EMOTION EFFICACY THERAPY

A Brief ACT-Based Protocol for Clients Who Struggle with Emotions

21 September 2019

New Harbinger Publications Oakland, CA

featuring

APRILIA WEST, PSYD, MTMATTHEW MCKAY, PHD

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Spencer Smith, Director5674 Shattuck Avenue, Oakland CA 94609 USA

spencer.smith@praxiscet.com

Dear friend:

Thank you so much for joining us for the Emotion EfficacyTherapy (EET) training here in Oakland with Aprilia West and Matthew McKay.

We’ve put together a schedule of trainings this year in cities across the country to introduce and build upon existing skills for clinicians and students practicing acceptance and commitment therapy. We’ve hand-picked some of the best trainers we could find. Our trainers are not only experts in their fields; they’re all excellent teachers, attentive and empathetic communicators, and they really, really care about helping you help the people you serve.

PraxisCET offers:

• Live training events, including ACT BootCamp - Philadelphia, PA, October 24-27, 2019, and ACT BootCamp - Seattle, WA, Spring 2020

• Online Learning Courses

• On-Demand Online Learning

You can always learn more about these projects at www.praxiscet.com.

I would like to extend a personal invitation to you today: PraxisCET is your company, serving your practice community. To take care of you, we need to know what you need. I invite you to let me know how we’re doing and what we can do better. You can reach me anytime by email at spencer.smith@praxiscet.com.

Thanks very much for your support. I hope you have a great learning experience with us.

All the very best,

Spencer Smith

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BOOK SALES

use code EETOAK19 at checkout

newharbinger publications

Workshop participants get 35% off all titles at www.newharbinger.com

PLUS FREE STANDARD US SHIPPING — THROUGH SATURDAY, 12 OCTOBER 2019 —

IMPORTANT INFORMATIONCHECK-IN / CHECK-OUT

• All attendee’s must sign-in in the morning when you arrive and sign-out in the evening when you leave, regardless of CE status.

• Attendees must complete the course in full and attend all sessions in order to receive ANY continuing education credit. No partial credit will be given.

HOW TO ACCESS YOUR CE CERTIFICATEIn order to print your CE certificate, you must first complete a workshop evaluation. Please give us a 3 day grace period after the event has concluded before you attempt to complete the evaluation.

• First, sign into your Praxis account at www.praxiscet.com/account.

• Click on the “My Workshop Evaluations” box.

• Choose the event you just completed and would like to complete the evaluation for.

• Click on “Feedback Survey” and complete the evaluation.

• Once the evaluation is submitted, you will receive an email with your CE certificate. You can also access your CE certificate by going to the “My Certificates” page in your Praxis account.

• Attendees have 6 months following the course to complete the workshop evaluation and print your CE certificate. If you have not done so after the 6 month mark, there is no guarantee that we will be able to provide you with a certificate.

Please email us at events@praxiscet.zendesk.com for any additional help.

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SCHEDULESaturday, 21 September 2019

• 8:30 am - 9:00 am: Registration/Check-in*

• 9:00 am – 11:00 am: Overview of Workshop and Learning Objectives Theoretical and Clinical Foundations of EET Introduction to Emotion Awareness Introduction to Mindful Acceptance Introduction to Emotion Surfing VIDEO: Emotion Surfing

• 11:00 am – 11:15 am: Morning Break*

• 11:15 am – 12:45 pm: Emotion Awareness and Mindfulness Acceptance Q&A Introduction to Values-Based Action VIDEO: Values-Based Action Monsters on the Bus Experiential

• 12:45 pm – 1:45 pm: Lunch Break*

• 1:45 pm – 3:30 pm: Values-Based Action Q&A Introduction to Mindful Coping VIDEO: Mindful Coping

• 3:30 pm – 3:45 pm: Afternoon Break*

• 3:45 pm – 5:30 pm: Mindful Coping Q&A Pulling It All Together: Troubleshooting Tips Assessing Outcomes Exposure Demo with Group Coaching Q&A / Check-out

