Inside Out- An Emotion Recognition & Processing Intervention

Thus far my blog has only had posts on my perspective on the spectrum or my "Perspectrum" if you will. Today is the day where you will hear about a music therapy interventions that I've developed to help kids figure out how they are feeling, what happened to make them feel that way, and what are some things that is in their control that they can do to fix the problem.

Emotions can be a really hard stimulus to deal with because it is your reaction to something that happens to you. When you can not figure out how to verbalize exactly how you feel because you do not know what you're feeling, it can be very overwhelming to anyone.

This intervention was inspired by Disney Pixar's movie Inside Out, which was released in summer of 2015. If you have not seen it yet I highly recommend it as it gives a very interesting insight to how the primary emotions function. The writers consulted with several psychologists who determined that the main emotions that a person has are Joy, Anger, Disgust, Sadness, and Fear. Of course this isn't all the feelings that someone can have. The more I thought about it the more I realized that the many different feelings that we can have branch off from the emotions depicted in the movie. To make my thought process more visual I have included a tree diagram.
                                  
So the primary emotion would be the colored word and the feeling would be the words underneath. Its not to say that you wouldn't be able to feel a colored emotion because you certainly could. This is just how I chose to categorize it based on the images I used for the visuals and the emotions I thought kids would be able to understand and verbalize easily.

I printed out visuals of the characters from the films from these websites and colored them in (yay for therapeutic adult coloring time!).
Joy: https://s-media-cache-ak0.pinimg.com/564x/fb/88/c7/fb88c7ad5b4d91b244b440e7fd63db0a.jpg
Sadness: http://www.colouring-page.org/sites/default/files/inside-out-coloring-pages-11.jpg
Anger: http://www.disneyclips.com/funstuff/imagestsgab8/insideout_anger_coloring.gif
Disgust: http://www.colouring-page.org/sites/default/files/inside-out-coloring-pages-03.jpg
Fear: http://mommyscene.com/images/blog/coloring-pages/disney-inside-out-fear-coloring-page.jpg

After I had colored them in I came up with the song and chord accompaniment and created my file folder.
                                      
                                      
Depending on what you're working on with the child you can adapt for many different uses and scaffold it until you are able to use the intervention for the original purpose.

The first tier of this intervention is to work on the ability to recognize the emotions. You can start with just having the client verbalize how each character is feeling in the picture.

Once the child has mastered the first tier of this intervention you can begin having them describe what that feeling means to them and what are some things that make them feel the same way as the character.

After this, you would have the child pick a character that they are identifying with that day and place it above the "I feel" part of the file folder. You can also show them visuals of the spelled out emotion if they are able to read to reinforce by matching the linguistic visual to the picture visual.
                                            
                                                                           
                                               
                                               
                                                
Once the client/child is able to accurately identify how they are feeling with he written linguistic aid combined with the picture visual, you can fade out the picture visual and just have them verbalize the linguistic visual. The way I created my written words was scaffolded as well, I had words that were in the colors that matched the characters so it would be easy to identify and match the word to the pictures and I also created written visuals of the word in black that could be used as the child became more successful at identifying and verbalizing the correct emotion.

When the child can successfully tell you how they are feeling you can move to asking them why they are feeling that way and what happened to make them feel that way. Using the opposite side of the folder.

If they are able to do so, ask them to identify what they can do next time if something happens that makes them feel mad or upset. Obviously if the child says that they feel happy or another "yellow" emotion you don't want to ask them what they can do differently but you can ask them to verbalize why they are feeling happy and what they can do to show others that they feel happy and share the happy feeling. You can even have the child choose instruments and play how they are feeling. If you are working with a group you can have the others try to guess what feeling the child was playing.

I think there are a lot of possibilities you have available to you with this intervention to help a child practice recognizing and validating their own emotions as well as others. Please feel free to use this in your own sessions/interactions with children and let me know if you are successful or if you have any thoughts on how to expand upon it!

"Music speaks what cannot be expressed, soothes the mind and gives it rest, heals the heart and makes it whole, flows from heaven to the soul."

The Sensory Brain and Music

In my last post, I talked about how emotional processing can be experienced differently by those on the spectrum especially in times of intense emotional happenings. I compared the fluctuation of emotions to sliders on a  soundboard. The same could be held true for other sensory input.

At any given moment in time there is sensory stimuli going into our brains. When a dog goes by us as we walk down the side walk we get visual, auditory, olfactory, and possibly vestibular stimuli as we orient where we are compared to the dog and if we need to stay calm or prepare for a battle. This is also known as the flight or fight response.

A neurotypical individual will quickly process and filter out unimportant information (e.g. a cat walking by, the hum of the air conditioner or computer, etc.) and won't pay attention to it. An individual on the spectrum however may be overwhelmed by something a neurotypical would simply brush off and be unable to function because of it, especially if it is a new situation or input to process.

