 This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. So I'd like to welcome everybody to today's presentation, emotion efficacy therapy, a brief exposure-based treatment for emotion regulation, integrating ACT and DBT. This is a book that I came across doing some research and I just happened to be one of those people who likes to look for techniques and new approaches because we know that what we use in our practice typically needs to be modified some because there's not a one-size-fits-all therapy for every single client. So I'm always looking for more tools to add to my toolbox. Then this book came to my attention and I really found it very, very interesting and a good eight-session protocol that you can really easily implement and I can see using it really effectively in groups. So if you do group work, this might be something else that you want to look at. So anyway, we're going to define what emotion efficacy therapy is and I will call it EET from here on out so I don't trip over my own tongue. Explore the underlying theory. Identify techniques used in EET and their rationale. Again, remember we're looking at a combination of ACT and DBT. So if you've studied either one of those or both of those, you kind of know where we're going with this. But they've taken the techniques from both of those and they've added some more experiential stuff which will look at how that enhances the treatment process. And then we'll theorize about how EET might be helpful to your clients. So what is emotion efficacy therapy? It's an eight-session protocol, which is great because a lot of our clients, if we can get them in, if we can get them to commit to eight sessions, we're doing really good. Most clients aren't going to want to be in session. They're not going to want to be in therapy indefinitely for six months, for 12 months. So if we can say there's an eight-session protocol, let's teach you these skills and then maybe take a break and you'll see how things are working for you. You'll see what's getting better. And then you can come back if you want. So you have episodic treatment instead of this ongoing relationship, if you will. It targets the trans-diagnostic drivers of low emotion efficacy and people with emotional dysregulation, anxiety, depression, stress, and impulsivity. Trans-diagnostic means that with all of those disorders or conditions, there are a lot of very similar features. You know, when we think about it, we think about difficulty concentrating, fatigue, irritability. So we're going to look at what the underlying thing is. It's not looking at the symptom. You know, if you have a cut on your arm and it gets infected, yeah, you're going to want to treat whatever is going on. But you want to treat the underlying issue. You want to help the wound heal, not just get rid of whatever bacteria happens to be there right now. The philosophical premise of EET is that while pain is unavoidable, you know, stuff happens, suffering is not. Part of it is sort of a paradigm shift in how we help clients look at what's going on in their life. EET skills focus on increasing distress tolerance and decreasing emotion avoidance. So yeah, one of the important things for a lot of our clients and clients that I've worked with who have co-occurring disorders in recovery, they say the greatest thing about recovery is you start to feel feelings. And the crappiest thing about recovery is you start to feel feelings because it can be overwhelming. So once they start to feel feelings again and they're actually kind of leaning into the feelings and going, okay, I want to feel, they have to develop distress tolerance skills. So using five components, emotion awareness, mindful acceptance, values-based action, mindful coping, and exposure-based skills practice, EET helps clients develop the ability to basically more effectively manage their emotions. We talk about self-efficacy, the belief that you can do something. Emotion efficacy is the belief that you can handle your emotions. You can deal with your emotions. You may not be able to control them, but they're not going to overpower you. Because learning and memory are created through the encoding of experiences, it follows that utilizing all sensory and perceptual components is essential for new learning. So if you go back and you think a couple presentations ago about how we talked about guided imagery and how we talked about the fact that you don't necessarily need to be actually in the experience for your body to react, for your brain to react. You don't have to be tasting the brownie to salivate. They're taking those principles and applying them here and saying, okay, there are a lot of things that you can imagine that will increase your stress. If you're terribly afraid of spiders, sometimes just imagining a spider or imagining a spider crawling on you will increase your distress levels. And through that exposure, in session, clients can learn how to better handle their emotional reactions. In EET, trans-emotional learning occurs through the activation of all emotional components. So trans-emotional, the way they use it, is referring to all the components of emotion, which are thoughts, sensations, feelings, and urges. In order to build these neural pathways, memories, around new behaviors, we typically have sort of a knee-jerk reaction to a lot of different things. You see a red light, you stop. You see a yellow light depending on who you are. You either slow down or you gun it. That's sort of hardwired. You don't think about that when