Emotion Efficacy Therapy
A Brief, Exposure-Based Treatment for Emotion Regulation Integrating ACT & DBT
Presented by: Dr. Dawn-Elise Snipes
Executive Director, AllCEUs
Continuing Education (CE) credits can be earned for this presentation at https://allceus.com/member/cart/index/product/id/580/c/
Objectives
~ Define EET
~ Explore the underlying theory
~ Identify techniques used in EET and their rationale
~ Theorize about how EET might be helpful to your clients
What is Emotion Efficacy Therapy
~ An 8-Session protocol
~ Targets the transdiagnostic drivers of low emotion efficacy in people with emotion dysregulation, anxiety, depression, stress, and impulsivity
~ The philosophical premise of EET is that while pain is unavoidable, suffering is not.
~ EET skills focus on increasing distress tolerance and decreasing emotion avoidance. Using five components— emotion awareness, mindful acceptance, values- based action, mindful coping, and exposure-based skills practice
~ Because learning and memory are created through the encoding of experiences, it follows that utilizing all sensory and perceptual components (cognitive, somatic, and affective) is essential for new learning.
~ In EET, transemotional learning occurs through the activation of all emotional components— thoughts, sensations, feelings, and urges— to build neural pathways around new behaviors.
~ EET leverages state- dependent learning through exposure, which facilitates new learning in emotionally activated states by increasing learning, retention, and recall of EET skills
Summary of the Foundation
~ EET is based on research of three foundational ideas for its treatment structure and content
~ A transdiagnostic approach is the most effective way to treat clients with emotion problems
~ Transemotional learning, which involves all four components of emotion, is essential to learning
~ New learning is enhanced in an activated state
Why
~ There are more commonalities than differences across diagnostic disorders, underscoring the need for transdiagnostic approaches to treatment (McEvoy, Nathan, & Norton, 2009).
~ Transdiagnostic formulation identifies and targets the mechanisms driving the symptoms (as opposed to the symptoms themselves) as a focus of intervention.
~ Transdiagnostic approaches allow for a single therapy for clients who present with a wide range of symptoms
Goals of Treatment
~ Power to experience themselves as distinct from their emotions
~ Power to experience intense emotions, instead of reacting and avoiding
~ Power to choose values- based action, even when emotionally triggered
~ Power to choose strategies to downregulate emotion and keep from making difficult situations worse
~ Apply to the following
~ Anger
~ Addiction
~ Self-harm
Vulnerabilities for Low Emotional Efficacy
~ Biological predisposition/sensitivity causing high levels of reactivity
~ High emotionality or experiential avoidance of uncomfortable sensations, emotions, and cognitions triggered by internal or external cues
~ Significant levels of distress intolerance
~ Significant lack of emotion- shifting/downregulate skills
~ Consistent and significant socially invalidating environments
~ Lack of understanding of their emotional experience
~ Ineffective tools to either tolerate difficult emotions, make values- consistent choices, or regulate their emotions.
5 Components of EET
~ Emotional Awareness
~ Thoughts, feelings, sensations, urges
~ Mindful Acceptance
~ Nonjudgmental acceptance
~ Values-Based Action
~ Proactive choice vs. reactive avoidance
~ Mindful Coping
~ Coping skills are usually used to avoid or change aversive emotion
~ Mindful coping helps clients expand their choices, so they can choose values- based action.
~ Exposure based skills practice
Typical Session
~ Mindful acceptance skills practice
~ Skills practice review and troubleshooting challenges
~ Review of previous week’s psychoeducation and skill
~ Psychoeducation on new skill
~ Practice of new skill
~ Imaginal or emotion exposure using new skill
~ Homework via skills practice record
Emotion Awareness
~ Emotions encompass
~ Thoughts
~ Feelings
~ Physical sensations
~ Behavioral urges
~ Emotions can be contextually unhelpful or helpful
~ Emotions are messages sent by the brain to help respond to perceived threats and opportunities.
~ Emotions are not the “truth”
~ Emotions urge us to action
~ Trigger Identification/Emotional Reaction Worksheet
Mindful Acceptance
~ Benefits to using mindful acceptance when you are emotionally triggered:
~ Learn to tolerate pain without acting on it.