Each individual takes in information differently both NTs and those with ASD. This is sometimes referred to as your learning style ("I'm a visual learner"etc). I have noticed both in myself and in my work with those on the spectrum that if we are overstimulated by anything in our environment and our system is on a heightened state there is a response or feedback. This brings me back to my soundboard analogy. When a microphone level (sensory intake) is too high (overstimulation) there is feedback (responses) and the speakers (persons body) react (behaviors) accordingly, i.e. squeal.

The more that I've learned, read, and interacted with others on the spectrum the more I have learned about myself and what I need to do to adapt to my environment and function successfully. For example my sensory soundboard would look something like this.

                                                
I put the stimuli that I find myself reacting more frequently as the higher levels because I'm more sensitive to them and notice changes about them first. The stimuli I pay less attention to I put at the lower levels because I am more likely to ignore those when taking in my environment. When I was younger I was more sensitive to specific sounds and would have outbursts when those sounds were present. I would be getting ready for school with my sister and she would be chewing too loudly so I would scream at her "STOP CHEWING." I've developed more ways to deal with hearing adverse sounds however if there is an unpleasant sound in my environment and I have the opportunity to escape I do so promptly. I also have noticed that I have a very keen sense of smell and have some negative reactions to smells that I do not like. I ABSOLUTELY HATE BANANAS, everything about them but especially the smell. I can not be in the same room as someone who is eating a banana, or has put a banana peel in the trash can. I get very overloaded by the smell and have not been able to find a way to adapt to this, I'm not sure if I ever would because I've been that way for as long as I can remember.

It is important for individuals, both NT and ASD, to become less reactive to certain stimuli and develop ways to cope when they are over stimulated. Music therapy can be used to introduce an individual to new sensory stimuli in a non-threatening environment. Exposure and practice with various sorts of sensory stimuli can help organize the brain and prepare it for higher level learning and let information get past the brainstem into higher cortices to develop language, cognitive, motor, and emotional processing skills. While I never had formal music therapy services growing up I know that being involved with music helped me overcome several sensory deficits that I had growing up. I am very excited to be able to use the musical skills that helped me improve so much to help others who are still struggling in their daily lives.

Death, Grief, and the Spectrum

The stereotype of those on the Autism spectrum is that there is an emotional disconnect from others around them. This could make it especially difficult for those individuals to develop friendships, romantic relationships, understand grief after death. The second of those generalizations is true to me, resulting in many unsuccessful attempts at online dating (I do not recommend it at all).

Recently I was talking with a guy from a site who was demonstrating behaviors that looked as if he would be emotionally abusive if I were to begin a relationship with him, this was only after 3 days of talking to this guy. As I was telling him that I no longer wished to speak with him, my father called but I was in the middle of a text message so I ignored it. When I was finished I called him back to see what he needed (most of the time my dad pocket dials a lot...not entirely sure how he does it on an iPhone but thats besides the point). 

He asked me how my day went and then began to say "I have some bad news to tell you." Of course I immediately thought one of my dogs had gotten out and was dead. This was almost as, if not more worse. 

The first experience with death of a close loved one was when I was in the 5th grade and my grandfather lost his battle with cancer. This was before my diagnosis of Asperger's so I didn't cry as much hearing the news as my younger siblings did. I did cry at the funeral, but not very long. When I was younger, our dog Murphy had gotten out and was killed by the neighbor kid speeding down the street to get to school, I cried for days after that and got over it relatively quick when we fostered liters of puppies that summer. 

What my dad said stunned me beyond belief, having taken psychology courses I of course recognized the shock and felt the sympathetic nervous system kick in with pins and needles. My uncle had suddenly lost his battle to cancer. I kept saying "You're kidding me right" and he went on to explain to me that he had heard from my other uncle (I have a large Catholic family) had called him earlier. 

One of my biggest struggles is trying to figure out how I truly feel. There is such a broad range of ways to feel and most of the time I'm pretty neutral, I might say I feel happy, but in reality I'm not really feeling anything but just neutral. Shortly after my father told me my uncle had passed so many neurons were firing that I could not figure out what I was feeling, if what I was feeling was a valid emotion (as it had been so long since I had experienced a close death), and what to do about it. I cried briefly and hung up the phone to resume cooking my dinner. I went to my room and the reality sunk in further, my uncle, the one who would enter the room and say "Who's ready to let me love on them" was no longer alive. 

Earlier that day I had finished making a visual aid for clients using the characters from Pixar's film Inside Out and had several different emotions that could be related to each face. I tried to sort out how I was feeling but was unsuccessful. I went for a jog, called my sister and my best friend to try and talk through these feelings. I still couldn't label what I was feeling or why I was feeling that way. 

I suppose a lucky thing about having therapists as friends is that they will help you process as best they can but still be your friend in the end of things. In my emotional overload I said several things to my friend that I immediately regretted after hanging up knowing that because of the state I was in I had no filter. This increased the activity in my amygdala, I could feel the neurons in my limbic system firing and I wanted it to stop. I started crying uncontrollably until I fell asleep. 

