Index

clients: assessment process for, 145–146; orienting to treatment, 13–14; providing ongoing support to, 146–147; self-assessment of emotion efficacy, 261; tailoring treatment for, 144

cognitive emotion avoidance, 44

confidentiality in groups, 167

Consequences of Emotion Avoidance handout, 44–45, 183

consolidating learning, 139–142, 198, 211, 259–262

coping thoughts, 103–112; examples of, 106, 108; exposure and, 105, 109–112, 229–230; guiding the creation of, 104–105; handout and worksheet on, 106–108, 233–235; introducing clients to, 104–105; O+A+C model and, 105; psychoeducation on, 229; replacing automatic thoughts with, 104–105, 107–108, 234–235; summary points about, 121; therapy dialogue example, 109–112. See also mindful coping

cue-controlled breathing, 93, 96, 221

defusion, 29

demoralization, 143–144

Depression, Anxiety, and Stress Scale–21 (DASS–21), 145, 156–157

dialectical behavior therapy (DBT), 3, 112

diaphragmatic breathing, 92, 95, 220

Difficulties in Emotion Regulation Scale (DERS), 145, 151–152

disclosure in groups, 167

distraction, 123–134; benefits of, 133; emotion exposure and, 243–244; explanation of, 123–124; handout on using, 133–134, 246; O+A+C model and, 131; psychoeducation on, 130, 243; steps for mindful, 133–134, 246; strategies for, 124–130, 247–252; summary points about, 138; therapy dialogue example, 131–133

Distraction Strategies handout, 124–130, 247–252

distress intolerance, 1, 4

distress tolerance, 7, 9, 89, 160, 163

Distress Tolerance Scale (DTS), 145, 150

distressing situations: accessing values during, 69–70, 75–76, 83–87; imaginal exposure using, 83–87

EET. See emotion efficacy therapy

eight-session protocol for EET, 142–143, 165–262. See also specific EET sessions

emotion activation, 144–145

emotion avoidance, 43, 44–49; consequences of, 45, 46–47; emotion efficacy and, 1, 4; mindful coping and, 133; pros and cons of, 46–47; strategies related to, 44, 45; therapy dialogue example, 48–49

Emotion Avoidance Consequences Worksheet, 47, 184

emotion awareness, 6, 13–25; components of emotion and, 19–25; demoralization related to, 143–144; feelings word list for, 24; handout explaining, 17–18, 171–172; introducing to clients, 16–19; psychoeducation on, 168; session protocol for, 165–177; summary points about, 27; therapy dialogue examples, 18–19, 21–22; worksheet for practicing, 23, 174

Emotion Awareness handout, 17–18, 171–172

emotion dysregulation, 2, 7, 9, 30, 33

emotion efficacy: client self-assessment of, 259; definition of, 1, 11, 15; explaining to clients, 14–16; impact of low, 2

Emotion Efficacy Scale (EES), 145, 155

emotion efficacy therapy (EET): assessment in, 145–146; components of, 5–8, 15–16; conceptualization of, 1–2; consolidating learning about, 139–142; eight-session protocol for, 142–143, 165–262; exposure used in, 33–37; foundational elements of, 3–5; moment of choice in, 37–41; orienting clients to, 13–14; outcome measures used in, 145, 149–158; providing ongoing support in, 146–147; reasons for using, 2–3; research results on, 159–163; session structure for, 10–11, 25; Skills Practice Record, 25–26, 168, 177; summary points about, 11, 147; treatment challenges in, 143–145; uniqueness of, 8–9. See also specific EET sessions

