Mind and Emotions (2 page)

This profusion of treatments had good and bad aspects. On the good news front, psychological science had developed multiple research-based protocols that had been proven effective. They helped people and changed lives. The bad news can be summarized as follows:

• People with comorbidity (more than one emotional problem) had to undergo more than one treatment. Treatments were often done sequentially, so therapy for one problem might be delayed until another emotional problem was addressed.
  
• Skills developed to cope with a particular emotional problem often couldn’t be applied to others. So, for example, if you underwent a successful treatment for social anxiety in your twenties, that wouldn’t have given you the tools you’d need to cope with depression in your thirties.
  
• It was hard to evaluate which of the research-based treatments available for a particular problem would work best for a given individual. Each treatment is based on a slightly different theory of what causes the problem, but almost no research has been done on matching treatments to an individual’s traits, characteristics, or typical ways of coping. So we didn’t know much about what works for whom.
  
• Most of the protocols for emotional disorders were focused on symptoms and symptom reduction. They didn’t address the common underlying factors that create and maintain all emotional disorders. Called transdiagnostic factors (TDFs), these can be understood as dysfunctional coping strategies that start out as attempts to manage stress but backfire and end up creating severe emotional pain. A treatment that targets TDFs—the cause of emotional problems—may be more effective than those focused solely on symptoms. (More on TDFs later.)
  

These problems were solved with the development of treatments that simultaneously target
all
emotional problems. Instead of focusing on symptoms, which are clearly different for each emotion, new treatments targeted the underlying causes of all negative emotions—causes such as avoidance, rumination, masking, and negative appraisals. We’ll discuss these causes in detail in chapter 2, The Nature of Emotions.

New Research: Universal Treatments for Emotional Problems

There are currently three research-based universal treatments for emotional disorders. The first is dialectical behavior therapy (DBT; Linehan 1993), which focuses on the following key skills for overcoming emotional problems:

• Mindfulness and acceptance
  
• Distress tolerance
  
• Self-soothing
  
• Doing the opposite
  
• Emotion regulation
  
• Interpersonal effectiveness
  

The second is acceptance and commitment therapy (ACT; Hayes, Strosahl, and Wilson 1999), which aims to build psychological flexibility by developing skills in the following areas:

• Mindfulness
  
• Observing and accepting emotions
  
• Defusion (observing and distancing from thoughts)
  
• Values-based committed action
  

A third universal protocol emerged from cognitive behavioral therapy (CBT; Moses and Barlow 2006; Allen, McHugh, and Barlow 2008). It emphasizes the following skills:

• Mindfulness
  
• Emotion awareness and acceptance
  
• Cognitive restructuring
  
• Changing emotion-driven behaviors
  
• Emotion exposure
  

The effectiveness of each of these therapies is supported by strong research evidence from numerous randomized controlled trials. All three have been proven to help people struggling with overwhelming emotions. As to the question of which is better, we don’t know. Very little research has evaluated these treatments in head-to-head trials. However, comparing and measuring which of these therapies has the best outcomes may not be terribly important, for three reasons:

• It may take years to get conclusive answers, if the data
  ever
  becomes clear.
  
• There is significant overlap between the three treatment programs. All include mindful observation of experience, some form of emotion acceptance, and exposure exercises to help people face difficult emotions. Each protocol has methods for changing how people relate to their thoughts, thereby making negative thinking less believable. And each treatment helps people learn how to steer away from emotion-driven behaviors, which only make emotional pain worse, and take more effective action instead.
  
• The treatment components that are unique to a particular protocol—self-soothing, doing the opposite, and interpersonal effectiveness in DBT, and defusion and values-based action in ACT—can be added to the common components to create a single universal treatment. There’s no reason to have a horse race to see which therapy is better. We can combine them.
  

So here’s the bottom line: These therapies work, and the combined protocol presented in this book works. You don’t have to learn individual and sometimes complex treatments for each emotional problem you face. You can work your way through a single set of steps and get help with any and all emotions.

In this book you’ll find the common elements of all three universal protocols, plus the most effective unique components of each. These are the topics covered in chapters 4 through 13, and they offer the best help that cutting-edge research has discovered:

• Values in Action
  
• Mindfulness and Emotion Awareness
  
• Defusion
  
• Cognitive Flexibility Training
  
• Self-Soothing
  
• Doing the Opposite
  
• Interpersonal Effectiveness
  
• Imagery-Based Emotion Exposure
  
• Interoceptive Emotion Exposure
  
• Situational Emotion Exposure
  

How to Use This Book

Before beginning the ten treatment chapters, you need basic information about how much your difficult emotions are affecting you right now, how emotions work, and how you get into emotional trouble. So do the exercise at the end of this chapter, and then read chapters 2 and 3 before doing anything else. The exercise at the end of this chapter will help you establish a baseline score for how much difficulty you’re having with emotion regulation right now.

In chapter 2, The Nature of Emotions, you’ll learn to identify the four components of an emotional response. Developing the ability to observe a problematic emotion is the first step toward regulating that emotion. Later in chapter 2 we’ll introduce you to seven transdiagnostic factors that underlie emotional disorders. Each of these TDFs is a coping strategy that attempts to provide immediate relief from emotional pain, but in the long term all of them only intensify emotions and make the pain worse. We provide a questionnaire to help you identify which TDFs are having the greatest influence on your emotional life. It’s quite possible that you don’t use all of these problematic coping strategies. If that’s the case, you may wish to skip chapters that target a TDF that isn’t relevant to you. By assessing your use of TDFs, you can tailor this program to your own needs.

