students with emotional/behavioral disorders (EBD) can be a particularly challenging task because of the necessity for multi-faceted and cohesive programming to effectively meet multiple needs.
Identification of Students with Emotional or Behavioral Disorders
An emotional/behavioral disorder can be described in the following way:
- Emotional or Behavioral Disorder (EBD) refers to a condition in which behavioral or emotional responses of an individual in school are so different from his/her generally accepted, age appropriate, ethnic or cultural norms that they adversely affect performance in such areas as self care, social relationships, personal adjustment, academic progress, classroom behavior, or work adjustment.
- EBD is more than a transient, expected response to stressors in the child’s or youth’s environment and would persist even with individualized interventions, such as feedback to the individual, consultation with parents or families, and/or modification of the educational environment.
- The eligibility decision [for special education services] must be based on multiple sources of data about the individual’s behavioral or emotional functioning. EBD must be exhibited in at least two different settings, at least one of which is school related.
- EBD can co-exist with other [disabling] conditions.
- This category may include children or youth with schizophrenia, affective disorders, anxiety disorders, or who have other sustained disturbances of conduct, attention, or adjustment.(National Association of School Psychologists, 2004, p. 1)
Information from the Twenty-fourth Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act (IDEA) (U.S. Department of Education, 2002) indicates that states served 5,775,722 students ages 6 through 21 under IDEA in 2000-2001. Nearly 474,000, or about 18%, of those students were identified as students with EBD. This is less than 1% of the entire student population in 2000-2001. The Report of the Surgeon General’s Conference on Children’s Mental Health (U.S. Public Health Service, 2000) proposes the actual number of students with EBD is much higher. This suggests that many of the children and youth who could qualify for service under IDEA may not be identified and may not receive adequate supports to assist them with emotional and behavioral challenges they face both in and out of school settings.
On the other hand, we find that children and youth who are African American are disproportionately over-identified as having EBD. Many concerns have been expressed about minority children being misplaced in special education, especially in certain disability categories. Researchers have determined the level of risk for various subgroups associated with being identified as having EBD. Using data from the U.S. Department of Education, analyses suggest that Black children are 2.88 times more likely than White children to be labeled as having mental retardation and 1.92 times more likely to be labeled as having an emotional/behavioral disorder (Losen & Orfield, 2002). Although students with disabilities are entitled to receive supports and services tied to their individual needs, the concern is that too often minority students are educated in separate settings, subject to lower expectations, and excluded from educational opportunities. While minority populations are often at greater risk of living in poverty, many individuals argue that the effect of poverty does not adequately explain the racial disparities in identification of EBD. Research suggests that unconscious racial bias, stereotypes, inequitable implementation of discipline policies, and practices that are not culturally responsive may contribute to the observed patterns of identification and placement for many minority students.
School and Post-School Outcomes
Much of what we know about students with EBD has been gathered through the National Longitudinal Transition Study (NLTS). This study collected data on the lives of youth with disabilities in their high school years and in their transition to adulthood during the early 1990s (Wagner et al., 1991). Overall, outcomes for youth with EBD were found to be “particularly troubling.” These youth showed a pattern of disconnectedness from school, academic failure, poor social adjustment, and involvement with the criminal justice system. Data from the Office of Special Education Programs shows that youth with EBD are at greatest risk of dropping out of school as compared with students in other disability categories; in 1999-2000, 51% of students with EBD age 14 and older dropped out of school (U.S. Department of Education, 2002). Furthermore, we know that as a group, a higher percentage of these youth are incarcerated or are not employed as compared to other students with disabilities after high school.
Instructional Settings
Where are students with EBD served? In general, they experience general educational instruction to a lesser degree than youth with disabilities as a whole. On average, 16% of youth with EBD take all of their courses in special education settings (compared with 9% of youth with disabilities as a whole who take only special education courses). Many also attend alternative schools, which are generally designed to serve students placed at risk of school failure due to circumstance or ability (e.g., behind in credits, suspended, pregnant or parenting). In addition to these settings, a high proportion of youth who are incarcerated have disabilities. One conservative estimate suggests that about 32% of youth in juvenile corrections have disabilities (Quinn, Rutherford, & Leone, 2001). Nearly 46% of the incarcerated youth with a disability were identified as having EBD. Most often, the transition back into the traditional school setting for these students is unsuccessful, and they go elsewhere (e.g., alternative schools, back into juvenile corrections, or drop out altogether).