you're getting ready to do it. So what we want to do is increase those memories, increase those automatic reactions for something that's more effective and more helpful than what the client is already doing. EET leverages state-dependent learning through exposure, facilitating new learning in emotionally activated states by increasing learning retention and recall of EET skills. When we are in a stressful state, think about clients. Let's take it to the extreme. Clients who are in crisis, do they remember very much from time to time or even minute to minute? No, and we don't expect them to because they are just trying to hold it together. They are just trying to figure out what just happened because their world turned upside down. So if somebody is in crisis, we're not expecting them to necessarily remember everything that we taught them two weeks ago, which is why in relapse prevention planning, we encourage people to keep a index card with them that has relapse prevention tools, keeping it on their phones, something where they can access it right away where it's written down. They don't have to recall it from memory. EET takes it a step further and actually activates people's emotion response system in session so they get used to recalling that new helpful behavior when they're under a lot of stress. EET is based on research of three foundational ideas for its treatment structure and content. A trans-diagnostic approach is the most effective way to treat clients with emotion problems. A lot of people come in and we know that when we look at the diagnostic criteria for anxiety, depression, and even to a large extent, addictive behaviors, there are a lot of similarities and one of those similarities is an emotional dysregulation that is just overwhelming the person, whether it's depression, anxiety, in addiction, it's generally a numb depression or anxiety. So we're looking at basically a very similar animal. So the trans-diagnostic approach says, all right, you're coming in with this host of problems and if you've done an assessment on somebody that you've never met before, which generally is how it goes, you get a lot of ideas about what's going on in the first meeting, but I'm never comfortable making a concrete diagnosis after knowing somebody for 90 minutes. You know, sometimes there are a lot of indicators that the person may be suffering from clinical depression or generalized anxiety disorder, but at that point in time, I haven't been able to rule out a whole bunch of other stuff. I haven't been able to get them to their doctor to see if there's any underlying biological cause. I haven't been able to really get to know everything. So what we're doing is we're saying there's a lot of underlying factors and we know that if you're upset, we know that if you are presenting because of emotional dysphoria, this particular approach can help start easing some of those symptoms. Does it deal with everything? No. We're not going to help people necessarily completely deal with PTSD symptoms, with trauma symptoms, with a whole host of psychotic behaviors. No, we're not talking about that. We're talking about helping people start to feel better. And then once we start getting that energy back and once they start feeling better, they have more self-efficacy and they also tend to have more dedication or enthusiasm about approaching therapy because it's like, hey, this is working. I'm feeling a little better. So trans-diagnostic. Trans-emotional learning involves all four components of emotion, which is essential to learning. We've talked about learning styles before when we want to make sure that the information we provide is visual, is auditory, and when it all possible, it's also kinesthetic. That is, we have the person manipulate the information and apply it to something they already know. The more ways you can present the information, the more senses you can tap into, the stronger those connections are. So the more readily those memories are available to the person. And new learning is enhanced in an activated state. If you learn something when you are all fired up, you're probably going to recall it better when you're all fired up. If you learn something when you're calm, then you're probably going to repeat it more effectively when you're calm. They've also done studies that have shown that I'm advocating for this, but when people who learn a skill under the influence of alcohol, marijuana, or any other myriad of drugs, they tend to recall it better when they are still under the influence of that. And so for a lot of my clients, when they go back out and they start back in the workforce again, trying to do the same things they did before when they were high as a kite is a lot more difficult. And I challenge them to understand the fact that their brain learned this in a whole other state of being. Same thing is true with crisis. You're not high, it's not where you are, but you are in a crisis state and your mind is focused on other things. So we want to help people learn how to activate these new skills, how to access these new skills when they're stressed out. Why is this effective? Why is this useful to our clients? Because there are more commonalities than differences across diagnostic disorders. And it underscores the need for a trans-diagnostic approach. In the book, Emotion Efficacy Therapy in the Appendices, all the research that they did on this with all the stats and all that kind of stuff is laid out for you. But it's important to kind of understand what the theory is