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by Nel Walker

No classes or tutorials are ever offered for handling emotions, yet it is something that is absolutely vital to our well being; our health, our sense of self and all our relationships depend upon it. We suffer if others close to us have problems themselves with it. Deficit in the area of affect/emotion regulation is a large factor in many, if not most, relationship problems, in violent behaviour towards self and others, phobias, addictive behaviour and depression. Affect/emotion regulation skills normally develop naturally within a good enough attachment relationship with the primary caregiver in the child’s earliest two to three years of life, and as healthy brain development unfolds. Other factors are: genetics (inheritance sets the thresholds for affects) and the child’s socio-emotional history from 3-4 years until adolescence. The person fortunate enough to have developed affect regulation skills in good enough measure is not usually aware of this valuable skill but often puzzled by others who have not been so fortunate. The skills usually operate unconsciously.

Whilst it is recognised that a good psychotherapeutic relationship provides for the unconscious transmission of self-regulation which can lead to some extent to the remediation of a client’s early deficits, Omaha proposes that they may be transmitted in psychotherapy in a more active way, and that the means to do this early in the therapy relationship also gives an opportunity for the client to experience flexibility and attunement from the therapist, leading to a greater sense of safety and security. Omaha also asserts that we have a responsibility to teach or transmit these skills as they are a vital part of preparing a client for working with traumatic material.

He emphasises the importance of this by pointing out the link with the child’s developing self-structure: ‘Affect regulation and structuring of the self are conjoint processes which cannot be separated.’ Clearly, any person suffering from a dissociative disorder (and also most with any significant psychopathology and a large proportion of the general population too) will have problems with regard to affect/emotion regulation. Any positive learning of affect regulation skills in treatment will contribute markedly to repairing deficits in the client’s self-structure and also helps to widen the window of tolerance for processing traumatic material.

Below are definitions of the words ‘affect’ and ‘emotion’ as used by Omaha, and as originally developed by Tomkins (1962 and 1963) and Nathanson (1992).

People may be overwhelmed by specific emotions by emotions in general, and also by the fear of experiencing any emotion at all. Some may experience panic attacks, or angry outbursts which they feel are outside of their control, or else others may be very flat or numb emotionally, or the emotion becomes displaced, projected or maybe being expressed somatically or in self-harm. Some clients, especially those with dissociative disorders may alternate from one state to another.

In some cases emotion regulation skills develop adequately in childhood, but subsequent overwhelming traumas seriously compromise this skill.

Affect regulation is the capacity for affects and emotions to be actively and appropriately available, for one to feel safe and grounded whilst feeling the emotion, for the emotion to be experienced at a level that is appropriate to the circumstances, and under the control of cognitive evaluation of the situation, but, more than that, affect regulation provides a basis for developing a secure self-structure.

Omaha, drawing on the recent work of many well-known authors and researchers in the field, presents a way of working with clients, which he calls Affect Management Skills Training (AMST), which can be used with clients to regulate affects. I have been using his model with a majority of my clients in one form or another for about five years, especially with victims of trauma. The client usually finds that he/she can use the skills outside of sessions, thereby reinforcing them and gradually developing a sense of mastery, leading to the unconscious operation of the skills as new neural pathways are developed which seem to fill the templates in the brain for the establishment of this natural ability.

In AMST the therapist communicates with the client’s right brain through the use of imagery and felt body sense, and links these with cognitions. There are several components involved. The first skill to be transmitted is the ability to confine disturbing material in an image of a container.

The second is the building in of a bodily-experienced locus of safety or comfort.

Then follow a series of skills for regulating specific affects. The client is helped to choose a target affect at a low level of intensity, on which to focus, then learns skills for recognising, noticing and tolerating the affect, whilst experiencing being grounded and in the present, and then the ability to down-modulate the affect to a chosen and ecologically appropriate level.

Usually a client is quite surprised at the difference, and is enthused to practice these steps on their own until they become automatic and body-led. In most cases this leads to the ability to regulate emotions without being cognitively aware of it.

Emotion management increases the integrative capacity and level of psychological tension required for processing trauma, so needs to be in place before any uncovering or treating of traumatic experiences is attempted.

John Omaha originally published a paper on AMST in 2001 in the arena of trauma therapy, specifically EMDR, and has continued to develop his thinking in conjunction with other therapists as they have discussed to queries and problematic case studies on his internet discussion forum and also through the workshops he presents. He is experienced in working with clients with DID and although AMST has built-in flexibility and responsiveness to the individual client’s needs, suggests further modifications in using this way of working with people with DID.


Nathanson D L (1992). Shame and Pride: Affect, sex and the birth of the self. New York: Norton.

Omaha J (2004). Psychotherapeutic Interventions for Emotion Regulation: EMDR and bilateral stimulation for affect management. New York: Norton.

Tomkins S S. (1962 & 1963) Affect / imagery /consciousness. Vols. 1&2. New York: Springer

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