Emotion Efficacy Therapy Skills handout, 139–140, 254

emotion exposure, 8, 33, 260; coping thoughts and, 229–230; distraction and, 243–244; final session exercise on, 260; mindful acceptance and, 34–37; radical acceptance and, 230–231; relaxation skills and, 216–217; self-soothing skills and, 217–218. See also exposure-based skills practice; imaginal exposure

emotion regulation: mindful coping and, 8, 104; research results on EET for, 159, 161–162

emotion surfing, 43–58; emotion avoidance vs., 44–49; emotion-driven behavior vs., 51–52; exposure-based practice and, 54–56; handouts for practicing, 53, 57, 192; key abilities required for, 43–44; mindful acceptance and, 52; psychoeducation on, 179; rumination vs., 50–51; script for guided, 55, 185; summary points about, 58; therapy dialogue examples, 53–54, 56

Emotion Surfing Practice handout, 57, 192

Emotion Watching Worksheet, 23, 174

emotion wave metaphor, 43

emotional triggers: imaginal exposure using, 83–87; values-based action and, 69–70, 75–76, 83–87

emotion-driven behavior, 43, 51–52; emotion intensified by, 51; talking with clients about, 52

emotions: activation of, 144–145; anatomy of, 20, 173; components of, 19–25; explaining to clients, 16, 17–18; psychoeducation on, 168; reasons people struggle with, 18

experiential avoidance, 1, 9, 160, 163

experiential exercises: five-senses relaxation, 93, 96–97, 221; Monsters on the Bus, 75–82, 209–210. See also guided practices

explanations, 50, 51

exposure therapy, 5

exposure-based skills practice, 5, 8, 33–37; coping thoughts and, 105, 109–112, 229–230; distraction and, 131; emotion surfing and, 54–56; final session exercise on, 258; handout for introducing, 34, 189; imaginal vs. emotion exposure in, 8, 33; mindful acceptance and, 34–37, 186–188; psychoeducation on, 186–188; radical acceptance and, 228–229; relaxation and, 214–215; self-soothing and, 215–216; values-based action and, 83–87, 194–196, 208–209

feelings: emotional experience and, 20; labeling without judging, 31, 180; list of words describing, 24, 175

Feelings Word List, 24, 175

five-senses exercise, 93, 96–97, 219

Frankl, Victor, 38

group dynamics, 167, 186, 188

guided practices: emotion surfing, 55; mindful acceptance, 32–33, 182. See also experiential exercises

handouts: Anatomy of an Emotion, 20, 173; Art of Radical Acceptance, 113–114, 234–235; Before You Act, Distract, 133–134, 244; Client Coping Thoughts, 106, 231; Consequences of Emotion Avoidance, 44–45, 183; Distraction Strategies, 124–130, 245–250; Emotion Awareness, 17–18, 171–172; Emotion Efficacy Therapy Skills, 139–140, 254; Emotion Surfing Practice, 57, 192; Feelings Word List, 24, 175; How to Surf an Emotion Wave, 53; Introduction to Exposure, 34, 189; Mindful Acceptance | Observe + Accept, 31–32, 180–181; Mindful Coping Through Relaxation, 95–97, 220–221; Moment of Choice, 37–38, 200; Rumination, 51; Take a Time-Out, 134, 253; What Is Emotion Efficacy?, 15, 170; What You Can Expect from Emotion Efficacy Therapy, 14, 169. See also worksheets

Hayes, Steven, 3

hearing, sense of, 98–99, 223–224

high emotion efficacy, 3, 15

How to Surf an Emotion Wave handout, 53

imaginal exposure, 8, 33; coping thoughts and, 105, 109–112; emotion surfing and, 54, 58; final session exercise on, 258; mindful acceptance and, 34–37, 186–188; psychoeducation on, 186–188; values-based action and, 83–87, 194–196, 210–211. See also emotion exposure; exposure-based skills practice

Introduction to Exposure handout, 34, 189

judgments, 50, 51

Kabat-Zinn, Jon, 30

learning: consolidating, 139–142, 198, 211, 259–262; state-dependent, 5, 57, 90; transemotional, 4–5