underneath this. Trans-diagnostic formulation identifies and targets the mechanism driving the symptom. Just like the cut I mentioned earlier, it's targeting the mechanism, this open wound that is a breeding ground for bacteria. It just happens to let bacteria get in there and proliferate. Trans-diagnostic approach allows for a single therapy for clients who present with a range of symptoms. Now, like I said, is this single therapy going to be the be-all end-all for everybody? No. That's not necessarily going to happen. Will it work for a lot of clients? Sure, because a lot of clients present with anxiety and depression and intermittent anger. They may help them address all of those things as they become more mindful and more able to make a decision consistent with their values during the time between the stimulus and the reaction, which in EET they called the moment of choice. The goals of treatment is to give the patient power to experience themselves as distinct from their emotions. You don't have to be angry. You are who you are, and you are having a feeling of anger. We want to give them the power to experience intention motions instead of reacting and avoiding. Help them develop the confidence that they can handle it. That wave of anger, that wave of anxiety that comes over them or comes towards them, they can handle it. They don't have to run from it. We want to help them develop the power to choose values-based actions that they have figured. I talked about that moment between stimulus and response. This takes us back to the ACT sort of theory. When something happens, when people can have the moment to think before they act, they can decide on a course of action that takes them closer to their values. If something happens and they get angry at their child, they have the option of screaming at the child or taking a few deep breaths and having a discussion with the child or handling it a myriad of other ways, but we're going to go with those two. What are the consequences of screaming at the child? You may get immediate submission or you may get immediate blowback, but does it end up helping the child not recreate that problem? Or does talking to the child and explaining why you got angry, why something else would have been a better choice, does that get you closer to where you want to be in terms of your relationship with the child? You have two choices of reaction. Which one is going to help get you closer to the relationship you want with your child? The power to choose strategies to down-regulate emotion and keep from making difficult situations worse. You find out something at the office and it just really ticks you off. Maybe your vacation got canceled. That's a bad situation. You can storm into your boss's office and start screaming at him or her. Or you can choose a different course of action. Again, looking at based on your values, based on what's important to you, do you need to keep the job? And what will be the fallout from running in and screaming at your boss? So you think about those choices. You think about where you want to be before you make your decision for action. So thinking about anger, addiction, and self-harm. We've talked about a couple of examples of getting angry. When people get angry, anger is your fight of the fight-or-flight reaction. So people are generally trying to gain power back, gain dominance, assert or dominate their opinion. And oftentimes it's a protection. A lot of times anger is used to push people away to protect themselves. So when we're thinking about that, when you get angry, is that what you want to do? The reaction that you normally choose, which often ends up creating more conflict, hurting feelings. You end up saying things you don't want to say. Is that getting you closer to where you want to be in terms of your relationships with other people, your relationships with your boss, your job, whatever? Or are there other options that you can choose? And depending on the client, their response options are going to vary, which is one of the reasons this can be really cool in group, because you can talk about what's your normal response to anger and list that on one side of the board. And then what are some other opportunities that you can explore when you get angry instead of using those old behaviors? In terms of addiction, when people have addictions, typically they want to use when they're trying to numb pain. And when they sober up, the pain comes back, so they want to numb it again. What are some options? When somebody is in recovery, this is going to be a little bit easier if they've already detoxed. But even, you know, that first day, they have to choose whether or not they are going to detox or they are going to use again. EET will help people look at what's going on, what their goals are, and make the choice that will help them get closer to their goals if they feel they can do it. And that's where the efficacy comes from. We need to make sure that they feel like they have the capacity and the tools to deal with these seemingly unpleasant and overwhelming emotions. And self-harm. We've talked briefly in other classes about self-harm, how a lot of times people do self-harming behaviors in areas that are not noticeable. So it's not as much of cry for attention as it is a way to focus on something external, something they have to control over, that kind of pain, versus the pain and the chaos that's going on in their head. So self-harm is a distraction technique in some ways for a lot of people. So if this person gets