Risk Factors Contributing to Student Outcomes
Findings from the current National Longitudinal Transition Study – 2 (NLTS2) suggest that students with EBD differ from the general population of youth in ways other than their disability (Wagner & Cameto, 2004). For example, as compared with the general population of youth, youth with EBD are more likely to live in poverty, have a head of household with no formal education past high school, and live in a single parent household. Nearly 38% of the NLTS-2 sample had been held back a grade, 75% had been suspended or expelled at least once, and about two- thirds were reported to have co-occurring attention deficit/hyperactivity disorder (ADHD). Students with EBD also experience greater school mobility than other youth with disabilities; 40% had attended five or more schools since kindergarten. Moving to multiple schools can be considerably disruptive and significantly decrease the chances of continuity across instructional programs. In addition, frequent moves increase the difficulties associated with establishing positive long-term relationships with adults and peers, and can heighten feelings of alienation and limit the sense of belonging.
Shifting From Deficits to Strengths
We know quite a bit about students with EBD (e.g., characteristics, numbers, factors placing them at increased risk of school failure, where they are served, outcomes). Fortunately, we also know much about effective strategies that we can use with these students to improve their success in school and after they leave school. Shifting from a deficit model that focuses on multiple risk factors and moving toward a focus on strengths is a difficult, yet necessary, step for those who hope to foster resilience, enhance competence, and facilitate successful school experiences for students with EBD.
Beginning with a Solid Foundation
With the move toward greater inclusion and providing instruction in the general education curriculum, there is an increased need for general education teachers to be well-informed about how to effectively educate students with EBD. It is essential for teacher education programs to train general educators to work with the increasingly diverse populations in their classrooms (including students with varying disabilities, abilities, socioeconomic standing, and cultural backgrounds). Necessary skills include the ability to actively engage students in coursework that is relevant to student backgrounds and interests, effectively organize a classroom environment, and manage student behavior using strategies that are evidence based (e.g., techniques to increase active student responding, small group or peer tutoring, applied principles of reinforcement, use of immediate feedback). In addition, opportunities for staff development must be provided on a regular basis to update and maintain skills.
Providing Supports at Varying Levels: The Three-Tiered Model
Students with or at risk for EBD can be provided with supports at a variety of levels. A three-tiered model that provides a framework for thinking about the provision of supports includes prevention at the primary, secondary, and tertiary levels (Sugai & Horner, 2002):
- Primary prevention. Includes strategies and programs that are designed to prevent the development of problems, target all students, provide students and school staff with a strong foundation for teaching appropriate behaviors, and have a low cost per individual. Examples include school-wide positive behavioral supports, school climate improvement projects, and collaboration between family, school and community.
- Secondary prevention. Includes programs that decrease the frequency or intensity of problems, are designed to address alterable factors that place students at risk (e.g., angry or violent behavior), and have a moderate cost per individual. About 10-15% of students may need more intensive supports at this level. Examples include conflict-resolution lessons, peer-tutoring programs, and social-skills instruction.
- Tertiary prevention. Includes programs designed to remediate established problems, reduce the duration, and preclude negative outcomes. Programs are highly individualized and student centered, provide an effective and efficient response to students most in need, and have a higher cost per individual. About 1-5% of students will have chronic problems that require more intensive supports. Examples include wrap-around services, individual functional behavior analysis, and individualized behavior management plans.
Educators and administrators at elementary, middle, and high schools can use this model to guide prevention and intervention efforts.
Building Competence Across Domains
In addition to offering interventions across different levels, interventions must address relevant domains of competence for students with EBD. Effective interventions not only prevent problems, but also assist in building skills and competencies. Skill areas and examples of interventions especially relevant to students with EBD are listed below:
- Academic. Using effective strategies to promote academic achievement, including explicit and systematic instruction in reading; using alternatives to out-of-school suspension to increase opportunities for learning.
- Social/behavioral. Implementing school-wide social development programs; using functional behavior assessment to understand and change behavior.
- Emotional. Implementing school-wide and individual strategies to promote mental health; providing instruction and opportunities for self-advocacy, counseling.
- Vocational. Providing access to vocational assessments; providing relevant opportunities to learn outside of school (e.g., work programs, extracurricular opportunities).
- Transition. Providing mentoring supports to facilitate transition and adjustment to school; using orientation and welcoming procedures to ease transition between schools; incorporating self-determination skills for transition from school to work.
Complex problems such as facilitating success for students with EBD are rarely solved with simple, uni-dimensional strategies. One issue critical to the selection and program planning process involves examining the resources available for program implementation. Sustained, cohesive programming is essential, in contrast to offering isolated programs that do not reach out to include collaborative efforts with others throughout the school, or with parents and community members. Students with EBD have many strengths, and their teachers are talented individuals. Nonetheless, effective, cohesive, programming is necessary and presents specific challenges that require understanding the issues faced by students with EBD, advanced skills in program implementation, and a comprehensive approach that is cohesive, multi-faceted, and multi-tiered.
Losen, D. J., & Orfield, G. (2002). Racial inequity in special education . Cambridge, MA: Harvard Education Publishing Group.
