Do not attempt to teach new skills/information while patient is in the midst of an intense emotional outburst as patient's cognitive capacity may be reduced at this time.
Teach new skills when patient is calm. Emotional outbursts physiologically are time-limited.- During the outburst, use a calm tone and communicate in short, direct, specific statements. Expect that patient may need extra time to process information and that instructions may need to be repeated as diminished cognitive capacity may impact processing of information.
- When the outburst has ended, ensure that patient's immediate physiologic needs (i.e., rest, nutrition, hydration, elimination) are addressed before engaging in interventions to reduce and prevent future outbursts. Basic physiologic needs must be met for patient to be able to engage therapeutically.
- Teach patient about the social impact of patient's emotional outbursts as needed. Ask patient to identify at least one person, besides self, who has been impacted by emotional outbursts. Ask patient to identify at least one way patient has been impacted socially and one way patient has been impacted occupationally (i.e., work, school) by outbursts to promote insight and stimulate motivation to engage in strategies to limit outbursts.
- Use nonjudgmental, matter-of-fact language to promote self-esteem.
- Engage patient in discussion of how life would be different if patient had better control over emotional outbursts to foster motivation and engagement in care.
- Ask patient to decide at least one reason why patient wants to better control emotional expression to foster motivation and engagement in interventions, and to promote self-efficacy.
- Teach patient to practice awareness of bodily sensations to help learn the early signs of emotional arousal.
- Assist patient to make linkages between bodily sensations and emotional state. Teach strategies to decrease physiologic arousal to help the patient to limit unwanted emotional outbursts.
- Assist patient to identify environmental and situational triggers to physiologic arousal, and engage patient to create a plan to limit physiologic arousal to promote self-efficacy in proactive management of emotional outbursts.
- Promote self-esteem. Emphasize therapeutic gains made by patient and encourage nonjudgmental, realistic appraisal of therapeutic challenges. Higher self-esteem promotes cognitive self-regulatory capacity.
- Assist patient to identify and practice strategies to manage distressing/exciting situations and strong emotions. Use vicarious learning or role play exercises to practice plan of response to limit emotional outbursts. Practice of strategies in a safe and controlled environment develops skills in strategies and builds confidence to apply strategies in triggering situations.
- Involve patient in own care. Provide options and solicit feedback on patient's experience of care. Partnering with patient promotes self-efficacy and self-esteem and strengthens the therapeutic alliance.
- Solicit patient's thoughts and experience of bodily sensations during care. Reinforce and support use of adaptive coping strategies to limit emotional outbursts to help patient further develop awareness of signs and triggers and to promote use of strategies to limit/prevent outbursts.
- Communicate continuous nonjudgmental acceptance of the patient through verbal and meta-communication to strengthen the therapeutic alliance, promote self-esteem.
- Provide patient with specific, simple, step-by-step information on what to expect in care to reduce/prevent emotional arousal, communicate respect, and engage patient in care.
- Chunk information according to immediate care requirements, and provide updates as each stage of care ensues. Chunking information decreases cognitive stress and promotes retention.
Assist patient with referral to specialized resources in mindfulness, dialectical behavior therapy, and/or cognitive behavioral therapy as indicated in consultation with the interdisciplinary care team. Mindfulness improves attention and body awareness, and promotes cognitive control and attentional capability in situations of high emotion. Mindfulness, dialectical behavioral therapy, and cognitive behavior therapy each have applications for improving cognitive control and emotional dysregulation.
Suggested NIC Interventions