overwhelmed and triggered, their knee-jerk reaction may be self-harm because that helps them get focused again. What are some other behaviors they can choose and in what ways does self-harm support their ultimate goals versus undermine them? Everything we do has a benefit. Everything we do in some way is trying to get us towards those ultimate goals. It just may not be the most effective option. Self-harm and addiction, both of them, if we want to think about it. When people do that, it's helping them survive what they perceive as intolerable, the intolerable wave of emotions that they don't know how to deal with. So they're trying to survive. They want to survive. As therapists, we want to help them do more than survive. We want to help them thrive. So let's look at those pluses and figure out if there are other tools they can use. People with low emotional efficacy. Some of them have a biological predisposition or sensitivity which causes high levels of reactivity. This comes from your DBT literature as well as a bunch of other information. We know that some people tend to be more emotionally reactive or sensitive than other people. Not that other people are callous, but some people, instead of going from a one to a four when something happens, may go from a one to a nine with the same event. So why is one person more reactive? Why are they more intensely triggered with the same event? High emotionality or experiential avoidance of uncomfortable sensations, emotions, and cognitions are triggered by internal or external cues. So again, we want to think about internal cues and that's that voice inside our head that tells us something bad is going to happen. Or it's the sensations, if your heart starts to race or if you start getting kind of shaky because you're nervous about something. Those are internal cues that came from somewhere that are telling you there's something bad fixing to happen. Some people will react to that by de-escalating themselves, but people with low emotional efficacy tend to take that and run with it and think that the sky is going to fall or they won't be able to handle whatever's coming towards them. Significant levels of distress intolerance, small amounts of distress, even minor upsets tend to just completely drain them or turn their world upside down. Lack of emotion shifting or down regulation skills. When they get upset, they have a hard time switching over from angry. I was angry about this thing that happened for a moment, but now I'm going to go have lunch and just let it be. People with low emotional efficacy have difficulty or cannot do that. They can't just compartmentalize and go, okay, I'm going to let it go. They also have difficulty down regulating. So when they realize that they're at a nine, they have difficulty using any skills to come down and go, okay, this is really more of a four than a nine. Consistent and significantly socially invalidating environments. Again, this takes us back to DBT where people are telling them you shouldn't feel that way. Well, you know what they do. And if you're telling me I shouldn't feel that way, then I think you need to give me some tools so I can not feel that way, but I don't know how to not feel that way. So helping people validate themselves for doing the best they can with the tools they have is part of our job as therapists and helping them see how they are different than other people. You know, not different in an odd sort of way, but two people are going to experience situations very differently based on their temperament, their history, all kinds of stuff. It doesn't mean they're worse or better. It just means that they're different. A lack of understanding of their emotional experience. So many times I work with clients, they're like, I don't know why I get so upset over this or I don't know why I'm so hung up on. So we need to talk about where's that coming from? Why? Why do you get so upset about that? What in your past told you that that was threatening or upsetting or scary? Ineffective tools to either tolerate difficult emotions because they happen, you know, we can't say that you're going to go through life and you're never going to have a really difficult emotion. If somebody passes away, if you are in a really bad car accident, you know, there's a whole lot of things that can happen and they really stink. And do you have the right to feel overwhelmingly upset? Sure. How do we deal with it? How do you tolerate it and how do you work with it? We want to help them develop the tools to make values consistent choices and or regulate their emotions. So the five components of EET, emotional awareness, first people need to figure out what it is they're dealing with. A lot of our clients with low emotional awareness can't identify one feeling from the other. They give you feelings like, or bleh. Wonky is my favorite one. They have difficulty putting labels like angry, scared. There was an interesting study I read when I was back in college that showed that a lot of people were kind of pre-programmed when we're infants. We don't differentiate between anger, anxiety and hunger and sleep, sleepy very well. But anger, anxiety and hunger are really close and we have to learn how to differentiate between them. So we want to help people start focusing on what does anger look and feel like for you. Not for your child, not for your parent, not for your boss, but for you. What are your thoughts when you get angry? What are your feelings, you know, emotional feelings? What are your physical sensations and