Linehan, Marsha, 3, 112

low emotion efficacy: characteristics of, 1–2; transdiagnostic treatment for, 3–4

maladaptive behavioral responses, 1

metaphors: emotion wave, 43; monsters on the bus, 75

mindful acceptance, 6–7, 29–42; benefits to using, 31; consolidating learning about, 140–141; emotion surfing and, 52; exposure-based practice and, 33–37; handout for introducing, 31–32, 182–183; moment of choice and, 37–41; psychoeducation on, 29–33, 179; script for guided, 32–33, 182; session protocol for, 178–194; summary points about, 42; therapy dialogue examples, 34–37, 38–41, 186–188. See also radical acceptance

Mindful Acceptance | Observe + Accept handout, 31–32, 180–181

mindful coping, 7–8, 89–138; advantages of, 90; consolidating learning about, 140, 141–142; coping thoughts and, 103–112, 233–235; criteria for using, 137; in daily life, 137–138; distraction and, 123–134, 246–252; explanation of, 89–90; introducing to clients, 90–91; O+A+C model and, 92, 101–102; outside-of-session use of, 101–102; psychoeducation on, 216; radical acceptance and, 112–120, 236–239; relaxation skills and, 92–97, 220–221; self-soothing techniques and, 97–101, 222–225; session protocols for, 215–257; steps for guiding practice of, 91; summary points about, 102, 121, 138; therapy dialogue examples, 91, 93–95, 101, 137–138; time-out and, 134–137

Mindful Coping Through Relaxation handout, 95–97, 220–221

Mindful Coping Through Self-Soothing worksheet, 97–100, 222–225

mindfulness: mindful acceptance derived from, 29, 31; videos for introducing, 30

moment of choice: client identification of, 7, 15; handout for introducing, 37–38, 200; mindful acceptance and, 29, 37–41; psychoeducation on, 196; therapy dialogue example, 38–41; values-based action and, 71, 88

Moment of Choice handout, 37–38, 200

Monsters on the Bus exercise, 75–82; in-session use of, 209–210; preparing clients for, 76; therapy dialogue example, 77–82

motivation, 60, 71, 74, 75–76, 88

negative thoughts. See automatic negative thoughts

negativity bias, 17

O+A+C (observe + accept + choose) model, 83; coping thoughts and, 105; distraction and, 131; imaginal exposure with VBA and, 83–84, 197, 210–211; mindful coping and, 92, 101–102; time-out and, 135

outcome measures, 145, 149–158; Acceptance and Action Questionnaire, 158; Depression, Anxiety, and Stress Scale–21, 156–157; Difficulties in Emotion Regulation Scale, 151–152; Distress Tolerance Scale, 150; Emotion Efficacy Scale, 155; Valued Living Questionnaire, 153–154

panic disorder, 143

Personalized Emotion Efficacy Plan, 140–142, 253–254

perspective taking, 29

pleasurable activities, 124, 128–129

posttreatment measures, 261

predictions, 50, 51

pretreatment measures, 166

productivity, focusing on, 124, 126–127

protective emotion avoidance, 44

psychoeducation: on coping thoughts, 229; on distraction, 130; on emotion awareness, 168; on emotion surfing, 179; on mindful acceptance, 29–33, 179; on mindful coping, 216; on moment of choice, 196; on radical acceptance, 230; on time-out, 135

radical acceptance, 112–120; emotion exposure and, 230–231; examples of, 113; explanation of, 112, 113–114; handout on art of, 113–114, 236–237; practice worksheet, 118–120, 238–239; psychoeducation on, 230; situational assessment, 118–120; steps for practicing, 120, 239; summary points about, 121; therapy dialogue example, 114–118. See also mindful acceptance

Radical Acceptance worksheet, 118–120, 238–239

relaxation, 92–97; emotion exposure and, 214–215; techniques used for, 92–93, 95–97, 220–221; therapy dialogue example, 93–95

relaxation without tension practice, 92–93, 96, 220

Replacing Automatic Thoughts with Coping Thoughts worksheet, 107–108

research results on EET, 159–163

rumination, 43, 50–51; handout about, 51; skill difficulties related to, 143; three main forms of, 50