* Not available for CE credit

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Saturday | 21 September 2019 | 9:00 am – 5:30 pm

EMOTION EFFICACY THERAPY

Aprilia West, PsyD, MT, is a licensed clinical psychologist and executive coach with practices in Los Angeles. Dr. West became interested in the concept for emotion efficacy and performance training working as a former advisor, organizational consultant, mediator, and executive coach to members of Congress, Fortune 500 companies, entertainment industry professionals, and international advocacy campaigns. She is co-author of Emotion Efficacy Therapy: A brief exposure-based treatment for emotion regulation integrating ACT & DBT. West holds a PsyD in clinical psychology from the Wright Institute in Berkeley, CA and an MA

in teaching from the University of Virginia.

The Institute for Better Health, Inc. (IBH), formerly IAHB, is responsible for the content, quality and scientific integrity of all CE/CME activities certified for credit. When an educational activity is offered for medical (CME), Nursing (ANCC) and/or Psychology (APA) continuing education credit, participants must be informed as to the source, amount, nature, and disposition of any funding used to support the activity, whether in the form of educational grants, cash contributions, or in-kind contributions.

Individuals in a position to influence course content must also disclose whether they have one or more relevant financial relationships with individuals and companies who have a financial interest in activity content. All those in a position to control the content of an education activity are asked to disclose any relevant financial relationships they have with any commercial interest.

Matthew McKay, PhD, has disclosed a relevant financial relationship with New Harbinger Publications/Praxis. Dr. McKay agrees that his presentations and other contributions to program content will be completely fair and unbiased, and will mention other healing processes and productions during his presentations when appropriate. If possible, he will refer to generics rather than to brand names when mentioning products, equipment, and services, and they will be selected/included on the basis of best available evidence.

Disclosure of Relevant Financial Relationships

Matthew McKay, PhD, is a professor at the Wright Institute in Berkeley, CA. He has authored and coauthored numerous books, including The Relaxation and Stress Reduction Workbook, Self-Esteem, Thoughts and Feelings, ACT on Life Not on Anger, and Seeking Jordan. McKay received his PhD in clinical psychology from the California School of Professional Psychology, and specializes in the treatment of post-traumatic stress disorder (PTSD) and traumatic grief. He lives and works in the greater San Francisco Bay Area.

Aprilia West, PsyD, MT, has disclosed a relevant financial relationship with New Harbinger Publications/Praxis. She agrees that her presentation and other contributions to program content will be completely fair and unbiased, and will mention other healing processes and productions during his presentations when appropriate. If possible, she will refer to generics rather than to brand names when mentioning products, equipment, and services, and they will be selected/included on the basis of best available evidence.

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LEARNING OBJECTIVES

� Objective #1: Explain the foundational theoretical and learning theories underlying emotion efficacy therapy.

� Objective #2: Describe the role and significance of emotion avoidance, distress tolerance, and emotion regulation in emotion efficacy.

� Objective #3: Demonstrate how to teach emotion awareness as way to decrease emotion avoidance.

� Objective #4: Demonstrate how to teach mindful acceptance as a way to increase distress tolerance and emotion regulation.

� Objective #5: Demonstrate how to teach values-based action as a way to increase mindful acceptance, distress tolerance, and valued living.

� Objective #6: Demonstrate how to teach mindful coping as a way to increase emotion regulation and values-based action.

� Objective #7: Demonstrate facility in guiding clients in exposure-based skills practice for each EET skill to enhance learning, retention and recall.

