Emotion Efficacy Therapy , livre ebook

For my dear friend, Jeff Wood, PsyD.
—Matt
For my parents, Robert and Peggye.
—April
Contents
Chapter 1: Emotion Efficacy Therapy
Why Emotion Efficacy Therapy?
Emotion Efficacy Therapy: Foundational Elements
Transdiagnostic Treatment to Treat Low Emotion Efficacy
Transemotional Learning as the Key to Change
Exposure-Based Skills Practice to Improve Learning, Retention, and Recall
Emotion Efficacy Therapy Protocol
Emotion Awareness
Mindful Acceptance
Values-Based Action (VBA)
Mindful Coping
Exposure-Based Skills Practice
How Is Emotion Efficacy Therapy Unique?
How to Use This Book
Summary
Chapter 2: Emotion Awareness
Orienting Clients to Treatment
Emotion Efficacy
Increasing Emotion Awareness
What Are Emotions Made Of?
Session Structure
Skills Practice Record
Summary
Chapter 3: Mindful Acceptance
Psychoeducation on Mindful Acceptance
Using Exposure in EET
Moment of Choice
Summary
Chapter 4: Emotion Surfing
How Emotion Avoidance Keeps Emotion at High Intensity
How Rumination Keeps Emotion at High Intensity
How Emotion-Driven Behavior Intensifies Emotion
The Art of Emotion Surfing
Choosing the Exposure Image
Summary
Chapter 5: Values-Based Action, Part 1
Assessing Client Values
Assessing Values By Domain
Accessing Values During Distress
Barriers to Values
Values-Based Action
Summary
Chapter 6: Values-Based Action, Part 2
Monsters on the Bus
Setting Up the Monsters on the Bus Exercise
Imaginal Exposure Using Values-Based Action
Conducting Imaginal Exposure with VBA
Summary
Chapter 7: Relaxation and Self-Soothing
Mindful Coping
Advantages of Mindful Coping
Introducing Mindful Coping to Clients
O+A+C + Mindful Coping
Mindful Coping with Relaxation
Mindful Coping with Self-Soothing
Using Mindful Coping Outside Session
Summary
Chapter 8: Coping Thoughts and Radical Acceptance
Coping Thoughts
Mindful Coping with Coping Thoughts
Radical Acceptance
Summary
Chapter 9: Distraction and Time-Out
Distraction
Mindful Coping with Distraction
Time-Out
Mindful Coping with Time-Out
Summary
Chapter 10: Pulling It All Together
Consolidating Learning
EET 8-Week Protocol Schedule
Potential Treatment Challenges and Opportunities
Difficulty with Specific Skills
Increased Awareness and Demoralization
Tailoring Treatment for Clients, aka “The Stretch”
Inducing Emotion Activation
Assessment
EET and Beyond
Summary
Appendix A: Outcome Measures for Assessment
Appendix B: Research and Results
Hypotheses and Results
Appendix C: EET Eight-Session Protocol
EET Session 1: O+A
1. Welcome and administration of pretreatment measures
2. Introduction of leader and group members
3. Overview of EET treatment and structure
4. Psychoeducation on emotions and emotion awareness
5. Emotion watching exercise
6. Introduction to skills practice and the Skills Practice Record
7. Session 1 skills assignment
EET Session 2: O + A
1. Skills practice review
2. Psychoeducation on mindful acceptance
3. Mindful acceptance practice
4. Introduction to emotion avoidance
5. Psychoeducation on emotion surfing
6. Psychoeducation on exposure and practice
7. Session 2 skills assignment
EET Session 3: O + A + Choose VBA
1. Mindful acceptance practice and feedback
2. Skills practice review
3. Psychoeducation on the moment of choice
4. Introduction to values-based action
5. Whiteboard exercise with values and emotional barriers
6. VBA using imaginal exposure and feedback
7. Session 3 skills assignment
EET Session 4: O + A + Choose VBA
1. Mindful acceptance practice and feedback
2. Skills practice review
3. Monsters on the Bus exercise
4. VBA using imaginal exposure and feedback
5. Session 4 skills assignment
EET Session 5: O + A + Choose Mindful Coping
1. Mindful acceptance practice and feedback
2. Skills practice review
3. Psychoeducation on mindful coping
4. Introduction to relaxation and self-soothing
5. Relaxation skills practice with emotion exposure and feedback
6. Self-soothing skills practice with emotion exposure and feedback
7. Session 5 skills assignment
EET Session 6: O + A + Choose Mindful Coping
1. Mindful acceptance practice and feedback
2. Skills practice review
3. Psychoeducation on coping thoughts
4. Coping thoughts practice with emotion exposure and feedback
5. Psychoeducation on radical acceptance
6. Radical acceptance practice with emotion exposure and feedback
7. Session 6 skills assignment
EET Session 7: O + A + Choose Mindful Coping
1. Mindful acceptance practice and feedback
2. Skills practice review
3. Psychoeducation on distraction and time-out
4. Distraction with imaginal or emotion exposure and feedback
5. Introduction to Personalized Emotion Efficacy Plan
6. Session 7 skills assignment
EET Session 8
1. Mindful acceptance practice and feedback
2. Skills practice review
3. Review of Personalized Emotion Efficacy Plans, feedback, and troubleshooting
4. Imaginal or emotion exposure with EET skill and feedback
5. Rate emotion efficacy
6. Closing remarks and appreciations
7. Administer any posttreatment questionnaires
EET References
Index
Chapter 1
Emotion Efficacy Therapy
Emotion efficacy is defined as how effectively a person can experience and respond to a full range of emotions in a contextually adaptive, values-consistent manner. As such, emotion efficacy encompasses both the beliefs people have about their ability to navigate their emotional life as well as their ability to do so. The more people can effectively experience difficult emotions, regulate their emotions through coping, and express their values, the higher their emotion efficacy.