Rumination handout, 51

sacred pause, 38

safe space in groups, 167

scripts: Guided Emotion Surfing, 55, 185; Guided Mindful Acceptance, 32–33, 182. See also experiential exercises

self-destructive behaviors, 124, 129–130

self-report scales, 145

self-soothing, 97–101; emotion exposure and, 217–218; five senses used for, 97–100, 222–225; therapy dialogue example, 101

sensations: emotional experience and, 20; mindful acceptance of, 31, 143, 180

senses: five-senses relaxation exercise, 93, 96–97; self-soothing using each of, 97–100, 222–225

session 1 of EET (Emotion Awareness), 165–177; description, 165; group dynamics, 167; handouts and worksheets, 169–175; materials list, 166; pretreatment measures, 166; procedures overview, 166–168; skills practice, 176–177

session 2 of EET (Mindful Acceptance), 178–192; description, 178; exposure exercise, 186–188; group dynamics, 186, 188; handouts and worksheets, 180–185, 189; materials list, 178; procedures overview, 179; scripts, 182, 185; skills practice, 190–191

session 3 of EET (Values-Based Action), 195–207; description, 195; handouts and worksheets, 199–205; imaginal exposure, 196–198; materials list, 195; procedures overview, 196–198; skills practice, 206–207

session 4 of EET (Values-Based Action), 208–214; description, 208; handouts and worksheets, 212–213; imaginal exposure, 210–211; materials list, 208; Monsters on the Bus exercise, 209–210; procedures overview, 208–211; skills practice, 213–215

session 5 of EET (Mindful Coping), 215–227; description, 215; emotion exposure, 216–218; handouts and worksheets, 219–225; materials list, 215; procedures overview, 216–218; relaxation practice, 216–217, 220–221; self-soothing practice, 217–218, 221–225; skills practice, 226–227

session 6 of EET (Mindful Coping), 228–241; coping thoughts practice, 229–230, 233–235; description, 228; emotion exposure, 229–231; handouts and worksheets, 232–239; materials list, 228; procedures overview, 229–231; radical acceptance practice, 230–231, 236–239; skills practice, 240–241

session 7 of EET (Mindful Coping), 242–258; description, 242; distraction practice, 243–244, 246–252; EET skills review, 254; emotion exposure, 243–244; handouts and worksheets, 245–256; materials list, 242; Personalized Emotion Efficacy Plan, 244, 255–256; procedures overview, 243–244; skills practice, 257–258; time-out practice, 253

session 8 of EET (Consolidation), 259–262; description, 259; emotion efficacy rating, 261; exposure exercise, 260; posttreatment measures, 261; procedures overview, 259–261; validation and closing remarks, 261

shifting attention, 124, 125–126, 130

sight, sense of, 98, 222–223

situational emotion avoidance, 44

skills: difficulty with specific, 143; importance of practicing, 168

Skills Practice Record, 25–26, 168, 177

smell, sense of, 97–98, 222

somatic emotion avoidance, 44

state-dependent learning, 5, 57, 90

“stretch” in EET, 144

Strosahl, Kirk, 3

substitution emotion avoidance, 44

SUDS rating, 34, 189

surfing emotions. See emotion surfing

symptom inventories, 145–146

Take a Time-Out handout, 134, 253

taste, sense of, 99–100, 224

thoughts: automatic negative, 103, 104; coping, 103–112; emotional experience and, 20; mindful watching of, 32, 50, 143, 181

time-out, 134–136; explanation of, 134; handout on taking, 134, 253; introducing to clients, 135; psychoeducation about, 135, 241; summary points about, 138; therapy dialogue example, 136

touch, sense of, 100, 224–225

transdiagnostic treatments, 3–4

transemotional learning, 4–5

triggering situations: coping thoughts and, 104; imaginal exposure using, 83–87; values-based action and, 69–70, 75–76, 83–87

urges: emotional experience and, 20; mindful noticing of, 32, 181; problem with acting on, 51