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EMOTIONEFFICACYTHERAPY

(EET)

APRILIA WEST PsyD,MT MATTHEW McKAY,PhD

PRAXISTRAININGSeptember 21.2019

LEARNINGOBJECTIVES

Participants will be able to:1. Describe the role and significance of emotion avoidance, distress

tolerance, and emotion regulation in emotion efficacy.2. Demonstrate how to teach Emotion Awareness as way to

decrease emotion avoidance.3. Demonstrate how to teach Mindful Acceptance as a way to

increase distress tolerance and emotion regulation.4. Demonstrate how to use Values-Based Action as a way to

increase mindful acceptance, distress tolerance, and valued living.5. Demonstrate how to teach Mindful Coping as a way to increase

emotion regulation and values-based action.6. Demonstrate facility in guiding clients in exposure-based skills

practice for each EET skill to enhance learning, retention and recall.

DISCLOSURE

We receive royalties from the sale of the clinician’s guide to

Emotion Efficacy Therapy (Context Press,2016).

© 2019ApriliaWest,PysD,MT

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WHAT IS EET?Emotion Efficacy Therapy (EET) is a brief protocol integrating Acceptance and CommitmentTherapy (ACT),ExposureTherapy and Dialectical BehavioralTherapy

(DBT) to help people increase their psychological flexibility.

WHYTREATEMOTIONEFFICACY?

•Over 75% of people who seek therapy struggle with low emotion efficacy

(emotion dysregulation+ distress intolerance + emotion avoidance) (Barlow, 2000;

Kring & Werner,2004).

• A transdx approach is supported in research literature. Research suggeststargeting Emotion Avoidance and Distress Intolerance will increase emotion

efficacy (Taylor & Clark, 2009; Wilamowska,Thompson-Hollands, Fairholme, Ellard, Farchione & Barlow, 2010; West,

2016)

•Learning is multi-layered: cognitive, affective, somatic & behavioral

components (Tryon,2005)

•State-dependent research supports the use of exposure-based learning to

accelerate retention and recall of new skills (Persons & Miranda, 1992; (Szymanski &O’Donohue,

1995;Matrrick et al,1989;Persons & Miranda,1991;Craske,2012)

• Need for more brief portable low-cost effective tx

WHAT ISEMOTION EFFICACY?

The ability— and the belief in the ability— to experience and respond to a full range of emotions in a contextually adaptive, values-consistent manner

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MINDFULNESS & ACCEPTANCE

PROCESSES

COMMITMENT & BEHAVIOR CHANGE

PROCESSES

QUICK PRIMER

ACCEPTANCE CHANGE

ACT MODEL DBT MODEL

DIALECTIC

MINDFUL ACCEPTANCE

“I can allow all parts of my  emotional experience  without acting on it”

VALUED ACTION

“I can identify what  matters most to me in  the moment of choice  

and act on it”

MINDFUL COPING “If I’m still flooded  after practicing Mindful Acceptance,  can downshift my emotional activation  

to access values‐based action”

EMOTION EFFICACYTHERAPY MODEL

EMOTION AWARENESS “I can observe all parts  of my emotional experience: sensations  

thoughts, feelings and urges”

EMOTIONS ARENOT PROBLEMS

It’s how we respond to emotions that is effective, workable and helpful, or ineffective unworkable and unhelpful.

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THE SEDUCTIONOFAVOIDANCE

It often feels better in the short term….

AVOIDANCE LEADSTOMALADAPTIVEEMOTION RESPONDING

Reassurance Seeking

Compulsions

Situational Avoidance

Thought Control

Thought Suppression

Worry

Interoceptive Avoidance

Emotion Driven Behavior

Cognitive Misappraisal

Attention Focus-Threat:

Externalizing

Internalizing

Rumination

Post Event Processing

AVOIDANCEDOESN’T

WORK• Ineffective escape or control strategies “don’t think of a

pink elephant”

• Creates habits by reinforcing the removal of the distressing stimulus (discomfort/distress/anxiety is "bad," or“dangerous”)

• Takes people out of the present moment where you access what is needed or valued

• Takes energy away from creating what matters

• Is exhausting and can lead to overwhelm and burnout

“don’t think of a pink elephant”

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WHY DOESTHISMATTERSO MUCH?