what behavioral urges do you have? Then we move on to mindful acceptance, which is just that non-judgmental acceptance of whatever's happening in the moment. Accepting that it is. Values-based action means making a proactive choice that gets you more toward where you want to be versus just a reactive avoidance, your knee-jerk reaction going, not going there. Mindful coping, this is one of our kind of new concepts. Coping skills are usually used to avoid or change an aversive emotion. But in mindful coping, we want to help clients expand their choices so they can choose values-based action. Mindful coping says you've got a repertoire of choices to choose from, not just one, not just two, you've got several things to choose from. So what coping skill is going to work best for you in this situation? Sometimes, you know, your knee-jerk reaction of getting the heck out of there is going to be the most effective situation or most effective response for that situation. So it's all about situationally appropriate coping. And then exposure-based skills practice. Once they learn the skills and as they're learning the skills, help them practice it by imagining some of their triggers. A typical session in EET starts with mindful acceptance skills practice. So practicing, becoming aware of where you are in the moment right then and there, sort of a grounding exercise. Skills practice review and troubleshooting challenges. So skills practice review, it's a worksheet that's in the book that helps people look at what skill they practiced or skills they practiced over the prior week, how it was effective, and in what ways or what situations it was ineffective or less effective than they wanted it to be. And how can you fix that? Why wasn't it ineffective? Then they review the previous week's psychoeducation and skill, provide psychoeducation on a new skill, practice that skill, then using imaginal or emotional exposure with the new skill. So thinking about a trigger, help the person get in a state of increased excitement or anxiety. We don't want them to be, you know, off the charts. That wouldn't be helpful, but increased so they can learn how to de-escalate themselves. If you think about systematic desensitization, which has been around for years and years and years, this is similar to what we're talking about here. And then homework via skills practice record. So they're going to assign people homework based on what skills they've learned so far, and then there's a practice record that people log their successes as well as their challenges with the new skill. So emotion awareness encompasses thoughts, feelings, physical sensations, and behavioral urges. It's important to help clients remember that emotions can be contextually unhelpful or helpful. If you get really angry about something, you know, you got angry. Now, what are you going to do with it? Is it going to be helpful to stay angry and fight or flee? Or is it not as helpful and you need to do something different? Emotions or messages sent by the brain to help respond to perceived threats and opportunities. We've talked about this repeatedly. Our brain is really smart and really stupid at the same time because it reacts based on our prior memories, our experiences combined with our perceptions of those experiences. And we know that people's perceptions are their reality, but they're not necessarily the reality. So if something happened when you were, you know, six, a dog came running to the fence and started barking at you and all its teeth and you were terrified and then you, from there on out, were terrified of that kind of dog, you know, that is your experience there. Now, me, I'd see a dog that comes rushing up to the fence and burying all its teeth. I'd be like, oh, hi puppy, it's okay. Of course, I'm the one that probably would chase down Kujo and try to catch him. So, you know, I don't necessarily say I used the best judgment, but we want to look at what is helping the person, again, get toward where they want to be. Emotions are not the truth. Emotions are your reaction to what happened combined with your expectations or schema associated with that. So again, with that dog, that dog may not have been vicious at all. You know, my dog does that. He will run to the door and he barks and barks and barks and he's got a really deep bark. But as soon as somebody comes in, he'll lick him to death. You know, he doesn't have an evil bone in his body. He doesn't have a protective bone either, but that's beside the point. Emotions urge us to action. When we get scared, that's fight or flee. When we get angry, that's fight or flee. Our body is saying, we want you to survive or I want you to survive. So you need to do something. The key is, or the challenge is, that sometimes we misinterpret what's going on and we see threats when there aren't any there. One way to start looking at what triggers people's emotional dysphoria is the trigger identification and emotional reaction worksheet which says, what's the trigger? What emotion does it trigger in you? And then again, what are your thoughts that happen? What are your feelings, physical sensations and behavioral urges when you're confronted with that particular trigger? So people start seeing how they are sort of creatively trying to survive in their perception, in their reality. And then they can choose maybe some other behaviors, some other responses that are more in line with where they want to go from here on out. Mindful acceptance. Benefits to using mindful acceptance when you're