If you've ever cried yourself to sleep, you know that it is not a pleasant sleep cycle because you are mostly in a-wave sleep having dreams about the things you're upset about and waking up from it is never pleasant. This held true for me. When I woke up I realized again, my loving, sweet, caring uncle was gone and started crying again. I went back to my visual board to pick out emotions that I was feeling in that moment. 

Sad: Obviously I was sad because I was crying, but besides the fact that I had lost my uncle I felt sad for my aunt, my three young cousins who would now grow up without their father, my dad, my other uncles and aunts, my other cousins, and my grandparents. No parent should ever have to bury their child. 

Upset: I was upset at the situation and myself. I know that I normally do not feel many emotions at all and for me to be feeling so many at one time made me feel very uncomfortable because I couldn't process anything. 

Afraid: I was surprised when I had picked this one but looking back I can see why. While every family has different viewpoints they are still family. I felt afraid because I was concerned that I would not be able to see my young cousins again at family vacations. I hope that even though their dad is gone, their mother will not exclude them from being part of family gatherings. They bring me such joy and inspiration. I swear they have more musical talent than I did at that age, the oldest has and can play every recorder made and has such an incredible ear for music it enlightens me. 

Confused: I was confused by all the emotions going on and not being able to process them at the same time. I felt overstimulated and out of control because I did not know what was going on and what I could do about it (when in reality there wasn't a whole lot I could do about it). I was also confused that my dad (who is also on the spectrum) wasn't feeling as many emotions as I was. 

Frustrated: In times of crisis I want to do things to help. I am more productive and focused on what is happening so obviously I felt frustrated that there was nothing I could do for my uncles family. I was frustrated that people kept telling me "Theres nothing you can do but give them space and pray." I was reading an article in Psychology Today  and a quote resounded with me rather strongly "It was logical to me to be as armed as possible with information so I could help." However in this situation not even my tools as a music therapist would be able to help because I knew that no one would want it. 

Angry: I also felt angry at the situation and the fact that I didn't reach out to my uncle more often, obviously he and his family know that I love them and care about them but I didn't make the effort to tell him that more frequently. It makes me realize that you need to tell the people that you love that you love them every day because the next day they may not be here.  I felt angry that God would give  a man so spiritual and loving such a terrible disease and then take him away from a family who loves him. I felt angry that there is not more research going on about cancer, then I felt angry about the lack of funding for music therapy services which, can be so beneficial to those going through emotional pain. 

Sick: Because I was crying so much and so upset I was feeling sick to my stomach and hardly ate anything. 

For me emotions are like a light switch on a switchboard they are either on or off. When they are turned on it is very obvious. This is both advantageous and detrimental at times. For example, one time I had to perform CPR on a man and I was able to remain calm and keep the mans heart beating through chest compressions and he came to. There was a task to be done and I had the skills to complete it. When I am overcome by emotion I turn in to Captain Kirk and have explosions of that emotion in spurts, sort of like a child playing with the light dimmer. Yet at other times my calmness can be deceptive because I am really experiencing an emotional overload and like a pot of water on the stove its bound to overflow and come out all at once. 

To make things more complicated I not only have to try and figure out what I'm feeling but also try and respect the space of others in my family. Even though I've gotten better at empathy, it is still a major area of struggle for me. For example, I want to make a slide show of pictures of my uncle and put it to a cover of a hymn or original melody (a technique sometimes used in hospice music therapy). However I was told to not email my family members requesting for picture for at least another week. I don't understand why it would be inappropriate to request pictures so that I can move forward in my bereavement process, but apparently it would be. 

This is event is still very fresh and it will undoubtedly take sometime before I accept the fact my uncle is gone. However I don't think there is any "to do list" on how to grieve or process the death of a loved one for neurotypical or those on the spectrum because each person goes through it differently and finds what works to help them cope. I do think though that it is more challenging for those on the spectrum to be able to tag and process the emotions they are feeling because there are so many. This could make it much harder for someone with ASD to go through the "stages of grief" thus increasing the amount of time it takes to get over the death of a loved one. 

John 14:1-4 

Welcome!

Congratulations! You have stumbled across this blog-Achievement Unlocked, KNOWLEDGE!

I suppose that I should describe why I think I am credible to provide information to you the reader of this blog. I am currently a music therapy intern having recently finished my coursework in music therapy at the University of Kansas (ROCK CHALK JAYHAWK!). I am doing my internship with Autism Spectrum Disorders. Additionally, I was formally diagnosed with Asperger's Syndrome/PDD-NOS when I was in the 8th grade. My whole childhood I grew up knowing that I was different and I never fully understood why and what I did to make people not want to be my friend. Through years of being in band, therapy sessions, and retraining myself I have come closer to being "neurotypical," however I Autism will always be a part of who I am.

The "purpose" of this blog is to give my personal insight about what it was like growing up for so long without a diagnosis, living with Asperger's as an adult, and to provide some ideas I've come up with for music therapy interventions.

Thanks for stopping by and if you have any suggestions or specific things you want to hear about let me know!