In conceptualizing emotion efficacy therapy (EET), we reviewed the full range of factors that make up a person’s relationship with his or her emotions, and we identified key factors implicated in emotion efficacy. We concluded that low emotion efficacy is likely to be the result of key vulnerabilities or patterns of maladaptive behavioral responses — behaviors enacted in response to emotional pain, or the desire to avoid pain, which fuel and maintain psychopathological processes. Some common vulnerabilities and patterns may take the form of one of more of the following: Biological predisposition or sensitivity that leads to high levels of reactivity Significant levels of emotion avoidance (sometimes also called experiential avoidance )—efforts to avoid experiencing uncomfortable sensations, emotions, and cognitions triggered by internal or external cues Significant levels of distress intolerance —the perception or the belief that one cannot tolerate aversive emotions Significant lack of emotion-shifting skills to downregulate emotion Consistent and significant socially invalidating environments
Individuals with these vulnerabilities often develop significant emotion problems. They may also lack understanding of their emotional experience and the clarity or tools to either tolerate difficult emotions, make values-consistent choices, or regulate their emotions. Over time, these vulnerabilities and life-long patterns of maladaptive behaviors can result in chronic emotion dysregulation and its downstream symptoms of depression, anxiety, and stress. In fact, these maladaptive patterns become so ingrained that they are all but hardwired and very difficult to change, leaving individuals feeling trapped, stuck, and hopeless.
In EET, we define emotion dysregulation as the full range of thoughts, feelings, somatic sensations, and behavioral urges that are contextually maladaptive. Emotion dysregulation is also problematic in that it frequently leads to behavior dysregulation —acting on emotion in contextually maladaptive ways. In this way, emotion dysregulation and behavior dysregulation lead to low emotion efficacy.
The impact of low emotion efficacy is wide and far reaching. Some data suggest that low emotion efficacy creates and maintains tremendous suffering for the more than 75 percent of people who seek psychotherapy across multiple diagnostic categories (Kring & Sloan, 2010). In addition, pervasive emotion problems can significantly impact clients across multiple domains including interpersonal, work, school, and legal. Low emotion efficacy can significantly impair quality of life, and, in more extreme cases, it can be life interfering.
For example, research shows emotion dysregulation has been correlated with higher levels of depression, anxiety, impulsivity, and suicide (Garnefski & Kraaij, 2007; Carver, Johnson, & Joormann, 2008; Kleiman & Riskind, 2012); reduced quality of life; increased distress and restricted life functioning; increased suffering and pain; impaired memory and problem solving; and diminished contact with meaningful and valued life activities (Richards & Gross, 2000; McCracken, Spertus, Janeck, Sinclair, & Wetzel, 1999; Marx & Sloan, 2002; Hayes, Luoma, Bond, Masuda, & Lillis, 2006). Additionally, emotion dysregulation has been linked to lower social skill functioning, substance abuse, low lifetime achievement, and low sense of self-efficacy (Berking et al., 2011; Eisenberg, Fabes, Guthrie, & Reiser, 2000; Caprara et al., 2008).
Why Emotion Efficacy Therapy?
Despite the prevalence of emotion-regulation problems, available treatments often treat just the symptoms and fail to identify and target the underlying drivers of the problem. In addition, treatments may teach clients how to use skills but can lack the experiential component essential to accelerate learning new ways of relating to and responding to difficult emotions. Even current evidence-based treatments show only modest treatment effects for improving emotion regulation and its downstream symptoms (Kliem, Kroger, & Kosfelder, 2010). Emotion efficacy therapy attempts to provide a more effective, portable, universal protocol for emotion p