emotionally triggered means you can learn to tolerate pain without acting on it. We can be triggered, we can be angry and we can say, I'm going to stop and I'm going to take a breath or I'm going to do something else. So mindful acceptance and you can go and do whole tons of reading on mindfulness but basically we're wanting people to stop fighting against their reactions and telling themselves they're stupid or they're weak or they're silly for having their feelings and just accepting, let it come, let it go. When you use mindful acceptance, you can recover more quickly from distress of a trigger. Something happens, you let it come, you let it go, you're done with it, you get cut off in traffic, it scares you, you slam on the brakes so you don't end up rear-ending the person, you let it come, you let it go or you can dwell on it and nurture it and have all kinds of adrenaline dumps after that. Does that get you closer to where you want to be as a happy person or further away? And you can learn how to find the space you need to thoughtfully and consciously choose how you will respond to the pain or the situation and that space is between the trigger and the response. People need to find that space instead of thinking they happen automatically. It's there, it's just really, really small. Mindful acceptance is practiced by learning to observe and accept the four parts of emotion, sensations, feelings, thoughts and urges. One exercise you can have clients do spend about 10 minutes each day scanning their body for sensations with the intention of observing and accepting them instead of reacting to them. They wake up in the morning, do a body scan. You know, when I wake up in the morning I've got some aches and pains and I'm just, yeah. I scan, I say, okay, you know, that's where I am today. Feeling labeling, identifying the feeling that goes with that sensation. So if there is an emotion that goes with it, contentment, dread, excitement, whatever that feeling is. During that period, also thought watching. What thoughts are going through my head while I'm laying there doing my body scan, thinking about what feelings going on. The thought comes, the thought goes. If a thought keeps coming back or I keep wanting to attend to it, one of the suggestions in the book is to label it as a sticky thought. Label it, this is a sticky thought and then let it go. Urge noticing. We want people to sit with the urge without acting on it or judging it. So if I'm laying there and I'm doing my body scan and I have the urge to get up, I have the urge to do something else. I keep telling myself, you know, I don't have 10 minutes this morning to sit here and do this. I want to sit with the urge without acting on it or judging it. And then notice what it's like not to act on it when you prevent response prevention. So we've talked about this moment of choice already. It's the moment between stimulus and response. When clients choose to use the skills that they're taught in EET. Emotion surfing, values-based action, relaxation and self-soothing, coping thoughts, distraction and timeouts. I'm not going to do all of these, but this is your repertoire that you're starting to develop with the clients. When something happens, you have four possible reactions in general. You can emotion surf. You can ride that wave and then let it go. You can avoid the emotion. You can stick your fingers in your ears and say, nah, nah, nah, nah, nah. You can do something different. There's a whole list of things. You can ruminate about it and just really nurture that emotion and think about why you're angry. Or you can engage in emotion-driven behaviors, which are typically acting out or acting in, if you will. Addiction, punching a wall, those sort of things. Abilities with emotion surfing. So obviously this is kind of where we want people to go. Observe and accept the emotion wave as it comes. Identify where you are on the wave and how triggered you are. Are you down on the bottom, not very triggered? Or are you up on the top, where it's going to be a big fall? Notice and watching the thoughts without getting fused with them about whatever you're thinking about, all of the automatic beliefs. If you go back to the ABCs of CBT, what are these thoughts that come in? Notice any desire to escape the emotion and continue to observe it instead. Don't tell yourself it needs to go away. Just be with it. And then notice any urges or impulses to act on the emotion and seeing the moment of choice, not engaging in emotion-driven behavior, not going, I've got to react. Taking a moment, thinking through your choices and then moving on to values-based action. There's an excellent section on explaining emotional avoidance and rumination, how the person engages in it and the consequences of it. They have some activities and some worksheets. I'm not going to go through that right here because we've talked about that in other classes. But if you want some tips and different worksheets, they're there. So I said we move on to values-based action. So you ride that wave, get to that place where you can say, all right, now I'm ready to make a choice based on what's important to me. Well, before you can do that, you need to know what's important to you. How many of us, and I say us to include us as therapists, as well as us, clients, our kids, everybody, really stop and think about our values and what we're doing from a moment to moment in order to move closer to those values. If your value is being caring and compassionate, when something happens, is your