Valued Living Questionnaire (VLQ), 145, 153–154

values: accessing during distress, 69–70; barriers to acting on, 70–71; client assessment of, 60–69

values assessment, 60–69; by life domain, 63–69; therapy dialogue example, 66–67; worksheets for, 61–62, 64, 68–69

Values Clarification Worksheet, 61–62; 193–194

Values Domains worksheet, 64–65, 68–69, 201–204

values-based action (VBA), 7, 59–88; assessing values for, 60–69; barriers to, 70–71; benefits of, 60, 72, 73; consolidating learning about, 140, 141; distressing situations and, 69–70, 75–76, 83–87; explanation of, 59–60; imaginal exposure and, 83–87, 196–198, 210–211; life domains and, 63–69; moment of choice and, 71, 88; Monsters on the Bus exercise and, 75–82; motivation and, 60, 71, 74, 75–76, 88; session protocols for, 195–214; summary points about, 73–74, 88; therapy dialogue examples, 66–67, 73, 77–82, 84–87

videos on mindfulness, 30

watching thoughts, 32, 50, 143, 181

What Is Emotion Efficacy? handout, 15, 170

What You Can Expect from Emotion Efficacy Therapy handout, 14, 169

Wilson, Kelly, 3

worksheets: Benefits of Values-Based Action, 72, 205; Emotion Avoidance Consequences, 47, 184; Emotion Watching, 23, 174; Mindful Coping Through Self-Soothing, 97–100, 222–225; Personalized Emotion Efficacy Plan, 140–142, 255–256; Radical Acceptance, 118–120, 238–239; Replacing Automatic Thoughts with Coping Thoughts, 107–108; Skills Practice Record, 25–26, 168, 177; Values Clarification, 61–62; Values Domains, 64–65, 68–69, 201–204. See also handouts

Publisher’s Note

This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering psychological, financial, legal, or other professional services. If expert assistance or counseling is needed, the services of a competent professional should be sought.

Distributed in Canada by Raincoast Books

Context Press

An imprint of New Harbinger Publications, Inc.

5674 Shattuck Avenue

Oakland, CA 94609

www.newharbinger.com

“Mindful Coping Through Self-Soothing” adapted from “Relax and Soothe Yourself” in THE DBT SKILLS WORKBOOK by Matthew McKay, Jeffrey C. Wood, and Jeffrey Brantley, copyright © 2007 Matthew McKay, Jeffrey C. Wood, and Jeffrey Brantley. Used by permission of New Harbinger Publications.

Cover design by Sara Christian

Acquired by Catharine Meyers

Edited by Marisa Solís

Indexed by James Minkin

Library of Congress Cataloging-in-Publication Data on file

“McKay and West have developed a brief, practical, and penetrating therapy that helps clients become more skillful with their critically important emotions. On a foundation of scientific evidence, they offer a structured program rich with useful tools, handouts for clients, clinical examples, and guidance for specific issues. This is an extremely well-considered, conceptualized, and thorough book—useful for clinicians at any level. Highly recommended.”

—Rick Hanson, PhD, author of Buddha’s Brain and Hardwiring Happiness

“This book is a must read for any therapist who wants to work with emotionally dysregulated clients in a time-effective fashion. The brief, structured, highly practical emotion efficacy therapy (EET) approach is clearly described—step by step—and integrates mindfulness, acceptance, and emotion processing strategies drawn from different therapy models in a masterful way. Each facet of EET is demonstrated via therapist-client dialogues, which make the concept come alive clinically. There are tons of patient handouts, worksheets, and other useful clinical tools. This book is so well organized that any clinician could use it off the shelf to deliver a highly effective emotion regulation treatment!”