OPURET-CPOOSMTETRSIATLU2D0I1E3S

ORUCTTC2O01M4E STUDIES

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ORUCTTC2O01M8E STUDIES

(Cohen’s D)

In a pre-post test pilot study conducted in 2016 at a dual-diagnosis treatment program with individuals struggling with significant chemical dependency problems, after EET treatment the relapse rate decreased by 50% compared to individuals receiving treatment as usual (CBT and 12-step).

OPURTE-CPOOSMTECSDTTURDIAILES

EMOTIONEFFICACYTHERAPY

PROTOCOL

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SESSION PROTOCOL

Session 1: EmotionAwarenessSession 2: Mindful Acceptance + EmotionSurfing Session 3: ValuesClarificationSession 4: Values-Based Action Session 5: Mindful Coping

Session 6: Mindful Coping Session 7: Mindful Coping Session 8: Pulling it allTogether

* Can be administered in individual or group format

SESSION STRUCTURE

1. Mindful Acceptance practice2. Skills Practice review3. Psychoeducation on new skill4. Practice new skill5. Exposure + new skill6. Feedback andTroubleshooting7. Review homework

SESSION STRUCTURE

DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7

emotional efficacy therapy

protocol

SKILLSPR

ACTIC

E

Observe 4 parts of an emotion: sensations, feelings, thoughts & urges

Observe, Accept and surf your emotional wave, with SUDS

Observe, Accept & Choose a Values-based Action

Observe, Accept and Choose a relaxation

Observe, Accept and Choose a self-soothing skill

Observe, Accept and Choose a coping thought

Observe, Accept and Choose to practice radical acceptance

Observe, Accept and Choose a distraction skill

EMOTIONAL TRIGGERS | Record any events or emotions that are distressing during this week:

Directions: Place a check ✔ next to the skill you practice each day. Record any triggers at the bottom. Bring this record to your next session.

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• Practice connecting to present moment

• Learn the adaptive function of emotions: “survival wiring” vs. maladaptive responding

• Identify ineffective avoidance patterns

• Distinguish themselves from their emotions (observer)

• Identify the four parts of emotion:•

SESSION ONE:EMOTION

AWARENESS

WHAT MAKES UP ANEMOTION?

HOW EMOTIONTRIGGERSWORK

trigger

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STEPSTOEMOTION

AWARENESS

STEP1: Sensations: observe and describe what you notice in your body e.g. pressure,tension,temperature,movement,pulsation,etc

STEP 2: Thoughts: observe and describe the content the mind is creating

STEP 3: Feelings: name the labels based on the felt sense or interpretation of the experience

STEP 4: Urges: notice the action the emotion creates to do something or not to do something

EMOTIONS ARENOT PROBLEMS

It’s how we respond to emotions that is effective, workable and helpful, or ineffective unworkable and unhelpful.

EMOTIONAWARENESS

EXPERIENTIAL

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• Understand lifespan of emotion wave

• Identify behaviors that intensify and prolong emotion waves: e.g. rumination, emotion-driven behavior, avoidance behaviors

• Identify ineffective avoidance patterns

• Learn to allow emotional experience instead of reacting or acting on it by surfing the wave until it resolves

• Learn to induce Emotion Exposure for practice in activated state•

SESSIONTWO:MINDFUL

ACCEPTANCE

STEPSTOMINDFUL

ACCEPTANCE

1.Sensations: observe and describe what you notice in your body and soften, lean into and allow what’s happening

2.Thoughts: observe and describe the content and let it go using the breath to anchor and wait for the next thought to arise

3.Feelings: name the labels based on the felt sense or interpretation of the experience without judgment and with compassion

4.Urges: notice the action the emotion creates to do something or not to do something and sit with the discomfort while watching the intensity of the wave resolve

INDUCINGEXPOSURE

• Psychoeducation on how exposure to aversive stimulus helps create new responses and also allows for habituation/desensitization

• Reviewing activation process of remembering and/or describing the emotion or event in detail until distress is mid-range (4-6 SUDS)

• Review of ability to stop or ground if necessary

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STEPSTOMINDFUL

ACCEPTANCE

STEP 1: Pick a scene or emotion (activating in the 4-6 SUDS range)

STEP 2: Describe the scene in present tense in as much detail as possible: (what IS HAPPENING? WHAT do you see, hear, touch,taste?)