National Association of School Psychologists . (2004). Position statement on students with emotional and behavioral disorders . Retrieved from http://www.nasponline.org/about_nasp/pospaper_sebd.aspx .
Quinn, M. M., Rutherford, R. B., & Leone, P. E. (2001). Students with disabilities in correctional facilities. ERIC EC Digest #E621 . Arlington, VA: ERIC Clearinghouse on Disabilities and Gifted Education.
Sugai, G., & Horner, R. H. (2002). Introduction to the special series on positive behavior support in schools. Journal of Emotional & Behavioral Disorders , 10 (3), 130–135.
U.S. Department of Education. (2002). Twenty-fourth annual report to Congress on the implementation of the Individuals with Disabilities Education Act (IDEA) Washington, D.C.: Author.
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Wagner, M., & Cameto, R. (2004). The characteristics, experiences, and outcomes of youth with emotional disturbances. NLTS-2 Data Brief , 3 (2).
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A scoping review on effective measurements of emotional responses in teamwork contexts
- Published: 27 June 2024
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- Xiaoshan Huang ORCID: orcid.org/0000-0002-2853-7219 1 &
- Susanne P. Lajoie 1
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Effective collaboration within teams relies significantly on emotion regulation, a process vital for managing and navigating emotional responses. Various methods have been employed to measure emotional responses in team contexts, including self-report questionnaires, behavioral coding, and physiological measures. This review paper aims to summarize studies conducted in teamwork contexts that measured team members' emotional responses, with a particular focus on the methods used. The findings from these studies can lead to identification of emotion regulation strategies and can lead to effective interventions to improve team performance in future. The core question guiding this review is: What are effective measures in capturing individuals' emotional responses in team dynamics? Using a scoping review, the study aims to answer three research questions (RQs): 1: What was the distribution over time of the studies that examined team members’ emotional responses and/or regulation of emotions in team dynamic? 2: What type(s) of data were collected, and what are the theories used in these studies? 3: What are the advantages and challenges of each type of measurement on emotional responses in team dynamics? The synthesis of the findings suggests that multimodal data, combining various measures such as physiological data, observations, and self-reports, offer a promising approach to capturing emotions in teamwork contexts. Furthermore, combining multimodal data can benefit capturing individual and inter-personal regulation, including self-, co-, and social emotion regulation in teamwork. This paper highlights the importance of integrating multiple measurement methods and provides insights into the advantages and challenges associated with each approach.
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We would like to express my sincere gratitude to Dr. Jason M. Harley and Dr. Adam K. Dubé for their invaluable contributions and insightful feedback during the development of the first draft of this article.
This work is supported by the Fonds de recherche du Québec – Société et culture (FRQSC) awarded to Xiaoshasn Huang and the Social Sciences and Humanities Research Council of Canada (SSHRC) under the grant number of 895–2011-1006. Any opinions, findings, and conclusions or recommendations expressed in this paper, however, are those of the authors and do not necessarily reflect the views of the FRQSC and the SSHRC.
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Xiaoshan Huang is a PhD candidate in the Department of Educational and Counselling Psychology (ECP) at McGill University, and a member of the ATLAS (Advanced Technologies for Learning in Authentic Settings) Lab. Her areas of research interests include investigating learners’ cognition, motivation, and emotion regulation in both academia and the workplace using intelligent tutoring systems, as well as socially shared regulation in collaborative learning.
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Huang, X., Lajoie, S.P. A scoping review on effective measurements of emotional responses in teamwork contexts. Curr Psychol (2024). https://doi.org/10.1007/s12144-024-06235-7
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Emotional and behavioral disorders are perceived to be as potential causes of disciplinary problems in the classroom. The main interest of the study is the EBD and achievements of the first ...
Research on the Academic Status of Children with Emotional and Behavioral Disorders: A Review of the Literature From 1961 to 2000 Alexandra L. Trout , Philip D. Nordness , […] , Corey D. Pierce , and Michael H. Epstein +1 -1 View all authors and affiliations
Effective collaboration within teams relies significantly on emotion regulation, a process vital for managing and navigating emotional responses. Various methods have been employed to measure emotional responses in team contexts, including self-report questionnaires, behavioral coding, and physiological measures. This review paper aims to summarize studies conducted in teamwork contexts that ...
The formal beauty of "objects" is the main focus of modern rural landscapes, ignoring human interaction with the environment and the emotional reflection in this behavioral process. It is unable to satisfy the emotional needs of younger people who aspire to a high-quality life in the rural environment. The research idea of this paper is 'first assessment—then design—then validation ...
A survey of 323 research studies in behavioral disorders/emotional disturbance was conducted to determine the nature and prevalence of the behavioral disorders/emotional disturbance identification criteria used to select subjects. Five categories of behavioral disorders emotional disturbance were found.