066 -Emotion Efficacy Therapy

 
 
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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/
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‚ÄĒ 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‚ÄĒ thoughts, sensations, feelings, and urges‚ÄĒ 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 ‚Äútruth‚ÄĚ
~    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‚ÄĒ in the face of emotional triggers‚ÄĒ 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‚ÄĒ 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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