reaction to that, when something negative happens, is your reaction to that one that supports your value of being caring and compassionate, or is it one that doesn't? So we have to help them develop clarity about their values. We have to help them understand that generally we have a hard wiring to avoid pain, especially uncontrollable pain, and to survive. But emotions don't have to be uncontrollable pain. We have to help them get out of the habit of acting on emotion. They need to act on facts. They need to act on where they are in the moment instead of just how they feel. If they feel scared and they act on that, they may run away, where it may have just been a momentary thing, a momentary wave of anxiety. And short-term reinforcement for acting on emotion-driven behavior. Yeah, if you're really upset and you scream at somebody really loud and you wave your arms, they may back down. And that's rewarding that behavior. So the short-term reward of getting that person to back down may make it more likely for people to engage in that behavior again instead of taking a moment and thinking about, based on my values, what's important to me and how people perceive me and how I interact with people, what's the best choice of action? Understanding the benefits of values-based action can increase motivation to choose an action based on values in the moment of choice instead of using an emotion-driven behavior. When I was coming up through the ranks, a lot of times we called this purposeful action. Every time you get ready to do something, stopping and going, why am I doing this and is this helping me or is this undermining me? Values-based action in the face of emotional triggers is only made possible by recognizing the moment of choice. We need to notice the painful emotion, including the feelings, thoughts, sensations. Observe what we want to do. What's our urge? What's our knee-jerk reaction? Remember the situation and your relevant values and intentions. So let's go back to parenting. If your child does something and you get really upset and you're just like, oh, I can't believe he or she did that. The urge may be to scream at them to come down and go all drill sergeant on them, but is that consistent with your relative values and intentions? Does that help them learn or does that just make them more submissive? And then decide what course of action to take because remember we have a whole repertoire of coping skills to choose from now. So what could we do instead of screaming and going drill sergeant? Relaxation and self-soothing. Sometimes you just need to get some space before you have that conversation with the child or with the person who did something that triggered you. Diachromatic breathing. Relaxation without tension. Now, this is where you inhale and then right before you exhale, they say a word. Whatever word works for them, like relax or let go or it's all good. And when they exhale, they feel the tension releasing. Cue control breathing. And the five senses exercise. Spend 30 seconds per sense, per sense. Think about positive examples of each sense that you can use. So think about a place that you really like looking at or things that you really like looking at. Think about sounds that you really like hearing. Think about smells that you really love smelling. These can all be ways to help you focus on things that will basically trigger the brain to release the calming chemicals because you're thinking about something pleasant instead of focused on whatever it is that's triggering the turmoil. And coping thoughts. They're simply personalized strengths-based declarations about resiliency and history or perspective shifts so they can effectively navigate the difficult emotion. If something happens and they go, I can't deal with this. Well, guess what's going to happen? They're going to feel like they can't deal with it. If they focus on other times in the past when they've dealt with it, if they know they can do it, if they know they've got a plan or if they say this really stinks but I can do this, then these are positive coping thoughts. When something happens, these triggers, we've started identifying them and at least in my groups, it's an ongoing process. I have people keep a journal and each week they come in and we look at their journal and we identify commonalities between their triggers. Sometimes maybe somebody will have several triggers that relate to feeling like they were put down. So then we'll talk about that. Or they may have several triggers related to feeling like they're going to fail so they get this really high level of anxiety. Want to draw those connections so people can see why certain things are triggers. And then we identify the automatic negative thoughts about those triggers that cause the body to go into fight-or-flight and call on all hands on deck. Why is it this makes you so anxious? What is it about this that feels threatening or feels scary to you? And then we want to create positive coping thoughts to counteract those negative thoughts. And radical acceptance. Radical acceptance doesn't mean you like or condone what happened. It just means you accept it did. Practicing coping thoughts and radical acceptance in an activated state will enhance learning and help clients recall the skills when they're triggered. When they're triggered, if they start accepting that something happened instead of getting all caught up in what they could have done or the fact that it stinks that it happened, they can practice radical acceptance and then they