STEP 3: Once you reach your target SUDS level, “cut off ” the scene

STEP 4: PRACTICE SURFING THROUGH ALL PARTS OFEMOTION:observing and accepting sensations, thoughts, feelings and urges

MINDFULACCEPTANCEVIDEO

MINDFULACCEPTANCEEXPERIENTIAL

IN DYADS(TIME PERMITTING)

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MORNINGBREAK

EMOTIONSURFINGVIDEO

• Clarify values (vs. shoulds/expectations)

• Locate Moment of Choice

• Understand Creative Hopelessness

• AccessWillingness

• Integrate with emotion exposure and imaginal exposure

SESSION 3-4VALUES-BASED

ACTION

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CLARIFYINGVALUES

STEPSTO VALUES-BASEDACTION PRACTICE

STEP 1: Pick an anticipated trigger scene

STEP 2: Identify value for anticipated trigger

STEP 3: Induce emotion activation by describing scene in present tense (e.g. what is happening? what do you see, hear, touch,taste?)

STEP 3:Once you reach a mid-range SUDS level,“cut off” the scene

STEP 4: Surf the wave using Mindful Acceptance (observing and accepting sensation thoughts, feelings and urges)

STEP 5: Rate SUDS (to track where you on the wave)

STEP 6:Visualize chosenVBA

STEP 7: Rate SUDS

VALUES-BASEDACTIONVIDEO

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MONSTERS ON THEBUSEXPERIENTIAL

LUNCHBREAK

SESSIONS 5,6 & 7MINDFUL COPING• Introduction to 6 Mindful Coping skills: relaxation and self-soothing:

diaphragmatic breathing, cue-controlled breathing, relaxation without tension, five senses exercise (Session 5); coping thoughts and radical acceptance (Session 6); distraction and time out (Session 7)

• Mindful Coping is only used after Mindful Acceptance in the moment of choice

• Functional analysis of coping as a “towards” values move instead of an“away” values

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STEPS TOMINDFULCOPING PRACTICESTEP 1: Pick an anticipated trigger scene

STEP 2: Identify Mindful Coping skill to use in the moment of choice

STEP 3: Induce emotion activation by describing scene in present tense (e.g. what is happening? what do you see, hear, touch,taste?)

STEP 3:Once you reach a mid-range SUDS level,“cut off” the scene

STEP 4: Surf the wave using Mindful Acceptance (observing and accepting sensations, thoughts, feelings and urges)

STEP 5: Rate SUDS (to track where you on the wave)

STEP 6: Use Mindful Coping Skill

STEP 7: Rate SUDS

MINDFULCOPINGVIDEO

GROUP COACHINGEXPERIENTIAL

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PULLING IT ALLTOGETHER

Review and consolidation of learning

Time to reflect on “what works” e.g. specific skills in specific situations

Troubleshoot “areas of difficulty” (e.g. chronic pain,inducing activation)

Personalized emotion efficacy plan

ASSESSMENTS

• Difficulties with Emotion Regulation Scale (DERS)

• Distress Intolerance index (DII)

• Acceptance and Avoidance Questionnaire II (AAQ-II)

• Valuing Questionnaire (VQ)

• Emotion Efficacy Scale (EES2)*corrected version with scoring directions

CONTACTINFO

APRILIA WEST, PSYD,MTaprilia@drapriliawest.com

MATTHEW McKAY,PhDFounder, New Harbinger Publications mattmckay@newharbinger.com

EET Training & consultation www.emotionefficacytherapy.com/training

EMOTION EFFICACY THERAPY (EET) clinician’s guide available at: www.newharbinger.com/emotion-efficacy-therapy

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NOTES

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