Chapter 3, The Cost of Avoiding Emotions, helps build your motivation for working with and sticking to this program. You’ll learn to recognize the many faces of avoidance and assess the costs of each. Avoidance takes a huge toll on your life and vitality, and paradoxically, it also intensifies the very emotions you’re trying to get away from. In chapter 3 we’ll also discuss the benefits of improved emotion regulation. The payoffs can be dramatic, so it’s worth it to know the benefits before beginning the program (and this will probably also help with motivation).

Chapters 4 through 13 are the treatment chapters. Work your way through these in order, but feel free to skip any that target TDFs you aren’t struggling with. However, do read and work through chapter 4, Values in Action, chapter 5, Mindfulness and Emotion Awareness, and chapters 11 through 13, on emotion exposure, regardless of the TDFs you use. They’re critical to learning emotion regulation and essential for everyone. Also, be sure to fill out the Difficulties in Emotion Regulation Scale (DERS; Gratz and Roemer 2004) halfway through your work with this book and again at the end of the emotion exposure chapters. This will give you an objective measure of how your emotion regulation skills are improving.

The last chapter, Relapse Prevention, is also vital. You need to know how to recognize the signs that emotional problems are reemerging and have a specific plan for what you’ll do about it. This will keep you from slipping back into old, ineffective patterns.

How to Work This Program

Just reading about emotion regulation skills isn’t enough. You can only master them by doing the exercises in this book and putting them into practice in your daily life. Changing your experience with overwhelming emotions starts with changing your behavior—how you think and how you act. Casting aside your old coping responses—the TDFs—is essential to creating a new life and a new relationship to your emotions.

We’ll be with you every step of the way, showing you the path, coaching you, and giving you examples of how others have succeeded. We’ll offer helpful strategies and step-by-step guidance, and also provide answers to many of your questions. We admit it: Working this program
is
work. But if you do the work and change your old avoidance patterns, a lot of your emotional pain will fall away and become just a memory. The research-tested approaches in this program can open the door to a new life.

We encourage you to start now, with the following exercise. The Difficulties in Emotion Regulation Scale (DERS; Gratz and Roemer 2004) will establish a baseline measurement of how much your difficult emotions are affecting you today. Halfway through your work with this book, you’ll fill out the DERS again to assess your progress, and then at the end of the book you’ll fill out the DERS one last time, to discover how far this journey has taken you. Pick up your pen, open the door to your future, and begin the changes you’ve been yearning for.

Difficulties in Emotion Regulation Scale (DERS)

Please indicate how often the following statements apply to you by writing the appropriate number from the scale below on the line beside each item.

1. _______ I am clear about my feelings.

2. _______ I pay attention to how I feel.

3. _______ I experience my emotions as overwhelming and out of control.

4. _______ I have no idea how I am feeling.

5. _______ I have difficulty making sense out of my feelings.

6. _______ I am attentive to my feelings.

7. _______ I know exactly how I am feeling.

8. _______ I care about what I am feeling.

9. _______ I am confused about how I feel.

10. _______ When I’m upset, I acknowledge my emotions.

11. _______ When I’m upset, I become angry with myself for feeling that way.

12. _______ When I’m upset, I become embarrassed for feeling that way.

13. _______ When I’m upset, I have difficulty getting work done.

14. _______ When I’m upset, I become out of control.

15. _______ When I’m upset, I believe that I will remain that way for a long time.

16. _______ When I’m upset, I believe that I will end up feeling very depressed.

17. _______ When I’m upset, I believe that my feelings are valid and important.

18. _______ When I’m upset, I have difficulty focusing on other things.

19. _______ When I’m upset, I feel out of control.

20. _______ When I’m upset, I can still get things done.

21. _______ When I’m upset, I feel ashamed at myself for feeling that way.

22. _______ When I’m upset, I know that I can find a way to eventually feel better.

23. _______ When I’m upset, I feel like I am weak.

24. _______ When I’m upset, I feel like I can remain in control of my behaviors.

25. _______ When I’m upset, I feel guilty for feeling that way.

26. _______ When I’m upset, I have difficulty concentrating.

27. _______ When I’m upset, I have difficulty controlling my behaviors.

28. _______ When I’m upset, I believe there is nothing I can do to make myself feel better.

29. _______ When I’m upset, I become irritated at myself for feeling that way.

30. _______ When I’m upset, I start to feel very bad about myself.

31. _______ When I’m upset, I believe that wallowing in it is all I can do.

32. _______ When I’m upset, I lose control over my behavior.

33. _______ When I’m upset, I have difficulty thinking about anything else.

34. _______ When I’m upset, I take time to figure out what I’m really feeling.

35. _______ When I’m upset, it takes me a long time to feel better.

36. _______ When I’m upset, my emotions feel overwhelming.

(Copyright 2004 by Kim L. Gratz, Ph.D., and Lizabeth Roemer, Ph.D. Used with permission.)

Scoring: Put a minus sign in front of your rating numbers for these items: 1, 2, 6, 7, 8, 10, 17, 20, 22, 24, and 34. Then sum up all your ratings, adding the positives and subtracting the negatives, and write the result here:_______.