Many evidence-based therapies focus on teaching clients to use coping skills that will help them in moments of emotional distress. In spite of the large number of people who struggle with emotion-regulation issues, most therapies tend not to focus on the component of treatment that teaches clients to respond to emotional challenges while in a triggered state.
A new treatment approach, integrating core components of Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT), aims to fill in this gap by focusing specifically on in-session, exposure-based skills training.
The aim of Emotion Efficacy Therapy (EET), developed by clinical psychologists Matthew McKay, PhD, and Aprilia West, PsyD, is to boost how well a client responds to emotions (including intense ones) effectively. Our level of emotion efficacy is determined by our ability to choose how we wish to respond to the thoughts and feelings that challenge us.
EET employs five integrated components that are used in conjunction with one another throughout the course of treatment. If you are trained in process-oriented, mindfulness-based therapies, these components will not be entirely new to you. Ultimately, it is the unique element of exposure-based skills training that ties them all together and gives additional clinical value to learning this approach.
Emotion awareness provides the bedrock for EET. Without the basic understanding that emotions are not facts, it will be difficult for a client to move forward within this model.
Oftentimes clients think that they have no choice but to react and act on their feelings. Developing awareness around their emotions is the first step toward learning to step back and observe. While it is impossible to escape distressing emotions entirely, one can choose how to respond to them. This means throwing out the assumption that emotions are “true.”
With practice, both in session and during the week outside of the session, clients will find that responding more adaptively to emotional distress will become easier. Sometimes simply knowing that there may be other ways of relating to their emotional experience can leave clients feeling more flexible and empowered.
Derived from the practice of mindfulness meditation and mindfulness-based stress reduction, mindful acceptance builds on the skills of emotion awareness and prepares clients to practice emotion surfing. Adding another layer to emotion awareness, mindful acceptance adds an intention of nonjudgmental observation and acceptance.
Mindful acceptance also emphasizes perspective taking on emotional experience, which helps clients distinguish themselves from their emotions, creating space and flexibility to respond to pain in more effective, values-consistent ways.
Clients who have habitually avoided their pain may struggle at first with exposing themselves to it. Discomfort is to be expected, especially since it requires doing the opposite of what our brains are wired to do: Avoid pain. Responding to difficult emotions will take time and practice, but it is essential to emotion efficacy.
Values-Based Action (VBA)
VBA is behavior that takes one’s life in a direction that matters to them, and that is in alignment with what feels important and right for the situation. It is the basis for a different choice in the face of emotional challenges and means acting on what is most important, rather than responding with purely emotion-driven reactions.
VBA is the result of turning abstract values into behavior. Once clients have clarified their values, they’ll have new, healthier, adaptive response options in triggering situations. These new ways of responding are the counterweights to patterns of emotion-driven behavior, which take clients away from what matters, and erodes their well-being through a host of secondary problems such as depression, relationship struggles, helplessness, and so forth.
As clients develop the skills to observe, accept, and choose what matters in the face of emotional challenges, they begin to change the belief that they can’t stand pain. Having fully experienced their pain and observed emotions that at one time felt too intense to handle, they are now able to locate the moment of choice that lets them opt-out of maladaptive, emotion-driven behaviors.
Clients with high emotion efficacy know that they have the skills to cope with pain, and this is why they choose acceptance over avoidance when faced with difficult feelings. Mindful coping begins with the practice of acceptance. After acceptance, clients are able to observe and “surf” a strong emotion.
Exposure-Based Skills Training
Unlike other forms of therapy in which clients may rehearse coping strategies and promptly forget them when triggered in the “real world,” EET employs imaginal exposure to induce an emotionally triggered state within the session, creating an opportunity for clients to practice skills in vivo.
Research supports the premise that practicing skills in an activated state improves learning, retention and recall, creates new neural pathways, and makes it easier to enact effective choices in the face of distressing emotions.