By Tim Aiello, MA, LPC, NCC, ADHD-CCSP
As a mental health therapist specializing in adult ADHD and autism, I’ve experienced firsthand how intense emotional dysregulation can disrupt our lives. I have long struggled with overwhelming emotions—often exacerbated by rejection sensitive dysphoria (RSD) and other triggers. Through personal trials and clinical practice, I developed a simple yet effective 4-step process known as S.T.O.P. This process combines principles from polyvagal theory and Cognitive Behavioral Therapy (CBT) to help bring calm and clarity when emotions run high.
In this blog, I’ll share the scientific evidence behind these approaches, detail the S.T.O.P. process, and explain how it has transformed my life—and the lives of many of my patients.
Understanding Emotional Dysregulation in ADHD and Autism
Adults with ADHD often experience emotional dysregulation, where emotions can feel overwhelming and disproportionate to the situation. Similarly, individuals on the autism spectrum may struggle with processing and expressing intense emotions. Both groups can be particularly sensitive to perceived rejection (RSD) or other triggers, which may lead to impulsive reactions and persistent distress (Barkley, 2015).
Research has demonstrated that targeted interventions, such as CBT, can help individuals identify and reframe distorted thoughts, reducing the intensity of emotional responses (Beck, 1976; Antshel & Barkley, 2011). Likewise, emerging studies in polyvagal theory highlight the importance of our physiological state in emotional regulation (Porges, 2007, 2011).
The Polyvagal Theory and Its Role in Emotional Regulation
Developed by Dr. Stephen Porges, polyvagal theory explains how the autonomic nervous system governs our responses to stress and social engagement. This theory posits that our body’s neural circuits help us determine whether a situation is safe, dangerous, or life-threatening. When we perceive a threat, our nervous system may trigger fight, flight, or freeze responses, leading to the intense emotional states associated with dysregulation (Porges, 2007).
Recent studies suggest that by recognizing and modulating these autonomic responses, we can “reset” our nervous system to a state that supports calm and social engagement (Porges, 2011). This framework provides a robust foundation for therapeutic interventions that promote self-regulation and safety.
Cognitive Behavioral Therapy: Rewiring Our Thought Patterns
Cognitive Behavioral Therapy (CBT) is another cornerstone of managing emotional dysregulation. CBT is based on the idea that our thoughts, feelings, and behaviors are interconnected. By challenging and reframing negative or disproportionate thoughts, we can change our emotional responses and behaviors (Beck, 1976). This approach has proven particularly effective for individuals with ADHD, who often experience rapid and intense emotional shifts (Antshel & Barkley, 2011).
Through CBT techniques, clients learn to identify cognitive distortions—such as catastrophizing or overgeneralizing—and develop healthier, more balanced thought patterns. This cognitive restructuring is critical for breaking the cycle of emotional dysregulation.
Introducing the S.T.O.P. Process
In my own journey toward managing emotional dysregulation, I needed a tool that was both practical and effective—a strategy that could be applied in the midst of an emotional crisis. That led to the creation of the S.T.O.P. process, a four-step method designed to help anyone, including myself, regain control during moments of high emotional intensity.
S: Stop
What It Means: Pause immediately—physically and mentally. Step away from the triggering situation if possible.
Evidence in Practice: Both polyvagal theory and CBT emphasize the importance of creating a pause to disrupt the escalation of emotional responses (Porges, 2011; Beck, 1976).
T: Think
What It Means: Once you’ve stopped, ask yourself, “Is this RSD or emotional dysregulation? Am I feeling an excessive amount of emotion for this situation?”
Evidence in Practice: This reflective step is grounded in CBT’s focus on cognitive restructuring. By evaluating your emotional reaction, you can begin to differentiate between appropriate and disproportionate responses (Beck, 1976).
O: Operate – MOVE
What It Means: Engage in physical activity—move your body. Whether it’s a short walk, some stretching, or another form of exercise, physical movement helps release pent-up energy.
Evidence in Practice: Physical activity has been shown to activate the parasympathetic nervous system, which aids in calming the body and mind. This connection is a central tenet of polyvagal theory (Porges, 2007), and research supports the role of movement in regulating mood and reducing stress (Martinsen, 2008).
P: Process
What It Means: Once you’re calm, take time to reflect on the experience. Ask yourself, “Was this emotional dysregulation? How might I view this situation more clearly now that I’m calm?”
Evidence in Practice: Processing the experience reinforces the cognitive shifts promoted by CBT and encourages a reflective state that fosters long-term emotional regulation (Beck, 1976; Porges, 2011).
Why S.T.O.P. Works: A Personal and Clinical Perspective
I developed the S.T.O.P. process out of necessity—seeking a reliable method to manage my own emotional dysregulation. Over time, I have seen firsthand how this process helps interrupt the cycle of impulsivity and intense emotion. Clinically, my patients have also benefited from using S.T.O.P. as a tangible, easy-to-remember tool to regain control in the midst of emotional distress.
By combining the “stop” moment to interrupt escalation, the reflective “think” step to reassess our emotions, the active “move” component to regulate our nervous system, and the “process” phase for learning and reframing, S.T.O.P. creates a comprehensive pathway to emotional well-being. This integrated approach is supported by the latest research in polyvagal theory and CBT, making it a trusted tool for anyone grappling with emotional dysregulation.
Final Thoughts
Emotional dysregulation can feel like a relentless storm that upends your life. However, by applying strategies grounded in robust scientific research—such as those derived from polyvagal theory and CBT—we can navigate these turbulent moments more effectively. The S.T.O.P. process is not about suppressing emotions; it’s about creating the necessary space to understand, process, and ultimately transform them.
I invite you to try the S.T.O.P. process the next time you feel overwhelmed. Whether you’re managing adult ADHD, autism-related challenges, or any form of emotional dysregulation, this method may just be the tool you need to find calm amid the storm.
If you have any questions or would like further guidance on using the S.T.O.P. process, please feel free to reach out. I’m here to support you on your journey to emotional well-being.
References
Antshel, K. M., & Barkley, R. A. (2011). Psychosocial interventions in attention-deficit/hyperactivity disorder: A meta-analytic review. Clinical Child and Family Psychology Review, 14(3), 245–256.
Barkley, R. A. (2015). Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (4th ed.). New York, NY: Guilford Press.
Beck, A. T. (1976). Cognitive Therapy and the Emotional Disorders. New York, NY: International Universities Press.
Martinsen, E. W. (2008). Physical activity in the prevention and treatment of anxiety and depression. Nordic Journal of Psychiatry, 62(sup47), 25–29.
Porges, S. W. (2007). The polyvagal perspective. Biological Psychology, 74(2), 116–143.
Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York, NY: W.W. Norton & Company.
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