Many young people who become clients of youth AOD services or associated service systems (child protection, youth justice, mental health, homelessness) experience overwhelming emotions and can benefit from learning how they can be better regulated.

Emotion dysregulation (see Box 1)
Emotion dysregulation (a serious problem with regulation) involves the experience of overwhelming emotions that interfere with the ability of the person to function well and work towards their life goals. Some of the forms that this takes include:

• Persistent suicidal ideation and suicide attempts;
• A tendency to anger quickly, and for anger to escalate into verbal abuse or violence towards others;
• Frequent and severe irritability associated with blaming behaviour that damages relationships;
• Painful agitation that can trigger substance use or self-harm;
• Self-criticism and self-hatred that may escalate into self destructive behaviours; and
• Anger, fear or anxiety that leads to manipulation of others.

Behaviours such as violence, blaming, substance misuse, suicide attempts, self-harm, and manipulation of others are associated with efforts to reduce overwhelming emotions, but they are not effective in the long term. Rather, these behaviours damage the ability of the young person to form and maintain positive relationships with others. These behaviours also frequently interfere with the ability of the young person to engage effectively with services that could assist them with substance use and other health issues.

The psychological process involved in emotion dysregulation has been explained in terms of primary emotions and secondary emotions (McKay, Wood, & Brantley, 2007).

• Primary emotions are basic initial reactions that come on very quickly and don’t involve any thinking.
• Secondary emotions are reactions to the primary emotions.

For example if someone bumps into us and we nearly fall over we may immediately feel surprise and fear. Anger may be an alternative primary emotion for some people. An initial behavioural response may be to lash out, call the person an idiot and hit them. Then later a feeling of guilt and regret may come. This is a secondary emotion. A behavioural response for some people may be to cut themselves, leading to temporary relief, followed by further guilt and shame.

It is possible for a primary emotional reaction to set off a limitless chain reaction of distressing secondary emotions interspersed with a series of undesirable behavioural responses.

Emotion regulation skills are mostly aimed at preventing or circumventing these chain reactions driven by distressing secondary emotions.