can also practice those strengths-based coping thoughts that say, okay, I can deal with this. They're going to be so much further ahead when they get to choosing that values-based action. So we want to help them. These are what I call de-escalation skills. These help them get through that initial adrenaline rush so they can get a clearer head. Distraction and timeout can also be used. Distraction follows the exposure of observing and accepting. So what we want to do is help people understand that sometimes they just need to focus on something different for a minute. It allows clients to shift attention away from the stimulating trigger, which is provoking unpleasant thought sensations, situations, urges. But we want to make sure they don't use this to exclusion. It's used mindfully. In some ways, you can say addiction is basically just perpetual distraction and avoidance because when people start to feel an unpleasant sensation, they numb it out. We don't want to numb it out. We just want to help them distract for a moment. So emotional dysregulation can keep people stuck. EET helps people learn to identify their emotions. And we're not just talking that superficial level. How are you feeling? You know, put the happy face little board in front of them and have them point to the face. I want to know what that feeling is and let's give it some depth. What's going on inside of you when you feel that way? When you feel excited, you know, sometimes you can have the turnies in your belly. You get that same journey in your belly when you get anxious. So how do you differentiate? So we want people to identify what it feels like to have the good emotions as well as the bad ones. Or I shouldn't say bad as well as the unpleasant ones because the emotions are there. They're good in a way because they help protect us. They spur us to action. It's just when they're overused or overgeneralized, they can become unhelpful. But we want people to be able to differentiate between excited and anxious. We want people to be able to differentiate between, you know, when they're angry versus when they're really hurt and disappointed. Those are kind of two different emotions. So how do they feel? What do they look like? Another activity that I've done in some of my groups is I'll put up an emotion on the board. And usually we do two or three in the course of a group. But I'll put it up there like disappointment and we'll talk about what triggers that feeling for people. And then we'll talk about their sensations, their thoughts, their urges when they feel disappointment. And that helps people really understand what it's like for them. But if they're not able to make contact with how that emotion feels for them personally, working in a group, they can hear what it feels like for others and go, oh, yeah, you know, you're right. When I'm disappointed, that really does kind of happen to me. And it helps people feel like they are sort of kindred spirits. It's like, oh, we all have those emotions. It's just figuring out how to deal with them and downregulate them. We want to help people learn to observe mindfully without reacting. We want to help them stop. Between the stimulus and the reaction, there needs to be a stop. And we need to help them use the moment of choice, which is that stop to decide on the best course of action based on what's important to them. Not what's important to me, but what's important to them. Mindful acceptance is the practice of observing and accepting the four components of emotional experience through accepting your sensations. It's, you know, it feels uncomfortable. You know, your heart may be beating, your tummy may be churning. We just accept it. Feeling labeling. Okay, when I feel this way, it means that I am having this emotion. Thought watching. What thoughts are going through my head when I start having this emotion? Maybe when the person was growing up, their parents always told them to suck it up. They had nothing to be anxious about or they had no right to be angry. Well, then those thoughts are probably still going through their head. So we want to know what thoughts go through and help them learn how to let those thoughts come and go. Think about hecklers in an audience. If you've ever performed on stage and had a heckler, hopefully you haven't. But a good performer can let those comments, let the hecklers comments come by and just go out without having to react to them. They don't have to attend to that person who's being unhelpful. And urge noticing. Noticing what they want to do. This is their knee-jerk reaction. And then deciding, is this the most helpful and productive response? So again, I said this presentation was based on the book Emotion, Efficacy, Therapy. I really like the book myself. I use the techniques and the tools in practice, but I also use a lot of what he talked about actually at home with my own ankle biters. So I personally like it, but y'all know I tend to be more CBT, DBT in nature anyway. Obviously, the book is not required for this presentation, but if you want it, I'm sure it's on Amazon, but you can also buy it directly from New Harbinger Publications. If you enjoy this podcast, please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceuse.com slash counselor toolbox. This episode has been brought to you in part by allceuse.com, providing 24-7 multimedia continuing education and pre-certification training to counselors, therapists and nurses since 2006. Use coupon code, counselor toolbox, to get a 20% discount off your order this month.