—Kirk Strosahl, PhD, cofounder of acceptance and commitment therapy (ACT), and coauthor of Inside This Moment

“In this excellent text, McKay and West present EET, a well-crafted treatment protocol that combines techniques from effective, emotion-focused, and transdiagnostic treatments. This well-written eight-week program gives concrete guidelines for the therapist to help their clients enhance their emotional awareness, utilize mindful acceptance and coping strategies to regulate emotions, and choose adaptive and value-based actions. Using concrete examples, monitoring forms, and summary points, this valuable book will provide clinicians with a powerful and much-needed clinical tool. It will help countless clients suffering from emotional distress. It is a must-read.”

—Stefan G. Hofmann, PhD, professor of psychology at Boston University, and author of Emotion in Therapy

“I learned a ton of super-helpful things from reading this book! Written by truly brilliant clinicians, it provides an easy-to-use set of concepts and tools. I love the progress monitoring scales, the transcripts of delivering the interventions, and especially the description of emotion exposure procedures. We often tell our patients to ‘sit with’ their painful emotions. I’ve frequently wondered what that meant and how to do that exactly. This book’s description of the skills of emotion surfing gives me the information I’ve been seeking. This book is a gift to me—and to my patients.”

—Jacqueline B. Persons, PhD, director of the Cognitive Behavior Therapy and Science Center in Oakland, CA; and clinical professor in the department of psychology at the University of California, Berkeley

“Based on sound, evidence-based principles, this book presents a straightforward approach to helping individuals who struggle with intense emotions with few resources or skills to manage them. I highly recommend this book.”

—Michael A. Tompkins, PhD, licensed psychologist; codirector of the San Francisco Bay Area Center for Cognitive Therapy; assistant clinical professor at the University of California, Berkeley; diplomate and founding fellow of the Academy of Cognitive Therapy; and author of Anxiety and Avoidance

“This highly practical and timely treatment flows naturally from the transdiagnostic literature, and offers therapists a clear, step-by-step guide to helping clients improve their awareness of and ability to cope with strong emotions—an important aspect of successful therapy outcomes. Every page is clear, concise, and to-the-point, allowing clinicians to quickly grasp the treatment rationale and master the protocol. The illustrative dialogues and accompanying worksheets reflect the authors’ expertise in translating techniques into practice with actual clients, which is supported by the robust initial outcome data. A ‘must’ for therapists, supervisors, and trainees attempting to treat multiple problems simultaneously using a transdiagnostic approach.”

—Rochelle I. Frank, PhD, assistant clinical professor of psychology at the University of California, Berkeley

“This is a refreshingly straightforward and practical resource for clinicians seeking to integrate components from acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and cognitive behavioral therapy (CBT) to target specific transdiagnostic mechanisms underlying problems with emotion regulation. Instructive handouts and sample therapist-client dialogues bring treatment components to life. Clinicians now have a resource that strategically guides them when helping clients increase awareness and acceptance of emotions, choose value-based actions, and practice distress tolerance skills, all within an exposure-based model. This is the book that clinicians have been waiting for!”

—Joan Davidson, PhD, codirector of the San Francisco Bay Area Center for Cognitive Therapy; assistant clinical professor in the clinical science program at the University of California, Berkeley; coauthor of The Transdiagnostic Road Map to Case Formulation and Treatment Planning; and author of Daring to Challenge OCD

“EET combines strategies from several proven approaches for dealing with distressing emotions. The strategies laid out in this well-written, accessible, and practical guide will show clients how to experience a full range of emotions while reducing their pain and suffering. Each chapter is filled with illustrative case examples and practical worksheets that make it easy to deliver the program.”

—Martin M. Antony, PhD, ABPP, professor of psychology at Ryerson University in Toronto, ON, Canada; and coauthor of The Shyness and Social Anxiety Workbook and The Anti-Anxiety Workbook