~ Learn to recover more quickly from the distress of the trigger.
~ Learn to find the space you need to thoughtfully and consciously choose how you will respond to the pain.
~ Mindful acceptance is practiced by learning to observe and accept the four parts of emotion: sensations, feelings, thoughts, and urges
Mindful Acceptance (Awareness) 10 Minutes
~ Sensation Acceptance
~ Scan your body for sensations with the intention of observing and accepting them instead of reacting to them.
~ Feeling Labeling
~ Identify the feeling that goes with the sensation
~ Thought watching and sticky thoughts
~ Urge Noticing
~ Sit with the urge, without acting on it or judging it.
~ Then notice what it’s like not to act on it.
Moment of Choice
~ The moment of choice is…
~ The moment between stimulus and response
~ When clients will choose to use EET skills
~ Emotion surfing (chapter 4)
~ Values- based action (chapter 5)
~ Relaxation and self- soothing (chapter 7)
~ Coping thoughts (chapter 8)
~ Distraction and time- outs (chapter 9)
Emotion Surfing
~ 4 Possible Reactions
~ Emotion surfing
~ Emotion avoidance
~ Rumination
~ Emotion-driven behaviors
Emotion Surfing 5 Key Abilities
~ Observing and accepting the emotion wave as it comes.
~ Identifying where you are on the wave and how triggered you are
~ Noticing and watching thoughts without getting fused with them.
~ Noticing any desire to escape the emotion, and continuing to observe it instead
~ Noticing any urges or impulses to act on the emotion, and seeing the moment of choice (not engaging in emotion- driven behavior)
Note
~ Excellent section on explaining
~ Emotional avoidance, rumination,
~ Identifying how the person engages in it
~ Identifying the consequences of it
Values Based Action
~ Clarifying values across life domains is the first step to being able to identify VBA in the moment of choice.
~ Barriers to choosing values- based action
~ Lack of clarity about values
~ A hard- wiring to avoid pain
~ The habit of acting on emotion
~ Short- term reinforcement for acting on emotion- driven behavior, or emotion avoidance
~ Understanding the benefits of VBA can increase motivation to choose an action based on values in the moment of choice instead of an emotion- driven behavior.
Values Based Action
~ Values- based action— in the face of emotional triggers— is only made possible by recognizing the moment of choice, which can be found using the following sequence:
1. Noticing painful emotion, including the components of feelings, thoughts, and sensations;
2. observing the action urge;
3. remembering situation- relevant values/intentions; and
4. deciding to act (on values/intentions or emotion- driven urges).
Relaxation and Self Soothing
~ Diaphragmatic breathing
~ Relaxation without tension (with cued breath)
~ Cue- controlled breathing
~ The five- senses exercise (30 seconds per sense)
~ Positive examples of each sense can be used for emotional downregulation
Coping Thoughts
~ Coping thoughts are simply personalized, strength- based declarations about resiliency, history, or perspective that shifts the client’s attention to help effectively navigate the difficult emotion
~ Identify triggers
~ Identify automatic negative thoughts
~ Create coping thoughts
Radical Acceptance
~ Radical acceptance does not mean you like or condone what happened. It just means that you accept the reality that it happened.
~ Practicing coping thoughts and radical acceptance in an activated state will enhance learning and help clients recall the skills when they are triggered.
Distraction Time Out
~ Distraction follows the exposure of observing and accepting.
~ Distraction allows clients to shift attention away from stimuli that trigger emotion: provoking thoughts, sensations, and situations.
~ Distraction is used mindfully— to intentionally shift attention to alternative present- moment experiences after observing and accepting emotions
Summary
~ Emotional dysregulation can keep people stuck
~ EET helps people learn to
~ Identify their emotions
~ Observe mindfully without reacting
~ Use the moment of choice to decide on the best course of action based on what is important to them
Summary
~ Mindful acceptance is the practice of observing and accepting the four components of emotional experience through:
~ sensation acceptance
~ feeling labeling
~ thought watching
~ urge noticing.
~ The moment of choice is the space between stimulus and response when clients can consciously and intentionally choose their response.
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