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://www.allceus.com/member/cart/index/product/id/580/c/
~ 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
~ 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
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
~ 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
~ Emotions encompass
~ 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
~ 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)
~ 4 Possible Reactions
~ Emotion surfing
~ Emotion avoidance
~ 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)
~ 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 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 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
~ 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
~ 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.
Unlimited Counseling CEUs for $59 https://www.allceus.com/
Specialty Certificate tracks starting at $89 https://www.allceus.com/certificate-tracks/
Live Webinars $5/hour https://www.allceus.com/live-interactive-webinars/
Patreon: https://www.patreon.com/CounselorToolbox Help us keep the videos free for everyone to learn by becoming a patron.
Nurses, addiction and mental health counselors, social workers and marriage and family therapists can earn continuing education credits (CEs) for this and other course at:
View the New Harbinger Catalog and get your 25% discount on their products by entering coupon code: 1168SNIPES at check out
AllCEUs has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 6261. Programs that do not qualify for NBCC Credit are clearly identified. AllCEUs is solely responsible for all aspects of the programs.
AllCEUs is also approved as an education provider for NAADAC, the States of Florida and Texas Boards of Social Work and Mental Health/Professional Counseling, the California Consortium for Addiction Professionals and Professions. Our courses are accepted in most states through those approvals.